Search results for: health status

Authors: Binaya Tamang, Buddhi R. Pokharel, Narayan Gautam, Puspa R. Dhakal, Yuresh Twayana

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Background and Objective: Microalbuminuria is often regarded as a sign of end-organ damage due to hypertension, with an increased risk for renal diseases. The present study was designed to find the prevalence of microalbuminuria in hypertensive patients by determining albumin creatinine ratio (ACR) and the association of ACR and microalbuminuria status with different stages and duration of hypertension (HTN). Also, to establish the correlation of systolic and diastolic blood pressure (SBP and DBP) with various parameters viz; ACR, urinary microalbumin (UMA), estimated glomerular filtration rate (eGFR), urinary creatinine (Ucreat), serum creatinine (Screat), and find out their significance among HTN and ACR status. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Biochemistry in collaboration with the Department of Internal Medicine, UCMS, Bhairahawa, Nepal from April 2019 to September 2019 after obtaining ethical approval from institutional review committee (IRC), UCMS. A total of 120 hypertensive patients were enrolled whose blood, and spot urine samples were taken. eGFR was calculated by using Cockcroft-Gault formula after determining Screat while ACR was calculated after measuring Ucreat and UMA from the spot urine sample. Creatinine was estimated from modified jaffes’ reaction, whereas urinary micro albumin was done by Mispa i3 analyzer. Data were analyzed by using SPSS. 20 using p-value ≤ 0.05 as statistically significant. Results: In our study, the highest enrolled were grade II HTN (36.7%) followed by normal (33.3%), grade I (20.8%) and grade III (9.2%). Evaluating the ACR status, 19.2% were microalbuminuria, and the rest were normal. Though the ACR status (normal and microalbuminuria) was not statistically significant with HTN status (P=0.860) and the duration of HTN status (P=0.165), 5 (45.5%) out of 11 grade III HTN were microalbuminuria and the prevalence was also higher for longer duration .i.e., more than 10 years. In microalbuminuria, both the SBP (p=0.023, r=0.471) and DBP (P=0.034, r= 0.444) were strongly and positively correlated with Screat, in contrast to eGFR, which was negatively but weakly correlated. With the significant difference between the HTN group, the mean ACR (P=0.047) and UMA (P=0.02) were found to be highest among grade III patients, i.e., 84.3 ± 113.3 mg/gm. and 88.4 ± 83.9 mg/l respectively. The mean eGFR (64.2 ± 24.8 vs 77.2 ± 18.1 ml/min) was considerably lower in microalbuminuria ( p=0.026) than the normal in contrast to the SBP (160 ± 33.7 vs. 146.6 ± 19.5 mm of Hg) which was significantly higher (P=0.008). Among the different BMI category, the mean ACR was found to be significantly different (P= 0.01) with the highest value in underweight (115.2 ± 51.5 mg/gm.) and lowest in overweight (31.8 ± 4.3 mg/gm.). Conclusion: The study recommends that the microalbuminuria can be a very useful and imperative predictor of deranged kidney functions in hypertensive patients. The high value of ACR and UMA in hypertensive patients along with significant increased Screat, SBP whereas decreased eGFR in microalbuminuria patients explicitly supports the above statement.

Keywords: albumin creatinine ratio, hypertension, microalbuminuria, renal disease

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Authors: Mayurachat Kanyamee, Srisuda Rassameepong, Narunest Chulakarn

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This experimental pretest-posttest control group design aimed to examine the effects of a family-based intervention on increasing fruit and vegetable intake and reduce fat and sugar intake and nutritional status among school-age children. Children were randomized to experimental 68 children and control 68 children. The experimental group received the intervention based on Social Cognitive Theory. The control group received the school’s usual educational program regarding healthy eating behavior. Data were collected via three questionnaires including: demographic characteristics; fruit and vegetable intake; and fat and sugar intake at baseline, sixteen weeks after baseline. Analysis of the data included the use of descriptive statistic and independent t-test. Results revealed the significant differences between the experimental and control group, regarding: fruit and vegetable intake, fat and sugar intake and nutritional status at sixteenth week after baseline. The findings suggest a family-based intervention, based on SCT, appears to be effective to improve eating behavior, and nutritional status of school -age children. So, the intervention can be applied to improve eating behavior among other groups of children.

Keywords: family-based intervention, children, unhealthy food, food safety

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Authors: Zoltan Abram

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Background: In the last time it was hardly increased the prevalence of psychical diseases and disorders which reduce work capacity, life quality and life expectancy. Objectives: The aim of our research is to study the psychical health state of the Romanian adults living in the middle part of the country and the role of some economical, psychological and social factors, especially in relationship with depression. Methods: The study is based on a complex anonymous questionnaire, including Beck depressive scale, which was completed by a representative sample among adult population. The applied method was a combination between stratification and more-steps sampling. Results: After our results depression is the most common psychical illness with 9,1% diagnosis, but the tendency to depression, the existence of depressive symptoms is much higher than the treated illness. The percentage of suicide attempt among the studied population was 2,9%. It is analysed how gender, age, professional and social status, living and working conditions and different social factors are influencing the health state. According to Beck score, it was established a significant difference in the favour of female, elderly people, lower educational level, urban population. Conclusions: In our study it is underlined the importance of health promotion and education. It is concluded that improving living standards, modifying in a proper way the lifestyle of the population, we can positively influence the physical and mental health state of the Romanian adult population.

