Search results for: poverty severity

Authors: G. Alston Rush, Gus A. Rush III, M. F. Horstemeyer

Abstract:

This study compares the shell-facemask responses of four commonly used American football helmets, under the National Operating Committee on Standards for Athletic Equipment (NOCSAE) drop impact test method, to show that the test standard would more accurately simulate in-use conditions by modification to include the facemask. In our study, the need for a more vigorous systematic approach to football helmet testing procedures is emphasized by comparing the Head Injury Criterion (HIC), the Gadd Severity Index (SI), and peak acceleration values for different helmets at different locations on the helmet under modified NOCSAE standard drop tower tests. Drop tests were performed on the Rawlings Quantum Plus, Riddell 360, Schutt Ion 4D, and Xenith X2 helmets at eight impact locations, impact velocities of 5.46 and 4.88 meters per second, and helmet configurations with and without facemasks. Analysis of NOCSAE drop test results reveal significant differences (p < 0.05) for when the facemasks were attached to helmets, as compared to the NOCSAE Standard, without facemask configuration. The boundary conditions of the facemask attachment can have up to a 50% decrease (p < 0.001) in helmet performance with respect to peak acceleration. While generally, all helmets with the facemasks gave greater HIC, SI, and acceleration values than helmets without the facemasks, significant helmet dependent variations were observed across impact locations and impact velocities. The variations between helmet responses could be attributed to the unique design features of each helmet tested, which include different liners, chin strap attachments, and faceguard attachment systems. In summary, these comparative drop test results revealed that the current NOCSAE standard test methods need improvement by attaching the facemasks to helmets during testing. The modified NOCSAE football helmet standard test gives a more accurate representation of a helmet’s performance and its ability to mitigate the on-field impact.

Keywords: football helmet testing, gadd severity index, head injury criterion, mild traumatic brain injury

Procedia PDF Downloads 430

Authors: Mariana Floria, Elena-Diana Năfureanu, Diana-Mihaela Gălăţanu, Anca-Ecaterina Grumeza, Cristina Gorea-Bocîncă, Diana-Elena Iov, Aurelian-Corneliu Moraru, Dragoș-Marian Popescu

Abstract:

SARS-CoV-2 is the most deadly and devastating virus of the last one hundred years, being more highly contagious than EBOLA, HIV, Swine Influenza, Severe Acute Respiratory Syndrome, or Middle Eastern Respiratory Syndrome. After two years of pandemic, planning and budgeting for use of healthcare resources and services is very important. The aim of this study was to analyze the costs for hospital stay in patients with predominantly moderate forms of COVID-19 in a support military hospital located in Nord-East of Romania. Inpatient COVID-19 hospitalizations costs, regardless of ICD-10 procedure codes (DRG payment), in a Covid-19 support military hospital were analyzed. From August 2020 through June 2021, 241 patientswere hospitalized. Our national protocol for the treatment of Covid-19 infection was applied. The main COVID-19 manifestations were: 69% respiratory (18% with severe pneumonia, 2.9% with pulmonary embolism, diagnosed by angio-computed tomography), 3.3% cardiac, 28% digestive, and 33% psychiatric (most common anxiety) manifestations. According to COVID-19 severity, most of the patients had moderate (104 patients – 43%) and severe (50 patients - 21%) forms. Seven patients with severe form died because of multiple comorbidities, and 30 patients were transferred in hospitals with COVID-19 intensive care units.Only two patients have had procalcitonin>10 ng/mL (high probability of severe sepsis or septic shock), and 1 patient had moderate risk for septic shock (0.5 - 2 ng/mL). The average estimated costs were about 3000€/patient, without significantly differences depending on disease severity. Equipment costs were 2 times higher than for drugs and 4 times than for laboratory tests. In a Covid-19 support military hospital that took care for predominantly moderate forms of COVID-19, the costs for equipment were much higher than that for treatment. Therefore, new criteria for hospitalization of these forms of COVID-19 deserve to be analyzed to avoid useless costs.

Keywords: Covid-19, costs, hospital stay, military hospital

Procedia PDF Downloads 151

Authors: Sara Alzahrani, Samia Bokari, Patan Khan, Muneera Alshareef, Rania Safwat, Mohammed Galal, Hamdi Alqadi, Ameerah Alzahrani, Rehab Alboraie

Abstract:

Introduction & Background: Diabetes in COVID-19 patients is individual risk factor and documented in worldwide studies to contribute to disease severity, increased length of stay and higher mortality. Aggressive management of blood sugars and acute diabetic complications reduce the length of stay and mortality. Methods: Randomly selected 200 patients admitted with diabetes and COVID-19 studied. The unified treatment protocol applied for all patients and blood sugars monitored closely and optimized .Data collected on bimonthly basis and analyzed. Patients’ characteristics taken from data extraction tool (Oasis) of hospital. Median values for length of stay and post discharge FBS and RBS were calculated via Microsoft Excel tool. Mortality rates were calculated by percentages. The results monitored in the post discharge clinic was 130 mg/dl and 170 mg/dl respectively. The results compared with the standard international studies. Discussion: Diabetes in COVID-19 patients posed great challenge as increased severity and mortalities reported compared to non-diabetic. Taking a pre-emptive strategy to combat this problem by aggressively manage diabetes help in reducing length of stay and morbidity. The length of stay in studded population was 3 days as compared to 13 days in a major international study. Financial saving come from rapid turnover of beds. The mortality was 2.5 % compared to reported 7.3% in a major study, reflecting the implications of aggressive management of diabetes. Regular follow-up and support by running post-discharge clinic definitely help reducing readmissions and acute complications of uncontrolled diabetes. Conclusion: Aggressive management of diabetes in COVID-19 patients by tailored treatment protocols and dedicated teams will help to decrease the morbidity and mortality.

Keywords: diabetes, covid-19, management, mortality

Procedia PDF Downloads 147

Authors: Sohaib Raza, Parvez Mantry

Abstract:

Frailty is a multi-system impairment associated with stressors such as age, disease, and invasive surgical procedures. This multi-system impairment can lead to increased post-transplant mortality and functional decline. Additionally, the prevalence and/or severity of frailty increases when patient pre-habilitation is unsatisfactory or lacking. We conducted a retrospective study to examine whether the COVID-19 Pandemic, and subsequent lack of patient access to pre-habilitation and physical therapy resources, led to an increase in the prevalence and severity of frailty, sarcopenia, and other comorbidities including diabetes, hypertension, and COPD. Secondarily, we examined the correlation between patient survival rate and liver frailty index as well as muscle wasting/sarcopenia. Data were analyzed in order to correlate variables associated with these parameters. Three hundred sixty-nine liver transplant candidates at Methodist Dallas Medical Center were administered pre-transplant frailty assessments, which consisted of chair stands, grip strength, and position balance time. A frailty score less than 3.2 indicated a robust condition, a score from 3.3 to 4.4 indicated a pre-frail condition, and a score greater than 4.5 indicated a frail condition. Greater than 50 percent of patients were found to have muscle wasting in the COVID-19 period (March 13, 2020 to February 28, 2022), an increase of 16.5 percent from the pre-COVID period (April 1st, 2018 to March 12, 2020). Additionally, sarcopenia was associated with a two-fold increase in patient mortality rate. Furthermore, high liver frailty index scores were associated with increased patient mortality. However, there was no significant difference in liver frailty index or number of comorbidities between patients in the two cohorts. Conclusion: The COVID-19 Pandemic exacerbated sarcopenia-related muscle wasting in liver transplant candidates, and patient survival rate was directly correlated with liver frailty index score and the presence of sarcopenia.

