Search results for: competence of health workers

Authors: Johnnie Hay

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New Zealand is well known for its natural beauty, diversity of people but also for its strong focus on mental health through the provision of a vast network of psycho-social support services. South African-trained psychologists often make New Zealand their new home when emigrating - as it is relatively simple to slot into the well-established mental health system. South Africa is bigger in size, population, GDP and probably people diversity than New Zealand but struggles to provide adequate educational and psychological support services to schools. This is mainly due to budgetary pressures brought about by the imperative to first ensure that the approximately 13 million learners all have a teacher in front of their classes and at an average ratio of not more than 40 learners per class. In this paper, perspectives on educational and psychological support in New Zealand and South African schools will be shared. Through basic qualitative research encompassing semi-structured interviews with two South African educational psychologists who returned from New Zealand, supplemented by document analysis, the New Zealand situation will be scrutinized. South African perspectives will be obtained through a number of semi-structured interviews and questionnaires administered by education support services specialists working in district-based support teams in three provinces of the country. This research is in process, but preliminary findings indicate large disparities between the two countries' emphasis, funding, post provisioning and structure regarding educational and psychological support services.

Keywords: educational psychological support services, support for learners experiencing special needs, education support services, diverse learner population

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Authors: Gaofetoge Lenetha, Malerato Moloi, Ntsoaki Malebo

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Microbial contamination of ready-to-eat foods and beverages sold by street vendors has become an important public health issue. In developing countries including South Africa, health risks related to such kinds of foods are thought to be common. Thus, this study assessed knowledge, attitude and practices of street food vendors. Street vendors in the city of Mangaung Metro were investigated in order to assess their knowledge, attitudes and handling practices. A semi-structured questionnaire and checklist were used in interviews to determine the status of the vending sites and associa. ted food-handling practices. Data was collected by means of a face-to-face interview. The majority of respondents were black females. Hundred percent (100%) of the participants did not have any food safety training. However, street vendors showed a positive attitude towards food safety. Despite the positive attitude, vendors showed some non-compliance when it comes to handling food. During the survey, it was also observed that the vending stalls lack basic infrastructures like toilets and potable water that is currently a major problem. This study indicates a need for improvements in the environmental conditions at these sites to prevent foodborne diseases. Moreover, based on the results observed food safety and food hygiene training or workshops for street vendors are highly recommended.

Keywords: food hygiene, foodborne illnesses, food safety, Street foods

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Authors: Akinbo Razak Yinka, Adesanya Kehinde Kazeem, Oladokun Oluwagbenga Peter

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Time series data are sequences of observations collected over a period of time. Such data can be used to predict health outcomes, such as disease progression, mortality, hospitalization, etc. The Statistical approach is based on mathematical models that capture the patterns and trends of the data, such as autocorrelation, seasonality, and noise, while Neural methods are based on artificial neural networks, which are computational models that mimic the structure and function of biological neurons. This paper compared both parametric and non-parametric time series models of patients treated for malaria in Maternal and Child Health Centres in Lagos State, Nigeria. The forecast methods considered linear regression, Integrated Moving Average, ARIMA and SARIMA Modeling for the parametric approach, while Multilayer Perceptron (MLP) and Long Short-Term Memory (LSTM) Network were used for the non-parametric model. The performance of each method is evaluated using the Mean Absolute Error (MAE), R-squared (R2) and Root Mean Square Error (RMSE) as criteria to determine the accuracy of each model. The study revealed that the best performance in terms of error was found in MLP, followed by the LSTM and ARIMA models. In addition, the Bootstrap Aggregating technique was used to make robust forecasts when there are uncertainties in the data.

Keywords: ARIMA, bootstrap aggregation, MLP, LSTM, SARIMA, time-series analysis

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Authors: Jalila Jbilou, Salaheddine El Adlouni, Pierre Gosselin

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Background: West Nile virus is increasingly an important public health issue in North America. In Canada, WVN was officially reported in Toronto and Montréal for the first time in 2001. During the last decade, several WNV events have been reported in several Canadian provinces. The main objective of the present study is to update the frequency of the climate conditions favorable to WNV outbreaks in Canada. Method: Statistical frequency analysis has been used to estimate the return period for climate conditions associated with WNV outbreaks for the 1961–2050 period. The best fit is selected through the Akaike Information Criterion, and the parameters are estimated using the maximum likelihood approach. Results: Results show that the climate conditions related to the 2002 event, for Montreal and Toronto, are becoming more frequent. For Saskatoon, the highest DD20 events recorded for the last few decades were observed in 2003 and 2007. The estimated return periods are 30 years and 70 years, respectively. Conclusion: The emergence of WNV was related to extremely high DD values in the summer. However, some exceptions may be related to several factors such as virus persistence, vector migration, and also improved diagnosis and reporting levels. It is clear that such climate conditions have become much more common in the last decade and will likely continue to do so over future decades.

Keywords: West Nile virus, climate, North America, statistical frequency analysis, risk estimation, public health, modeling, scenario, temperature, precipitation

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Authors: Sunday Sedodo Nupo, Clara Berstien Oguntona, Babatunde Oguntona, Oluseyi Akinloye, P. A. Olunusi Adeboye

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Cardiovascular diseases are now becoming dominant sources of morbidity and mortality worldwide. This study investigated the lipid profile of civil servants. A cross-sectional study was carried out among randomly selected 202 male and 298 female civil servants in Abeokuta Ogun state. A pretested structured questionnaire was used to elicit information on history of non-communicable diseases and physical activity pattern of the respondents. The blood pressures of the subjects were measured and classified using World Health Organization criteria. The total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL). Ethical approval was obtained from Ogun State Ministry of Health. Data collected were analysed using Statistical package for social science version 17.1. Results showed that majority (76%) of the subjects were within the age range of 20 - 40 years, 75% earned between N58,500 - N98,000 monthly and 68% were sedentary. The mean energy intake of men and women were 3942±38 kcal and 2791±3 kcal respectively, while the protein intake for men was 65±49 g/day and 54.28±40 g/day for women. Desirable TC level (<200 mg/dl) was found in 80% of the selected subjects while the normal TG (<150 mg/dl) and LDL (<129 mg/dl) was found in 95% and 90% subjects respectively. The mean TC was 78.91±11 mg/dl and 62.69±9 mg/dl in men and women respectively. The study showed that most of the subjects had normal lipid in terms of serum triglycerides, total cholesterol, HDL cholesterol and LDL cholesterol.

