Search results for: maternal and child health services

Authors: Lamia Bouzgarrou, Amira Omrane, Malika Azzouzi, Asma Kheder, Amira Saadallah, Ilhem Boussarsar, Kamel Rejeb

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Introduction: Increasing the women’s labor force participation is a political issue in countries with developed economies and those with low growth prospects. However, in the labor market, women continue to face several obstacles, either for the integration or for the maintenance at work. This study aims to assess the prevalence of premature withdrawal from working life -due to invalidity or medical justified early retirement- among active women in the Tunisian center and to identify its determinants. Material and methods: We conducted a cross-sectional study, over one year, focusing on the agreement for invalidity or early retirement for premature usury of the body- delivered by the medical commission of the National Health Insurance Fund (CNAM) in the central Tunisian district. We exhaustively selected women's files. Data related to Socio-demographic characteristics, professional and medical ones, were collected from the CNAM's administrative and medical files. Results: During the period of one year, 222 women have had an agreement for premature departure of their professional activity. Indeed, 149 women (67.11%) benefit of from invalidity agreement and 20,27% of them from favorable decision for early retirement. The average age was 50 ± 6 years with extremes of 23 and 62 years, and 18.9% of women were under 45 years. Married women accounted for 69.4% and 59.9% of them had at least one dependent child in charge. The average professional seniority in the sector was 23 ± 8 years. The textile-clothing sector was the most affected, with 70.7% of premature departure. Medical reasons for withdrawal from working life were mainly related to neuro-degenerative diseases in 46.8% of cases, rheumatic ones in 35.6% of cases and cardiovascular diseases in 22.1% of them. Psychiatric and endocrine disorders motivated respectively 17.1% and 13.5% of these departures. The evaluation of the sequels induced by these pathologies concluded to an average permanent partial disability equal to 61.4 ± 17.3%. The analytical study concluded that the agreement of disability or early retirement was correlated with the insured ‘age (p = 10-3), the professional seniority (p = 0.003) and the permanent partial incapacity (PPI) rate assessed by the expert physician (p = 0.04). No other social or professional factors were correlated with this decision. Conclusion: Despite many advances in labour law and Tunisian legal text on employability, women still exposed to several social and professional inequalities (payment inequality, precarious work ...). Indeed, women are often pushed to accept working in adverse conditions, thus they are more vulnerable to develop premature wear on the body and being forced to premature departures from the world of work. These premature withdrawals from active life are not only harmful to the concerned women themselves, but also associated with considerable costs for the insurance organism and the society. In order to ensure maintenance at work for women, a political commitment is imperative in the implementation of global prevention strategies and the improvement of working conditions, particularly in our socio-cultural context.

Keywords: Active Women , Early Retirement , Invalidity , Maintenance at Work

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Authors: Maturos Chongchaikit, Sitthikorn Sumalee, Nopphawan Chimroylarp, Nongluck Manowaluilou, Thapanee Thammetha

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The 2015 Kasetsart University Research Plan, which was funded by the National Research Institutes: TRF – NRCT, comprises four sub-research projects on the development of three OER websites and on their usage study by students in international programs. The goals were to develop the open educational resources (OER) in the form of websites that will promote three key skills of quality learning and achievement: Academic English, Educational Research, and ICT Literacy, to graduate students in international programs of Thailand. The statistics from the Office of Higher Education showed that the number of foreign students who come to study in international higher education of Thailand has increased respectively by 25 percent per year, proving that the international education system and institutes of Thailand have been already recognized regionally and globally as meeting the standards. The output of the plan: the OER websites and their materials, and the outcome: students’ learning improvement due to lecturers’ readiness for open educational media, will ultimately lead the country to higher business capabilities for international education services in ASEAN Community in the future. The OER innovation is aimed at sharing quality knowledge to the world, with the adoption of Creative Commons Licenses that makes sharing be able to do freely (5Rs openness), without charge and leading to self and life-long learning. The research has brought the problems on the low usage of existing OER in the English language to develop the OER on three specific skills and try them out with the sample of 100 students randomly selected from the international graduate programs of top 10 Thai universities, according to QS Asia University Rankings 2014. The R&D process was used for product evaluation in 2 stages: the development stage and the usage study stage. The research tools were the questionnaires for content and OER experts, the questionnaires for the sample group and the open-ended interviews for the focus group discussions. The data were analyzed using frequency, percentage, mean and SD. The findings revealed that the developed websites were fully qualified as OERs by the experts. The students’ opinions and satisfaction were at the highest levels for both the content and the technology used for presentation. The usage manual and self-assessment guide were finalized during the focus group discussions. The direct participation according to the concept of 5Rs Openness Activities through the provided tools of OER models like MERLOT and OER COMMONS, as well as the development of usage manual and self-assessment guide, were revealed as a key approach to further extend the output widely and sustainably to the network of users in various higher education institutions.

Keywords: open educational resources, international education services business, academic English, educational research, ICT literacy, international graduate program, OER

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Authors: Elizabeth Perry, Jylana Sheats

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Scholars posit that there is an overlap between the fields of Behavioral Economics (BE) and Behavior Science (BSci)—and that consideration of concepts from both may facilitate a greater understanding of health decision-making processes. For example, the ‘intention-action gap’ is one BE concept to explain sup-optimal decision-making. It is described as having knowledge that does not translate into behavior. Complementary best BSci practices may provide insights into behavioral determinants and relevant behavior change techniques (BCT). Within the context of BSci, this exploratory study aimed to apply a BE concept with demonstrated effectiveness in financial decision-making to a health behavior: influenza (flu) vaccine uptake. Adults aged >18 years were recruited on Amazon’s Mechanical Turk, a digital labor market where anonymous users perform simple tasks at low cost. Eligible participants were randomized into 2 groups, reviewed a scenario, and then completed a survey on the likelihood of receiving a flu shot. The ‘usual care’ group’s scenario included standard CDC guidance that supported the behavior. The ‘intervention’ group’s scenario included messaging about people who did not receive the flu shot. The framing was such that participants could learn from others’ (strangers) mistakes and the subsequent health consequences: ‘Last year, other people who didn’t get the vaccine were about twice as likely to get the flu, and a number of them were hospitalized or even died. Don’t risk it.’ Descriptive statistics and chi-square analyses were performed on the sample. There were 648 participants (usual care, n=326; int., n=322). Among racial/ethnic minorities (n=169; 57% aged < 40), the intervention group was 22% more likely to report that they were ‘extremely’ or ‘moderately’ likely to get the flu vaccine (p = 0.11). While not statistically significant, findings suggest that framing messages from the perspective of learning from the mistakes of unknown others coupled with the BCT ‘knowledge about the health consequences’ may help influence flu vaccine uptake among the study population. With the widely documented disparities in vaccine uptake, exploration of the complementary application of these concepts and strategies may be critical.