Keywords: frailty, sarcopenia, covid-19, patient mortality, pre-habilitation, liver transplant candidates

Procedia PDF Downloads 83

Authors: Dyah Larasati, Karishma Alize Huda, Sri Kusumastuti Rahayu, Martin Daniel Siyaranamual

Abstract:

Indonesia continues to reform its social protection system to provide the needed protection for its citizen. Indonesia Social Protection consisted of social assistance programs (non-contributory/tax-financed) specifically targeted for the poor and at-risk and social security/insurance program (contributory system). The social assistance programs have mostly been implemented since 1998. The national health insurance has been implemented since 2014 and the employment social insurance since 2015. One major reform implemented has been improving the targeting performance of its major social assistance portfolios including (1) Food Assistance for the poor families (Rastra and BPNT/noncash foods assistance); (2) Education Assistance for poor children; (3) Conditional Cash Transfer for poor families (PKH); and (4) Subsidized beneficiaries of National Health Insurance (JKN-PBI) for the poor and at-risk individuals. For the Social Insurance (through BPJS Employment program), several initiatives have been implemented to expand the program contributing members, although it mostly benefits the formal sector workers. However, major gaps still exist especially for the emerging middle-income groups who typically work at the informal sectors. They have yet to get the protection needed to sustain their social and economic growth. Since 2017, TNP2K (the National Team for Poverty Reduction) under the Vice President office has led the social protection discourse as the government understands the need to address vulnerabilities across the lifecycle and prioritize support to the most at-risk population particularly the elderly, young children and people with disabilities. Discussion and advocacy to recommend for more investment is continuing in order for the government to establish a comprehensive social protection system in the near future (2020-2024) that protects children through an inclusive child benefit program; build a system to benefit more working-age adults (including individuals with disabilities) and a three-tier elderly protection as they reach 65 years.

Keywords: poverty reduction, social assistance, social insurance, social protection

Procedia PDF Downloads 155

Authors: Teresa Smith, Farrah Jacquez

Abstract:

Health-risk behaviors (e.g., smoking, poor diet) directly increase the risk for chronic disease and morbidity. There is substantial evidence of a negative association between socioeconomic status (SES) and engagement in health-risk behaviors. However, due to the complexity of SES, researchers have suggested looking beyond this factor to fully understand the mechanisms that underlie engagement in health-risk behaviors. Stress is one plausible mechanism through which SES impacts health-risk behaviors. Currently, it remains unclear how stress occurring across the life course might impact health behaviors and explain the association between SES and these behaviors. To address the gaps in the literature, 172 adults between the ages of 18-49 were surveyed about their lifetime stress exposure, sociodemographic variables, and health-risk behaviors via an online recruitment portal, Prolific. Five major findings emerged from the current study. First, SES was negatively associated with engagement in health-risk behaviors and lifetime stress above and beyond current stress and other relevant demographics. Second, lifetime stress was significantly associated with health-risk behaviors above and beyond current stress and relevant demographic variables. Third, lifetime stress fully mediated the association between SES and health-risk behaviors above and beyond current stress and other demographics. Fourth, the severity of stress experienced emerged as the most significant lifetime stress variable that explains the relation between SES and health-risk behaviors. Fifth and finally, lower SES and experiencing financial and legal/crime stressors increased the likelihood of engaging in health-risk behaviors. The current study results align with previous research and suggest that stress occurring over the lifespan impacts the relation between SES and health-risk behaviors, which are in turn known to impact health outcomes. However, our findings move the current literature forward by providing a more nuanced understanding of the specific aspects of stress that influence this association. Specifically, the severity of stress experienced across the entire lifespan was the most important aspect of stress when examining the association between SES and health-risk behaviors. Further, individuals most at risk for engaging in health-risk behaviors are those of the lowest SES and experience financial and legal/crime stressors. These findings have the potential to inform interventions and policies aimed at addressing health-risk behaviors by providing a more sophisticated understanding of the impact of stress.

Keywords: stress, health behaviors, socioeconomic status, health

Procedia PDF Downloads 125

Authors: Akalework Mengesha

Abstract:

The adoption of improved agricultural technologies has been connected with higher earnings and lower poverty, enhanced nutritional status, lower staple food prices, and increased employment opportunities for landless laborers. The adoption and extension of the technologies are vastly crucial in that it enables the countries to achieve the millennium development goals (MDG) of reducing extreme poverty and hunger. There are efforts which directed to the enlargement and provision of modern crop varieties in sub-Saharan Africa in the past 30 years. Nevertheless, by and large, the adoption and expansion of rates for improved technologies have insulated behind other regions. This research aims to assess social and economic barriers in the adoption and expansion of agricultural technologies by local communities living around a private agricultural farm in Woliatta Zone, Southern Ethiopia. The study has been carried out among rural households which are located in the three localities selected for the study in the Woliatta zone. Across sectional mixed method, the design was used to address the study objective. The qualitative method was employed (in-depth interview, key informant, and focus group discussion) involving a total of 42 in-depth informants, 17 key-informant interviews, 2 focus group discussions comprising of 10 individuals in each group through purposive sampling techniques. The survey method was mainly used in the study to examine the impact of attitudinal, demographic, and socioeconomic variables on farmers’ adoption of agricultural technologies for quantitative data. The finding of the study revealed that Amibara commercial farm has not made a resolute and well-organized effort to extend agricultural technology to the surrounding local community. A comprehensive agricultural technology transfer scheme hasn’t been put in place by the commercial farm ever since it commenced operating in the study area. Besides, there is an ongoing conflict of interest between the farm and the community, which has kept on widening through time, bounds to be irreversible.

Keywords: adoption, technology transfer, agriculture, barriers

Procedia PDF Downloads 124

Authors: Isabel Lopez-Oliva, Akshay Paropkari, Shweta Saraswat, Stefan Serban, Paola de Pablo, Karim Raza, Andrew Filer, Iain Chapple, Thomas Dietrich, Melissa Grant, Purnima Kumar

Abstract:

Objective: We aimed to explicate the role of the subgingival microbiome in the causal link between rheumatoid arthritis (RA) and periodontitis (PD). Methods: Subjects with/without RA and with/without PD were randomized for treatment with scaling and root planing (SRP) or oral hygiene instructions. Subgingival biofilm, gingival crevicular fluid, and serum were collected at baseline and at 3- and 6-months post-operatively. Correlations were generated between 72 million 16S rDNA sequences, immuno-inflammatory mediators, circulating antibodies to oral microbial antigens, serum inflammatory molecules, and clinical metrics of RA. The dynamics of inter-microbial and host-microbial interactions were modeled using differential network analysis. Results: RA superseded periodontitis as a determinant of microbial composition, and DAS28 score superseded the severity of periodontitis as a driver of microbial assemblages (p=0.001, ANOSIM). RA subjects evidenced higher serum anti-PPAD (p=0.0013), anti-Pg-enolase (p=0.0031), anti-RPP3, anti- Pg-OMP and anti- Pi-OMP (p=0.001) antibodies than non-RA controls (with and without periodontitis). Following SRP, bacterial networks anchored by IL-1b, IL-4, IL-6, IL-10, IL-13, MIP-1b, and PDGF-b underwent ≥5-fold higher rewiring; and serum antibodies to microbial antigens decreased significantly. Conclusions: Our data suggest a circular relationship between RA and PD, beginning with an RA-influenced dysbiosis within the healthy subgingival microbiome that leads to exaggerated local inflammation in periodontitis and circulating antibodies to periodontal pathogens and positive correlation between severity of periodontitis and RA activity. Periodontal therapy restores host-microbial homeostasis, reduces local inflammation, and decreases circulating microbial antigens. Our data highlights the importance of integrating periodontal care into the management of RA patients.