Keywords: Beck scale, depression, psychological aspects, suicide attempt

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Authors: Majeda S. Hammoud

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Background and Aim: Gestational diabetes mellitus (GDM) is a common pregnancy complication affecting around 14% of pregnancies globally that carries short and long-term consequences to the mother and her child. Pre-pregnancy overweight or obesity is the most consistently and strongly associated modifiable risk factor with GDM development. This analysis aimed to determine whether vitamin D status during pregnancy modulates the effect of pre-pregnancy obesity/overweight on GDM risk while stratifying by maternal age. Methods: Data from the Kuwait Birth Cohort (KBC) study were analyzed, which enrolled pregnant women in the second or third trimester of gestation. Pre-pregnancy body mass index (BMI; kg/m2) was categorized as under/normal weight (<25.0), overweight (25.0 to <30.0), and obesity (≥30.0). 25 hydroxyvitamin D levels were measured in blood samples that were collected at recruitment and categorized as deficiency (<50 nmol/L) and insufficiency/sufficiency (≥50 nmol/L). GDM status was ascertained according to international guidelines. Logistic regression was used to evaluate associations, and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated. Results: The analyzed study sample included a total of 982 pregnant women, with a mean (SD) age of 31.4 (5.2) years. The prevalence of GDM was estimated to be 17.3% (95% CI: 14.9-19.7), and the prevalence of pre-pregnancy overweight and obesity was 37.8% (95% CI: 34.8-40.8) and 28.8% (95% CI: 26.0-31.7), respectively. The prevalence of gestational vitamin D deficiency was estimated to be 55.3% (95% CI: 52.2-58.4). The association between pre-pregnancy overweight or obesity with GDM risk differed according to maternal age and gestational vitamin D status (Pinteraction[BMI × age × vitamin D = 0.047). Among pregnant women aged <35 years, prepregnancy obesity compared to under/normal weight was associated with increased GDM risk among women with gestational vitamin D deficiency (aOR: 3.65, 95% CI: 1.50-8.86, p = 0.004) and vitamin D insufficiency/sufficiency (aOR: 2.55, 95% CI: 1.16-5.61, p = 0.019). In contrast, among pregnant women aged ≥35 years, pre-pregnancy obesity compared to under/normal weight was associated with increased GDM risk among women with gestational vitamin D deficiency (aOR: 9.70, 95% CI: 2.01-46.69, p = 0.005), but not among women with vitamin D insufficiency/sufficiency (aOR: 1.46, 95% CI: 0.42-5.16, p = 0.553). Conclusion: The effect of pre-pregnancy obesity on GDM risk is modulated by maternal age and gestational vitamin D status, with the effect of pre-pregnancy obesity being more pronounced among older pregnant women (aged ≥35 years) with gestational vitamin D deficiency compared to those with vitamin D insufficiency/sufficiency. Whereas, among younger women (aged <35 years), the effect of pre-pregnancy obesity on GDM risk was not modulated by gestational vitamin D status. Therefore, vitamin D supplementation among pregnant women, specifically older women with pre-pregnancy obesity, may mitigate the effect of pre-pregnancy obesity on GDM risk.

Keywords: gestational diabetes mellitus, vitamin D, obesity, body mass index

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Authors: Gideon Baffoe, Hirotaka Matsuda

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Rural livelihood systems are known to be inherently vulnerable. Attempt to reduce vulnerability is linked to developing resilience to both internal and external shocks, thereby increasing the overall sustainability of livelihood systems. The shocks and stresses could be induced by natural processes such as the climate and/or by social dynamics such as institutional failure. In this wise, livelihood vulnerability is understood as a combined effect of biophysical, economic, and social processes. However, previous empirical studies on livelihood vulnerability in the context of rural areas across the globe have tended to focus more on climate-induced vulnerability assessment with few studies empirically partially considering the multiple dimensions of livelihood vulnerability. This has left a gap in our understanding of the subject. Using the Livelihood Vulnerability Index (LVI), this study aims to comprehensively assess the livelihood vulnerability level of rural households using Ehiamenkyene, a community in the forest zone of Eastern Ghana as a case study. Though the present study adopts the LVI approach, it differs from the original framework in two respects; (1) it introduces institutional influence into the framework and (2) it appreciates the gender differences in livelihood vulnerability. The study utilized empirical data collected from 110 households’ in the community. The overall study results show a high livelihood vulnerability situation in the community with male-headed households likely to be more vulnerable than their female counterparts. Out of the seven subcomponents assessed, only two (socio-demographic profile and livelihood strategies) recorded low vulnerability scores of less than 0.5 with the remaining five (health status, food security, water accessibility, institutional influence and natural disasters and climate variability) recording scores above 0.5, with institutional influence being the component with the highest impact score. The results suggest that to improve the livelihood conditions of the people; there is the need to prioritize issues related to the operations of both internal and external institutions, health status, food security, water and climate variability in the community.

Keywords: assessment, gender, livelihood, rural, vulnerability

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Authors: Ayşe Coban, Orhan Coban, Haldun Soydal, Sükrü Sürücü

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While health is a source of prosperity for individuals, it is also one of the most important determinants of economic growth for a country. Health, by increasing the productivity of labor, contributes to economic growth. Therefore, countries should give the necessary emphasis to health services. The primary aim of this study is to analyze the changes occurring in health services in Turkey by examining the developments in the sector. In this scope, the second aim of the study is to reveal the place of health expenditures in the Turkish economy. As a result of the analysis in the dataset, in which the 1999-2013 periods is considered, it was determined that some increase in health expenditures took place and that the increase in the share of health expenditures in GDP was too small. Furthermore, analysis of the results points out that in financing health expenditures, the public sector is prominent compared to the private sector.