Keywords: public health, decision-making, vaccination, behavioral science

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Authors: Abdullah Malek, Muzn Al Khaldi, Lian Odeh, Atheer Tariq, Mohammad Al Fardan, Hiba Barqawi

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H. pylori bacterium is a known underlying agent for gastritis, peptic ulcer disease, and gastric cancer and is believed to infect half of the world’s population. Even with the ubiquity of H. pylori bacterium, there is lack of knowledge regarding its modes of transmission, associated diseases, carcinogenic effect and means of prevention; especially in the UAE. A cross sectional study of 500 participants, of which 58% (n= 289) of the respondents were female, and 42% (n=210) were male, was conducted in Sharjah to assess the knowledge, and explore the attitudes and practices among UAE residents towards Helicobacter Pylori and its associated PUD as well as its carcinogenic nature. A structured self-administered questionnaire was distributed to the target population to establish their demographic background and selected aspects of their lifestyle. General knowledge about H. Pylori was poor, only 24.6% stated they have heard of H. pylori. Attitudes towards prevention and practices were relatively poor as well. Subjects who suffered from severe symptoms (ALARM symptoms) had significantly lower habit scores than those with mild and moderate symptoms (p=0.0078**). To the authours’ knowledge, no previous studies were conducted in the United Arab Emirates regarding the epidemiology of the infection to detect the extent of H. Pylori’s impact on the public health. The results of this study can be used to draw conclusions about the average knowledge of the UAE population regarding H. pylori. It can also be a starting point to devise new education programs and campaigns that raise awareness of this health issue which could be easily avoided with early diagnosis and antibiotic treatment.

Keywords: chronic gastritis, community health, gastric cancer, Helicobacter pylori, peptic ulcers

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Authors: Jaci Mastrandrea

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Background: The National Comprehensive Cancer Network (NCCN) recommends that healthcare institutions have established processes for integrating palliative care (PC) into cancer treatment and that all cancer patients be screened for PC needs upon initial diagnosis as well as throughout the entire continuum of care (National Comprehensive Cancer Network, 2021). Early PC screening is directly correlated with improved patient outcomes. The Sky Lakes Cancer Treatment Center (SLCTC) is an institution that has access to PC services yet does not have protocols in place for identifying patients with palliative needs or a standardized referral process. The aim of this quality improvement project is to improve early access to PC services by establishing a standardized screening and referral process for outpatient oncology patients. Method: The sample population included all adult patients with an oncology diagnosis who presented to the SLCTC for treatment during the project timeline from March 15th, 2022, to April 29th, 2022. The “Palliative and Supportive Needs Assessment'' (PSNA) screening tool was developed from validated and evidence-based PC referral criteria. The tool was initially implemented using paper forms and later was integrated into the Epic-Beacon EHR system. Patients were screened by registered nurses on the SLCTC treatment team. Nurses responsible for screening patients received an educational inservice prior to implementation. Patients with a PSNA score of three or higher were considered to be a positive screen. Scores of five or higher triggered a PC referral order in the patient’s EHR for the oncologist to review and approve. All patients with a positive screen received an educational handout on the topic of PC, and the EHR was flagged for follow-up. Results: Prior to implementation of the PSCNA screening tool, the SLCTC had zero referrals to PC in the past year, excluding referrals to hospice. Data was collected from the first 100 patient screenings completed within the eight-week data collection period. Seventy-three percent of patients met criteria for PC referral with a score greater than or equal to three. Of those patients who met referral criteria, 53.4% (39 patients) were referred for a palliative and supportive care consultation. Patients that were not referred to PC upon meeting the criteria were flagged in the EHR for re-screening within one to three months. Patients with lung cancer, chronic hematologic malignancies, breast cancer, and gastrointestinal malignancy most frequently met criteria for PC referral and scored highest overall on the scale of 0-12. Conclusion: The implementation of a standardized PC screening tool at the SLCTC significantly increased awareness of PC needs among cancer patients in the outpatient setting. Additionally, data derived from this quality improvement project supports the national recommendation for PC to be an integral component of cancer treatment across the entire continuum of care.

Keywords: oncology, palliative care, symptom management, symptom screening, ambulatory oncology, cancer, supportive care

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Authors: Siveshnee Devar

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Background: The rate of absenteeism and prevalence of NCDs in South Africa is extremely high. This is consistent with other educational institutions and workplaces around the globe. In most cases the absence of health and the presence of one or more non communicable diseases coupled with the lack of physical exercise is a major factor in absenteeism. Absenteeism at the workplace comes at a huge cost to the employer and the country as a whole. Aim: Findings from this study was to develop a suitable nutritional wellness program for the workplace. Methodology: A needs analysis in the form of 24-hour recall, food frequency, health and socio demographic questionnaires was undertaken to determine the need for a wellness program for the institution. Anthropometric indices such as BMI, waist circumference and blood pressure were also undertaken to determine the state of health of the staff. Results: This study has found that obesity, central obesity, hypertension as well as deficiencies in nutrients and minerals were prevalent in this group. Fruit and vegetable consumption was also below the WHO recommendation. This study showed a link between diet, physical activity and diseases of lifestyle. There were positive correlations between age and systolic blood pressure, waist circumference and systolic blood pressure, waist circumference and diastolic blood pressure and waist-to-height ratio and BMI. Conclusion: The results indicated the need for immediate intervention in the form of a wellness program. Nutrition education is important for both the workplace and out. Education and knowledge are important factors for lifestyle changes. The proposed intervention is aimed at improving presenteeism and decreasing the incidence of non- communicable diseases. Presenteeism and good health are important factors for quality education at all educational institutions.

Keywords: absenteeism, non-communicable diseases, nutrition, wellness

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Authors: Kevin Krupski

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Private Military Security Companies have grown to become a major force contributor to nations in military operations. Scholars have debated the implications of this in relation to control and efficiency related to the privatization of violence, but there has been little discussion on how these companies affect the profession of arms. Specifically, this paper seeks to address how the privatization of violence influences the military’s stewardship, whether private military security companies are capable of stewardship of the military profession, and whether there are aspects of stewardship of the military profession that private military security companies are capable of emulating. This paper reviews literature on stewardship, the relationship of the military to the state, and private military security companies in order to identify overlap between uniformed military services and the private sector. Then, it offers a typology for determining under what conditions an organization would act as a steward. Ultimately, there are insufficient reasons for private military security companies to act as stewards of the profession of arms.