Keywords: rheumatoid arthritis, periodontal, subgingival, DNA sequence analysis, oral microbiome

Procedia PDF Downloads 76

Authors: Laraib Niaz

Abstract:

This paper analyzes the ways in which education and economic deprivation are linked to terrorism in Pakistan using data for terrorist incidents from the Global Terrorism Database (GTD). It employs the technique of negative binomial regression for the years between 1990 and 2013, presenting evidence for a positive association between education and terrorism. Conversely, a negative correlation with economic deprivation is signified in the results. The study highlights the element of radicalization as witnessed in the curriculum and textbooks of public schools as a possible reason for extremism, which in turn may lead to terrorism.

Keywords: education, Pakistan, terrorism, poverty

Procedia PDF Downloads 354

Authors: Leonore Robieux, Franck Zenasni, Marc Pocard, Clarisse Eveno

Abstract:

Empirical data in health psychology studies show the necessity to consider the doctor-patient communication and its positive impact on outcomes such as patients’ satisfaction, treatment adherence, physical and psychological wellbeing. In this line, the present research aims to define the role and determinants of an effective doctor–patient communication during the treatment of patients with serious illness (peritoneal carcinomatosis). We carried out a prospective longitudinal study including patients treated for peritoneal carcinomatosis of various origins. From November 2016, to date, data were collected using validated questionnaires at two times of evaluation: one month before the surgery (T0) and one month after (T1). Thus, patients reported their (a) anxiety and depression levels, (b) standardized and individualized quality of life and (c) how they perceived communication, attitude and empathy of the surgeon. 105 volunteer patients (Mean age = 58.18 years, SD = 10.24, 62.2% female) participated to the study. PC arose from rare diseases (14%), colorectal (38%), eso-gastric (24%) and ovarian (8%) cancer. Three groups are defined according to the severity of their pathology and the treatment offered to them: (1) important surgical treatment with the goal of healing (53%), (2) repeated palliative surgical treatment (17%), and (3) the patients recused for surgical treatment, only palliative approach (30%). Results are presented according to Baron and Kenny recommendations. The regressions analyses show that only depression and anxiety are sensitive to the communication and empathy of surgeon. The main results show that a good communication and high level of empathy at T0 and T1 limit depression and anxiety of the patients in T1. Results also indicate that the severity of the disease modulates this positive impact of communication: better is the communication the less are the level of depression and anxiety of the patients. This effect is higher for patients treated for the more severe disease. These results confirm that, even in the case severe disease a good communication between patient and physician remains a significant factor in promoting the well-being of patients. More specific training need to be developed to promote empathic care.

Keywords: clinical empathy, determinants, healthcare, psychological wellbeing

Procedia PDF Downloads 101

Authors: Francisco Fernandez de Castro

Abstract:

The Conditional Cash Transfer (CCT) model gives monetary transfers to beneficiary families on the condition that they take specific education and health actions. According to the economic rationale of CCTs the poor need incentives to invest in their human capital because they are trapped by a lack of information and misleading beliefs. If left to their own decision, the poor will not be able to choose what is in their best interests. The basic assumption of the CCT model is that the poor need incentives to take care of their own education and health-nutrition. Due to the incentives (income cash transfers and conditionalities), beneficiary families are supposed to attend doctor visits and health talks. Children would stay in the school. These incentivized behaviors would produce outcomes such as better health and higher level of education, which in turn will reduce poverty. Based on a grounded theory approach to conduct a two-year period of qualitative data collection in northern Mexico, this study shows that this explanation is incomplete. In addition to the information failure and inadequate beliefs, there are structural barriers in everyday life of households that make health-nutrition and education investments difficult. In-depth interviews and observation work showed that the program takes for granted local conditions in which beneficiary families should fulfill their co-responsibilities. Data challenged the program’s assumptions and unveiled local obstacles not contemplated in the program’s design. These findings have policy and research implications for the CCT agenda. They bring elements for late programming due to the gap between the CCT strategy as envisioned by policy designers, and the program that beneficiary families experience on the ground. As for research consequences, these findings suggest new avenues for scholarly work regarding the causal mechanisms and social processes explaining CCT outcomes.

Keywords: conditional cash transfers, incentives, poverty, structural barriers

Procedia PDF Downloads 91

Authors: James Boag

Abstract:

The needs of people with a diagnosis of dementia and their carers and families are physical, psychosocial, and psychological and begin at the time of diagnosis. There is frequently a lack of emotional support and counselling. Care- giving support is required from the presentation of the first symptoms of dementia until death. Alzheimer's disease begins decades before the clinical symptoms begin to appear, and in many cases, it remains undiagnosed, or diagnosed too late for any possible interventions to have any effect. However, if an incorrect diagnosis is given, it may result in a person being treated, without effect, for a type of dementia they do not have and delaying the interventions they should have received. Being diagnosed with dementia can cause emotional distress to the person, and physical and emotional support is needed, which will become more important as the disease progresses. The severity of the patient's dementia and their symptoms has a bearing of the impact on the carer and the support needed. A lack of insight and /or a denial of the diagnosis, grief, reacting to anticipated future losses, and coping methods to maximise the disease outcome, are things that should be addressed. Because of the stigma, it is important for carers not to lose contact with family and others because social isolation leads to depression and burnout. The impact on a carer's well- being and quality of life can be influenced by the severity of the illness, its type of dementia, its symptoms, healthcare support, financial and social status, career, age, health, residential setting, and relationship to the patient. Carer burnout due to lack of support leads to people diagnosed with dementia being put into residential care prematurely. Often dementia is not recognised as a terminal illness, limiting the ability of the person diagnosed with dementia and their carers to work on advance care planning and getting access to palliative and other support. Many carers have been satisfied with the physical support they were given in their everyday life, however, it was agreed that there was an immense unmet need for psychosocial support, especially after diagnosis and approaching end of life. Providing continuity and coordination of care is important. Training is necessary for providers to understand that every case is different, and they should understand the complexities. Grief, the emotional response to loss, is suffered during the progression of the disease and long afterwards, and carers should continue to be supported after the death of the person they were caring for.

