Search results for: barriers in disability care

Authors: Kenneth Larsen, Astrid Aasland, Synnve Schjølberg, Trond Diseth

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Autism Spectrum Disorders (ASD) are neurodevelopmental disorders emerging in early development characterized by impairment in social communication skills and a restricted, repetitive and stereotyped patterns of behavior and interests. Early identification and interventions potentially improve development and quality of life of children with ASD. Symptoms of ASD are apparent through the second year of life, yet diagnostic age are still around 4 years of age. This study explored whether symptoms associated with ASD are possible to identify in typical Norwegian day-care centers in the second year of life. Results of this study clearly indicates that most described symptoms also are identifiable by day-care staff, and that a short observation list of 5 symptoms clearly identify children with ASD from a sample of normal developing peers.

Keywords: autism, early identification, day-care, screening

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Authors: Bridget J. Kenny, Elizabeth Hoban, Jo Williams

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Adolescent pregnancy presents a significant public health challenge for Cambodia. Despite declines in the overall fertility rate, the adolescent fertility rate is increasing. Adolescent pregnancy is particularly problematic in the Northeast provinces of Ratanak Kiri and Mondul Kiri where 34 percent of girls aged between 15 and 19 have begun childbearing; this is almost three times Cambodia’s national average of 12 percent. Language, cultural and geographic barriers have restricted qualitative exploration of the sexual and reproductive health (SRH) challenges that face indigenous adolescents in Northeast Cambodia. The current study sought to address this gap by exploring the SRH practices of adolescent mothers from indigenous populations in Ratanak Kiri Province. Twenty-two adolescent mothers, aged between 15 and 19, were recruited from seven indigenous villages in Ratanak Kiri Province and asked to participate in a combined body mapping exercise and semi-structured interview. Participants were given a large piece of paper (59.4 x 84.1 cm) with the outline of a female body and asked to draw the female reproductive organs onto the ‘body map’. Participants were encouraged to explain what they had drawn with the purpose of evoking conversation about their reproductive bodies. Adolescent mothers were then invited to participate in a semi-structured interview to further expand on topics of SRH. The qualitative approach offered an excellent avenue to explore the unique SRH challenges that face indigenous adolescents in rural Cambodia. In particular, the use of visual data collection methods reduced the language and cultural barriers that have previously restricted or prevented qualitative exploration of this population group. Thematic analysis yielded six major themes: (1) understanding of the female reproductive body, (2) contraceptive knowledge, (3) contraceptive use, (4) barriers to contraceptive use, (5) sexual practices, (6) contact with healthcare facilities. Participants could name several modern contraceptive methods and knew where they could access family planning services. However, adolescent mothers explained that they gained this knowledge during antenatal care visits and consequently participants had limited SRH knowledge, including contraceptive awareness, at the time of sexual initiation. Fear of the perceived side effects of modern contraception, including infertility, provided an additional barrier to contraceptive use for indigenous adolescents. Participants did not cite cost or geographic isolation as barriers to accessing SRH services. Child marriage and early sexual initiation were also identified as important factors contributing to the high prevalence of adolescent pregnancy in this population group. The findings support the Ministry of Education, Youth and Sports' (MoEYS) recent introduction of SRH education into the primary and secondary school curriculum but suggest indigenous girls in rural Cambodia require additional sources of SRH information. Results indicate adolescent girls’ first point of contact with healthcare facilities occurs after they become pregnant. Promotion of an effective continuum of care by increasing access to healthcare services during the pre-pregnancy period is suggested as a means of providing adolescents girls with an additional avenue to acquire SRH information.

Keywords: adolescent pregnancy, contraceptive use, family planning, sexual and reproductive health

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Authors: Rishana Bilimoria, Selina Tang, Sajni Shah, Marianne Henien, Christopher Sproat

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Temporomandibular disorders (TMD) may affect up to a third of the general population, and there is evidence demonstrating the majority of Myofascial TMD cases improve after education and conservative measures. In 2015 our department implemented a modified care pathway for myofascial TMD patients in an attempt to improve the patient journey. This involved the use of an interactive group therapy approach to deliver education, reinforce conservative measures and promote self-management. Patient reported experience measures from the new group clinic revealed 71% patient satisfaction. This service is efficient in improving aspects of health status while reducing health-care costs and redistributing clinical time. Since its’ establishment, 52 hours of clinical time, resources and funding have been redirected effectively. This Quality Improvement Project was initiated because it was felt that this new service was being underutilised by our surgical teams. The ‘Plan-Do-Study-Act cycle’ (PDSA) framework was employed to analyse utilisation of the service: The ‘plan’ stage involved outlining our aims: to raise awareness amongst clinicians of the unified care pathway and to increase referral to this clinic. The ‘do’ stage involved collecting data from a sample of 96 patients over 4 month period to ascertain the proportion of Myofascial TMD patients who were correctly referred to the designated clinic. ‘Suitable’ patients who weren’t referred were identified. The ‘Study’ phase involved analysis of results, which revealed that 77% of suitable patients weren’t referred to the designated clinic. They were reviewed on other clinics, which are often overbooked, or managed by junior staff members. This correlated with our original prediction. Barriers to referral included: lack of awareness of the clinic, individual consultant treatment preferences and patient, reluctance to be referred to a ‘group’ clinic. The ‘Act’ stage involved presenting our findings to the team at a clinical governance meeting. This included demonstration of the clinical effectiveness of the care-pathway and explaining the referral route and criteria. In light of the evaluation results, it was decided to keep the group clinic and maximize utilisation. The second cycle of data collection following these changes revealed that of 66 Myofascial TMD patients over a 4 month period, only 9% of suitable patients were not seen via the designated pathway; therefore this QIP was successful in meeting the set objectives. Overall, employing the PDSA cycle in this QIP resulted in appropriate utilisation of the modified care pathway for patients with myofascial TMD in Guy’s Oral Surgery Department. In turn, this leads to high patient satisfaction with the service and effectively redirected 52 hours of clinical time. It permitted adoption of a collaborative working style with oral surgery colleagues to investigate problems, identify solutions, and collectively raise standards of clinical care to ensure we adopt a unified care pathway in secondary care management of Myofascial TMD patients.