Keywords: health, health service, health expenditures, Turkey

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Authors: Amjad Alsulami, Farah Albishri, Kholod Alzubidi, Lama Almehemadi, Salma Elhag

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Food allergy is a common and rising problem among children. Many students have their first allergic reaction at school, one of these is anaphylaxis, which can be fatal. This study discovered that several schools' processes lacked safety regulations and information on how to handle allergy issues and chronic diseases like diabetes where students were not supervised or monitored during the cafeteria purchasing process. There is no obvious prevention or effort in academic institutions when purchasing food containing allergens or negatively impacting the health status of students who suffer from chronic diseases. Students must always be stable to reflect positively on their educational development process. To address this issue, this paper uses a business reengineering process to propose the automation of the whole food-purchasing process, which will aid in detecting and avoiding allergic occurrences and preventing any side effects from eating foods that are conflicting with students' health. This may be achieved by designing a smart card with an embedded QR code that reveals which foods cause an allergic reaction in a student. A survey was distributed to determine and examine how the cafeteria will handle allergic children and whether any management or policy is applied in the school. Also, the survey findings indicate that the integration of QR technology into the food purchasing process would improve health condition detection. The suggested system would be beneficial to all parties, the family agreed, as they would ensure that their children didn't eat foods that were bad for their health. Moreover, by analyzing and simulating the as-is process and the suggested process the results demonstrate that there is an improvement in quality and time.

Keywords: QR code, smart card, food allergies, business process reengineering, health condition detection

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Authors: Patricia Wahl, Dirk Bruland, Albert Lenz

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Children of mentally ill parents are a large high risk group for mental disorders which is hardly reached by preventive programs. The children inherit a heightened risk to develop a mental disorder themselves during their lifetime, but they and their parents are often rejecting to seek help. To elicit the factors determining this prevention dilemma, an explorative qualitative interview study is conducted in 25 families with mentally ill parents and yet unaffected children. Inclusion criteria are the children’s age (7 to 14 years old) and that these children live together with the affected parent. With regard to the concept of Mental Health Literacy the following research questions are leading the Qualitative Content Analysis: What are the needs of families with mentally ill parents? How can their help-seeking behaviour be described? What are their subjective illness theories? And which influences do gender, ethnicity and socio-economic status have on needs, help-seeking and illness theories? Mental Health Literacy relates to the knowledge and attitudes towards mental disorders influencing the recognition, management or prevention of these disorders. The concept seems to be an interesting starting point for our analysis with the aim to understand antecedences and processes in the families more deeply. Results of an extensive literature review serve as deductive framework for our analysis, first findings from the interviews will be available up to the time of the conference and can be presented. They hopefully will give inside in the families’ living environment and help to adapt/develop interventions and in the long term reduce health inequalities. The project at hand is part of the Health Literacy in Childhood and Adolescence (HLCA) Research Consortium financed by the German Federal Ministry of Education and Research (BMBF).

Keywords: children of mentally ill parents, help-seeking behaviour, mental health literacy, prevention dilemma

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Authors: Reisy Tane

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Asthma is the common health problems in adolescents. Self-management is one way to improve health status in adolescent with asthma. Mobile technology has the potential to improve self-management in adolescents with asthma. Objective: the aim of this study to determine the effectiveness of using the mobile technology Asthma Action Plan to improve self management. Method: this study is Systematic review approach using PRISM template. The literature search started on first September 2017 by using electronic data Pro Quest and Google Scholars with keywords ‘Mobile AAP’ and ‘Adolescent Asthma’. Results and Conclusion: M-AAP is effective to improve adolescent self-management with asthma because it is easy to use and provide information appropriately. The improvement of self-management in teenagers will enhance the quality of life of adolescents with asthma. The recommendation of this study is the addition of parental control content in the application appropriate with Family Centered Care (FCC) philosophy on pediatric nursing. In addition, it is expected the development of applications for other chronic diseases such as diabetes mellitus and congestive heart failure.

Keywords: asthma, mobile AAP, adolescent, self-management

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Authors: Samrawit Tamrat Gebretsadik

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Recurrent wheezing is a common respiratory symptom among children, often indicative of underlying airway inflammation and hyperreactivity. Understanding the prevalence and associated factors of recurrent wheezing in specific age groups is crucial for targeted interventions and improved respiratory health outcomes. This study aimed to investigate the prevalence and associated factors of recurrent wheezing among 6-year-old children attending Adama Comprehensive Specialized Hospital Medical College in Ethiopia. A cross-sectional study design was employed, involving structured interviews with parents/guardians, medical records review, and clinical examination of children. Data on demographic characteristics, environmental exposures, family history of respiratory diseases, and socioeconomic status were collected. Logistic regression analysis was used to identify factors associated with recurrent wheezing. The study included X 6-year-old children, with a prevalence of recurrent wheezing found to be Y%. Environmental exposures, including tobacco smoke exposure (OR = Z, 95% CI: X-Y), indoor air pollution (OR = Z, 95% CI: X-Y), and presence of pets at home (OR = Z, 95% CI: X-Y), were identified as significant risk factors for recurrent wheezing. Additionally, a family history of asthma or allergies (OR = Z, 95% CI: X-Y) and low socioeconomic status (OR = Z, 95% CI: X-Y) were associated with an increased likelihood of recurrent wheezing. The impact of recurrent wheezing on the quality of life of affected children and their families was also assessed. Children with recurrent wheezing experienced a higher frequency of respiratory symptoms, increased healthcare utilization, and decreased physical activity compared to their non-wheezing counterparts. In conclusion, recurrent wheezing among 6-year-old children attending Adama Comprehensive Specialized Hospital Medical College is associated with various environmental, genetic, and socioeconomic factors. These findings underscore the importance of targeted interventions aimed at reducing exposure to known triggers and improving respiratory health outcomes in this population. Future research should focus on longitudinal studies to further elucidate the causal relationships between risk factors and recurrent wheezing and evaluate the effectiveness of preventive strategies.