Keywords: dementia, caring, challenges, needs

Procedia PDF Downloads 66

Authors: Khachen Kongpakwattana, Nathorn Chaiyakunapruk

Abstract:

Background: Decision-analytic models for Alzheimer’s disease (AD) have been advanced to discrete-event simulation (DES), in which individual-level modelling of disease progression across continuous severity spectra and incorporation of key parameters such as treatment persistence into the model become feasible. This study aimed to apply the DES to perform a cost-effectiveness analysis of treatment for AD in Thailand. Methods: A dataset of Thai patients with AD, representing unique demographic and clinical characteristics, was bootstrapped to generate a baseline cohort of patients. Each patient was cloned and assigned to donepezil, galantamine, rivastigmine, memantine or no treatment. Throughout the simulation period, the model randomly assigned each patient to discrete events including hospital visits, treatment discontinuation and death. Correlated changes in cognitive and behavioral status over time were developed using patient-level data. Treatment effects were obtained from the most recent network meta-analysis. Treatment persistence, mortality and predictive equations for functional status, costs (Thai baht (THB) in 2017) and quality-adjusted life year (QALY) were derived from country-specific real-world data. The time horizon was 10 years, with a discount rate of 3% per annum. Cost-effectiveness was evaluated based on the willingness-to-pay (WTP) threshold of 160,000 THB/QALY gained (4,994 US$/QALY gained) in Thailand. Results: Under a societal perspective, only was the prescription of donepezil to AD patients with all disease-severity levels found to be cost-effective. Compared to untreated patients, although the patients receiving donepezil incurred a discounted additional costs of 2,161 THB, they experienced a discounted gain in QALY of 0.021, resulting in an incremental cost-effectiveness ratio (ICER) of 138,524 THB/QALY (4,062 US$/QALY). Besides, providing early treatment with donepezil to mild AD patients further reduced the ICER to 61,652 THB/QALY (1,808 US$/QALY). However, the dominance of donepezil appeared to wane when delayed treatment was given to a subgroup of moderate and severe AD patients [ICER: 284,388 THB/QALY (8,340 US$/QALY)]. Introduction of a treatment stopping rule when the Mini-Mental State Exam (MMSE) score goes below 10 to a mild AD cohort did not deteriorate the cost-effectiveness of donepezil at the current treatment persistence level. On the other hand, none of the AD medications was cost-effective when being considered under a healthcare perspective. Conclusions: The DES greatly enhances real-world representativeness of decision-analytic models for AD. Under a societal perspective, treatment with donepezil improves patient’s quality of life and is considered cost-effective when used to treat AD patients with all disease-severity levels in Thailand. The optimal treatment benefits are observed when donepezil is prescribed since the early course of AD. With healthcare budget constraints in Thailand, the implementation of donepezil coverage may be most likely possible when being considered starting with mild AD patients, along with the stopping rule introduced.

Keywords: Alzheimer's disease, cost-effectiveness analysis, discrete event simulation, health technology assessment

Procedia PDF Downloads 102

Authors: Wisam Ismail, Sarah Hosgood, Michael Nicholson

Abstract:

The research hypothesis is that early post-transplant allograft fibrosis will be linked to donor factors and that acute rejection and/or delayed graft function in the recipient will be independent risk factors for the development of fibrosis. This research hypothesis is to explore whether acute rejection/delay graft function has an effect on the renal transplant fibrosis within the first year post live donor kidney transplant between 1998 and 2009. Methods: The study has been designed to identify five time points of the renal transplant biopsies [0 (pre-transplant), 1 month, 3 months, 6 months and 12 months] for 300 live donor renal transplant patients over 12 years period between March 1997 – August 2009. Paraffin fixed slides were collected from Leicester General Hospital and Leicester Royal Infirmary. These were routinely sectioned at a thickness of 4 Micro millimetres for standardization. Conclusions: Fibrosis at 1 month after the transplant was found significantly associated with baseline fibrosis (p<0.001) and HTN in the transplant recipient (p<0.001). Dialysis after the transplant showed a weak association with fibrosis at 1 month (p=0.07). The negative coefficient for HTN (-0.05) suggests a reduction in fibrosis in the absence of HTN. Fibrosis at 1 month was significantly associated with fibrosis at baseline (p 0.01 and 95%CI 0.11 to 0.67). Fibrosis at 3, 6 or 12 months was not found to be associated with fibrosis at baseline (p=0.70. 0.65 and 0.50 respectively). The amount of fibrosis at 1 month is significantly associated with graft survival (p=0.01 and 95%CI 0.02 to 0.14). Rejection and severity of rejection were not found to be associated with fibrosis at 1 month. The amount of fibrosis at 1 month was significantly associated with graft survival (p=0.02) after adjusting for baseline fibrosis (p=0.01). Both baseline fibrosis and graft survival were significant predictive factors. The amount of fibrosis at 1 month was not found to be significantly associated with rejection (p=0.64) after adjusting for baseline fibrosis (p=0.01). The amount of fibrosis at 1 month was not found to be significantly associated with rejection severity (p=0.29) after adjusting for baseline fibrosis (p=0.04). Fibrosis at baseline and HTN in the recipient were found to be predictive factors of fibrosis at 1 month. (p 0.02, p <0.001 respectively). Age of the donor, their relation to the patient, the pre-op Creatinine, artery, kidney weight and warm time were not found to be significantly associated with fibrosis at 1 month. In this complex model baseline fibrosis, HTN in the recipient and cold time were found to be predictive factors of fibrosis at 1 month (p=0.01,<0.001 and 0.03 respectively). Donor age was found to be a predictive factor of fibrosis at 6 months. The above analysis was repeated for 3, 6 and 12 months. No associations were detected between fibrosis and any of the explanatory variables with the exception of the donor age which was found to be a predictive factor of fibrosis at 6 months.

Keywords: fibrosis, transplant, renal, rejection

Procedia PDF Downloads 210

Authors: Rajendra Kumar Pandey

Abstract:

Forest genetic resources not only represent regional biodiversity but also have immense value as the wealth for securing livelihood of poor people. These are vulnerable to ecological due to depletion/deforestation and /or impact of climate change. These resources of various plant categories are vulnerable on the floor of natural tropical forests, and leading to the threat on the growth and development of future forests. More than 170 species, including NTFPs, are in critical condition for their survival in natural tropical forests of Central India. Forest degradation, commensurate with biodiversity loss, is now pervasive, disproportionately affecting the rural poor who directly depend on forests for their subsistence. Looking ahead the interaction between forest and water, soil, precipitation, climate change, etc. and its impact on biodiversity of tropical forests, it is inevitable to develop co-operation policies and programmes to address new emerging realities. Forests ecosystem also known as the 'wealth of poor' providing goods and ecosystem services on a sustainable basis, are now recognized as a stepping stone to move poor people beyond subsistence. Poverty alleviation is the prime objective of the Millennium Development Goals (MDGs). However, environmental sustainability including other MDGs, is essential to ensure successful elimination of poverty and well being of human society. Loss and degradation of ecosystem are the most serious threats to achieving development goals worldwide. Millennium Ecosystem Assessment (MEA, 2005) was an attempt to identify provisioning and regulating cultural and supporting ecosystem services to provide livelihood security of human beings. Climate change may have a substantial impact on ecological structure and function of forests, provisioning, regulations and management of resources which can affect sustainable flow of ecosystem services. To overcome these limitations, policy guidelines with respect to planning and consistent research strategy need to be framed for conservation and sustainable development of forest genetic resources.