Keywords: high density lipoprotein, morbidity, mortality, triglycerides

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Authors: Mehdi Mirzaei Alavijeh, Farzad Jalilian

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Background: Marijuana is the most widely used illicit drug worldwide, especially among adolescents and young adults, which can cause numerous complications. The aim of this study was to determine the pattern, motivation use, and factors related to marijuana use among Iranian youths based on the integrative model of behavioral prediction Methods: A cross-sectional study was conducted among 174 youths marijuana user in Kermanshah County and Isfahan County, during summer 2014 which was selected with the convenience sampling for participation in this study. A self-reporting questionnaire was applied for collecting data. Data were analyzed by SPSS version 21 using bivariate correlations and linear regression statistical tests. Results: The mean marijuana use of respondents was 4.60 times at during week [95% CI: 4.06, 5.15]. Linear regression statistical showed, the structures of integrative model of behavioral prediction accounted for 36% of the variation in the outcome measure of the marijuana use at during week (R2 = 36% & P < 0.001); and among them attitude, marijuana refuse, and subjective norms were a stronger predictors. Conclusion: Comprehensive health education and prevention programs need to emphasize on cognitive factors that predict youth’s health-related behaviors. Based on our findings it seems, designing educational and behavioral intervention for reducing positive belief about marijuana, marijuana self-efficacy refuse promotion and reduce subjective norms encourage marijuana use has an effective potential to protect youths marijuana use.

Keywords: marijuana, youth, integrative model of behavioral prediction, Iran

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Authors: Akiko Ohta, Masahiro Minami, Yusra Qadir, Jennifer York

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The Home Instruction for Parents of Preschool Youngsters (HIPPY) is a home instruction program for mothers of children 3 to 5 years old. Using role-play as a method of teaching, the participating mothers work with their home visitors and learn how to deliver the HIPPY curriculum to their children. Applying HIPPY, Reviving Hope and Home for High-risk Refugee Mothers Program (RHH) was created to provide more personalized peer support and to respond to ongoing settlement challenges for isolated and vulnerable Government Assisted Refugee (GAR) mothers. GARs often have greater needs and vulnerabilities than other refugee groups. While the support is available, they often face various challenges and barriers in starting their new lives in Canada, such as inadequate housing, low first-language literacy levels, low competency in English or French, and social isolation. The pilot project was operated by Mothers Matter Centre (MMC) from January 2019 to March 2021 in partnership with the Immigrant Services Society of BC (ISSofBC). The formative evaluation was conducted by a research team at Simon Fraser University. In order to provide more suitable support for GAR mothers, RHH intended to offer more flexibility in HIPPY delivery, supported by a home visitor, to meet the need of refugee mothers facing various conditions and challenges; to have a pool of financial resources to be used for the RHH families when necessitated during the program period; to have another designated staff member, called a community navigator, assigned to facilitate the support system for the RHH families in their settlement; to have a portable device available for each RHH mother to navigate settlement support resources; and to provide other variations of the HIPPY curriculum as an option for the RHH mothers, including a curriculum targeting pre-HIPPY age children. Reflections on each program component was collected from RHH mothers and staff members of MMC and ISSofBC, including frontline workers and management staff, through individual interviews and focus group discussions. Each of the RHH program components was analyzed and evaluated by applying Moore’s four domains framework to identify key information and generate new knowledge (data). To capture RHH mothers’ program experience more in depth based on their own reflections, the photovoice method was used. Some photos taken by the mothers will be shared to illustrate their RHH experience as part of their life stories. Over the period of the program, this evaluation observed how RHH mothers became more confident in various domains, such as communicating with others, taking public transportations alone, and teaching their own child(ren). One of the major factors behind the success was their home visitors’ flexibility and creativity to create a more meaningful and tailored approach for each mother, depending on her background and personal situation. The role of the community navigator was tested out and improved during the program period. The community navigators took the key role to assess the needs of the RHH families and connect them with community resources. Both the home visitors and community navigators were immigrant mothers themselves and owing to their dedicated care for the RHH mothers; they were able to gain trust and work closely and efficiently with RHH mothers.

Keywords: refugee mothers, settlement support, program evaluation, Canada

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Authors: Abdelkader Guendouz, Fatima Zohra Adel

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Even if both the economic and the human development are an axial pillar in its global policy, Algerian government seems to be more and more engaged in the international context aiming to reach of the so called millennium development goals, and this since its beginning. By looking closely at the Algerian economic policy, it is easy to mention the existence of several programs in which both economic and social realisations including among others, poverty reduction, enhancement of education level and conditions, woman statute and gender equity amelioration targets. The efforts of Algerian government in the field of these targets had been acheminated through three main plans, which are: -PSRE (Plan de Soutien à la Relance Economique), for the period of 2001 to 2004, initiated with about 7 billion US dollar, had been focused on three objectives, namely, poverty reduction, job creation and regional equilibrium with rural areas revitalization. -PCSC (le Programme complémentaire de soutien à la croissance économique), for the period of 2005 to 2009, with a starting funding of 114 billion US dollar. This program aims to develop public services and supporting public investments, especially in which concerns social infrastructures. Now, and at the end of the maturity of the MDGs agenda, an important question is to be asked: what are the main realizations regarding these MDGs? In order to answer this question, the present paper tries to examine the Algerian economic policy (but also the social one) by considering the MDGs challenges, for the period from 2000 to 2010, but also until 2015. This examination is focused on three main targets, namely poverty, education, and health. Firstly, statistical assessment for the Algerian economic and social situation shows that almost all MDGs had been reached during the period of 2000 to 2009 and it continues to maintain and improve them. This observation can be endorsed by invoking some achievements. Starting by the reduction of poverty, the proportion of population living with less than 1 US dollar per a day passed from 8.0 % in 2000 to 0.5 % in 2009, and 0.3 % in 2015. For education sphere, the enrolment ratio of six-year child, which is the most significant index for school attendance, is about 98 % for 2009 against 93 % in 1999, and only 43 % in 1966. Concluding with health care and relevant services; the Algerian government has accomplished big steps in providing easy access to this sector for the population. Moreover, the percentage of assisted accouchement had been raised from 91.2 % in 2000 to 97.2 % in 2009.