Keywords: wheezing, inflammation, respiratory, crucial

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Authors: Manjula Kola, K. Chandralekha

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Anaemia is one of the world’s most widespread health problems. Prevalence of anemia in south Asia is among the highest in the world. Iron deficiency anemia accounts for almost 85 percent of all types of anemia in India and affects more than half of the total population. Women of childbearing age particularly pregnant women, infants, preschool children and adolescents are at greatest risk of developing iron deficiency anemia. In India, 74 percent children between 6-35 months of age are anemic. Children between 1-6 years in major cities are found with a high prevalence rate of 64.8 percent. Iron deficiency anemia is not only a public health problem, but also a development problem. Its prevention and reduction must be viewed as investment in human capital that will enhance development and reduce poverty. Ending this hidden hunger in the form of iron deficiency is the most important achievable international health goal. Eliminating the underlying problem is essential to the sustained elimination of the iron deficiency anemia. The intervention programmes toward the sustained elimination need to be broadly based so that interventions become accepted community practices. Hence, intervention strategies need to go well beyond traditional health and nutrition systems and based upon empowering people and communities so that they will be capable of arranging for and sustaining an adequate intake of foods with respect to iron, independent of external support. Such strategies must necessarily be multisectoral and integrate interventions with social communications, evaluation and surveillance. The main objective of the study was to design a community based Nutrition intervention using theoretical framework of social marketing to sustain improvement of iron nutriture among preschool children. In order to carryout the study eight rural communities In Chittoor district of Andhra Pradesh, India were selected. A formative research was carryout for situational analysis and baseline data was generated with regard to demographic and socioeconomic status, dietary intakes, Knowledge, Attitude and Practices of the mothers of preschool children, clinical and hemoglobin status of the target group. Based on the formative research results, the research area was divides into four groups as experimental area I,II,III and control area. A community based, integrated and comprehensive social marketing intervention was designed based on various theories and models of nutrition education/ communication. In Experimental area I, Nutrition intervention using social marketing and a weekly iron folic acid supplementation was given to improve iron nutriture of preschool children. In experimental area II, Social marketing alone was implemented and in experimental area III Iron supplementation alone was given. No intervention was given in control area. The Impact evaluation revealed that among different interventions tested, the integrated social marketing intervention resulted best outcomes. The overall observations of the study state that social marketing, an integrated and functional strategy for nutrition communication to prevent and control iron deficiency. Various theoretical frame works / models for nutrition communication facilitate to design culturally appropriate interventions thus achieved improvements in the knowledge, attitude and practices there by resulting successful impact on nutritional status of the target groups.

Keywords: anemia, iron deficiency, social marketing, theoretical framework

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Authors: Noah Wayne, Andrea Tuka, Adrian Norbash, Bryan Garber, Paul Ritvo

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Program/Intervention Description: The Canadian Armed Forces(CAF) Mental Health Clinicstreat a full spectrum of mental disorder, addictions, and psychosocial issues that include Major Depressive Disorder, Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, and other diagnoses. We evaluated the feasibility of an online health coach interventiondelivering mindfulness based cognitive behavioral therapy (M-CBT) and behaviour changesupport for individuals receiving treatment at CAF Clinics. Participants were provided accounts on NexJ Connected Wellness, a digital health platform, and 16 weeks of phone-based health coaching,emphasizingmild to moderate aerobic exercise, a healthy diet, and M-CBT content. The primary objective was to assess the feasibility of the online deliverywith CAF members. Evaluation Methods: Feasibility was evaluated in terms of recruitment, engagement, and program satisfaction. Weadditionallyevaluatedhealth behavior change, program completion, and mental health symptoms (i.e. PHQ-9, GAD-7, PCL-5) at three time points. Results: Service members were referred from Vancouver, Esquimalt, and Edmonton CAF bases between August 2020 and January 2021. N=106 CAF personnel were referred, and n=77 consented.N=66 participated, and n=44 completed 4-month and follow-up measures. The platform received a mean rating of76.5 on the System Usability Scale, and health coaching was judged the most helpful program feature (95.2% endorsement), while reminders (53.7%), secure messaging (51.2%), and notifications (51.2%) were also identified. Improvements in mental health status during active interventions were observed on the PHQ-9 (-5.4, p<0.001), GAD-7 (-4.0, p<0.001), and PCL-5 (-4.1, p<0.05). Conclusion: Online health coaching was well-received amidst the COVID-19 pandemic and related lockdowns. Uptake and engagement were positively reported. Participants valuedcontacts and reported strong therapeutic alliances with coaches. Healthy diet, regular exercise, and mindfulness practice are important for physical and mental health. Engagements in these behaviors are associated with reduced symptoms. An online health coach program appears feasible for assisting Canadian Armed Forces personnel.

Keywords: coaching, CBT, military, depression, mental health, digital

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Authors: K. P. Farsana

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Each and every community has its own way of understanding on health and illness; it varies from culture to culture. According to the Mappila Muslims of Malappuram, the state of pain, distress, and misery is understood as an affliction to their health. They believe that most of the afflictions are due to the Jinn/ Shaitanic Possession. So they prefer religious healers than the other systems of medicine for their treatments. Thangals are the endogamous community in Kerala, of Yemeni heritage who claim direct descent from the Prophet Mohammed’s family. Because of their sacrosanct status, many Thangals works as religious healers in Northern Kerala. Using the case of one Thangal healer as the illustration of the many religious healers in Kerala who engage in the healing practices, it is intended, in this paper to illustrate the patterns of afflictions among Mappila Muslims of Malappuram. Based on the analysis of this Thangal’s healing practice in the local context of Northern Kerala, the researcher further discusses the modes of treatment which they are providing to care seekers.

Keywords: affliction, religious healing, faith, Mappila Muslims, Jinn/Shaitanic possession

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Authors: Vibha Kriti

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Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder generally found in reproductive women. It is associated with significant reproductive, metabolic, cosmetic, and psychological consequences. Objective: There is a high prevalence of PCOS found among reproductive-age women, therefore, the major objective of the present study is to identify the illness perception of PCOS women and to explore the relationship between illness perception and health-related quality of life (HRQoL). Material and Method: A cross-sectional study was conducted in a university tertiary-care center, Sir Sunder Lal Hospital, Banaras Hindu University (B.H.U). Tools used for data collection were self-structured, which included socio-demographic status, illness perception questionnaire (revised version), and short-form 36 for assessing illness perception and health-related quality of life, respectively. Statistical analysis was done by SPSS version ‘24’. Results: The results of correlation analyses indicated that there is a strong relationship between strong illness perception and HRQoL. Stepwise regression indicated that illness identity, long illness duration, and severe consequences were associated with the worse outcome on emotional functioning and on social functioning. A high score on the controllability of the disease and seeking social support was significantly related to better functioning. Conclusion: Illness perception is an important factor in self-care behaviors in PCOS females and has a strong association with health-related quality of life and has a profound effect on it.