Keywords: myofascial, quality Improvement, PDSA, TMD

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Authors: N. R. N. Mendis, S. N. Silva

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Introduction: Patient satisfaction of services provided by primary care health services depends on many factors. One key factor in this depends on is the nursing services received in primary care. Since majority of the primary care in Sri Lanka is provided by the private sector, it is important to assess patient satisfaction on this. Objective: To assess the satisfaction among the public on nurses working in dispensaries in Sri Lanka. Methods: A descriptive study was done on 200 individual selected using convenient sampling among dispensaries in Gampaha district, Sri Lanka. Results: 59.3% of the sample had long term illnesses or disabilities and all of them preferred speaking to a nurse. 70.9% of the sample used to make appointments with nurses while 57.8% out of them were comfortable in discussing their health concerns. 98.9 % agreed that they get individual attention by the nurses. Majority of the sample that is 34.2% spends around 20 minutes with the nurse without even making any pay. Significantly, the whole sample believes that the nurses are professional and admits that the care given is of high quality. All 100% of the sample said that the nurses could understand their concerns while 93.5% admitted that it was very useful in their recovery. Conclusions: Majority of the public were very much satisfied with the nurses and their practice at the dispensaries.

Keywords: health education, nurses practices, patient satisfaction, primary care

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Authors: P. Srisuruk, P. Narot

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The purpose of this research were 1) to develop the curriculum and instructional approach that are suitable for children with autism, attention deficit hyperactivity disorder and learning disability as well as to arrange the instructional approach that can be integrated into inclusive classroom 2) to increase the competency of the children in these group. The research processes were to a) study related documents, b) arrange workshops to clarify fundamental issues in developing core curriculum among the researchers and experts in curriculum development, c) arrange workshops to develop the curriculum, submit it to the experts for criticism and editing, d) implement the instructional approach to examine its effectiveness, e) select the schools to participate in the project and arrange training programs for teachers in the selected school, f) implement the instruction approach in the selected schools in different regions. The research results were 1) the core curriculum to enhance the competency of children with autism, attention deficit hyperactivity disorder and learning disability , and to be used as a guideline for teachers, and these group of children in order to arrange classrooms for students with special needs to study with normal students, 2) teaching and learning methods arranged for students with autism, attention deficit, hyperactivity disorder and learning disability to study with normal students can be used as a framework for writing plans to help students with parallel problems by developing teaching materials as part of the instructional approach. However, the details of how to help the students in each skill or content differ according to the demand of development as well as the problems of individual students or group of students. Furthermore; it was found that most of target teacher could implement the instructional approach based on the guideline model developed by the research team. School in each region does not have much difference in their implementation. The good point of the developed instructional model is that teacher can construct a parallel lesson plan. So teacher did not fell that they have to do extra work it was also shown that students in regular classroom enjoyed studying with the developed instructional model as well.

Keywords: instructional approach, autism, attention deficit hyperactivity disorder, learning disability

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Authors: Zeinab Aliyas

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Walking is known as the most common type of physical activity that helps mental and physical health of people. In the recent years, promoting walking activity in neighborhood areas and cities become as one of the important issues in terms of sustainable cities. Therefore the study aimed to investigate the influence of fear of crime and personal barriers as social and personal factor respectively on neighborhood walking. 464 questionnaires in Bandar Baru Bangi in Malaysia was distributed to collect data, and finally, 424 questionnaires were qualified to be used in the study. The Smart-PLS was used to analyze the data. The findings of the study revealed that individual barriers and fear of crime both have significant influence on the level of walking behavior in the neighborhood area. It was found that fear of crime has higher influence on walking behavior in comparison to individual factors. The finding of this study can help urban researcher and planner to know the significant influence of crime safety and individual attitudes on the level of walking activity.

Keywords: fear of crime, neighborhood walking, personal barriers, residential neighborhood

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Authors: Adekunle O. Afolabi, Pekka Toivanen

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The world is expected to experience growth in the number of ageing population, and this will bring about high cost of providing care for these valuable citizens. In addition, many of these live with chronic diseases that come with old age. Providing adequate care in the face of rising costs and dwindling personnel can be challenging. However, advances in technologies and emergence of the Internet of Things are providing a way to address these challenges while improving care giving. This study proposes the integration of recommendation systems into homecare to provide real-time recommendations for effective management of people receiving care at home and those living with chronic diseases. Using the simplified Training Logic Concept, stakeholders and requirements were identified. Specific requirements were gathered from people living with cancer. The solution designed has two components namely home and community, to enhance recommendations sharing for effective care giving. The community component of the design was implemented with the development of a mobile app called Recommendations Sharing Community for Aged and Chronically Ill People (ReSCAP). This component has illustrated the possibility of real-time recommendations, improved recommendations sharing among care receivers and between a physician and care receivers. Full implementation will increase access to health data for better care decision making.