Keywords: stewardship, military profession, civil-military, security

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Authors: Maria L. G. Lourenco, Keylla H. N. P. Pereira, Viviane Y. Hibaru, Fabiana F. Souza, Joao C. P. Ferreira, Simone B. Chiacchio, Luiz H. A. Machado

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Neonatal sepsis is a systemic response of acute infection by bacteria that may lead to high mortality in a litter. This study aims to report a case of sepsis by alpha-hemolytic Streptococcus and Mannheimia haemolytica in neonate dogs. A pregnant, mixed-breed bitch at approximately the 60th day of pregnancy was admitted to the Sao Paulo State University (UNESP) Veterinary Hospital, Botucatu, Sao Paulo, Brazil, and subjected to a c-section due to uterine atony and fetuses no heartbeats on the ultrasound examination. The mother presented leukopenia of 1.6 thousand leukocytes, and there was no other information regarding previous clinical history. Among the offspring, four were stillborn, and five were born alive. On clinical examination, neonates weighed between 312 and 384 grams. Reflexes were present, and the newborn's body temperature was between 89.9 ºF and 96.4 ºF. Neonates also presented clinical signs of neonatal infection: omphalitis, abdomen, and extremities with cyanotic color, hematuria, and diarrhea (meconium). Complementary tests revealed leukopenia. The presence of alpha hemolytic streptococcus and Mannheimia haemolytica was revealed in the bacterial culture. The bacteria were sensitive to cephalosporins and penicillin on the antibiogram. Treatment for sepsis was instituted with the drug ceftriaxone, at a dose of 50 mg per kilogram, administered intravenous (jugular vein). Subsequently administered subcutaneous, every 12 hours, for seven days. Heated fluid therapy was performed, with Ringer lactate, at a dose of 4 ml per 100 grams of weight, intravenous. Heating measures were instituted. Blood plasma was also administered, at a dose of 2 mL per 100 grams of weight, administered subcutaneous, as a source of passive immunity. A maternal milk substitute was instituted, and lactation was discontinued since the mother was unable to nurse due to the infection. The mother was neutered during the c-section and treated with ceftriaxone (50 mg/kg). After seven days, the newborns presented normal clinical signs and no alterations in the hemogram. Early diagnosis and intervention were essential for the survival of these patients.

Keywords: neonatal infection, puppies, bacteria, newborn

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Authors: S. Vasundra, D. Venkatesh

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Wireless networks have gone through an extraordinary growth in the past few years, and will keep on playing a crucial role in future data communication. The present wireless networks aim to make communication possible anywhere and anytime. With the converging of mobile and wireless communications with Internet services, the boundary between mobile personal telecommunications and wireless computer networks is disappearing. Wireless networks of the next generation need the support of all the advances on new architectures, standards, and protocols. Since an ad hoc network may consist of a large number of mobile hosts, this imposes a significant challenge on the design of an effective and efficient routing protocol that can work well in an environment with frequent topological changes. This paper proposes improved ant colony optimization (IACO) technique. It also maintains load balancing in wireless networks. The simulation results show that the proposed IACO performs better than existing routing techniques.

Keywords: wireless networks, ant colony optimization, load balancing, architecture

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Authors: Diana K. Kwok

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Despite the fact that Hong Kong government aims to develop an inclusive society, sexual minority students continue to encounter sexual prejudice without legal protection. They also have difficulties accessing relevant services from mental health and educational professionals, who do not receive systematic training to work with sexual minority students. Informed by the literature on sexual prejudice, heterosexual hegemony, genderism, as well as code of practice for frontline practitioners, the authors explored self-perceived knowledge of teachers and sexual minorities on sexuality and sexual prejudice, and how they perceive prejudice towards sexual minorities in Chinese cultural context. Semi-structure qualitative interviews were carried out with 31 school personnel informants (school teachers and counseling team members) and 25 sexual minority informants on their understanding of sexuality knowledge, their perception of sexual prejudice within school context in Hong Kong, as well as their suggested themes on teachers training on sexual prejudice reduction. This presentation specifically focuses on transcripts from sexual minority informants. Data analysis was carried out through NVivo, and followed the procedures spelt out in the qualitative research literature. Trustworthiness of the study was addressed through various strategies. Preliminary themes emerged from transcript content analysis: 1) A gap of knowledge between sexual minority informants and teachers; 2) Perception on sexual prejudice within cultural context; 3) Heterosexual hegemony and genderism within school system; 4) Needs for mandatory training: contents and strategies. The sexual minority informants found that teachers they encountered were predominantly adopted concepts of binary sex and dichotomous gender. Informants also indicated that the teachings of Confucianism cultural values, religiosity in Hong Kong might well be important cultural forces contributing to sexual prejudice manifested in school context. Although human rights and social justice concepts were embedded in professional code of practice of teachers and school helping professionals, informants found that teachers they encountered may face a dilemma when supporting sexual minority students navigating heterosexual hegemony and genderism in, as a consequence of their personal, institutional, cultural and religious backgrounds. Acknowledgments: The sexual prejudice project was funded by the Hong Kong Research Grant Council (ECS28401614), 2015 to 2017.

Keywords: sexual prejudice, Chinese teachers, Chinese sexual minorities, teacher training

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Authors: Subas Chandra Biswas, Kazi Sameen Naser, Farzana Misha