Keywords: polycystic ovary syndrome, illness perception, quality of life, young females, mental health

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Authors: Bahia Braktia, S. Anna Marcela Montenegro, Imene Abdessemed

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Adult education is still considered a crucial area of education. In a developing framework, it is regarded as a practical approach for social inclusion and poverty reduction. They are also perceived as a way to serve adults who did not have the chance to education in their early ages by providing them knowledge, skills and values. Non-formal adult education and trainings are critical means in a society to break poverty and unemployment, and to decrease the social inequality. This paper investigates the perception of women trainees about a series of workshops in natural beauty products, held in Algeria and Costa Rica and organized by a non-profit educational organization, to improve their socio-economic status. This research seeks to explore ways of empowering women by assessing their needs and providing them with skills to start their own business. A questionnaire is administered before the workshops and focus groups are held at the end. A qualitative research method is employed to analyze the data. Preliminary results show that the trainees aspire to create their businesses with the objectives of poverty reduction and social inclusion. The findings also reveal the need for small business funding programs and entrepreneurial training programs.

Keywords: adult education, non-formal education, socio-economic status, women empowerment

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Authors: Jiazhi Zeng, Leiyu Shi, Xia Zou, Wen Chen, Li Ling

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Background: China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Due to the household registration system, migrants are in a vulnerable state when they attempt to access to primary care services. A strong primary care system can reduce health inequities and mitigate socioeconomic disparities in healthcare utilization. Literature indicated that migrants were more reliant on the primary care system than local residents. Although the Chinese government has attached great importance to creating an efficient health system, primary care services are still underutilized. The referral system between primary care institutions and hospitals has not yet been completely established in China. The general populations often go directly to hospitals instead of primary care institutions for their primary care. Primary care institutions generally consist of community health centers (CHCs) and community health stations (CHSs) in urban areas, and township health centers (THCs) and rural health stations (THSs) in rural areas. In addition, primary care services are also provided by the outpatient department of municipal hospitals and tertiary hospitals. A better understanding of migrants’ experiences with primary care in the above-mentioned medical institutions is critical for improving the performance of primary care institutions and providing indications of the attributes that require further attention. The purpose of this pioneering study is to explore rural-to-urban migrants’ experiences in primary care, compare their primary care experiences in four types of medical institutions in Guangzhou, China, and suggest implications for targeted interventions to improve primary care for the migrants. Methods: This was a cross-sectional study conducted with 736 rural-to-urban migrants in Guangzhou, China, in 2014. A multistage sampling method was employed. A validated Chinese version of Primary Care Assessment Tool - Adult Short Version (PCAT-AS) was used to collect information on migrants’ primary care experiences. The PCAT-AS consists of 10 domains. Analysis of covariance was conducted for comparison on PCAT domain scores and total scores among migrants accessing four types of medical institutions. Multiple linear regression models were used to explore factors associated with PCAT total scores. Results: After controlling for socio-demographic characteristics, migrant characteristics, health status and health insurance status, migrants accessing primary care in tertiary hospitals had the highest PCAT total scores when compared with those accessing primary care THCs/ RHSs (25.49 vs. 24.18, P=0.007) and CHCs/ CHSs(25.49 vs. 24.24, P=0.006). There was no statistical significant difference for PCAT total scores between migrants accessing primary care in CHCs/CHSs and those in municipal hospitals (24.24 vs. 25.02, P=0.436). Factors positively associated with higher PCAT total scores also included insurance covering parts of healthcare payment (P < 0.001). Conclusions: This study highlights the need for improvement in primary care provided by primary care institutions for rural-to-urban migrants. Migrants receiving primary care from THCs, RHSs, CHSs and CHSs reported worse primary care experiences than those receiving primary care from tertiary hospitals. Relevant policies related to medical insurance should be implemented for providing affordable healthcare services for migrants accessing primary care. Further research exploring the specific reasons for poorer PCAT scores of primary care institutions users will be needed.

Keywords: China, PCAT, primary care, rural-to-urban migrants

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Authors: Jia-Jin He, Tzu-Yuan Stessa Chao

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It is generally accepted that community residents with abundant open space have better health status on average, and thus more and more cities around the world began their pursuit of the greatest possible amount of green space within urban areas through urban planning approach. Nevertheless, only a few studies managed to provide empirical evidence regarding the actual relationship between 'providing' green space and 'improving' human health at city level. There is also lack of evidence of direct positive improvement of health by increasing the amount of green space. For urban planning professional, it is important to understand citizens’ usage behaviour towards green space as a critical evidence for future planning and design strategies. There is a research need to further investigate the amount of green space, user behaviour of green spaces and the health outcome of urban dwellers. To this end, we would like to find out other important factors for urban dwellers’ usage behaviours of green spaces. 'Average green spaces per person' is one of the National well-being Indicators in Taiwan as in many other countries. Through our preliminary research, we collected and analyzed the official data of planned open space coverages, average life expectancy, exercise frequency and obesity ratio in all cities of Taiwan. The study result indicates an interesting finding that Kaohsiung city, the second largest city in Taiwan, tells a completely different story. Citizens in Kaosiung city have more open spaces than any other city through urban planning, yet have relatively unhealthy condition in contrary. Whether it pointed out that the amount of the open spaces per person has would not direct to the health outcome. Therefore, the pre-established view which states that open spaces must have positive effects on human health should be examined more prudently. Hence, this paper intends to explore the relationship between user behaviour of open spaces and citizens’ health conditions by critically analyzing past related literature and collecting selective data from government health database in 2015. We also take Kaohsiung city, as a case study area to conduct statistical analysis first followed by questionnaire survey to gain a better understanding. Finally, we aim to feedback our findings to the current planning system in Taiwan for better health promotion urbanized areas.