Keywords: recommendation systems, Internet of Things, healthcare, homecare, real-time

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Authors: Ming-Juei Chang, Hui-Ing Ma, Tsung-Hsueh Lu

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Introduction: Because of the advance of medical care (e.g., ventilation techniques and gastrostomy feeding), more and more children with CP can live to adulthood. However, little is known about the use of health care services from children to adults who have CP. The patterns of utilization of ambulatory care are heavily influenced by insurance coverage and primary care gatekeeper regulation. The purpose of this study was to examine patterns of ambulatory care utilization among individuals with CP in Taiwan, a country with universal coverage and no gatekeeper regulation. Methods: A representative sample of one million patients (about 1/23 of total population) covered by Taiwan’s National Health Insurance was used to analyze the ambulatory care utilization in individuals with CP. Data were analyzed by 3 different age groups (children, youth and adults) during 2000 to 2003. Participants were identified by the presence of CP diagnosis made by pediatricians or physicians of physical and rehabilitation medicine and stated at least three times in claims data. Results: Annual rates of outpatient physician visits were 31680 for children, 16492 for youth, and 28617 for adults with CP (per 1000 persons). Individuals with CP received over 50% of their outpatient care from hospital outpatient department. Higher use of specialist physician services was found in children (54.7%) than in the other two age groups (28.4% in youth and 18.8% in adults). Diseases of respiratory system were the most frequent diagnoses for visits in both children and youth with CP. Diseases of the circulatory system were the main reasons (24.3%) that adults with CP visited hospital outpatient care department or clinics. Conclusion: This study showed different patterns of ambulatory care utilization among different age groups. It appears that youth and adults with CP continue to have complex health issues and rely heavily on the health care system. Additional studies are needed to determine the factors which influence ambulatory care utilization among individuals with CP.

Keywords: cerebral palsy, health services, lifespan, universal coverage

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Authors: Dil Ware Alam, Faiza Zebeen, Sumaya Binte Masud

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COVID-19) has impacted the whole world, including Bangladesh. The epidemic has reduced access to health care, particularly for women, creating challenges for an increasingly disadvantaged population. Women's health and well-being in Bangladesh are susceptible to a rise in domestic violence and need to be addressed quickly. The planet has been greatly influenced by Coronavirus disease 2019 (COVID-19), and Bangladesh is no difference. The pandemic has resulted in a decline in the availability of health care, notably for women's health problems, leading to an increase in difficulties for an increasingly marginalized group. Maternity care, maternal health programs, medical interventions, nutritional counseling and mental health care, are not discussed, and women's health and well-being in Bangladesh is vulnerable with a spike in domestic violence and needs to be resolved urgently.

Keywords: Covid-19, mental health, reproductive health, Bangladesh

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Authors: Samuel Olugbenga King

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Using a reflective analysis tool to provide both local and global perspectives, this study focuses on the longitudinal evaluation of the Graduate Student Development (GSD) initiative, the Preparing Future Faculty (PFF) program. The reflection process involves examining the past and present to identify challenges, and culminates in the creation of an action plan to address barriers to further growth and teaching development of graduate students, thus positively impacting student experience. The outcomes of the reflective critique of the PFF program indicate that lack of mentoring as well as inadequate feedback and funding are barriers that need to be addressed to positively impact the graduate student experience. Consequently, interventions, such as peer and student evaluations, and alumni surveys are highlighted as pragmatic modes of addressing the inadequate feedback and mentoring barriers. However, funding remains an ongoing challenge. This article is a contribution to the literature on the use of critical reflection approaches to investigate and evaluate specific programming that focuses on enhancing the graduate student experience and development.

Keywords: graduate student experience, longitudinal reflection, quality enhancement, teaching

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Authors: Karish Thavabalan, Aman Sutaria, Alistair Ovenell, Annabelle Parkhouse, Numan Baydemir, Theodore Lally

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Background: Open discussions surrounding menopause are often associated with stigma, with many women feeling uncomfortable engaging in them with friends, colleagues, and healthcare professionals. Though the barriers regarding safe discussions of symptom management experienced by menopausal women are well documented, existing research offers little insight into whether these were shared by pre-menopausal women. This study aimed to explore the barriers regarding safe discussions about menopausal symptom management as perceived or experienced by pre-menopausal and menopausal women. Methods: This qualitative study was conducted over a 2-month period (March 2022 - April 2022) under the auspices of Imperial College Business School, London, UK. Snowball sampling was used to recruit both menopausal (age 45-70) and pre-menopausal participants (age <45) and sampling continued until data saturation was achieved. Sixteen semi-structured online interviews were conducted, and transcripts were thematically analyzed following Braun and Clarke’s six-step methodology. Results: A total of 7 higher themes regarding safe discussion of menopausal symptom management were identified by both pre-menopausal and menopausal women, including: “ineffective coping mechanisms,” “perceived onus to self-endure,” “lack of workplace support,” “poor knowledge of management approaches,” “poor healthcare infrastructure,” “poor support from friends and family,” “lack of knowledge and interest from a young age.” Conclusion: Identifying the barriers regarding safe discussion helped to highlight which areas require the most significant intervention. Alongside tackling the barriers, menopausal women face, ultimately, there is a pertinent need to address the lack of insight into menopause from a younger age and to encourage earlier discussions so as to not propagate the cycle of stigma.