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Little is known about the sexual behavior of male youth, particularly unmarried young men in Bangladesh as most of the sexual and reproductive health and rights-related research and intervention are mainly focused on females and married couples. To understand the unmarried youth’s sexual behavior, data from a nationwide survey conducted in all 64 districts of Bangladesh were analyzed. Using multistage systematic random sampling, a survey was conducted among 11,113 male youth aged 15-24 years from May-August, 2019. This article analyzed and presented findings of the sexual behavior of unmarried respondents based on the data collected from 10,026 unmarried male youth. Findings showed that 18% had ever experience of sexual relationship, and the reported mean age of first sexual intercourse was 16.5years. For unmarried male youth, those who had a sexual experience, their first sexual partners were female friends/classmate (57%), female neighbors (16%), and female sex workers (12%), relatives (6%) and girlfriends with whom they had love relationship (4%). However, about 36% reported that they had a love relationship with girlfriends, and among them, 23% reported that they had sexual intercourse with their girlfriend. Those who had sexual relations with their girlfriend, 47% reported that they did not use the condom in their last sex with their girlfriend. Furthermore, 29% reported that they had sexual relationships with others besides their girlfriends. Other reported partners were female sex workers (32%), neighbors (29%), female friends (19%), relatives (12%), and cousins (5%). Also, 46% reported that they did not even use the condom during sex with other partners. About 9% used some sort of sexual stimulant to increase their libido. Among the respondents, 376 reported that they bought sex in the last six months, and the mean expenditure of buying sex for the respondent was 1,140 Taka (13.46 US Dollar). Though premarital sexual relations are not socially accepted, findings showed a large portion of male youth are engaged in these relationships and risky sexual behavior. Lack of awareness of sexual and reproductive health, unprotected sexual intercourse, use of the drug during sexual intercourse also increase the threats to health. Thus these findings are important to understand the sexual behavior of male youth in policy and programmatic implications. Therefore, to ensure a healthy sexual life and wellbeing, an immediate and culturally sensitive sexual health promotion intervention is needed for male youth in Bangladesh.

Keywords: Bangladesh, male youth, sexual and reproductive health, sexual behavior

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Authors: Wanwadee Neamsakul

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VARK learning style is an effective method of learning that could enhance all skills of the students like visual (V), auditory (A), read/write (R), and kinesthetic (K). This learning style benefits the students in terms of professional competencies, critical thinking and lifelong learning which are the desirable characteristics of the nursing students. This study aimed to develop a model of teaching and learning clinical practicum at postpartum ward for nursing students by using VARK learning styles, and evaluate the nursing students’ opinions about the developmental model. A methodology used for this study was research and development (R&D). The model was developed by focus group discussion with five obstetric nursing instructors who have experiences teaching Maternal Newborn and Midwifery I subject. The activities related to practices in the postpartum (PP) ward including all skills of VARK were assigned into the matrix table. The researcher asked the experts to supervise the model and adjusted the model following the supervision. Subsequently, it was brought to be tried out with the nursing students who practiced on the PP ward. Thirty third year nursing students from one of the northern Nursing Colleges, Academic year 2015 were purposive sampling. The opinions about the satisfaction of the model were collected using a questionnaire which was tested for its validity and reliability. Data were analyzed using descriptive statistics. The developed model composed of 27 activities. Seven activities were developed as enhancement of visual skills for the nursing students (25.93%), five activities as auditory skills (18.52%), six activities as read and write skills (22.22%), and nine activities as kinesthetic skills (33.33%). Overall opinions about the model were reported at the highest level of average satisfaction (mean=4.63, S.D=0.45). In the aspects of visual skill (mean=4.80, S.D=0.45) was reported at the highest level of average satisfaction followed by auditory skill (mean=4.62, S.D=0.43), read and write skill (mean=4.57, S.D=0.46), and kinesthetic skill (mean=4.53, S.D=0.45) which were reported at the highest level of average satisfaction, respectively. The nursing students reported that the model could help them employ all of their skills during practicing and taking care of the postpartum women and newborn babies. They could establish self-confidence while providing care and felt proud of themselves by the benefits of the model. It can be said that using VARK learning style to develop the model could enhance both nursing students’ competencies and positive attitude towards the nursing profession. Consequently, they could provide quality care for postpartum women and newborn babies effectively in the long run.

Keywords: model, nursing students, postpartum ward, teaching and learning clinical practicum

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Authors: M. Cabral, A. Verdin, G. Garçon, A. Touré, C. Diop, M. Fall, S. Bouhsina, D. Dewaele, F.Cazier, A. Tall Dia, P. Shirali, A. Diouf

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This case-control study dealt with the health adverse effects within the population neighboring the Mbeubeuss waste dump, which is located near the district of Malika (Diamalaye II) in Dakar (Senegal). All the household and industrial waste arising from Dakar are stored in this open landfill without being covered and are therefore possible sources of Pb and Cd contaminated air emissions and lixiviates. The objective of this study is part of improving the health of the population neighboring Mbeubeuss by determining Pb and Cd concentrations both in environment and humans, and studying possible renal function alterations within the adults. Soil and air samples were collected in the control site (Darou Salam) and the waste dump neighboring site (Diamalaye II). Control and exposed adults were recruited as living in Darou Salam (n = 52) and in Diamalaye II (n = 77). Pb and Cd concentrations in soil, air and biological samples were determined. Moreover, we were interested in analyzing some impregnation (zinc protoporphyrin, d-aminolevulinic acid dehydratase) and oxidative stress biomarkers (malonedialdehyde, gluthatione status), in addition to several nephrotoxicity parameters (creatinuria, proteinuria, lactate dehydrogenase, CC16 protein, glutathione S-transferase-alpha and retinol binding protein) in blood and/or urine. The results showed the significant Pb and Cd contamination of the soil and air samples derived from the landfill, and therefore of the neighboring population of adults. This critical exposure to environmental Pb and Cd had some harmful consequences for their health, as shown by the reported oxidative stress and nephrotoxicity signs.

Keywords: Pb and Cd environmental exposure, impregnation markers, landfill, nephrotoxicity markers

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Authors: S. Nikpour, S. Vahidi, H. Haghani

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Introduction: Exercise has mental and physical health benefits for patients with advanced stage cancer who actively receive chemotherapy, yet little is known about patients’ levels of interest in becoming more active or their confidence in increasing their activity level. Methods and materials: A convenience sample of 200 patients with advanced-stage cancer who were receiving chemotherapy completed self-report measures assessing physical activity level, mood, and quality-of-life variables. Qualitative data on patient-perceived benefits of, and barriers to, physical activity also were collected, coded by independent raters, and organized by predominant themes. Results: Current physical activity level, physical activity outcome expectations, and positive mood were significantly associated with self-efficacy. Fatigue was the most frequently listed barrier to physical activity; improved physical strength and health were the most commonly listed benefits. Participants identified benefits related to both general health and cancer-symptom management that were related to exercise. 59.5% of participants reported that they were seriously planning to increase or maintain their physical activity level, and over 40% reported having interest in receiving an intervention to become more active. Conclusion: These results suggested that many advanced-stage cancer patients who receive chemotherapy are interested in maintaining or increasing their physical activity level and in receiving professional support for exercise. In addition, these individuals identified general health and cancer-specific benefits of, and barriers to, physical activity. Future research will investigate how these findings may be incorporated into physical activity interventions for advanced-stage oncology patients receiving medical treatment.