Keywords: Algerian economic policy, MDGs, poverty, education, health

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Authors: Ana Ferraz, Martim Santos, M. Graça Pereira

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Distress among parents of children with acute lymphoblastic leukemia (ALL) is common during treatment and can persist several years post-diagnosis, impacting the adjustment of children and parents themselves. Current evidence is needed to examine the scope and nature of parental distress in childhood ALL. This review focused on associated variables, predictors, and outcomes of parental distress following their ALL diagnosis of their child. PubMed, Web of Science, and PsycINFO databases were searched for English and Spanish papers published from 1983 to 2021. PRISMA statement was followed, and papers were evaluated through a standardized methodological quality assessment tool (NHLBI). Of the 28 papers included, 16 were evaluated as fair, eight as good, and four as poor. Regarding results, 11 papers reported subgroup differences, and 15 found potential predictors of parental distress, including sociodemographic, psychosocial, psychological, family, health, and ALL-specific variables. Significant correlations were found between parental distress, social support, illness cognitions, and resilience, as well as contradictory results regarding the impact of sociodemographic variables on parental distress. Family cohesion and caregiver burden were associated with distress, and the use of healthy coping strategies was associated with less anxiety. Caregiver strain contributed to distress, and the overall impact of illness positively predicted anxiety in mothers and somatization in fathers. Differences in parental distress were found regarding group risk, time since diagnosis, and treatment phases. Thirteen papers explored the outcomes of parental distress on psychological, family, health, and social/education outcomes. Parental distress was the most important predictor of family strain. Significant correlations were found between parental distress at diagnosis and further psychological adjustment of parents themselves and their children. Most papers reported correlations between parental distress on children’s adjustment and quality of life, although few studies reported no association. Correlations between maternal depression and child participation in education and social life were also found. Longitudinal studies are needed to better understand parental distress and its consequences on health outcomes, in particular. Future interventions should focus mainly on parents on distress reduction and psychological adjustment, both in parents and children over time.

Keywords: childhood acute lymphoblastic leukemia, family, parental distress, psychological adjustment, quality of life

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Authors: Albert Amagyei, Julia Carroll, Amanda R. Amorim Adegboye, Laura Strumidlo, Rosie Kneafsey

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Introduction: Classroom-based learning has persisted as the mainstream model of pre-registration nurse education. This model is often rigid, teacher-centered, and unable to support active learning and the practical learning needs of nursing students. Health Education England (HEE), a public body of the Department of Health and Social Care, hypothesises that blended learning (BL) programmes may address health system and nursing profession challenges, such as nursing shortages and lack of digital expertise, by exploring opportunities for providing predominantly online, remote-access study which may increase nursing student recruitment, offering alternate pathways to nursing other than the traditional classroom route. This study will provide evidence for blended learning strategies adopted in nursing education as well as examine nursing student learning experiences concerning the challenges and opportunities related to using blended learning within nursing education. Objective: This review will explore the challenges and opportunities of BL within pre-registration nurse education from the student's perspective. Methods: The search was completed within five databases. Eligible studies were appraised independently by four reviewers. The JBI-convergent segregated approach for mixed methods review was used to assess and synthesize the data. The study’s protocol has been registered with the International Register of Systematic Reviews with registration number// PROSPERO (CRD42023423532). Results: Twenty-seven (27) studies (21 quantitative and 6 qualitative) were included in the review. The study confirmed that BL positively impacts nursing students' learning outcomes, as demonstrated by the findings of the meta-analysis and meta-synthesis. Conclusion: The review compared BL to traditional learning, simulation, laboratory, and online learning on nursing students’ learning and programme outcomes as well as learning behaviour and experience. The results show that BL could effectively improve nursing students’ knowledge, academic achievement, critical skills, and clinical performance as well as enhance learner satisfaction and programme retention. The review findings outline that students’ background characteristics, BL design, and format significantly impact the success of the BL nursing programme.

Keywords: nursing student, blended learning, pre-registration nurse education, online learning

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Authors: U. Thisara G. Perera, C. M. Kanchana N. K. Chandrasekara

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Dengue is an epidemic which is spread by Aedes Egyptai and Aedes Albopictus mosquitoes. The cases of dengue show a dramatic growth rate of the epidemic in urban and semi urban areas spatially in tropical and sub-tropical regions of the world. Incidence of dengue has become a prominent reason for hospitalization and deaths in Asian countries, including Sri Lanka. During the last decade the dengue epidemic began to spread from urban to semi-urban and then to rural settings of the country. The highest number of dengue infected patients was recorded in Sri Lanka in the year 2016 and the highest number of patients was identified in Colombo district. Together with the commercial, industrial, and other supporting services, the district suffers from rapid urbanization and high population density. Thus, drainage and waste disposal patterns of the people in this area exert an additional pressure to the environment. The district is situated in the wet zone and thus low lying lands constitute the largest portion of the district. This situation additionally facilitates mosquito breeding sites. Therefore, the purpose of the present study was to assess the spatial and temporal distribution patterns of dengue epidemic in Kolonnawa MOH area (Medical Officer of Health) in the district of Colombo. The study was carried out using 615 recorded dengue cases in Kollonnawa MOH area during the south east monsoon season from May to September 2016. The Moran’s I and Kernel density estimation were used as analytical methods. The analysis of data was accomplished through the integrated use of ArcGIS 10.1 software packages along with Microsoft Excel analytical tool. Field observation was also carried out for verification purposes during the study period. Results of the Moran’s I index indicates that the spatial distribution of dengue cases showed a cluster distribution pattern across the area. Kernel density estimation emphasis that dengue cases are high where the population has gathered, especially in areas comprising housing schemes. Results of the Kernel Density estimation further discloses that hot spots of dengue epidemic are located in the western half of the Kolonnawa MOH area, which is close to the Colombo municipal boundary and there is a significant relationship with high population density and unplanned urban land use practices. Results of the field observation confirm that the drainage systems in these areas function poorly and careless waste disposal methods of the people further encourage mosquito breeding sites. This situation has evolved harmfully from a public health issue to a social problem, which ultimately impacts on the economy and social lives of the country.

Keywords: Dengue epidemic, health hazards, Kernel density, Moran’s I, Sri Lanka

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Authors: L. Kashyap, S. Jha, D. Shende, V. K. Mohan, P. Khanna, A. Aravindan, S. Kashyap, L. Singh, S. Aggarwal