Keywords: menopause, safe discussion, symptom management, stigma

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Authors: Deependra Prasad Sarraf, Gajendra Prasad Rauniar, Robin Maskey, Rajiv Maharjan, Ashish Shrestha, Ramayan Prasad Kushwaha

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Objectives: To assess the perception of faculties towards online teaching-learning activities conducted during the COVID-19 pandemic and to identify barriers and facilitators to conducting online teaching-learning activities in our context. Methods: A cross-sectional study was conducted among faculties at B. P. Koirala Institute of Health Sciences using a 26-item semi-structured questionnaire. A Google Form was prepared, and its link was sent to the faculties via email. Descriptive statistics were calculated, and findings were presented as tables and graphs. Results: Out of 158 faculties, the majority were male (66.46%), medical faculties (85.44%), and assistant professors (46.84%). Only 16 (10.13%) faculties had received formal training regarding preparing and/or delivering online teaching learning activities. Out of 158, 133 (84.18%) faculties faced technical and internet issues. The most common advantage and disadvantage of online teaching learning activities perceived by the faculties were ‘not limited to time or place’ (94.30%) and ‘lack of interaction with the students’ (82.28%), respectively. Majority (94.3%) of them had a positive perception towards online teaching-learning activities conducted during COVID-19 pandemic. Slow internet connection (91.77%) and frequent electricity interruption (82.91%) were the most common perceived barriers to online teaching-learning. Conclusions: Most of the faculties had a positive perception towards online teaching-learning activities. Academic leaders and stakeholders should provide uninterrupted internet and electricity connectivity, training on online teaching-learning platform, and timely technical support.

Keywords: COVID-19 pandemic, faculties, medical education, perception

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Authors: Reda Goweda, Mokhtar Shatla, Arawa Alzaidi, Arij Alzaidi, Bashair Aldhawani, Hibah Alharbi, Noran Sultan, Daniah Alnemari, Badr Rawa

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Background: 20.5% of Saudis between 20 and 79 years are diabetics. Diabetic foot is a chronic complication of diabetes. The incidence of non traumatic lower extremity amputations is at least 15 times greater in those with diabetes than non diabetics. Patient education is important to reduce lower extremity complications. Objective: To assess the knowledge and practices of the diabetic patients regarding foot care and diabetic foot complications. Methods: In Makkah hospitals, 350 diabetic patients who met the inclusion criteria were involved in this cross sectional study. Interviewing questionnaire and patients’ charts review were used to collect the data. Results: Mean age of patients was 53.0083±13.1 years, and mean duration of diabetes was 11.24±8.7 years. 35.1% had history of foot ulcer while 25.7% had ulcer on the time of interview. 11.7 % had history of amputation and 83.1% had numbness. 77.1 % examine their feet while 49.1% received foot care education and 34% read handouts on foot care. 34% walk around in bare feet. There is a significant statistical association between foot education, foot care practices, and diabetic foot ulcer (p-value < 0.022). Conclusion: Patient knowledge and practices regarding diabetic foot care is significantly associated with the reduction of diabetic foot ulcer.

Keywords: knowledge, practice, attitude, diabetes, foot, care

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Authors: Nattanon Peerapen, Wanwisa Insang, Lanlalin Khumman, Wipada Juanprajak, Sikan Na Chiangmai, Wacharin Suksanan, Thanasak Tantinakom

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This research was intended to study guidelines from elderly care businesses that are continuously growing and rapidly benefitting because these businesses respond to the needs of those who cannot find time to in take care of their elderly people, including intimate care services from the caregivers, thus rapidly expanding elderly care businesses to have recently become interesting domestically and internationally. Chiang Mai is a popular choice for the businesses because of excellent weathers and simple and peaceful ways of living, thus making the businesses grow rapidly and continuously. The sample group consisted of 5 persons, executives and staff, from each of the 4 businesses that provide elderly cares chosen to interview by the researches, which were Vivo Bene Village, Baan Donsuk, PT Nursing Home, and PD Nursing Home. The interviews indicated that most elderly care businesses are located in rural areas with moving traffics, shady environments, and far from crowded urban areas since elderly people need peacefulness and clean environments that will affect their physical and mental health directly. The sections within the businesses are distinctly divided with definite duties assigned to each personnel, including welfares, remunerations, uniforms, accommodations, food and social occasions, such as birthdays or New Year festivities.

Keywords: elderly, elderly care, business strategy, success factors

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Authors: Anna Wiltshire, Rebecca Markham

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Over the last decade, a growing body of evidence has indicated that children with disabilities are often amongst the most excluded and vulnerable in society. The World Bank estimates that 20% of those living in poverty in developing countries are disabled which means that those with the least bear the greatest burden. Furthermore, children with disabilities in Africa have to face a multitude of difficulties ranging from the physical to the psychological. Misconceptions and cultural beliefs are used to justify violence against, or complete shunning of these individuals and their families. In addition, discrimination can prevent access to both education and health services, further compromising these individuals. All children, irrespective of their disability should be able to enjoy human rights without discrimination, but this is often not the case. This poster explores how and why children with disabilities in Africa are subject to violations of their human rights, and suggests ways of addressing these problems.