Keywords: physical activity, cancer, self-efficacy

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Authors: Rachelle M. Johnson, Jenna E. Finch

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Motivation, persistence, and learning disability status are all associated with academic performance, but to the author's knowledge, little research has been done on how these variables interact with one another and how that interaction looks different within children with and without learning disabilities. The present study's goal was to examine the role motivation and persistence play in the academic success of children with learning disabilities and how these variables interact. Measurements were made using surveys and direct cognitive assessments on each child. Analyses were run on student's scores in motivation, persistence, and ability to learn compared to other fifth grade students. In this study, learning ability was intended as a proxy for learning disabilities (LDs). This study included a nationally representative sample of over 8,000 fifth-grade children from across the United States. Multiple interactions were found among these variables of motivation, persistence, and motivation as they relate to academic achievement. The major finding of the study was the significant role motivation played in academic achievement. This study shows the importance of measuring the within-group. One key finding was that motivation was associated with academic success and was moderated by the other variables. The interaction results were different for math and reading outcomes, suggesting that reading and math success are different and should be addressed differently. This study shows the importance of measuring the within-group differences in levels of motivation to better understand the academic success of children with and without learning disabilities. This study's findings call for further investigation into motivation and the possible need for motivational intervention for students, especially those with learning disabilities

Keywords: academic achievement, learning disabilities, motivation, persistence

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Authors: Gaurangi Saxena, Ravindra Saxena

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Lately, cloud computing is used to enhance the ability to attain corporate goals more effectively and efficiently at lower cost. This new computing paradigm “The Cloud Computing” has emerged as a powerful tool for optimum utilization of resources and gaining competitiveness through cost reduction and achieving business goals with greater flexibility. Realizing the importance of this new technique, most of the well known companies in computer industry like Microsoft, IBM, Google and Apple are spending millions of dollars in researching cloud computing and investigating the possibility of producing interface hardware for cloud computing systems. It is believed that by using the right middleware, a cloud computing system can execute all the programs a normal computer could run. Potentially, everything from most simple generic word processing software to highly specialized and customized programs designed for specific company could work successfully on a cloud computing system. A Cloud is a pool of virtualized computer resources. Clouds are not limited to grid environments, but also support “interactive user-facing applications” such as web applications and three-tier architectures. Cloud Computing is not a fundamentally new paradigm. It draws on existing technologies and approaches, such as utility Computing, Software-as-a-service, distributed computing, and centralized data centers. Some companies rent physical space to store servers and databases because they don’t have it available on site. Cloud computing gives these companies the option of storing data on someone else’s hardware, removing the need for physical space on the front end. Prominent service providers like Amazon, Google, SUN, IBM, Oracle, Salesforce etc. are extending computing infrastructures and platforms as a core for providing top-level services for computation, storage, database and applications. Application services could be email, office applications, finance, video, audio and data processing. By using cloud computing system a company can improve its customer relationship management. A CRM cloud computing system may be highly useful in delivering a sales team a blend of unique functionalities to improve agent/customer interactions. This paper attempts to first define the cloud computing as a tool for running business activities more effectively and efficiently at a lower cost; and then it distinguishes cloud computing with grid computing. Based on exhaustive literature review, authors discuss application of cloud computing in different disciplines of management especially in the field of marketing with special reference to use of cloud computing in CRM. Study concludes that CRM cloud computing platform helps a company track any data, such as orders, discounts, references, competitors and many more. By using CRM cloud computing, companies can improve its customer interactions and by serving them more efficiently that too at a lower cost can help gaining competitive advantage.

Keywords: cloud computing, competitive advantage, customer relationship management, grid computing

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Authors: S. Grinnell

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A PhD Research Project exploring the Social Health and Well-Being Impacts associated with Hydraulic Fracturing, with an aim to produce a Best Practice Support Guidance for those anticipating dealing with planning applications or submitting Environmental Impact Assessments (EIAs). Amid a possible global energy crisis, founded upon a number of factors, including unstable political situations, increasing world population growth, people living longer, it is perhaps inevitable that Hydraulic Fracturing (commonly referred to as ‘fracking’) will become a major player within the global long-term energy and sustainability agenda. As there is currently no best practice guidance for governing bodies the Best Practice Support Document will be targeted at a number of audiences including, consultants undertaking EIAs, Planning Officers, those commissioning EIAs Industry and interested public stakeholders. It will offer a robust, evidence-based criteria and recommendations which provide a clear narrative and consistent and shared approach to the language used along with containing an understanding of the issues identified. It is proposed that the Best Practice Support Document will also support the mitigation of health impacts identified. The Best Practice Support Document will support the newly amended Environmental Impact Assessment Directive (2011/92/EU), to be transposed into UK law by 2017. A significant amendment introduced focuses on, ‘higher level of protection to the environment and health.’ Methodology: A qualitative research methods approach is being taken with this research. It will have a number of key stages. A literature review has been undertaken and been critically reviewed and analysed. This was followed by a descriptive content analysis of a selection of international and national policies, programmes and strategies along with published Environmental Impact Assessments and associated planning guidance. In terms of data collection, a number of stakeholders were interviewed as well as a number of focus groups of local community groups potentially affected by fracking. These were determined from across the UK. A theme analysis of all the data collected and the literature review will be undertaken, using NVivo. Best Practice Supporting Document will be developed based on the outcomes of the analysis and be tested and piloted in the professional fields, before a live launch. Concluding statement: Whilst fracking is not a new concept, the technology is now driving a new force behind the use of this engineering to supply fuels. A number of countries have pledged moratoria on fracking until further investigation from the impacts on health have been explored, whilst other countries including Poland and the UK are pushing to support the use of fracking. If this should be the case, it will be important that the public’s concerns, perceptions, fears and objections regarding the wider social health and well-being impacts are considered along with the more traditional biomedical health impacts.

Keywords: fracking, hydraulic fracturing, socio-economic health, well-being

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Authors: Faiza Manzoor

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The main purpose of this study is to examine the socioeconomic and institutional determinants that affect farmers' probability of agricultural technology adoption. Primary survey data was gathered from 350 small household farmers of developing economies, and the empirical analysis was completed by exploiting a logit and probit model. The outcomes of this research emphasize that socioeconomic factors such as farmers' age, education level, and farm size impact farmers' behavior in adopting digital farming technology. The results show that cooperative membership and institutional characteristics such as access to credit and extension services have also affected small farmers' use and adoption of agricultural technologies. Digitalization also helps farmers by increasing their understanding and improving their decision-making abilities. Some policy implications and future directions are discussed.