Keywords: climate change, forest ecosystem services, sustainable forest management, biodiversity conservation

Procedia PDF Downloads 270

Authors: Nefzi Ahlem, Aydi Ben Abdallah Rania, Jabnoun-Khiareddine Hayfa, Ammar Nawaim, Mejda Daami-Remadi

Abstract:

Fusarium Crown and Root Rot (FCRR) caused by Fusarium oxysporum f. sp. radicis-lycopersici (FORL) is a serious tomato (Solanum lycopersicum L.) disease in Tunisia. Its management is very difficult due to the long survival of its resting structures and to the luck of genetic resistance. In this work, we explored the wild Solanaceae species Withania somnifera, growing in the Tunisian Centre-East, as a potential source of biocontrol agents effective in FCRR suppression and tomato growth promotion. Seven fungal isolates were shown able to colonize tomato roots, crowns, and stems. Used as conidial suspensions or cell-free culture filtrates, all tested fungal treatments significantly enhanced tomato growth parameters by 21.5-90.3% over FORL-free control and by 27.6-93.5% over pathogen-inoculated control. All treatments significantly decreased the leaf and root damage index by 28.5-92.8 and the vascular browning extent 9.7-86.4% over FORL-inoculated and untreated control. The highest disease suppression ability (decrease by 86.4-92.8% in FCRR severity) over pathogen-inoculated control and by 81.3-88.8 over hymexazol-treated control) was expressed by I6 based treatments. This endophytic fungus was morphologically characterized and identified using rDNA sequencing gene as Fusarium sp. I6 (MG835371). This fungus was shown able to reduce FORL radial growth by 58.5–83.2% using its conidial suspension or cell-free culture filtrate. Fusarium sp. I6 showed chitinolytic, proteolytic and amylase activities. The current study clearly demonstrated that Fusarium sp. (I6) is a promising biocontrol candidate for suppressing FCRR severity and promoting tomato growth. Further investigations are required for elucidating its mechanism of action involved in disease suppression and plant growth promotion.

Keywords: antifungal activity, associated fungi, Fusarium oxysporum f. sp. radicis-lycopersici, Withania somnifera, tomato growth

Procedia PDF Downloads 125

Authors: Kyra Kannen, Sonja D. Roelen, Sebastian Schnieder, Jarek Krajewski, Steffen Holsteg, André Karger, Johanna Askeridis, Celina Slawik, Philip Mildner, Jens Piesk, Ruslan David, Holger Kürten, Benjamin Oster, Robert Malzan, Mike Ludemann

Abstract:

Virtual Reality (VR) is increasingly recognized for its potential in transforming mental disorder treatment, offering advantages such as cost-effectiveness, time efficiency, accessibility, reduced stigma, and scalability. While the application of VR in the context of anxiety disorders has been extensively evaluated and demonstrated to be effective, the utilization of VR as a therapeutic treatment for depression remains under-investigated. Our goal is to pioneer immersive VR therapy modules for treating major depression, alongside a web-based system for home use. We develop a modular digital therapy platform grounded in psychodynamic therapy interventions which addresses stress reduction, exploration of social situations and relationship support, social skill training, avoidance behavior analysis, and psychoeducation. In addition, an automated depression monitoring system, based on acoustic voice analysis, is implemented in the form of a speech-based diary to track the affective state of the user and depression severity. The use of immersive VR facilitates patient immersion into complex and realistic interpersonal interactions with high emotional engagement, which may contribute to positive treatment acceptance and satisfaction. In a proof-of-concept study, 45 depressed patients were assigned to VR or web-platform modules, evaluating user experience, usability and additional metrics including depression severity, mindfulness, interpersonal problems, and treatment satisfaction. The findings provide valuable insights into the effectiveness and user-friendliness of VR and web modules for depression therapy and contribute to the refinement of more tailored digital interventions to improve mental health.

Keywords: virtual reality therapy, digital health, depression, psychotherapy

Procedia PDF Downloads 32

Authors: Alphonso Goliath

Abstract:

With mandatory minimum sentences, even with its qualification of “substantial and compelling circumstances”, the sentence severity for violent crimes has increased substantially to combat crime. Considering the upsurge in violent crime, the paper argues that minimum sentences failed to prevent or curb violent crime. These sentences deprive offenders more than what is reasonably necessary of their freedom to curb the offense and punish the offender. Minimum sentences amount to cruel, inhuman, and degrading punishment unjustified and vulnerable to constitutional challenge.

Keywords: constitutionality, deterrence, incapacitation, minimum sentencing legislation, prison overcrowding, rehabilitation, recidivism, retribution, violent crime

Procedia PDF Downloads 65

Authors: Uliana N. Tumanova, Viacheslav M. Lyapin, Vladimir G. Bychenko, Alexandr I. Shchegolev, Gennady T. Sukhikh

Abstract:

All cases of stillbirth undoubtedly subject to postmortem examination, since it is necessary to find out the cause of the stillbirths, as well as a forecast of future pregnancies and their outcomes. Determination of the time of death is an important issue which is addressed during the examination of the body of a stillborn. It is mean the period from the time of death until the birth of the fetus. The time for fetal deaths determination is based on the assessment of the severity of the processes of maceration. To study the possibilities of postmortem magnetic resonance imaging (MRI) for determining the time of intrauterine fetal death based on the evaluation of maceration in the kidney. We have conducted MRI morphological comparisons of 7 dead fetuses (18-21 gestational weeks) and 26 stillbirths (22-39 gestational weeks), and 15 bodies of died newborns at the age of 2 hours – 36 days. Postmortem MRI 3T was performed before the autopsy. The signal intensity of the kidney tissue (SIK), pleural fluid (SIF), external air (SIA) was determined on T1-WI and T2-WI. Macroscopic and histological signs of maceration severity and time of death were evaluated in the autopsy. Based on the results of the morphological study, the degree of maceration varied from 0 to 4. In 13 cases, the time of intrauterine death was up to 6 hours, in 2 cases - 6-12 hours, in 4 -12-24 hours, in 9 -2-3 days, in 3 -1 week, in 2 -1,5-2 weeks. At 15 dead newborns, signs of maceration were absent, naturally. Based on the data from SIK, SIF, SIA on MR-tomograms, we calculated the coefficient of MR-maceration (M). The calculation of the time of intrauterine death (MP-t) (hours) was performed by our formula: МR-t = 16,87+95,38×М²-75,32×М. A direct positive correlation of MR-t and autopsy data from the dead at the gestational ages 22-40 weeks, with a dead time, not more than 1 week, was received. The maceration at the antenatal fetal death is characterized by changes in T1-WI and T2-WI signals at postmortem MRI. The calculation of MP-t allows defining accurately the time of intrauterine death within one week at the stillbirths who died on 22-40 gestational weeks. Thus, our study convincingly demonstrates that radiological methods can be used for postmortem study of the bodies, in particular, the bodies of stillborn to determine the time of intrauterine death. Postmortem MRI allows for an objective and sufficiently accurate analysis of pathological processes with the possibility of their documentation, storage, and analysis after the burial of the body.