Keywords: Africa, children, disability, discrimination, human rights

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Authors: Mustafa Gulsen, Mitat Koz

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The aim of this study is to investigate the effect of lumbar stabilisation and proprioceptive neuromuscular facilitation (PNF) training on muscle strength and muscle endurance. The participants were 64 between the ages of 15-69 (53.04 ± 14.59), who were graded protrusion and bulging lumbar herniation according to 'Macnab Classification'. The participants were divided into four groups as each group had 16 participants: lumbar stabilitation training, PNF training, physical therapy and control groups. Sociodemographic features were recorded. Then their muscle strength tests (by isokinetic dynamometer (Cybex 770 Norm Lumex Inc, Ronkonkoma, NY, USA) were recorded. Before and after applications; visual analogue scale (VAS), Oswestry Disability İndex were applied by a physical therapist. The participants in lumbar stabilisation group performed 45 minutes, 5 days in a week for 4 weeks strength training with a physical therapist observation. The participants in PNF group performed 5 days in a week for 4 weeks with pelvic patterns of PNF by a physiotherapist. The participants in physical therapy group underwent Hotpack, Tens and Ultrasound therapy 5 days in a week for 4 weeks. The participants in control group didn’t take any training programme. After 4 weeks, the evaluations were repeated. There were significant increases in muscle strength and muscle endurance in lumbar stabilization training group. Also in pain intensity at rest and during activity in this group and in Oswestry disability index of patients, there were significant improvements (p < 0.05). In PNF training group likewise, there were significant improvements in muscle strength, muscle endurance, pain intensity at rest and with activity and in Oswestry disability index (p < 0.05). But improvements in the Lumbar Stabilization group was better than PNF Group. We found significant differences only in pain intensity at rest and with activity and in Oswestry disability index (p < 0.05). in the patients in Physical Therapy group. We think that appropriate physiotherapy and rehabilitation program which will be prepared for patients, to protect the waist circumference of patients with low muscle strength and low muscle endurance will increase muscle strength and muscle endurance. And it is expected that will reduce pain and will provide advances toward correcting functional disability of the patients.

Keywords: disc herniation, endurance, lumbar stabilitation exercises, PNF, strength

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Authors: Yen Sun, Pariang Siagian

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The aim of this paper is to examine the progress of financial inclusion in Indonesia. The object of this paper is Micro Enterprises (MEs) and methodology used will be qualitative method by using surveys and questionnaires. The results show that there are still 20% MEs have no banking facilities at all and about 78% MEs still use their own capital to run their business. Furthermore, personal characteristics such as gender and education are factors that can explain financial inclusion. It is also said that in general MEs need banking product and services. However, there are still barriers that hinder them to be financially included. The most barriers they have to face are marketing exclusion. It shows that they have lack information about banking product and services since marketing strategy from bank is not disseminated clearly through various media.

Keywords: financial inclusion, financial exclusion, micro enterprises, Indonesia

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Authors: Jessica Gladden

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Yoga has been accepted in the majority of communities in the United States as a method of assisting individuals with improving their physical health. Both community yoga classes and yoga-based therapy have been shown to be highly useful for individual’s mental health. Yoga-based therapy has been supported by research to be an evidence-based practice for individuals experiencing anxiety, depression, and disordered eating and for those experiencing post traumatic stress disorder in the wake of trauma. Many individuals who have experienced trauma, as well as other mental health diagnoses, are either very disconnected from their physical bodies or feel unsafe in their bodies. Yoga can be a method of creating safety and control in the body. This is recommended by some of the leading researchers in trauma therapy as a beginning step towards finding safety in the body in order to begin to work on the additional mental health challenges before addressing other long-term challenges. Unfortunately, yoga for physical and mental health is underutilized in black and brown communities despite the research regarding the benefits. Very few studies have examined the barriers to access to yoga for black, brown, and indigenous individuals. This study interviewed 15 yoga practitioners who identified as black or brown and explored the barriers they see in their communities related to accessing yoga and yoga-based services. Several of the themes reported include not feeling welcome, cost of services, time, and cultural/ religious components. Methods for reducing barriers will also be discussed.

Keywords: yoga, sport, barrier, black

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Authors: Semira Zeru Haileslassie

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Lack of awareness and practices of PEP treatment were observed among respondents, but they had a better attitude towards PEP. To this end, a formal training for all respondents regarding PEP for HIV prior to their clinical attachments is of utmost importance. The training ought to incorporate a brief clarification with respect to the unpleasant impact of non-adherence that essentially incorporate destitute treatment result and most prominent hazard of resistance and few given as a major cause for non-compliance to PEP, common transient side-effects of PEP and its administrations ought to be cloister educated healthcare specialists to diminish its effect on adherence. Besides, the propensity of detailing needle adhere harm was destitute that needs endeavors to progress. Progressing the culture of detailing and making the detailing handle simple is very necessary. In reality, announcing such wounds as early as conceivable will educate others not to commit same issue once more and, for the most part, will empower stakeholders to intercede the issue sometime prior to it re-occur. At long last, as distant as get up and go utilize has cleared out with so numerous bothers, risk decrease is the foremost choice. With this, taking the increased significance of protective barriers so as to decrease the hazard of exposure to HIV, distinctive stakeholders (the healing center hardware supply chain director, the HIV/ Helps clinic, the clinic chief, hardware and supply quality confirmation group, and other authoritative bodies) ought to work together in co-ordination to secure the supply and guarantee the quality of those crucial protective barriers and to advance demand health laborers to continuously wear protective barriers when exposed to HIV hazard components as well as to dispose appropriately once done. At long last, we prescribe future examiners to conduct planned multicenter studies with extra goals (counting indicator investigation) for way better generalization and result. In spite of satisfactory information and favorable state of mind towards PEP for HIV in most of the respondents, this study uncovered that there were delays in starting, low utilization, and fragmented use of the prescribed PEP. So, health care staff need to progress their practice on PEP of HIV through diverse training program related to PEP of HIV.