Keywords: digital agriculture technologies, socioeconomics, institutional, developing economies

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Authors: Yadchol Tawetanawanich

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Depression of elderly is a mental health problem that impacts tremendously on the elderly themselves, their family, and society. the purposes of this descriptive research were to examine prevalence rate of elderly depression and to study factors related to depression in elderly including 1) individual factors: sex, education, marital status, 2) economic factors: occupation, adequate income 3) health factors: chronic illnesses , disability, 4) social factors: family relationship, community relationship, 5) knowledge of depression, and 6) self-care behavior. The subject in this study included 273 elderly in Ladboakao sub-district, Banpong district, Ratchaburi province, Thailand. Data were collected through questionnaires and were analyzed using percentage, mean, standard deviation, chi-square, and one-way ANOVA. The results of the study revealed that: The prevalence rate of elderly depression were 21.61%, factors included economic factors, health factors, knowledge about depression, and self-care behavior were statistically significant positively related to depression of elderly (p<0.05), but individual factors and social factors were not significantly related to depression. It is also important for nurses to assess factors related to depression of the elderly in order to develop the model of care and use self-care strategies to contribute the positive outcomes.

Keywords: associated factors, depression, elderly, self-care

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Authors: Margarita Zavala, Gabriel Chavira, José González, Jorge Orozco, Julio Rolón, Roberto Pichardo

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Adolescence is a neuralgic stage in the formation of every human being, generally this stage is when the middle school level is studied. In 2006, Mexico incorporated 'mentoring' space to assist students in their integration and participation in life. In public middle schools, it is sometimes difficult to be aware of situations that affect students because of the number of them and traditional records management. With this, they lose the opportunity to provide timely support as a preventive way. In order to provide this support, it is required to know the students by detecting the relevant information that has greater impact on their learning process. This research is looking to check if it is possible to identify student’s relevant information to detect when it is at risk, and then to propose a model to manage in a proper way such information.

Keywords: adolescence, mentoring, middle school students, mentoring system support

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Authors: Chen-Chang Lee, Po-Chou Chen, Jo-Chi Jao, Chun-Chung Lui, Leung-Chit Tsang, Lain-Chyr Hwang

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Fetal Magnetic Resonance Imaging (MRI) is a challenge task because the fetal movements could cause motion artifact in MR images. The remedy to overcome this problem is to use fast scanning pulse sequences. The Single-Shot Fast Spin-Echo (SSFSE) T2-weighted imaging technique is routinely performed and often used as a gold standard in clinical examinations. Fast spoiled gradient-echo (FSPGR) T1-Weighted Imaging (T1WI) is often used to identify fat, calcification and hemorrhage. Fast Imaging Employing Steady-State Acquisition (FIESTA) is commonly used to identify fetal structures as well as the heart and vessels. The contrast of FIESTA image is related to T1/T2 and is different from that of SSFSE. The advantages and disadvantages of these two scanning sequences for fetal imaging have not been clearly demonstrated yet. This study aimed to compare these three rapid MRI techniques (SSFSE, FIESTA, and FSPGR) for fetal MRI examinations. The image qualities and influencing factors among these three techniques were explored. A 1.5T GE Discovery 450 clinical MR scanner with an eight-channel high-resolution abdominal coil was used in this study. Twenty-five pregnant women were recruited to enroll fetal MRI examination with SSFSE, FIESTA and FSPGR scanning. Multi-oriented and multi-slice images were acquired. Afterwards, MR images were interpreted and scored by two senior radiologists. The results showed that both SSFSE and T2W-FIESTA can provide good image quality among these three rapid imaging techniques. Vessel signals on FIESTA images are higher than those on SSFSE images. The Specific Absorption Rate (SAR) of FIESTA is lower than that of the others two techniques, but it is prone to cause banding artifacts. FSPGR-T1WI renders lower Signal-to-Noise Ratio (SNR) because it severely suffers from the impact of maternal and fetal movements. The scan times for these three scanning sequences were 25 sec (T2W-SSFSE), 20 sec (FIESTA) and 18 sec (FSPGR). In conclusion, all these three rapid MR scanning sequences can produce high contrast and high spatial resolution images. The scan time can be shortened by incorporating parallel imaging techniques so that the motion artifacts caused by fetal movements can be reduced. Having good understanding of the characteristics of these three rapid MRI techniques is helpful for technologists to obtain reproducible fetal anatomy images with high quality for prenatal diagnosis.

Keywords: fetal MRI, FIESTA, FSPGR, motion artifact, SSFSE

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Authors: Yan Li, Qi-Fan Jia, Jie Zhou

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In today’s China, primary and secondary teachers are living a hard life with high pressure but low payment, which results in a sense of unfair and less satisfaction of life. However, teachers’ life satisfaction is a significant factor of their mental health and plays an important role in the development and progress of the society. This study was aimed to explore the effect of teachers’ perception of social justice on life satisfaction. 450 primary and secondary teachers from China were measured with life satisfaction scales, social justice scales, income satisfaction scale, job satisfaction scale, pressure condition scale, and major life event scale. Results showed their pressure is significantly higher than average, while life satisfaction, job satisfaction, income satisfaction and perceived social justice are lower. Hierarchical regression analysis showed that demographic variables, i.e., gender, age, education level and matric status, and factors related to occupation, i.e., professional title, school type and working hours per day cannot predict teachers’ life satisfaction. Teachers who had worked for 11-20 years had a lower life satisfaction compared to those with 1-5 years working experience. However, social status, monthly household income, income satisfaction, as well as job satisfaction were positively related to life satisfaction, whereas pressure condition was negatively related to it. After controlling for demographic factors and individual attitudes, social justice still had a positive effect on life satisfaction, among which distributive justice played a more important role than procedural justice. The suggestions on teachers’ condition in China and the implications for education reform to improve teachers’ mental health are discussed.