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Obesity is associated with a chronic inflammatory state. During surgery, there is an interplay between anaesthetic and surgical stress vis-a-vis the already present complex immune state. Moreover, the postoperative period is dictated by inflammation, which is crucial for wound healing and regeneration. An excess of inflammatory response might hamper recovery besides increasing the risk for infection and complications. There is definite evidence of the immunosuppressive role of inhaled anaesthetic agents. This immune modulation may be brought into effect directly by influencing the innate and adaptive immunity cells. The effects of propofol on immune mechanisms in has been widely elucidated because of its popularity. It reduces superoxide generation, elastase release, and chemotaxis. However, there is no unequivocal proof of one’s superiority over the other. Hence, an anaesthetic regimen with lesser inflammatory potential and specific to the obese patient is needed. OBESITA trial protocol (2019) by Sousa and co-workers in progress aims to test the hypothesis that anaesthesia with sevoflurane results in a weaker proinflammatory response compared to propofol, as evidenced by lower IL-6 and other biomarkers and an increased macrophage differentiation into M2 phenotype in adipose tissue. IL-6 was used as the objective parameter to evaluate inflammation as it is regulated by both surgery and anesthesia. It is the most sensitive marker of the inflammatory response to tissue damage since it is released within minutes by blood leukocytes. We hypothesized that maintenance of anaesthesia with propofol would lead to less inflammation than that with desflurane. Aims: The effect of two anaesthetic techniques, total intravenous anaesthesia (TIVA) with propofol and desflurane, on surgical stress response was evaluated. The primary objective was to compare serum interleukin-6 (IL-6) levels before and after surgery. Methods: In this prospective single-blinded randomized controlled trial undertaken, 30 obese patients (BMI>30 kg/m2) undergoing laparoscopic bariatric surgery under general anaesthesia were recruited. Patients were randomized to receive desflurane or TIVA using a target-controlled infusion for maintenance of anaesthesia. As a marker of inflammation, pre-and post-surgery IL-6 levels were compared. Results: After surgery, IL-6 levels increased significantly in both groups. The rise in IL-6 was less with TIVA than with desflurane; however, it did not reach significance. IL-6 rise post-surgery correlated positively with the complexity of procedure and duration of surgery and anaesthesia, rather than anaesthetic technique. Both groups did not differ in terms of intra-operative hemodynamic and respiratory variables, time to awakening, postoperative pulmonary complications, and duration of hospital stay. The incidence of nausea was significantly higher with desflurane than with TIVA. Conclusion: Inflammatory response did not differ as a function of anaesthetic technique when propofol and desflurane were compared. Also, patient and surgical variables dictated post-operative inflammation more than the anaesthetic factors. Further, larger sample size is needed to confirm or refute these findings.

Keywords: bariatric, biomarkers, inflammation, laparoscopy

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Authors: Aishwarya Venkat, Anastasia Marshak, Ryan B. Simpson, Elena N. Naumova

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Livestock ownership is simultaneously linked to improved nutritional status through increased availability of animal-source protein, and increased risk of enteric infections through higher exposure to contaminated water sources. Agrarian and agro-pastoral households, especially those with cattle, goats, and sheep, are highly dependent on seasonally various environmental conditions, which directly impact nutrition and health. This study explores global spatiotemporally explicit evidence regarding the relationship between livestock ownership, enteric infections, and malnutrition. Seasonal and cyclical fluctuations, as well as mediating effects, are further examined to elucidate health and nutrition outcomes of individual and communal livestock ownership. The US Agency for International Development’s Demographic and Health Surveys (DHS) and the United Nations International Children's Emergency Fund’s Multi-Indicator Cluster Surveys (MICS) provide valuable sources of household-level information on anthropometry, asset ownership, and disease outcomes. These data are especially important in data-sparse regions, where surveys may only be conducted in the aftermath of emergencies. Child-level disease history, anthropometry, and household-level asset ownership information have been collected since DHS-V (2003-present) and MICS-III (2005-present). This analysis combines over 15 years of survey data from DHS and MICS to study 2,466,257 children under age five from 82 countries. Subnational (administrative level 1) measures of diarrhea prevalence, mean livestock ownership by type, mean and median anthropometric measures (height for age, weight for age, and weight for height) were investigated. Effects of several environmental, market, community, and household-level determinants were studied. Such covariates included precipitation, temperature, vegetation, the market price of staple cereals and animal source proteins, conflict events, livelihood zones, wealth indices and access to water, sanitation, hygiene, and public health services. Children aged 0 – 6 months, 6 months – 2 years, and 2 – 5 years of age were compared separately. All observations were standardized to interview day of year, and administrative units were harmonized for consistent comparisons over time. Geographically weighted regressions were constructed for each outcome and subnational unit. Preliminary results demonstrate the importance of accounting for seasonality in concurrent assessments of malnutrition and enteric infections. Household assets, including livestock, often determine the intensity of these outcomes. In many regions, livestock ownership affects seasonal fluxes in malnutrition and enteric infections, which are also directly affected by environmental and local factors. Regression analysis demonstrates the spatiotemporal variability in nutrition outcomes due to a variety of causal factors. This analysis presents a synthesis of evidence from global survey data on the interrelationship between enteric infections, malnutrition, and livestock. These results provide a starting point for locally appropriate interventions designed to address this nexus in a timely manner and simultaneously improve health, nutrition, and livelihoods.

Keywords: diarrhea, enteric infections, households, livestock, malnutrition, seasonality

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Authors: Alex Hughes

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Patients with advanced heart failure develop specific palliative care needs due to the progressive symptom burden and unpredictable disease trajectory. NICE guidance advises that palliative care should be provided to patients with both cancer and non-cancer conditions as and when required. However, there is some way to go before this guidance is consistently and effectively implemented nationwide in conditions such as heart failure. The Ambitions for Palliative and End of Life Care: A national framework for local action in England provides a set of foundations and ambitions which outline a vision for what high-quality palliative and end-of-life care look like in England. This poster aims to critically consider how to improve access to palliative care for heart failure patients in England by analysing the foundations taken from this framework to generate specific recommendations using Soft Systems Methodology (SSM). The eight foundations analysed are: ‘Personalised care planning’, ‘Shared records’, ‘Evidence and information’, ‘Involving, supporting and caring for those important to the dying Person’, ‘Education and training’, ‘24/7 access’, ‘Co-design’ and ‘Leadership.’ A number of specific recommendations have been generated which highlight a need to close the evidence-policy gap and implement policy with sufficient evidence. These recommendations, alongside the creation of an evidence-based national strategy for palliative care and heart failure, should improve access to palliative care for heart failure patients in England. Once implemented, it will be necessary to evaluate the effect of these proposals to understand if access to palliative care for heart failure patients actually improves.

Keywords: access, health systems, heart failure, palliative care

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Authors: Keith T. S. Tung, H. W. Tsang, Rosa S. Wong, Frederick K. Ho, Patrick Ip

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Objectives: Atopic diseases are increasingly prevalent among children and adolescents, both locally and internationally. One of the possible contributing factors could be the hypercholesterolemia which leads to cholesterol accumulation in macrophages and other immune cells that would eventually promote inflammatory responses, including augmentation of toll-like receptor (TLR). Meanwhile, physical activity is well known for its beneficial effects against the condition of hypercholesterolemia and incidence of atopic diseases. This study, therefore, explored whether atopic diseases were associated with increased cholesterol levels and whether physical activity habit influenced this association. Methods: This is a sub-study derived from the longitudinal cohort study which recruited a group of children at five years of age in Kindergarten 3 (K3) to investigate the long-term impact of family socioeconomic status on child development. In 2018/19, adolescents (average age: 13 years old) were asked to report their physical activity habit and history of any atopic diseases. During health assessment, peripheral blood samples were collected from the adolescents to study their lipid profile [total cholesterol, high-density lipoprotein (HDL)-cholesterol, and low-density lipoprotein (LDL)-cholesterol]. Regression analyses were performed to test the relationships between variables of interest. Results: Among the 315 adolescents, 99 (31.4%) reported to have allergic rhinitis. There were 45 (14.3%) with eczema, 17 (5.4%) with a food allergy, and 12 (3.8%) with asthma. Regression analyses showed that adolescents with a history of any type of atopic diseases had significantly higher total cholesterol (B=13.3, p < 0.01) and LDL cholesterol (B=7.9, p < 0.05) levels. Further subgroup analyses were conducted to examine the effect of physical activity level on the association between atopic diseases and cholesterol levels. We found stronger associations among those who did not meet the World Health Organization recommendation of at least 60 minutes of moderate-to-vigorous activities each day (total cholesterol: B=15.5, p < 0.01; LDL cholesterol: B=10.4, p < 0.05). For those who met this recommendation, the associations between atopic diseases and cholesterol levels became insignificant. Conclusion: Our study results support the current research evidence on the relationship between an elevated level of cholesterol and atopic diseases. More importantly, our results provide preliminary support for the protective effect of regular exercises against elevated cholesterol level due to atopic diseases. The findings highlight the importance of a healthy lifestyle for keeping cholesterol levels in the normal range, which can bring benefits to both physical and mental health.