Keywords: intrauterine death, maceration, postmortem MRI, stillborn

Procedia PDF Downloads 106

Authors: Siobhan Hegarty, Michael Bloomfield, Kim Entholt, Dorothy Williams, Helen Kennerley

Abstract:

Complex Post-Traumatic Stress Disorder (CPTSD) confers greater risk of poor outcomes than does Post-Traumatic Stress Disorder (PTSD). Despite this, the current treatment guidelines for CPTSD aim to reduce only the ‘core’ symptoms of re-experiencing, hyper-vigilance and avoidance, while not addressing the Disturbances of Self Organisation (DSO) symptoms that distinguish this novel diagnosis from PTSD. The Recovering from Child Abuse Programme (RCAP) is a group protocol, based on the principles of cognitive behavioural therapy (CBT). Preliminary evidence suggests the program is effective at reducing DSO symptoms. This pilot study is the first to investigate the potential effectiveness of the RCAP for the specific treatment of CPTSD. This study was conducted as a service evaluation in a secondary care, traumatic stress service. Treatment was delivered once a week, in two-hour sessions, to ten existing female CPTSD patients of the service, who had experienced sexual abuse in childhood. The programme was administered by two therapists and two additional facilitators, following the RCAP protocol manual. Symptom severity was measured before the administration of therapy and was tracked across a range of measures (International Trauma Questionnaire; Patient Health Questionnaire; Community Assessment of Psychic Experience; Work and Social Adjustment Scale) at five time points, over the course of treatment. Qualitative appraisal of the programme was gathered via weekly feedback forms and from audio-taped recordings of verbal feedback given during group sessions. Preliminary results suggest the programme causes a slight reduction in CPTSD and depressive symptom severity and preliminary qualitative analysis suggests that the RCAP is both helpful and acceptable to group members. Final results and conclusions will follow completed thematic analysis of results.

Keywords: Child sexual abuse, Cognitive behavioural therapy, Complex post-traumatic stress disorder, Recovering from child abuse programme

Procedia PDF Downloads 110

Authors: Goodness Thandi Ntuli

Abstract:

As one of the sub-Saharan African countries, South Africa has a majority of women living at the receiving end of all ferocious atrocities, afflictions and social ills such as utter poverty, unemployment, morbidity, sexual exploitation and abuse, gender-based and domestic violence. The response to these social ills that permeate the South African context like wildfire requires postcolonial feminism as a lens which needs to directly address this particular context. In the empirical study that was conducted among the Zulu people about Zulu young women in the South African context, it was found that a postcolonial young woman has a lot of social challenges that militate against her. In her struggle to liberate herself, there are layers of oppression that she has to deal with before attaining emancipation of any kind. These layers of oppression emanate from postcolonial effects on cultural norms that come with patriarchal issues, racial issues as the woman of colour and socio-economic issues as the poverty-stricken marginalised woman. Such layers also render marginalized women voiceless on many occasions, and hence the kind of feminism that needs to be applied in this context has to give them a voice, worth and human dignity that they deserve. From the postcolonial feminist perspective, this paper examines the condition of women from the margins and seeks the ways in which the layers of oppression could be disengaged. In the process of the severed layers of oppression, these women can be uplifted to becoming the women of worth, restored to life-giving dignity from the inferiority complex of racial discrimination and liberation from all forms of patriarchy and its upshots that keep them bound by gender inequality. This requires, in particular, postcolonial feminism that would find profound ways of reaching into the deep-seated socialization and internalization of every kind of prejudice against women. It is the kind of feminism that questions the status core even among those who consider themselves feminists. With the ruination of all postcolonial layers of oppression, women in the margins could find real emancipation that they have always longed for through feminism that will take into consideration their context. This calls for the rethinking of feminism in different contexts because the conditions of the oppressed woman of the South cannot be the same as the conditions of the woman who considers herself oppressed in the North.

Keywords: exploration, feminism, postcolonial, margins, South African, women

Procedia PDF Downloads 177

Authors: Silvia A. Magalhaes, Vasco P. De Freitas, Jose L. Alexandre

Abstract:

Most of the European literature concerning energy efficiency and thermal comfort of dwellings assumes permanent heating and focuses on energy-saving measures. European National regulations are designed for those permanent comfort conditions. On the other hand, very few studies focus on the effect of the improvement measures in comfort reduction, for free-floating conditions or intermittent heating, in fuel poverty vulnerable countries. In Portugal, only 21% of the household energy consumptions (and 10% of the cost) are spent in space heating, while, on average European bills, this value rises to 67%. The mild climate, but mainly fuel poverty and cultural background, justifies these low heating practices. This study proposes a “passive discomfort” index definition, considering free-floating temperatures or with intermittent heating profiles (more realistic conditions), putting the focus on comfort rather than energy consumption (which is low for these countries). The aim is to compare both energy (regarding the legal framework of national regulation) and comfort (considering realistic conditions of use) to identify some correlation. It was developed an experimental campaign of indoor thermal conditions in a 19th building located in Porto with several apartments. One dwelling was chosen as a case study to carry out a sensitivity analysis. The results are discussed comparing both theoretical energy consumption (energy rates from national regulation) and discomfort (new index defined), for different insulation thicknesses, orientations, and intermittent heating profiles. The results show that the different passive options (walls insulation and glazing options) have a small impact on winter discomfort, which is always high for low heating profiles. Moreover, it was shown that the insulation thickness on walls has no influence, and the minimum insulation thickness considered is enough to achieve the same impact on discomfort reduction. Plus, for these low heating profiles, other conditions are critical, as the orientation. Finally, there isn’t an unequivocal relation between the energy label and the discomfort index. These and other results are surprising when compared with the most usual approaches, which assume permanent heating.

Keywords: dwellings in historical buildings, low-heating countries, mild climates, thermal comfort

Procedia PDF Downloads 106

Authors: Hager Elsheikh, Juliane Glaubitz, Frank Ulrich Weiss, Matthias Sendler

Abstract:

Aim: Acute pancreatitis (AP) and chronic pancreatitis (CP) are both accompanied by a prominent immune response which influences the course of disease. Whereas during AP the pro-inflammatory immune response dominates, during CP a fibroinflammatory response regulates organ remodeling. The transcription factor signal transducer and activator of transcription 6 (STAT6) is a crucial part of the Type 2 immune response. Here we investigate the role of STAT6 in a mouse model of AP and CP. Material and Methods: AP was induced by hourly repetitive i.p. injections of caerulein (50µg/kg/bodyweight) in C57Bl/6 J and STAT6-/- mice. CP was induced by repetitive caerulein injections 6 times a day, 3 days a week over 4 weeks. Disease severity was evaluated by serum amylase/lipase measurement, H&E staining of pancreas. Pancreatic infiltrate was characterized by immunofluorescent labeling of CD68, CD206, CCR2, CD4 and CD8. Pancreas fibrosis was evaluated by Azan blue staining. qRT-PCR was performed of Arg1, Nos2, Il6, Il1b, Col3a, Socs3 and Ym1. Affymetrix chip array analyses were done to illustrate the IL4/IL13/STAT6 signaling in bone marrow derived macrophages. Results: AP severity is mitigated in STAT6-/- mice, as shown by decreased serum amylase and lipase, as well as histological damage. CP mice surprisingly showed only slightly reduced fibrosis of the pancreas. Also staining of CD206 a classical marker of alternatively activated macrophages showed no decrease of M2-like polarization in the absence of STAT6. In contrast, transcription profile analysis in BMDM showed complete blockade of the IL4/IL13 pathway in STAT6-/- animals. Conclusion: STAT6 signaling pathway is protective during AP and mitigates the pancreatic damage. During chronic pancreatitis the IL4/IL13 – STAT6 axisis involved in organ fibrogenesis. Notably, fibrosis is not dependent on a single signaling pathway, and alternative macrophage activation is also complex and involves different subclasses (M2a, M2b, M2c and M2d) which could be independent of the IL4/IL13 STAT6 axis.