Keywords: life satisfaction, mental health, primary and secondary teachers, social justice

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Authors: Ketwadee Madden

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Product or service image is among the vital factors that predict individuals’ choice of buying a product or services, goes to a place or attached to a person. Similarly, in the context of tourism, the destination image is a very important factor to which tourist considers before making their tour destination decisions. In light of this, the objective of this study is to conceptually investigate among French tourists, the determinants of Thailand’s tourism destination image. For this objective to be achieved, prior studies were reviewed, leading to the development of conceptual framework highlighting the determinants of destination image. In addition, this study develops some hypotheses that are to be empirically investigated. Aside these, based on the conceptual findings, suggestions on how to motivate European tourists to chose Thailand as their preferred tourism destination were made.

Keywords: cognitive destination image, affective destination image, motivations, risk perception, word of mouth

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Authors: Susanne Manes, Anni Glaeser, Katharina Wick, Bernhard Strauss, Uwe Berger

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Introduction: Over the last decades growing rates of mental health concerns among children and adolescents have been observed. At the same time, physical well-being of children and adolescents becomes increasingly impaired as well. Schools play an important role in preventing mental and physical disorders and in promoting well-being. Self-esteem, as well as social integration, are vital influence factors for mental and physical well-being. The purpose of this study was to develop and evaluate the program 'VorteilJena' for secondary schools in Germany focusing on self-esteem and social integration to improve mental and physical well-being. Method: The school-based health promotion program was designed for students in 5th grade and higher. It consists of several short pedagogical exercises instructed by a teacher and were integrated into the regular class over the course of ten weeks. The exercises focused on fostering social integration using either tasks improving team spirit or exercises that increase tolerance and sense of belonging. Other exercises focused on strengthening the self-esteem of the students. Additionally, the program included a poster exhibition titled 'Belonging' which was put up in the school buildings. The exhibition comprised ten posters which addressed relevant risk factors and resources related to social integration and self-esteem. The study was a randomized controlled sequential study with a pre and post measurement conducted in ten German schools. A total of 1642 students (44% male) were recruited. Their age ranged from 9 to 21 years (M=12.93 years; SD= 2.11). The program was conducted in classes ranging from 5th to 12th grade. Results: The program improved wellbeing, self-esteem and social integration of the involved students compared to the control group. Differential effects depending on implementation rates or age of the students will be analyzed. Moreover, implications for future school-based health promotion programs targeting self-esteem and social integration will be discussed. Conclusion: Social integration considerably influences self-esteem and well-being of students and can be targeted by school-based programs including short and modest exercises. Since a sufficient implementation of health promotion programs is essential, the present program due to its practicability represents a good opportunity to install health promotion focusing on social integration in schools.

Keywords: social integration, well-being, health promotion in schools, self-esteem

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Authors: Neimenuo Kengurusie

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Human trafficking is considered a form of slavery in modern day era and a gross violation of human rights and one of the most organized crimes of the day transcending cultures, geography and time. Human trafficking is a highly complex phenomenon involving many actors like victims, survivors, their families, communities and third parties that recruit, transport and exploit the trafficked victims. It takes different forms such as child trafficking, trafficking for labour, trafficking for sexual exploitation, trafficking for organ transplantation etc. and affects virtually every corner of the world. This research draws on a variety of sources, including books, articles, journals, newspaper reports, human rights reports, online materials and interviews. In India, particularly the North East region, the issue of human trafficking has become a concern regionally, nationally and internationally. The focus of this paper is on the North Eastern part of India as it is a socially and economically backward region of the country which makes women and children susceptible to trafficking. Women and children from these regions are trafficked within and outside the state. Therefore, the paper seeks to explore the issue of human trafficking, especially trafficking of women and children in North East India, which receives insufficient attention in literature. The paper seeks to analyze and understand the trend and patterns of trafficking and the mechanisms that reinforces the process and perpetuates the phenomenon of trafficking considering the nature and scope of the problem. The paper also analyzes the anti-trafficking laws initiated by India and the North East states in particular for combating human trafficking in North East India.

Keywords: children, human trafficking, North East India, women

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Authors: Michael Ricardo Lang, AdriéLle Costa, Ivana Iesbik, Karine Haag, Leonardo Trindade Buffara, Oscar Reimann Junior, Chelin Auswaldt Steclan

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Stroke affects not only the individual, but has significant impacts on the social and family context. Therefore, it is necessary to know the peculiarities of each region, in order to contribute to regional public health policies effectively. Thus, the present study discusses biomarkers in a post-stroke population, admitted to a stroke unit (U-stroke) of reference in the southern region of Brazil. Biomarkers were analyzed, such as age, length of stay, mortality rate, survival time, risk factors and family history of stroke in patients after ischemic stroke. In this studied population, comparing men and women, it was identified that men were more affected than women, and the average age of women affected was higher, as they also had the highest mortality rate and the shortest hospital stay. The risk factors identified here were according to the global scenario; with SAH being the most frequent and those associated with sedentary lifestyle in women the most frequent (dyspilipidemia, heart disease and obesity). In view of this, the importance of studies that characterize populations regionally is evident, strengthening the strategic planning of policies in favor of health care.

Keywords: biomarkers, sex, stroke, stroke unit, population

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Authors: Anshu Radha Aggarwal

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As per the Right to Education Act (RTE), 2009, every child in the age group of 6-14 years shall be admitted in a neighborhood school. All the Out of School Children identified have to be enrolled / mainstreamed in to age appropriate class and there-after be provided special training. This paper addresses issues emerging from provisions in the RTE Act that specifically refer to the enrolment of out-of school children into age appropriate classes and the requirement to provide special trainings that will enable this to take place. In the context of RTE Act, the Out-of-School Children are first enrolled in the formal school and then they are provided with Special Training through NRSTCs (Long Term / Short term basis). These centers are functioning in formal school campus itself. This paper specifies the role of special training centers (STC). It presents a re-envisioning of assessment that recognizes two principal functions of assessment, assessment for learning and assessment of learning, instead of the more familiar categories of formative, diagnostic, summative, and evaluative assessment. The use of these two functions of assessment highlights and emphasizes the role of special training centers (STC) to assess their level for giving them appropriate special training and to evaluate their improvement in learning level. Challenge of problem faced by teachers to do diagnostic assessment, including its place in the sequence of assessment procedures appropriate in identifying and addressing individual children’s learning difficulties are solved by special training centers (STC). It is important that assessment is used to identify children with learning difficulties at the earliest possible stage so that appropriate support and intervention can be put in place. So appropriate challenges with tools are presented here for their assessment at entry level and at completion level of primary children by special training centers (STC).