Keywords: atopic diseases, Chinese adolescents, cholesterol level, physical activity

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Authors: Wahhaj Ahmed Farooqi, Bilal Ahmad, Sandra Maritza Zambrano Bernal

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In view of structural engineering, monitoring of structural responses over time is of great importance with respect to recent developments of construction technologies. Recently, developments of advanced computing tools have enabled researcher’s better execution of structural health monitoring (SHM) and control systems. In the last decade, building information modeling (BIM) has substantially enhanced the workflow of planning and operating engineering structures. Typically, building information can be stored and exchanged via model files that are based on the Industry Foundation Classes (IFC) standard. In this study a modeling approach for semantic modeling of SHM and control systems is integrated into the BIM methodology using the IFC standard. For validation of the modeling approach, a laboratory test structure, a four-story shear frame structure, is modeled using a conventional BIM software tool. An IFC schema extension is applied to describe information related to monitoring and control of a prototype SHM and control system installed on the laboratory test structure. The SHM and control system is described by a semantic model applying Unified Modeling Language (UML). Subsequently, the semantic model is mapped into the IFC schema. The test structure is composed of four aluminum slabs and plate-to-column connections are fully fixed. In the center of the top story, semi-active tuned liquid column damper (TLCD) is installed. The TLCD is used to reduce effects of structural responses in context of dynamic vibration and displacement. The wireless prototype SHM and control system is composed of wireless sensor nodes. For testing the SHM and control system, acceleration response is automatically recorded by the sensor nodes equipped with accelerometers and analyzed using embedded computing. As a result, SHM and control systems can be described within open BIM, dynamic responses and information of damages can be stored, documented, and exchanged on the formal basis of the IFC standard.

Keywords: structural health monitoring, open building information modeling, industry foundation classes, unified modeling language, semi-active tuned liquid column damper, nondestructive testing

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Authors: Ilona Buchem, Carolin Gellner

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The call for the support of senior learners in the development of digital literacy has become prevalent in recent years, especially in view of the aging societies paired with advances in digitalization in all spheres of life, including e-health. The goal has been to create opportunities for learning that incorporate the use of context in a reflective and dialogical way. Contextual learning has focused on developing skills through the application of authentic problems. While major research efforts in supporting senior learners in developing digital literacy have been invested so far in e-learning, focusing on knowledge acquisition and cognitive tasks, little research exists in reflective mentoring and coaching with the help of pedagogical agents and addressing the contextual dimensions of learning. This paper describes an approach to creating opportunities for senior learners to improve their digital literacy in the authentic context of the electronic health record (EHR) with the support of an intelligent virtual learning coach. The paper focuses on the design of the virtual coach as part of an e-learning system, which was developed in the EPA-Coach project founded by the German Ministry of Education and Research. The paper starts with the theoretical underpinnings of contextual learning and the related design considerations for a virtual learning coach based on previous studies. Since previous research in the area was mostly designed to cater to the needs of younger audiences, the results had to be adapted to the specific needs of senior learners. Next, the paper outlines the stages in the design of the virtual coach, which included the adaptation of the design requirements, the iterative development of the prototypes, the results of the two evaluation studies and how these results were used to improve the design of the virtual coach. The paper then presents the four prototypes of a senior-friendly virtual learning coach, which were designed to represent different preferences related to the visual appearance, the communication and social interaction styles, and the pedagogical roles. The first evaluation of the virtual coach design was an exploratory, qualitative study, which was carried out in October 2020 with eight seniors aged 64 to 78 and included a range of questions about the preferences of senior learners related to the visual design, gender, age, communication and role. Based on the results of the first evaluation, the design was adapted to the preferences of the senior learners and the new versions of prototypes were created to represent two male and two female options of the virtual coach. The second evaluation followed a quantitative approach with an online questionnaire and was conducted in May 2021 with 41 seniors aged 66 to 93 years. Following three research questions, the survey asked about (1) the intention to use, (2) the perceived characteristics, and (3) the preferred communication/interaction style of the virtual coach, i. e. task-oriented, relationship-oriented, or a mix. This paper follows with the discussion of the results of the design process and ends with conclusions and next steps in the development of the virtual coach including recommendations for further research.

Keywords: virtual learning coach, virtual mentor, pedagogical agent, senior learners, digital literacy, electronic health records

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Authors: Pamela Tancsik

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The stage production in 2018, titled ‘From‘Marikana to Mahagonny’, began with a prologue in the form of the award-winning documentary ‘Miners Shot Down' by Rehad Desai, followed by Brecht/Weill’s song play or scenic cantata ‘Mahagonny’, premièred in Baden-Baden 1927. The central directorial concept of the DUT musical production ‘From Marikana to Mahagonny’ was to show a connection between the socio-political alienation of mineworkers in present-day South Africa and Brecht’s alienation effect in his scenic cantata ‘Mahagonny’. Marikana is a mining town about 50 km west of South Africa’s capital Pretoria. Mahagonny is a fantasy name for a utopian mining town in the United States. The characters, setting, and lyrics refer to America with of songs like ‘Benares’ and ‘Moon of Alabama’ and the use of typical American inventions such as dollars, saloons, and the telephone. The six singing characters in ‘Mahagonny’ all have typical American names: Charlie, Billy, Bobby, Jimmy, and the two girls they meet later are called Jessie and Bessie. The four men set off to seek Mahagonny. For them, it is the ultimate dream destination promising the fulfilment of all their desires, such as girls, alcohol, and dollars – in short, materialistic goals. Instead of finding a paradise, they experience how money and the practice of exploitive capitalism, and the lack of any moral and humanity is destroying their lives. In the end, Mahagonny gets demolished by a hurricane, an event which happened in 1926 in the United States. ‘God’ in person arrives disillusioned and bitter, complaining about violent and immoral mankind. In the end, he sends them all to hell. Charlie, Billy, Bobby, and Jimmy reply that this punishment does not mean anything to them because they have already been in hell for a long time – hell on earth is a reality, so the threat of hell after life is meaningless. Human life was also taken during the stand-off between striking mineworkers and the South African police on 16 August 2012. Miners from the Lonmin Platinum Mine went on an illegal strike, equipped with bush knives and spears. They were striking because their living conditions had never improved; they still lived in muddy shacks with no running water and electricity. Wages were as low as R4,000 (South African Rands), equivalent to just over 200 Euro per month. By August 2012, the negotiations between Lonmin management and the mineworkers’ unions, asking for a minimum wage of R12,500 per month, had failed. Police were sent in by the Government, and when the miners did not withdraw, the police shot at them. 34 were killed, some by bullets in their backs while running away and trying to hide behind rocks. In the musical play ‘From Marikana to Mahagonny’ audiences in South Africa are confronted with a documentary about Marikana, followed by Brecht/Weill’s scenic cantata, highlighting the tragic parallels between the Mahagonny story and characters from 1927 America and the Lonmin workers today in South Africa, showing that in 95 years, capitalism has not changed.