Keywords: chronic pancreatitis, macrophages, IL4/IL13, Type immune response

Procedia PDF Downloads 31

Authors: Amna Shoaib, Sidrah Hanif, Rashid Mehmood

Abstract:

Current research work was carried out to check influence of farmyard manure (FYM) in Lycopersicon esculentum L. against Fusarium oxysporum f. sp. lycopersici (FO) in copper polluted soil. Silt-loam soil naturally enriched with 70 ppm of Cu was inoculated with 1 x 106 spore suspensions of FO and incorporated with 0%, 1%, 1.5% or 2% FYM. The multilateral interaction of host-pathogen-metal-organic amendment was assessed in terms of morphology, growth, yield, physiology, biochemistry and metal uptake in tomato plant after 30 and 60 days of sowing. When soil was inoculated with FO, plant growth and biomass were significantly increased during vegetative stage, while declining during flowering stage with substantial increase in productivity over control. Infected plants exhibited late wilting and disease severity was found on 26-50% of plant during reproductive stage. Incorporation of up to 1% FYM suppressed disease severity, improved plant growth and biomass, while it decreased yield. Rest of manure doses was found ineffective in suppressing disease. Content of total chlorophyll, sugar and protein were significantly declined in FO inoculated plants and incorporation of FYM caused significant reduction or no influence on sugar and chlorophyll content, and no pronounced difference among different FYM doses were observed. On the other hand, proline, peroxidase, catalase and nitrate reductase activity were found to be increased in infected plants and incorporation of 1-2% FYM further enhanced the activity of these enzymes. Tomato plant uptake of 30-40% of copper naturally present in the soil and incorporation of 1-2% FYM markedly decreased plant uptake of metal by 15-30%, while increased Cu retention in soil. Present study concludes that lower dose (1%) of FYM could be used to manage disease, increase growth and biomass, while being ineffective for yield and productivity in Cu-polluted soil. Altered physiology/biochemistry of plant in response to any treatment could be served as basis for resistant against pathogen and metal homeostasis in plants.

Keywords: Lycopersicon esculentum, copper, Fusarium wilt, farm yard manure

Procedia PDF Downloads 388

Authors: Taif Rocky, Uttam Saha, Mahobul Islam

Abstract:

With a rapid urbanisation in Bangladesh, waste management remains one of the core challenges. Turning municipal waste into biogas for mass usage is a solution that Bangladesh needs to adopt urgently. Practical Action with its commitment to challenging poverty with technological justice has piloted such idea in Gaibandha. The initiative received immense success and drew the attention of policy makers and practitioners. We believe, biogas from waste can highly contribute to meet the growing demand for energy in the country at present and in the future. Practical Action has field based experience in promoting small scale and innovative technologies. We have proven track record in integrated solid waste management. We further utilized this experience to promote waste to biogas at end users’ level. In 2011, we have piloted a project on waste to biogas in Gaibandha, a northern secondary town of Bangladesh. With resource and support from UNICEF and with our own innovative funds we have established a complete chain of utilizing waste to the renewable energy source and organic fertilizer. Biogas is produced from municipal solid waste, which is properly collected, transported and segregated by private entrepreneurs. The project has two major focuses, diversification of biogas end use and establishing a public-private partnership business model. The project benefits include Recycling of Wastes, Improved institutional (municipal) capacity, Livelihood from improved services and Direct Income from the project. Project risks include Change of municipal leadership, Traditional mindset, Access to decision making, Land availability. We have observed several outcomes from the initiative. Up scaling such an initiative will certainly contribute for sustainable cleaner and healthier urban environment and urban poverty reduction. - It reduces the unsafe disposal of wastes which improve the cleanliness and environment of the town. -Make drainage system effective reducing the adverse impact of water logging or flooding. -Improve public health from better management of wastes. -Promotes usage of biogas replacing the use of firewood/coal which creates smoke and indoor air pollution in kitchens which have long term impact on health of women and children. -Reduce the greenhouse gas emission from the anaerobic recycling of wastes and contributes to sustainable urban environment. -Promote the concept of agroecology from the uses of bio slurry/compost which contributes to food security. -Creates green jobs from waste value chain which impacts on poverty alleviation of urban extreme poor. -Improve municipal governance from inclusive waste services and functional partnership with private sectors. -Contribute to the implementation of 3R (Reduce, Reuse, Recycle) Strategy and Employment Creation of extreme poor to achieve the target set in Vision 2021 by Government of Bangladesh.

Keywords: kitchen waste, secondary town, biogas, segregation

Procedia PDF Downloads 190

Authors: S. Vaibhav Kant Sahu, Surabhi Bipin Seth

Abstract:

Human well-being has multiple constituents including the basic material for a good life, freedom and choice, health, good social relations, and security. Poverty is also multidimensional and has been defined as the pronounced deprivation of well-being. Dhurwa tribe of Bastar (India) have symbiotic relation with nature, it provisions ecosystem service such as food, fuel and fiber; regulating services such as climate regulation and non-material benefits such as spiritual or aesthetic benefits and they are managing their forest from ages. The demand for ecosystem services is now so great that trade-off among services become rule. Aim of study to explore evidences for linkages between ecosystem services and well-being of indigenous community, how much it helps them in poverty reduction and interaction between them. Objective of study was to find drivers of change and evidence concerning link between ecosystem, human development and sustainability, evidence in decision making does it opt for multi sectoral objectives. Which means human well-being as the central focus for assessment, while recognizing that biodiversity and ecosystems also have intrinsic value. Ecosystem changes that may have little impact on human well-being over days or weeks may have pronounced impacts over years or decades; so assessments needed to be conducted at spatial and temporal scales under social, political, economic scales to have high-resolution data. Researcher used framework developed by Millennium ecosystem assessment; since human action now directly or unknowingly virtually alter ecosystem. Researcher used ethnography study to get primary qualitative data, secondary data collected from panchayat office. The responses were transcribed and translated into English, as interview held in Hindi and local indigenous language. Focus group discussion were held with group of 10 women at Tiriya village. Researcher concluded with well-being is not just gap between ecosystem service supply but also increases vulnerability. Decision can have consequences external to the decision framework these consequences are called externalities because they are not part of the decision-making calculus.