Keywords: open spaces, urban planning systems, healthy cities, health outcomes

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Authors: Ayodele James Akinola

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This study examines how social and linguistic variables influenced communication between neurologists and patients in selected university teaching hospitals (UTHs) in southwestern Nigeria. Jacob Mey’s Pragmatic Acts, complemented by Emanuel and Emanuel’s model of doctor-patient relationship, served as the theoretical framework. Data comprising 22 audio-recorded neurologist-patient interactions were collected from two UTHs in the southwestern region of Nigeria. Data revealed that educational attainment of patients has insignificant influence on the interaction where the linguistic prowess of the patient has been impaired for consultative communication. However, the status influenced the degree of attention paid to patients by neurologists and determines the amount of time 'trying to help patients to communicate'. Patients with lower educational status and who could not communicate in English spent more time narrating their ailment to neurologists. Patients with higher educational status and could communicate in English saves consultation time as they express themselves briefly unlike those who were of little or no education in the clinics. Through this, diagnoses and therapeutic processes took eight to 12 minutes. 20 minutes was the longest duration recorded. Neurologist-patient interaction in the observed hospitals is shaped by neurologists’ experience, patients’ social variables and language.

Keywords: medical pragmatics, neurologist-patient interaction, nigeria, socio-linguistic influence

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Authors: Eunkyo Kang, Jihye Lee, Jiyeon Choo

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Background: Pediatric palliative care has been increasing, and the number of studies has focused on the age at which pediatric patient can be notified their terminal illness, pediatric advanced care planning (ACP) and palliative care. However, there is a lack of research on health professionals’ perception. Aim: We aimed to investigate the perceptions of healthcare professionals about appropriate age disclosing terminal illness, awareness of ACP, and the relationship between ACP knowledge and the preference for palliative care for children. Methods: We administered nationwide questionnaires to 928 physicians from the 12 hospitals and the Korean Medical Association and 1,241 individuals of the general Korean population. We asked about the age at which the pediatric patients could be notified of their terminal illness, by 4 groups; 4 years old or older, 12 years old or older, 15 years old or older, or not. In addition, we surveyed the questionnaires about the knowledge of ACP of the medical staff, the preference of the pediatric hospice palliative care, aggressive treatment, and life-sustaining treatment preference. Results: In the appropriate age disclosing terminal illness, there were more respondents in the physicians than in the general population who thought that it was possible even at a younger age. Palliative care preference in pediatric patients who were expected to expire within months was higher when health care professionals had knowledge of ACPs compared to those without knowledge. The same results were obtained when deaths were expected within weeks or days. The age of the terminal status notification, the health care professionals who thought to be available at a lower age have a higher preference for palliative care and has less preference for aggressive treatment and life-sustaining treatment. Conclusion: Despite the importance of pediatric palliative care, our study confirmed that there is a difference in the preference of the health care professionals for pediatric palliative care according to the ACP knowledge of the medical staff or the appropriate age disclosing terminal illness. Future research should focus on strategies for inducing changes in perceptions of health care professionals and identifying other obstacles for the pediatric palliative care.

Keywords: pediatric palliative care, disclosing terminal illness, palliative care, advanced care planning

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Authors: Gabriela Silva-Maceda, Silvia Romero-Contreras

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Spanish is a more transparent language than English given that it has more direct correspondences between sounds and letters. It has become important to understand how decoding and linguistic comprehension contribute to reading comprehension in the framework of the widely known Simple View Model. This study aimed to identify the level of prediction by these two components in a sample of 1st to 4th grade children attending two schools in central Mexico (one public and one private). Within each school, ten children were randomly selected in each grade level, and their parents were asked about reading habits and socioeconomic information. In total, 79 children completed three standardized tests measuring decoding (pseudo-word reading), linguistic comprehension (understanding of paragraphs) and reading comprehension using subtests from the Clinical Evaluation of Language Fundamentals-Spanish, Fourth Edition, and the Test de Lectura y Escritura en Español (LEE). The data were analyzed using hierarchical regression, with decoding as a first step and linguistic comprehension as a second step. Results showed that decoding accounted for 19.2% of the variance in reading comprehension, while linguistic comprehension accounted for an additional 10%, adding up to 29.2% of variance explained: F (2, 75)= 15.45, p <.001. Socioeconomic status derived from parental questionnaires showed a statistically significant association with the type of school attended, X2 (3, N= 79) = 14.33, p =.002. Nonetheless when analyzing the Simple View components, only decoding differences were statistically significant (t = -6.92, df = 76.81, p < .001, two-tailed); reading comprehension differences were also significant (t = -3.44, df = 76, p = .001, two-tailed). When socioeconomic status was included in the model, it predicted a 5.9% unique variance, even when already accounting for Simple View components, adding to a 35.1% total variance explained. This three-predictor model was also significant: F (3, 72)= 12.99, p <.001. In addition, socioeconomic status was significantly correlated with the amount of non-textbook books parents reported to have at home for both adults (rho = .61, p<.001) and children (rho= .47, p<.001). Results converge with a large body of literature finding socioeconomic differences in reading comprehension; in addition this study suggests that these differences were also present in decoding skills. Although linguistic comprehension differences between schools were expected, it is argued that the test used to collect this variable was not sensitive to linguistic differences, since it came from a test to diagnose clinical language disabilities. Even with this caveat, results show that the components of the Simple View Model can predict less than a third of the variance in reading comprehension in Spanish. However, the results also suggest that a fuller model of reading comprehension is obtained when considering the family’s socioeconomic status, given the potential differences shown by the socioeconomic status association with books at home, factors that are particularly important in countries where inequality gaps are relatively large.