Keywords: alienation, brecht/Weill, mahagonny, marikana/South Africa, musical theatre

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Authors: Ahmeda Ali, Mary Codd, Susan Brundage

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Importance: This research focuses on devising and improving Health Service Executive (HSE) policy and legislation and therefore improving patient trauma care and outcomes in Ireland. Objectives: The study measures components of the Trauma System in the district hospital setting of the Cavan/Monaghan Hospital Group (CMHG), HSE, Ireland, and uses the collected data to identify the strengths and weaknesses of the CMHG Trauma System organisation, to include governance, injury data, prevention and quality improvement, scene care and facility-based care, and rehabilitation. The information will be made available to local policy makers to provide objective situational analysis to assist in future trauma service planning and service provision. Design, setting and participants: From 28 April to May 28, 2016 a cross-sectional survey using World Health Organisation (WHO) Trauma System Assessment Tool (TSAT) was conducted among healthcare professionals directly involved in the level III trauma system of CMHG. Main outcomes: Identification of the strengths and weaknesses of the Trauma System of CMHG. Results: The participants who reported inadequate funding for pre hospital (62.3%) and facility based trauma care at CMHG (52.5%) were high. Thirty four (55.7%) respondents reported that a national trauma registry (TARN) exists but electronic health records are still not used in trauma care. Twenty one respondents (34.4%) reported that there are system wide protocols for determining patient destination and adequate, comprehensive legislation governing the use of ambulances was enforced, however, there is a lack of a reliable advisory service. Over 40% of the respondents reported uncertainty of the injury prevention programmes available in Ireland; as well as the allocated government funding for injury and violence prevention. Conclusions: The results of this study contributed to a comprehensive assessment of the trauma system organisation. The major findings of the study identified three fundamental areas: the inadequate funding at CMHG, the QI techniques and corrective strategies used, and the unfamiliarity of existing prevention strategies. The findings direct the need for further research to guide future development of the trauma system at CMHG (and in Ireland as a whole) in order to maximise best practice and to improve functional and life outcomes.

Keywords: trauma, education, management, system

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Authors: Georgitta Joseph Valiyamattam

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Autism spectrum disorders (ASD) are a growing phenomenon in India with over 10 million cases being recorded. Children with various levels and forms of ASD can be a major challenge both within the context of regular or special schooling. According to statistics by the Centers for Disease Control and Prevention (CDC), one in every 88 children today is born with autism spectrum disorder (ASD) against a ratio of one in 110 few years back. The growing number of children with autism spectrum disorders places greater demands on health services and necessitates the roping in of non-traditional modes of treatment to complement or even substitute traditional health care methods when possible. Research evidence, particularly from Western countries, as also some parts of Asia, suggests that animal-assisted therapy, or zootherapy, may be used as an effective individual or complementary therapeutic tool for increasing overall wellbeing and quality of life among children with Autism spectrum disorders. The paper through a case-study format seeks to evaluate the efficacy (initial stage) of animal assisted therapy (canine-therapy with visiting dog: breed-Golden retriever), as a non-conventional treatment modality for improving cognitive functioning and managing the behavioral and psychological symptoms of Autism Spectrum Disorders. As a pilot study forming the basis for subsequent larger application of AAT, it analyses areas of efficacy as also the challenges faced, both with regard to the mode of therapy, as also particular to the Indian setting.

Keywords: animal assisted therapy, autism, canine therapy, analyzing initial efficacy

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Authors: Veliswa Nonfundo Hoho, Jabulani Gilford Kheswa

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This paper reports on teenage motherhood and its adverse outcomes on the academic performance, emotional well-being and sexual relationships that adolescent females encounter. Drawing from Ryff’s six dimensions of psychological well-being and Bronfenbrenner’s ecological model which underpinned this study, teenage motherhood has been found to link with multiple factors such as poverty, negative self-esteem, substance abuse, cohabitation, intimate partner violence and ill-health. Furthermore, research indicates that in schools where educators fail to perform their duties as loco-parentis to motivate adolescent females learners who are mothers, absenteeism, poor academic performance and learned helplessness, are likely. The aim of this research was two-fold, namely; (i) to determine the impact of teenage motherhood on the psychological well-being of the teenage mothers and (ii) to investigate the policies which protect the human rights of teenage mothers attending secondary schools. In a qualitative study conducted in one secondary school, Fort Beaufort, Eastern Cape, South Africa, fifteen Xhosa-speaking teenage mothers, aged 15-18 years old, were interviewed. The sample was recruited by means of snow-ball sampling. To safeguard the human dignity of the respondents, informed consent, confidentiality, anonymity and privacy of the respondents were assured. For trustworthiness, this research ensured that credibility, neutrality, and transferability, are met. Following an axial and open coding of responses, five themes were identified; Health issues of teenage mothers, lack of support, violation of human rights, impaired sense of purpose in life and intimate partner-violence. From these findings, it is clear that teenage mothers lack resilience and are susceptible to contract sexually transmitted infections and HIV/AIDS because they are submissive and hopeless. Furthermore, owing to stigma that the teenage mothers' experience from family members, they resort to alcohol and drug abuse, and feel demotivated to bond with their babies. In conclusion, the recommendations are that the Health and Social Development departments collaborate to empower the psychological well-being of teenage mothers. Furthermore, school policies on discrimination should be enacted and consistently implemented.