Keywords: Bastar, Dhurwa tribe, ecosystem services, millennium ecosystem assessment, sustainability

Procedia PDF Downloads 277

Authors: Enobong Akpan-Etuk

Abstract:

The willingness of smallholder farmers in Africa to adopt new agricultural technologies has been low, despite the technological advancement in agriculture. Although technology is seen as the main route out of the traditional methods of food production and poverty, the rate of adoption of agricultural technology remains low among farmers in Africa. Factors affecting the adoption of agricultural technologies include the acquisition of information, characteristics of the technology, education of farmers, social capital, farm size, and household size. This paper explored the literature on the influence of the factors that determine the adoption of technology by smallholder farmers.

Keywords: smallholder, technology, adoption

Procedia PDF Downloads 116

Authors: Wondale Getinet Alemu, Lillian Mwanri, Clemence Due, Telake Azale, Anna Ziersch

Abstract:

Background: Mental illness is one of the most severe, chronic, and disabling public health problems that affect patients' Quality of life (QoL). Improving the QoL for people with mental illness is one of the most critical steps in stopping disease progression and avoiding complications of mental illness. Therefore, we aimed to assess the QoL and its determinants in patients with mental illness in outpatient clinics in Northwest Ethiopia in 2023. Methods: A facility-based cross-sectional study was conducted among people with mental illness in an outpatient clinic in Ethiopia. The sampling interval was decided by dividing the total number of study participants who had a follow-up appointment during the data collection period (2400) by the total sample size of 638, with the starting point selected by lottery method. The interviewer-administered WHOQOL BREF-26 tool was used to measure the QoL of people with mental illness. The domains and Health-Related Quality of Life (HRQoL) were identified. The indirect and direct effects of variables were calculated using structural equation modeling with SPSS-28 and Amos-28 software. A p-value of < 0.05 and a 95% CI were used to evaluate statistical significance. Results: A total of 636 (99.7%) participants responded and completed the WHOQOL-BREF questionnaire. The mean score of overall HRQoL of people with mental illness in the outpatient clinic was (49.6 ± 10 Sd). The highest QoL was found in the physical health domain (50.67 ±9.5 Sd), and the lowest mean QoL was found in the psychological health domain (48.41±10 Sd). Rural residents, drug nonadherence, suicidal ideation, not getting counseling, moderate or severe subjective severity, the family does not participate in patient care, and a family history of mental illness had an indirect negative effect on HRQoL. Alcohol use and psychological health domain had a direct positive effect on QoL. Furthermore, objective severity of illness, having low self-esteem, and having a history of mental illness in the family had both direct and indirect effects on QoL. Furthermore, sociodemographic factors (residence, educational status, marital status), social support-related factors (self-esteem, family not participating in patient care), substance use factors (alcohol use, tobacco use,) and clinical factors (objective and subjective severity of illness, not getting counseling, suicidal ideation, number of episodes, comorbid illness, family history of mental illness, poor drug adherence) directly and indirectly affected QoL. Conclusions: In this study, the QoL of people with mental illness was poor, with the psychological health domain being the most affected. Sociodemographic factors, social support-related factors, drug use factors, and clinical factors directly and indirectly, affect QoL through the mediator variables of physical health domains, psychological health domains, social relation health domains, and environmental health domains. In order to improve the QoL of people with mental illnesses, we recommend that emphasis be given to addressing the scourge of mental health, including the development of policy and practice drivers that address the above-identified factors.

Keywords: quality of life, mental wellbeing, mental illness, mental disorder, Ethiopia

Procedia PDF Downloads 40

Authors: K. V. Venugopalan

Abstract:

Micro, Small and Medium Enterprises (MSMEs) have been accepted as the engine of economic growth and for promoting equitable development. The major advantage of the sector is its employment potential at low capital cost. The labour intensity of the MSME sector is much higher than that of the large enterprises. The MSMEs constitute over 90% of total enterprises in most of the economies and are credited with generating the highest rates of employment growth and account for a major share of industrial production and exports. Kerala is a small state in India with the limited land area with high potential in educated human resources need micro, small and medium enterprises for development. Kerala has the highest Physical Quality of Life Index (PQLI) in India and the highest Human Development Index (HDI) at par with the developed countries SME play an important role in alleviating poverty and contribute significantly towards the growth of developing economies. Financial institutions can play a vital role for the promotion of micro, small and medium enterprises in Kerala. The study entitled “Financial Institutions and its role in the promotion of Small and Medium Enterprises in Kerala “examine the progress of MSME in Kerala and India and also the role of financial institutions and the problems faced by entrepreneurs for getting advances with reference to ‘Kerala Financial Corporation’-an agency set up by the government for promoting small and medium enterprises in the state. This study is based on both secondary and primary data. Primary data for the study was collected from those entrepreneurs who availed advances from financial institutions. The secondary data include the investment made, goods and services provided, the employment generated and the number of units registered in MSME sector for the last 10 years in Kerala. The study concluded that financial institutions providing finance with simple procedures and charging smaller interest rates will increase the number of MSME's and also contribute gross state domestic product and reduce the unemployment problem and poverty in the economy.

Keywords: gross state domestic product, human development index, micro, small and medium enterprises

Procedia PDF Downloads 383

Authors: Arfan Fadli, Marini Kristina Situmeang, Mukhammad Fatkhullah, Siti Hazar Sitorus

Abstract:

Merantau is one of the traditions that has been done by the Minangkabau tribe since the 15th century where it is based on socio-economic factors. In fact, that is not only limited to economic factors alone but more how to develop themselves through the experience to get the skills or education. The lack of jobs opportunity in the hometown causes the community, especially for young men to seek livelihoods in other areas. Unemployment impacts on the economy of the community that led to change in the pattern of employment from farmers to traders or new businesses in areas outside of their homeland. This is also worsened because many young people are not interested in becoming a farmer and working on the land in their village. In this context, merantau is considered to be an alternative to fulfilling livelihoods, and therefore this study examines how the merantau tradition constructed by the Minangkabau community, West Sumatera Province. The research method is done by literature review by collecting information related to the social construction of merantau tradition from various scientific publications. The results show how merantau becomes a solution of economic problems for Minangkabau society. Merantau which has now become an institutionalized tradition for the Minangkabau community where the culture of merantau occurred like a chain that can raise the people from the condition of poverty. When there are people who have successfully in merantau, they tend to bring other relatives who have not found a job to be able to trade with them. In the place of merantau, they will be disciplined to learn how to trade. Eventually, they will have new skills to trade and even make their own business. The tradition of bringing relatives to the rantau to be empowered is a unique side of merantau because it is influenced by the Matrilinear kinship system. The matrilineal kinship system in Minangkabau is the largest in the world where helping relatives are considered to be of the highest value. This system also places men as high positions where men should be encouraged to go abroad for financial success and to help their relatives in their hometown. The success of this tradition (to uplift and resolve the poverty and manpower issues) is demonstrated by the tradition of Minangkabau communities that have been successful in the area of Rantau that send money to their relatives in their homes (remittance). Merantau tradition can also be an alternative in reducing unemployment especially for young people where it is demonstrated by the culture of helping relatives to get work outside of their homeland.

Keywords: matrilineal kinship system, merantau, minangkabau community, reducing unemployment

Procedia PDF Downloads 179