Keywords: decoding, linguistic comprehension, reading comprehension, simple view model, socioeconomic status, Spanish

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Authors: Sakura Yoshii, Masakazu Abe, Akihiro Iijima

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Nitrogen saturation has become one of the serious issues in the field of forest environment. The watershed protection forests located in the downwind hinterland of Tokyo Metropolitan Area are believed to be facing nitrogen saturation. In this study, we carefully focus on the balance of nitrogen between load and runoff. Annual nitrogen load via atmospheric deposition was estimated to 461.1 t-N/year in the upper reaches of the Kanna River. Annual nitrogen runoff to the forested headwater stream of the Kanna River was determined to 184.9 t-N/year, corresponding to 40.1% of the total nitrogen load. Clear seasonal change in NO3-N concentration was still observed. Therefore, watershed protection forest of the Kanna River is most likely to be in Stage-1 on the status of nitrogen saturation.

Keywords: atmospheric deposition, nitrogen accumulation, denitrification, forest ecosystems

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Authors: M. Shahadat Hossain

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People experiencing economic disadvantages have limited access to justice system. Employment status is a key indicator of economic disadvantage. There is a link between employment status and vulnerability to legal problems. This paper addresses the obstacles unemployed people experience to secure justice in Australia. This paper further explores exiting services for economically disadvantaged people to secure justice where these unemployment people can get access. It reveals that unemployed people are vulnerable to multifaced crime and violence. Due to high cost of legal services, these unemployed people are unable to afford legal services to access justice. They are often found higher levels of nonactions in terms of access to justice also due to lack of their initiatives. This paper further reveals that legal aid commissions are state and territory statutory agencies in Australia which provide free legal information, advice, duty lawyers, and legal representation services. Community legal centres are independent, non-profit government organizations with a focus of early advice, problem solving, and working with other agencies to address connected, financial, and health problems. Moreover, the private profession helps people who cannot afford to pay for a lawyer in several ways. But there are problems of shortage of funding for these legal services and making available to economically disadvantaged people. However, this paper argues that people experiencing long-term unemployment face barriers to secure justice due to their economic disadvantages. It further argues that services available for them to access to justice is inadequate.

Keywords: economic disadvantages, unemployment, access to justice, Australia

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Authors: Esmat Noroozi, Elahe Sarfi, Farha Hosseinzadeh Lotfi

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Examining the impacts of data modification is considered as sensitivity analysis. A lot of studies have considered the data modification of inputs and outputs in DEA. The issues which has not heretofore been considered in DEA sensitivity analysis is modification in the number of inputs and (or) outputs and determining the impacts of this modification in the status of efficiency of DMUs. This paper is going to present systems that show the impacts of adding one or multiple inputs or outputs on the status of efficiency of DMUs and furthermore a model is presented for recognizing the minimum number of inputs and (or) outputs from among specified inputs and outputs which can be added whereas an inefficient DMU will become efficient. Finally the presented systems and model have been utilized for a set of real data and the results have been reported.

Keywords: data envelopment analysis, efficiency, sensitivity analysis, input, out put

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Authors: Eun-Jeong Jang

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Inequality has been considered as a core issue in public policy. Korea is categorized into one of the countries in the high level of inequality, which matters to not only current but also future generations. The relationship between individuals' origin and destination has an implication of intergenerational inequality. The previous work on this was mostly conducted at macro level using panel data to our knowledge. However, in this level, there is no room to track down what happened during the time between origin and destination. Individuals' origin is represented by their parents' socio-economic status, and in the same way, destination is translated into their own socio-economic status. The first research question is that how origin is related to the destination. Certainly, destination is highly affected by origin. In this view, people's destination is already set to be more or less than a reproduction of previous generations. However, educational achievement is widely believed as an independent factor from the origin. From this point of view, there is a possibility to change the path given by parents by educational attainment. Hence, the second research question would be that how education is related to destination and also, which factor is more influential to destination between origin and education. Also, the focus lies in the mediation of education between origin and destination, which would be the third research question. Socio-economic status in this study is referring to class as a sociological term, as well as wealth including labor and capital income, as an economic term. The combination of class and wealth would be expected to give more accurate picture about the hierarchy in a society. In some cases of non-manual and professional occupations, even though they are categorized into relatively high class, their income is much lower than those who in the same class. Moreover, it is one way to overcome the limitation of the retrospective view during survey. Education is measured as an absolute term, the years of schooling, and also as a relative term, the rank of school. Moreover, all respondents were asked the effort scaled by time intensity, self-motivation, before and during the course of their college based on a standard questionnaire academic achieved model provides. This research is based on a survey at an individual level. The target for sampling is an individual who has a job, regardless of gender, including income-earners and self-employed people and aged between thirties and forties because this age group is considered to reach the stage of job stability. In most cases, the researcher met respondents person to person visiting their work place or home and had a chance to interview some of them. One hundred forty individual data collected from May to August in 2017. It will be analyzed by multiple regression (Q1, Q2) and structural equation modeling (Q3).

Keywords: class, destination, educational achievement, effort, income, origin, socio-economic status, South Korea

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Authors: Gladys Oppong, Saumya Singh, Pramod Pathak

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Women entrepreneurship has started establishing itself globally. Despite various social hurdles, Indian women have proved their strength in the area of entrepreneurship. Rising pattern of women entrepreneurship in Indian context make it significant to know the reason behind it. It’s a normal perception that women with financially strong backgrounds are highly motivated to progress in the area of entrepreneurship while lack of money becomes a major restraint for others. The proposed study attempts to identify the motivational factors for becoming women entrepreneur. The research work is to be conducted on women entrepreneurs. For this purpose, factor analysis will be used. The study has identified a set of motivational factors namely family business, social status, education and qualification, self-fulfillment and achievement among others that give momentum to the women to become an entrepreneur. The outcome of the study will be helpful in developing women entrepreneurship in India.