Keywords: depression, discrimination, self-esteem, teenage mothers

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Authors: R. Hassan, J. Duncombe, E. Darke, A. Dias, K. Anderson, R. G. Middleton

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NHS England has set itself the task of delivering a “Net Zero” National Health service by 2040. It is incumbent upon all health care practioners to work towards this goal. Orthopaedic surgeons are no exception. Distal radial fractures are the most common fractures sustained by the adult population. However, studies are shortcoming on individual patient experience. The aim of this study was to assess the patient’s satisfaction and outcomes with woodcast used in the conservative management of distal radius fractures. For all patients managed with woodcast in our unit, we undertook a structured questionnaire that included the Patient Rated Wrist Evaluation (PRWE) score, The EQ-5D-5L score and the pain numerical score at the time of injury and six weeks after. 30 patients were initially managed with woodcast. 80% of patients tolerated woodcast for the full duration of their treatment. Of these, 20% didn’t tolerate woodcast and had their casts removed within 48 hours. Of the remaining, 79.1% were satisfied about woodcast comfort, 66% were very satisfied about woodcast weight, 70% were satisfied with temperature and sweatiness, 62.5% were very satisfied about the smell/odour, and 75% were satisfied about the level of support woodcast provided. During their treatment, 83.3% of patients rated their pain as five or less. For those who completed their treatment in woodcast, none required any further intervention or utilised the open appointment because of ongoing wrist problems. In conclusion, when woodcast is tolerated, patients’ satisfaction and outcome levels were good. However, we acknowledged 20% of patients in our series were not able to tolerate woodacst, Therefore, we suggest a comparison between the widely used synthetic plaster of Paris casting and woodcast to come in order.

Keywords: distal radius fractures, ecological cast, sustainability, woodcast

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Authors: Abdulrazaq Yahaya, Omobola Okoh, Anthony Okoh

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Polychlorinated biphenyls (PCBs) are generated from short emission or leakage from capacitors and electrical transformers, industrial chemicals wastewater discharge and careless disposal of wastes. They are toxic, semi-volatile compounds which can persist in the environment, hence classified as persistent organic pollutants. Their presence in the environmental matrices has become a global concern. In this study, we assessed the concentrations and distribution patterns of 19 polychlorinated biphenyls congeners (PCB 1, 5, 18, 31, 44, 52, 66, 87, 101, 110, 138, 141, 151, 153, 170, 180, 183, 187, and 206) at six sampling points in water along the course of Buffalo River, Eastern Cape, South Africa. Solvent extraction followed by sulphuric acid, potassium permanganate and silica gel cleanup were used in this study. The analysis was done with gas chromatography electron capture detector (GC-ECD). The results of the analysis of all the 19 PCBs congeners ranged from not detectable to 0.52 ppb and 2.5 ppb during summer and autumn periods respectively. These values are generally higher than the World Health Organization (WHO) maximum permissible limit. Their presence in the waterbody suggests an increase in anthropogenic activities over the seasons. In view of their volatility, the compounds are transportable over long distances by air currents away from their point of origin putting the health of the communities at risk, thus suggesting the need for strict regulations on the use as well as save disposal of this group of compounds in the communities.

Keywords: organic pollutants, polychlorinated biphenyls, pollution, solvent extraction

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Authors: Nebila Lichiheb, LaToya Myles, William Pendergrass, Bruce Hicks, Dawson Cagle

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Atmospheric transport of hazardous materials in urban areas is increasingly under investigation due to the potential impact on human health and the environment. In response to health and safety concerns, several dispersion models have been developed to analyze and predict the dispersion of hazardous contaminants. The models of interest usually rely on meteorological information obtained from the meteorological models of NOAA’s National Weather Service (NWS). However, due to the complexity of the urban environment, NWS forecasts provide an inadequate basis for dispersion computation in urban areas. A dense meteorological network in Washington, DC, called DCNet, has been operated by NOAA since 2003 to support the development of urban monitoring methodologies and provide the driving meteorological observations for atmospheric transport and dispersion models. This study focuses on the comparison of wind observations from the DCNet station on the U.S. Department of Commerce Herbert C. Hoover Building against the North American Mesoscale (NAM) model outputs for the period 2017-2019. The goal is to develop a simple methodology for modifying NAM outputs so that the dispersion requirements of the city and its urban area can be satisfied. This methodology will allow us to quantify the prediction errors of the NAM model and propose adjustments of key variables controlling dispersion model calculation.

Keywords: meteorological data, Washington D.C., DCNet data, NAM model

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Authors: Ines Vieira, Luisa Faria

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Globally, half of all mental disorders begin by age 14 and the current gap of poorly addressed adolescent mental health has future consequences in adulthood. Schoolwork pressure to achieve good performance in secondary education might lead to lower levels of life satisfaction in youth and individual emotional competencies are crucial in this life stage. The present study aimed to determine how mindfulness relates to school achievements and well-being in adolescence and whether such a relationship might be mediated by emotional intelligence. We also studied the moderation interaction effects of gender and the involvement in non-curricular activities. A sample of 597 Portuguese adolescents aged 15 to 17 years old (N=597; 292 girls; 298 boys), enrolled in secondary education completed self-report measures of mindfulness (CAMM), emotional intelligence (TEIQue-ASF) and well-being (SWLS) in their Portuguese versions. Using SPSS and AMOS, the results were obtained through path analyses and multiple linear regression. A Confirmatory Factor Analysis was also conducted. The correlation coefficients reported a positive and statistically significant relationship between mindfulness, emotional intelligence and well-being. Regression analysis indicated that mindfulness reduced its influence on well-being and on school results when emotional intelligence was added to the model. Overall, our results provided further evidence supporting the development of robust hypotheses by perceiving the relevance of mindfulness and individual emotional competencies to school achievements and well-being in a way of improving adolescents’ health, wellness, and school success.

Keywords: mindfulness, emotional intelligence, well-being, adolescence, school

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Authors: Karnsunaphat Balthip, Bunrome Suwanphahu

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Purpose in life is one attribute of the concept of spirituality which is used in health promotion to promote holistic wellbeing. Purpose is a significant foundation of motivation and achievement that guides adolescents down positive life paths. Adolescents who have life purpose are more likely to achieve greater success and wellbeing in their lives. The current study used qualitative research methodology to describe the experiences that enhanced the purpose in life of 27 Thai adolescents from different backgrounds, living in urban areas in southern Thailand. Data were gathered through in-depth interviews and observation. Thematic analysis methods guided data analysis. The results showed that love and connectedness are important in enhancing purpose in life. They illustrate four attributes of love and connection reflecting the four attributes of gratitude that enhance purpose in life: (1) self-love, or gratitude to oneself, whereby participants endeavor to live life in a positive way by taking care of themselves based on moral and ethical values; (2) connectedness or gratitude to parents or significant others, whereby participants are committed to taking holistic care (physical, psychological, and spiritual) of their significant others; (3) connectedness or gratitude to peers, whereby participants support their peers to help them live their own lives in a positive way; and (4) connectedness or gratitude to the wider world (environment, society, nation and beyond), through a sense of altruism towards others. The findings provide helpful insights for parents, nurses, and other health professionals supporting adolescents to obtain a purpose in life.