Keywords: HIV infection, prophylaxis, knowledge, attitude

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Authors: Merav Ben Natan, Moran Makhoul Khuri, Haviel Hammer, Maya Yarkoni

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Background: Studies indicate that nursing students often rank hospice nursing among their least preferred career paths. Understanding factors influencing their intent to work in hospice care is essential for improving interest in this field. Aim: This study aimed to explore the relationship between nursing students' intention to pursue a career in hospice care and various factors, including their attitudes towards caring for dying patients, death anxiety, personal or professional experience with dying patients, and the type of nursing program they are enrolled in. Methods: In this cross-sectional study, 200 nursing students completed an online survey using the Frommelt Attitude Toward Care of the Dying Scale and the Turkish Death Anxiety Scale. The survey assessed students' intentions to work in hospice care and related variables. Results: Only 11% of participants expressed an interest in working in hospice care. Students in the accelerated program for non-nursing Bachelor of Arts graduates showed a higher intention to work in hospice care compared to those in the generic program (β = 0.27, P < .001). Conversely, completion of clinical experience in a medical ward was associated with a lower intention to work in hospice care (β = −0.21, P < .01). Conclusions: The findings suggest that nursing students in accelerated programs for non-nursing graduates are more likely to intend to work in hospice care. Enhanced experience and support are recommended to sustain their interest. Clinical experience in medical wards does not effectively substitute for hospice-specific clinical experience.

Keywords: hospice nursing, nursing students, death anxiety, career intentions

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Authors: Emni Omar Daw Hussin, Pathmawathi Subramanian, Wong Li Ping

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Background: To provide quality care at the end of life, nurses should possess knowledge and skills to provide effective end-of-life care, as well as develop the attitudes and interpersonal competence to provide compassionate care. Aim: This study aimed to assess nurses’ knowledge and attitude towards end of life care and caring for terminal ill patients and to examine relationships among demographic variables and nurse’s knowledge and attitudes toward end of life care and caring for terminal ill patients. Method: a cross-sectional study was conducted at 1 tertiary hospital located in Kuala Lumpur, Malaysia. Self-administrative questionnaire was used to collect data from 553 nurses from over all departments except emergency department, operation theater and outpatient clinic. Two tools were used in this study, the Frommelt’s Attitude Toward Care of the Dying (FATCOD) Scale to assess the nurses’ attitude and End of Life Knowledge Assessment to assess the nurses’ knowledge. Result: the result of this study yielded that, the majority of participants (54.8%) and (54.4%) have less positive attitude and knowledge towards end of life care and caring for terminal ill patients respectively. As well as there is no significant relationship were found between nurses’ ethnicity, religion, and the total score of FATCOD scale; End of Life Knowledge Assessment score. On other hand there is significant relationship among nurses’ age, working experience, level of education, attending any post basic courses and the total score of both FATCOD scale and End of Life Knowledge Assessment. Conclusion: A lack of education and experience and post basic course about end of life care and palliative care may contribute to the negative attitudes and poor knowledge regarding end of life care. Providing sufficient courses about end of life care could enhance the nurses’ knowledge towards end of life care, as well as providing a reflective narrative environment in which nurses can express their personal feelings about death and dying could be a potentially effective approach. Implication for Practice: This study elaborates the need for further research to develop an effective educational programs to enhance nurses’ knowledge and to promote positive attitude towards death and dying, as well as enhance communication skills, and coping strategies.

Keywords: knowledge, attitude, nurse, end of life care

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Authors: R. Ananthanarayanan, S. B. Nakula, D. R. Seenivasagam, J. Naua, B. Sharma

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Product packaging is a critical component of production, trade, and marketing, playing numerous vital roles that often go unnoticed by consumers. Packaging is essential for maintaining the shelf life, quality assurance, and safety of both manufactured and agricultural products. For example, harvested produce or processed foods can quickly lose quality and freshness, making secure packaging crucial for preservation and safety throughout the food supply chain. In Fiji, agricultural packaging has primarily been managed by local companies for international trade, with gradual advancements in these practices. To further enhance the industry’s performance, this study examines the challenges and constraints hindering the optimization of agricultural packaging practices in Fiji. The study utilizes Multi-Criteria Decision Making (MCDM) tools, specifically Interpretive Structural Modeling (ISM) and Cross-Impact Matrix Multiplication Applied to Classification (MICMAC). ISM analyzes the hierarchical structure of barriers, categorizing them from the least to the most influential, while MICMAC classifies barriers based on their driving and dependence power. This approach helps identify the interrelationships between barriers, providing valuable insights for policymakers and decision-makers to propose innovative solutions for sustainable development in the agricultural packaging sector, ultimately shaping the future of packaging practices in Fiji.

Keywords: agricultural packaging, barriers, ISM, MICMAC

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Authors: Alya Al Ghufli, Kelaithim Al Tunaiji, Sara Al Ali, Khalid Samara

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It is well known that health care systems encompass a variety of key knowledge sources that need to be integrated and shared amongst all types of users to attain higher-levels of motivation and productivity. The development of Health Integrated Systems (HIS) is often seen as a crucial step in strengthening the integration of knowledge to help serve the information needs of health care users. As an emergent economy, the United Arab Emirates (UAE) is regarded as a new arrival in the area of health information systems. As a new nation, there may be several challenges in terms of organisational climate and the sufficient skills and knowledge activities for effective use of HIS. In this regard, the lack of coordination, attitudes and practice of health-related systems can eventually result in unnecessary data and generally poor use of the system. This paper includes results from a qualitative preliminary study carried out from a case study investigation in a single large primary health care organisation in the United Arab Emirates (UAE) comprising various health care users. The study explored health care user’s perceptions about health integration and the impact it has on their practice. The main sources of information were semi-structured interviews and non-obtrusive observations. The authors conclude by presenting various recommendations for the development of HIS and knowledge activities and areas for further study.