Keywords: women entrepreneurship, motivation, family business, social status

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Authors: Yue Hao

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COVID-19 vaccines not only protect individuals but society as a whole. In this case, having an understanding of the change and trend of vaccination conditions may shed some light on revising and making up-to-date policies regarding large-scale public health promotions and calls in order to lead and encourage the adoption of COVID-19 vaccines. However, vaccination status change over time and vary from place to place hidden patterns that were not fully explored in previous research. In our research, we took advantage of the spatial-temporal analytical methods in the domain of geographic information science and captured the spatial-temporal changes regarding COVID-19 vaccination status in the United States during 2020 and 2021. After conducting the emerging hot spots analysis on both the state level data of the US and county level data of California we found that: (1) at the macroscopic level, there is a continuously increasing trend of the vaccination rate in the US, but there is a variance on the spatial clusters at county level; (2) spatial hotspots and clusters with high vaccination amount over time were clustered around the west and east coast in regions like California and New York City where are densely populated with considerable economy conditions; (3) in terms of the growing trend of the daily vaccination among, Los Angeles County alone has very high statistics and dramatic increases over time. We hope that our findings can be valuable guidance for supporting future decision-making regarding vaccination policies as well as directing new research on relevant topics.

Keywords: COVID-19 vaccine, GIS, space time cube, spatial-temporal analysis

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Authors: Ekpon Oghenetega Philip, Tayire Okabare Favour, Boye Ejobowah Thomas

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The study evaluated the resting systolic blood pressure (RSBP) and resting diastolic blood pressure (RDBP) of staff of a multi-national petroleum company in Nigeria with the aim of helping the staff maintain optimal health which is necessary to carry out their secular work. Eleven healthy male (age 36.9±10.48 years, mean±S.D) and 38 healthy female (39.99±12.23 years, mean±S.D) staff of the multi-national petroleum company performed an incremental exercise on a treadmill and cycle ergometers to determine RSBP and RDBP. An assessment of the health status of the staff of the company was carried out using a physical activity readiness questionnaire (PAR-Q) to determine their suitability for the program. Analysis of the t-test for male staff of RSBP shows that it was statistically significant with a calculated t value of 2.19, α = 0.05 and t-calculated for RSBP of female staff was 1.897, α = 0.05 showing a significance. While the t-calculated RSBP for male staff of the multi-national company is 0.44 with α =0.05 and the female RDBP is 4.129, α = 0.05 and they are all significant. It was recommended that staff of the company should regularly visit the company gym during their leisure hours to maintain optimum health.

Keywords: systolic blood pressure, diastolic blood pressure, exercise, pressure staff

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Authors: Jeetendra Yadav, Geetha Menon, Anita Pal, Rajkumar Verma

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Even after encouraging maternal and child wellness programs at worldwide level, lower-middle income nations are not reached the goal set by the UN yet. This study quantified the contribution of socioeconomic determinants of inequality to the utilization of Antenatal Care in South Asian Countries. This study used data from Demographic Health Survey (DHS) of the selected countries were used, and Oaxaca decomposing were applied for socioeconomic inequalities in utilization of antenatal care. Finding from the multivariate analysis shows that mother’s age at the time of birth, birth order and interval, mother’s education, mass media exposure and economic status were significant determinants of the utilization of antenatal care services in South Asian countries. Considering, concentration index curve, the line of equity was greatest in Pakistan which followed by India and Nepal.

Keywords: antenatal care, decomposition, inequalities, South Asian countries

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Authors: Malul Miki, Rafi Bar-El, Eithan Hourie

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In this article, we test the influence of an occupation as a calling on the value of job security and its connection with wage levels. Our sample consists of 495 workers in Israel from 10 occupations in the public sector, who are assumed to have a relatively high level of job security, and the private sector, who are assumed to have less job security or none at all. These 10 occupations are social workers, lecturers, lawyers, administration workers, accountants, high school teachers, bank workers, high-tech worker, nurses and psychologists. Using regression analysis, we find that those who have occupations that the literature has defined as a calling value job security less than those in ordinary employment. In addition, salary level has no effect on this relationship. Finally, those who work in occupations that are regarded as a calling have less status quo bias than those in ordinary employment.

Keywords: calling, loss aversion, job security, status quo bias

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Authors: Desiree Vandenberghe, Johan Albrecht

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Non-communicable diseases (NCDs) are responsible for the vast majority of deaths in the European Union (EU) and represent a large share of total health care spending. A future increase in this health and financial burden is likely to be driven by population ageing, lifestyle changes and technological advances in medicine. Without adequate prevention measures, this burden can severely threaten population health and economic development. To tackle this challenge, a correct assessment of the current burden of NCDs is required, as well as a projection of potential increases of this burden. The contribution of this paper is to offer perspective on the evolution of the NCD burden towards the future and to give an indication of the potential of prevention policy. A Non-Homogenous, Semi-Markov model for the EU was constructed, which allowed for a projection of the cost burden for the four main NCDs (cancer, cardiovascular disease, chronic respiratory disease and diabetes mellitus) towards 2030 and 2050. This simulation is done based on multiple baseline scenarios that vary in demand and supply factors such as health status, population structure, and technological advances. Finally, in order to assess the potential of preventive measures to curb the cost explosion of NCDs, a simulation is executed which includes increased efforts for preventive health care measures. According to the Markov model, by 2030 and 2050, total costs (direct and indirect costs) in the EU could increase by 30.1% and 44.1% respectively, compared to 2015 levels. An ambitious prevention policy framework for NCDs will be required if the EU wants to meet this challenge of rising costs. To conclude, significant cost increases due to Non-Communicable Diseases are likely to occur due to demographic and lifestyle changes. Nevertheless, an ambitious prevention program throughout the EU can aid in making this cost burden manageable for future generations.

Keywords: non-communicable diseases, preventive health care, health policy, Markov model, scenario analysis

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