Keywords: adolescent, gratitude, purpose in life, spirituality

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Authors: Abdullah Abdulsalam, Adamu Balami, Olajide Olubanji Olowe, Maryam Abdu Abdulkadir

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The development and persistence of low back pain may be influenced by several factors which include lifestyle factors, previous pain symptoms, psychological factors, workplace factors as well as socio-demographic variables. The focus of this study was to determine the socio-demographic and work related variables as a predictor of persistence of back pain and disability among civil servants receiving physiotherapy in tertiary health institutions in Kano, Nigeria. One hundred and twenty nine newly referred low back pain patients for physiotherapy participated in the study. This study was a cross sectional study involving patients that were newly diagnosed of back pain, referred and received physiotherapy. The convenience sampling technique was used to select the patients based on the inclusion criteria. The data obtained was analysed using simple percentage and multiple regression for stated hypothesis at 0.05 level of significance. The findings reveal that all the variables are not significant predictor of persistence of back pain and disability. The study recommended that determinants of low back pain recovery by clinician should include other clinical factors not only reduction in pain intensity.

Keywords: socio-demographic, work related variables, Kano state, back pain and disability

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Authors: Jennifer Zelmer

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The debate regarding the morality, and therefore legality, of abortion has many social, political, and medical ramifications worldwide. In a developing country like Bolivia, carrying a pregnancy to delivery is incredibly risky. Given the very high maternal mortality rate in Bolivia, greater consideration has been given to the (de)criminalization of abortion – a contributing cause of maternal death. In the spring of 2017, the Bolivian government proposed to loosen restrictions on women’s access to receiving a safe abortion, which was met with harsh criticism from 'pro-vida' (pro-life) factions. Although the current Bolivian government Movimiento al Socialismo (Movement Toward Socialism) portrays an agenda of decolonization, or to seek a 'traditionally-modern' society, nevertheless, Bolivia still has one of the highest maternal mortality rates in the Americas, because of centuries of colonial and patriarchal order. Applying a feminist critique and using the abortion debate as the central point, this paper argues that the 'traditionally-modern' society Bolivia strives towards is a paradox, and in fact only contributes to the reciprocal process of the death of 'mother tongues' and the unnecessary death of women. This claim is supported by a critical analysis of historical texts about Spanish Colonialism in Bolivia; the linguistic reality of reproductive educational strategies, and the philosophical framework which the Bolivian government and its citizens implement. This analysis is demonstrated in the current state of women’s access to reproductive healthcare in Cochabamba, Bolivia based on recent fieldwork which included audits of clinics and hospitals, interviews, and participant observation. This paper has two major findings: 1) the language used by opponents of abortion in Bolivia is not consistent with the claim of being 'pro-life' but more accurately with being 'pro-potential'; 2) when the topic of reproductive health appears in Cochabamba, Bolivia, it is often found written in the Spanish language, and does not cater to the many indigenous communities that inhabit or visit this city. Finally, this paper considers the crucial role of public health documentation to better inform the abortion debate, as well as the necessity of expanding reproductive health information to more than text-based materials in Cochabamba. This may include more culturally appropriate messages and mediums that cater to the oral tradition of the indigenous communities, who historically and currently have some of the highest fertility rates. If the objective of one who opposes abortion is to save human lives, then preventing the death of women should equally be of paramount importance. But rather, the 'pro-life' movement in Bolivia is willing to risk the lives of to-be mothers, by judicial punishment or death, for the chance of a potential baby. Until abortion is fully legal, safe, and accessible, there will always be the vestiges of colonial and patriarchal order in Bolivia which only perpetuates the needless death of women.

Keywords: abortion, feminist theory, Quechua, reproductive health education

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Authors: Karen J. Polvado, Betty Bowles, Jansen Lauren, Gibson Martha, Robin Lockhart

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The purpose of this study was to identify motivation to participate in the Hotter ‘n Hell Hundred (HHH) bicycling event, and the participants’ demographics, health risk factors, and preparation to ride in the event. A convenience sample of adults pre-registered for non-competitive cycling events (N = 7,472) were requested to complete a survey. Of these, 2,645 (35%) responded. Questions identified the participants’ demographics, preparation, previous experience with HHH, and motives for riding. The HHH attracted riders of all ages (18-80), genders, ethnicities, and educational levels. The majority were males, 40-59 years old, married, college graduates, and identified themselves as non-Hispanic whites. The majority (68%) reported no existing medical conditions, and were normal weight (70%), although 52% had been overweight or obese in the past. Preparation to ride in the HHH varied from riding more than five times a week for the last year, to riding 1-2 times per week one month before the event. Most (93%) had ridden in the HHH an average of 5 times. Motivations to ride included: personal challenge (75%); to experience the HHH ride (57%); a chance to ride with family/friends/coworkers (52%); improving health (47%); fun (33%); challenge by others (15%); part of a weight loss plan (11%); training for another event (10%); and raising money for a cause (2%). The motivation to participate appeared to move from extrinsic to intrinsic motivation as age increased. Exploration of the exercise habits and motivations of older adults (70+) is suggested by this study.

Keywords: cycling, motivation, physical activity, training

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Authors: Theresa N. Uzor

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The word cardiovascular fitness is a topic of much interest to people of Nigeria, especially during this time, some heart diseases run in families. Cardiovascular fitness is the ability of the heart and lungs to supply-rich blood to the working muscle tissues. This type of fitness is a health-related component of physical fitness that is brought about by sustained physical activity such as plyometric training. Plyometric is a form of advanced fitness training that uses fast muscular contractions to improve power and speed in the sports performance by coaches and athletes. Plyometric training involves a rapid stretching of muscle (eccentric phase) immediately followed by a concentric or shortening action of the same muscle and connective tissue. However, the most basic example of true plyometric training is running and can be safe for a wide variety of populations. This paper focused on building cardiovascular health through Plyometric Training. The centre focus of the article is cardiovascular fitness and plyometric training with factors of cardiovascular fitness. Plyometric training at any age provides multiple benefits even beyond weight control and weight loss, decrease the risk of cardiovascular diseases, stroke, high blood pressure, diabetes, and other diseases, among other benefits of plyometric training to cardiovascular fitness. Participation in plyometric training will increase metabolism of an individual, thereby burning more calories even when at rest and reduces weight is also among the benefits of plyometric training. Some guidelines were recommended for planning plyometric training programme to minimise the chance of injury. With plyometric training in Nigeria, fortune can change for good, especially now that there has been an increase in cardiovascular diseases within the society for great savings would be saved.

Keywords: aerobic, cardiovascular, concentric, stretch-shortening cycle, plyometric

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