Keywords: health integrated systems, knowledge sharing, knowledge activities, health information systems

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Authors: Mostafa Gabr, Rania Abdul Galil, Nihal Salim

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Various interventions are applied in cities with the aim to improve living and acoustic environmental conditions. Noise is one of the most influential and critical factors in the environment that has an effect on the QOL (quality of life) and urban environment. It ranks second among environmental pollution issues according to EEAA. Traffic noise is a major source of noise. Noise barriers are one of the physical techniques in landscape design used to reduce the impact of noise pollution in urban areas. Roadways noise pollution can be best controlled by a noise barrier. The aim of this paper is to consider all facets of sustainability when designing a comfortable acoustic environment in roadways, through different strategies related to planning and the design process. The study focuses on the relation between the design of noise barriers as a landscape noise mitigation installation and their materiality in so far as it influences the sustainability of the open space and the acceptability of users. According to previous studies, design of noise barrier mainly depends on cost as a decisive factor. This study asserts that environmental and socioeconomic costs associated are equally important. Hence, the paper presents a strategy for sustainable soundscape design. It builds a framework focusing on materiality considering the environmental and socioeconomic impact of noise barriers shaping urban open space around the road ways, and the different academic and market positions on noise barrier types and materials. Finally, it concludes with a matrix of the relation between the noise barrier design consideration and the three pillars of sustainability (social, economic and environmental).

Keywords: traffic noise level, acoustic sustainability, noise barrier, noise reduction, noise control, acoustical level

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Authors: Eddy K. Mukadi

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The aim of this study was to provide contributing elements to improve the management of the asthma crisis in the intensive care unit of the General Reference Hospital of Kinshasa. This was a descriptive study of all patients in the intensive care unit presenting with the asthma attack during the period from February 5, 2013 to February 5, 2014. The main data were obtained from consultation registry and medical records. A total of 35 patients, 21 of whom were male (majority) compared to 14 female. Average age of patients was 46.48 plus or minus 16.98 with extremes ranging from 21-75 years. The clinic was dominated by dyspnea in 100% of cases, followed by rales with 91.4% of cases. In spite of the control of the crisis obtained after the treatment with B2 mimetic by inhalation was introduced A 91.5%; 88% corticosteroids; 80% oxygen, the therapeutic principle recommended for the management of asthma attacks was not respected in the majority of cases. This is why we suggest that improving the quality of care to be administered to patients will yield more adequate results.

Keywords: asthma crisis, intensive care, general hospital, Kinshasa

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Authors: D. M. Lewis, L. Frisby, U. Stead

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Objective: Many patients are receiving invasive treatments in acute care or are dying in hospital without having had comprehensive goals of care conversations. Some of these treatments may not align with the patient’s wishes, may be futile, and may cause unnecessary suffering. While many staff may recognize the benefits of engaging patients and families in Serious Illness Conversations (a goal of care framework developed by Ariadne Labs in Boston), few staff feel confident and/or competent in having these conversations in acute care. Another barrier to having these conversations may be due to a lack of incorporation in the current workflow. An educational exercise, titled the Two Question Challenge, was initiated on four medical units across two Vancouver Coastal Health (VCH) hospitals in attempt to engage the entire interdisciplinary team in asking patients and families questions around goals of care and to improve the documentation of these expressed wishes and preferences. Methods: Four acute care units across two separate hospitals participated in the Two Question Challenge. On each unit, over the course of two eight-hour shifts, all members of the interdisciplinary team were asked to select at least two questions from a selection of nine goals of care questions. They were asked to pose these questions of a patient or family member throughout their shift and then asked to document their conversations in a centralized Advance Care Planning/Goals of Care discussion record in the patient’s chart. A visual representation of conversation outcomes was created to demonstrate to staff and patients the breadth of conversations that took place throughout the challenge. Staff and patients were interviewed about their experiences throughout the challenge. Two palliative approach leads remained present on the units throughout the challenge to support, guide, or role model these conversations. Results: Across four acute care medical units, 47 interdisciplinary staff participated in the Two Question Challenge, including nursing, allied health, and a physician. A total of 88 questions were asked of patients, or their families around goals of care and 50 newly documented goals of care conversations were charted. Two code statuses were changed as a result of the conversations. Patients voiced an appreciation for these conversations and staff were able to successfully incorporate these questions into their daily care. Conclusion: The Two Question Challenge proved to be an effective way of having teams explore the goals of care of patients and families in an acute care setting. Staff felt that they gained confidence and competence. Both staff and patients found these conversations to be meaningful and impactful and felt they were notably different from their usual interactions. Documentation of these conversations in a centralized location that is easily accessible to all care providers increased significantly. Application of the Two Question Challenge in non-medical units or other care settings, such as long-term care facilities or community health units, should be explored in the future.

Keywords: advance care planning, goals of care, interdisciplinary, palliative approach, serious illness conversations