Keywords: right to education, assessment, challenges, out of school children

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Authors: Hung Lin-Zin, Lai Mei-Yen

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Prostate cancer is the most commonly diagnosed male cancer in the U.S. The prevalence is around 1 in 8. The etiology of prostate cancer is still unknown, but some predisposing factors, such as age, black race, family history, and obesity, may increase the risk of the disease. In 2020, a total of 7,178 Taiwanese people were nearly diagnosed with prostate cancer, accounting for 5.88% of all cancer cases, and the incidence rate ranked fifth among men. In that year, the total number of deaths from prostate cancer was 1,730, accounting for 3.45% of all cancer deaths, and the death rate ranked 6th among men, accounting for 94.34% of the cases of male reproductive organs. Looking for domestic and foreign literature on the use of OMOP (Observational Medical Outcomes Partnership, hereinafter referred to as OMOP) database analysis, there are currently nearly a hundred literature published related to nursing-related health problems and nursing measures built in the OMOP general data model database of medical institutions are extremely rare. The OMOP common data model construction analysis platform is a system developed by the FDA in 2007, using a common data model (common data model, CDM) to analyze and monitor healthcare data. It is important to build up relevant nursing information from the OMOP- CDM database to assist our daily practice. Therefore, we choose prostate cancer patients who are our popular care objects and use the OMOP- CDM database to explore the common associated health problems. With the assistance of OMOP-CDM database analysis, we can expect early diagnosis and prevention of prostate cancer patients' comorbidities to improve patient care.

Keywords: OMOP, nursing diagnosis, health problem, prostate cancer

Procedia PDF Downloads 76

Authors: Durri Andriani, Irsan Tahar, Lilian Sarah Hiariey

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Every institution has to develop, implement, and control its policies to ensure the effectiveness of the institution. In doing so, all related stakeholders have to be involved to maximize the benefit of the policies and minimize the potential constraints and resistances. Open and distance education (ODE) institution is no different. As an education institution, ODE institution has to focus their attention to fulfilling academic needs of their students through open and distance measures. One of them is quality learning support system. Significant stakeholders in learning support system are tutors since they are the ones who directly communicate with students. Tutors are commonly seen as objects whose main responsibility is limited to implementing policies decided by management in ODE institutions. Nonetheless, tutors’ perceptions of tutorials are believed to influence tutors’ performances in facilitating learning support. It is therefore important to analyze tutors’ perception on various aspects of learning support. This paper presents analysis of tutors’ perceptions on policies of tutoriala in ODE institution using Policy Analysis Framework (PAF) modified by King, Nugent, Russell, and Lacy. Focus of this paper is on on-line tutors, those who provide tutorials via Internet. On-line tutors were chosen to stress the increasingly important used of Internet in ODE system. The research was conducted in Universitas Terbuka (UT), Indonesia. UT is purposely selected because of its large number (1,234) of courses offered and large area coverage (6000 inhabited islands). These posed UT in a unique position where learning support system has, to some extent, to be standardized while at the same time it has to be able to cater the needs of different courses in different places for students with different backgrounds. All 598 listed on-line tutors were sent the research questionnaires. Around 20% of the email addresses could not be reached. Tutors were asked to fill out open-ended questionnaires on their perceptions on definition of on-line tutorial, roles of tutors and students in on-line tutorials, requirement for on-line tutors, learning materials, and student evaluation in on-line tutorial. Data analyzed was gathered from 40 on-line tutors who sent back filled-out questionnaires. Data were analyzed qualitatively using content analysis from all 40 tutors. The results showed that using PAF as entry point in choosing learning support services as area of policy with delivery learning materials as the issue at UT has been able to provide new insights of aspects need to be consider in formulating policies in online tutorial and in learning support services. Involving tutors as source of information could be proven to be productive. In general, tutors had clear understanding about definition of online tutorial, roles of tutors and roles of students, and requirement of tutor. Tutors just need to be more involved in the policy formulation since they could provide data on students and problem faced in online tutorial. However, tutors need an adjustment in student evaluation which according tutors too focus on administrative aspects and subjective.

Keywords: distance education, on-line tutorial, tutorial policy, tutors’ perspectives

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Authors: Marco Sewald

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Due to the current enforcement of exterritorial U.S. legislation, up to 9 million U.S. (dual) citizens residing abroad are subject to U.S. double and surcharge taxation and at risk of losing access to otherwise basic financial services and investment opportunities abroad. The United States is the only OECD country that taxes non-resident citizens, lawful permanent residents and other non-resident aliens on their worldwide income, based on local U.S. tax laws. To enforce these policies the U.S. has implemented ‘saving clauses’ in all tax treaties and implemented several compliance provisions, including the Foreign Account Tax Compliance Act (FATCA), Qualified Intermediaries Agreements (QI) and Intergovernmental Agreements (IGA) addressing Foreign Financial Institutions (FFIs) to implement these provisions in foreign jurisdictions. This policy creates systematic cases of double and surcharge taxation. The increased enforcement of compliance rules is creating additional report burdens for U.S. persons abroad and FFIs accepting such U.S. persons as customers. FFIs in Europe react with a growing denial of specific financial services to this population. The numbers of U.S. citizens renouncing has dramatically increased in the last years. A case study is chosen as an appropriate methodology and research method, as being an empirical inquiry that investigates a contemporary phenomenon within its real-life context; when the boundaries between phenomenon and context are not clearly evident; and in which multiple sources of evidence are used. This evaluative approach is testing whether the combination of policies works in practice, or whether they are in accordance with desirable moral, political, economical aims, or may serve other causes. The research critically evaluates the financial and non-financial consequences and develops sufficient strategies. It further discusses these strategies to avoid the undesired consequences of exterritorial U.S. legislation. Three possible strategies are resulting from the use cases: (1) Duck and cover, (2) Pay U.S. double/surcharge taxes, tax preparing fees and accept imposed product limitations and (3) Renounce U.S. citizenship and pay possible exit taxes, tax preparing fees and the requested $2,350 fee to renounce. While the first strategy is unlawful and therefore unsuitable, the second strategy is only suitable if the U.S. citizen residing abroad is planning to move to the U.S. in the future. The last strategy is the only reasonable and lawful way provided by the U.S. to limit the exposure to U.S. double and surcharge taxation and the limitations on financial products. The results are believed to add a perspective to the current academic discourse regarding U.S. citizenship based taxation, currently dominated by U.S. scholars, while providing sufficient strategies for the affected population at the same time.

Keywords: citizenship based taxation, FATCA, FBAR, qualified intermediaries agreements, renounce U.S. citizenship

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