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Authors: Nurten Çelik

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Under the new developments in science, medicine, sociology, psychology and literary theories, body studies has gained huge importance and the body has become a debatable issue. There has emerged, among sociologists and literary theorists, an overwhelming consensus that body is socially, politically and culturally perceived and constructed and thus, the position of an individual in the society is determined in accordance with his/her body image. In this regard, the most complicated point is the theoretical views propounded upon disability studies, where the disabled body is considered to be a site upon which social and political restrictions as well as repressions are inscribed. There has been the widely-accepted view that no matter what kind of disability it is, those with physical, mental or learning impairments face varied social, political and environmental obstacles that prevent them from being an active citizen, worker, lover and even a family member. In parallel with these approaches, the matter of the sufferings of disabled individuals attains its place in cinema and literature as well as in theatre studies under the category of disability theatre. One of the prominent plays that deal with physical disability came from the contemporary British playwright Nina Raine. In her awarded play Tribes, which premiered at the Royal Court Theatre in 2010, Raine develops the social strata where her deaf protagonist, Billy, caught up between two tribes – namely his family and his lover Slyvia, a member of the deaf community– experiences personal and social hardships due to his hearing impairment. In the play, intransigent and self-opinionated family members foster no sense of empathy towards Billy, there are noisy talking and shouting, but no communication, love, compassion or mutual understanding, and language becomes just a tool for the expression of rage and oppression. In the disordered atmosphere of the family life, Billy experiences isolation and loneliness. Billy’s hopes for success and love are destroyed when Slyvia, troubled between hearing and deafness, rejects him because she does not utterly grasp what Billy is experiencing. Drawing upon the hardships, Billy undergoes in his relationships with his family and his girlfriend, Tribes problematizes the concept of deafness and explores to what extent a deaf person can find a place in the hearing world. Setting ‘the disabled’ bodies against ‘the abled’ bodies in a family, a microcosm of the society where bodies are socially shaped and constructed, Tribes dramatizes how the disabled bodies are disenfranchised, stigmatised, marginalized and othered on the grounds that they are socially misfit. Tribes, with a specific focus on the dysfunctional family, shows that the lack of communication and empathy numbs the characters to the feelings of each other and thereby, they become more disabled than Billy. In conclusion, this paper, with the reference to the embodiment of disability and social theories, aims to explore how disabled bodies are socially marked and segregated from family and society.

Keywords: body, deafness, disability, disability theatre, Nina Raine, tribes

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Authors: Lucie Litvack, Malaz Elsaddig, Kevin Jones

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There is strong evidence to support the efficacy of the World Health Organization (WHO) Surgical Safety Checklist in improving patient safety; however, its use can be associated with difficulties. This study uses qualitative data collected in Kitovu Healthcare Complex, a rural Ugandan hospital, to identify factors that may influence the use of the checklist in a low-income setting. Potential barriers to and motivators for the hospital’s use of this checklist are identified and explored through observations of current patient safety practices; semi-structured interviews with theatre staff; a focus group with doctors; and trial implementation of the checklist. Barriers identified include the institutional context; knowledge and understanding; patient safety culture; resources and checklist contents. Motivators for correct use include prior knowledge; team attitudes; and a hospital advocate. Challenges are complex and unique to this socioeconomic context. Stepwise change to improve patient safety practices, local champions, whole team training, and checklist modification may assist the implementation and sustainable use of the checklist in an effective way.

Keywords: anaesthesia, patient safety, Uganda, WHO surgical safety checklist

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Authors: J. Raub, H. Schillok, L. Kaupe, C. Jung-Sievers, G. Pitschel-Walz, M. Bühner, J. Gensichen, F. D. Pokal-Gruppe

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Introduction: In Germany, depression ranks among the top ten diseases with the highest disease burden and often occurs with comorbidities. Collaborative Care (CC), a concept developed in the United States for the primary care management of chronic diseases, has been identified as an efficient model for the treatment of depression in general medicine. A recent meta-analysis highlights research gaps regarding CC in patients with psychiatric multimorbidity. The highest prevalence of psychiatric comorbidities in depression is observed in anxiety disorders, post-traumatic stress disorder (PTSD), and substance use disorders. Methods: We conducted a literature search following the PRISMA guidelines with three components: Collaborative Care, Depression and randomized controlled trial on the common databases. We focused on the examination of psychiatric comorbidities in depression, specifically Posttraumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD). Results: During the screening process, we identified nine relevant articles related to PTSD, the number of articles related to Substance Use Disorder (SUD) was ten. We examined a total of 8,634 individuals. Our literature review did not reveal any overall significant superiority of the Collaborative Care model compared to Usual Care in patients with depression with comorbid Substance Use Disorder (SUD) or Posttraumatic Stress Disorder (PTSD). Discussion: Five studies demonstrate a faster and statistically significant improvement in depression outcomes among patients with Substance Use Disorder (SUD) and Posttraumatic Stress Disorder (PTSD). Currently, several randomized controlled trials on the topic of Collaborative Care in depression with psychiatric comorbidity are ongoing, such as miCare, Claro and COMET.

Keywords: Depression, primary care, collaborative care, PTSD, Substance use Disorder

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Authors: Harriet Nalubega, Eddie Mwebesa

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In Uganda, over 90% of people use herbal remedies. Herbal medicine use has been associated with delayed clinical appointments, presentation with advanced cancers, financial constraints, and misdiagnosis. This study aimed to evaluate the prevalence of herbal medicine use and practices amongst cancer patients receiving Palliative Care at Mobile Hospice Mbarara (MHM) and the associated challenges. This was a mixed-methods prospective study conducted in 2022 at MHM, where patients were interviewed, and a questionnaire was completed. 87% of the patients had used herbal medicine. Of these, 83% were female, and 59% had not received formal education. 27% of patients had used herbal remedies for a year or more. 51% of patients who were consuming herbs stopped using them after starting palliative care treatment. Motivations for herbal medicine use were in the hope for a cure in 59%, for pain relief in 30%, and peer influence in 10%. There is a high prevalence of herbal medicine use in Palliative Care. Female gender and lack of formal education were disproportionately associated with herbal remedy use. Most patients consume herbal remedies in search of a cure or to relieve severe pain. Education of cancer patients about herbal remedy use may improve treatment outcomes in Palliative Care.

Keywords: prevalence, herbal medicine, cancer patients, palliative care

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