Search results for: healthcare and social services integration

Authors: Abu S. M. G. Kibria, Alison M. Behie, Robert Costanza, Colin Groves, Tracy Farrell

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This study is aimed to understand the level of access and the influence of livelihood capitals in maintaining access and control of ecosystem services (ESS) in the Sundarbans, Bangladesh. Besides the villagers, we consider other stakeholders including the forest department, coast guard, police, merchants, pirates and villagers who ‘controlled’ or ‘maintained’ access to ESS (crab catching, shrimp fry, honey, shrimp, mixed fish, fuel wood) in this region. Villagers used human, physical, natural and social capitals to gain access to ESS. The highest level of access was observed in crab catching and the lowest was found in honey collection, both of which were done when balancing the costs and benefits of accessing one ESS against another. The outcomes of these ongoing access negotiations were determined by livelihood capitals of the households. In addition, it was often found that the certain variables could have a positive effect on one ESS and a negative effect on another. For instance, human, social and natural capitals (eldest daughter’s education and No. of livelihood group membership and) had significant positive effects on honey collection while two components of human and social capitals including ‘eldest son’s education’ and ‘severity of pirate problem’ had exactly the opposite impact. These complex interactions were also observed in access to other ESS. It thus seems that access to ESS is not anything which is provided, but rather it is achieved by using livelihood capitals. Protecting any ecosystem from over exploitation and improve wellbeing can be achieved by properly balancing the livelihood capital-access nexus.

Keywords: provisioning services, access level, livelihood capital, interaction, access gain

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Authors: Devansh Jain, Shu Ting Goh

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With the aim of improving the quality of life of people of Singapore with provision of better transport services, Land and Transport Authority Singapore recently published its Master Plan 2013. The major objectives mentioned in the plan were to make a comprehensive public transport network with better quality Mass Rapid Transit, bus services along with cycling and walking. MRT is the backbone of the transport system in Singapore, and to promote and increase the MRT ridership, good accessibility to access the MRT stations is a necessity. The aim of this paper is to investigate the relationship between MRT ridership and the provision of feeder bus services in Singapore planning areas and also to understand the hub and spoke model adopted by Singapore for provision of transport services. The findings of the study will lead to conclusions made from the Regression model developed by the various factors affecting MRT ridership, and hence will benefit to enhance the services provided by the system.

Keywords: quality of life, public transport, mass rapid transit, ridership

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Authors: Anass Rahouti, Guillaume Salze, Ruggiero Lovreglio, Sélim Datoussaïd

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In healthcare facilities, training the staff for firefighting and evacuation in real buildings is very challenging due to the presence of a vulnerable population in such an environment. In a standard environment, traditional approaches, such as fire drills, are often used to train the occupants and provide them with information about fire safety procedures. However, those traditional approaches may be inappropriate for a vulnerable population and can be inefficient from an educational viewpoint as it is impossible to expose the occupants to scenarios similar to a real emergency. Immersive serious games could be used as an alternative to traditional approaches to overcome their limitations. Serious games are already being used in different safety domains such as fires, earthquakes and terror attacks for several building types (e.g., office buildings, train stations, tunnels, etc.). In this study, we developed an immersive serious game to improve the fire safety skills of staff in healthcare facilities. An accurate representation of the healthcare environment was built in Unity3D by including visual and audio stimuli inspired from those employed in commercial action games. The serious game is organised in three levels. In each of them, the trainee is presented with a specific fire emergency and s/he can perform protective actions (e.g., firefighting, helping non-ambulant occupants, etc.) or s/he can ignore the opportunity for action and continue the evacuation. In this paper, we describe all the steps required to develop such a prototype, as well as the key questions that need to be answered, to develop a serious game for firefighting and evacuation in healthcare facilities.

Keywords: fire safety, healthcare, serious game, training

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Authors: Sonia Butalia, Huong Luu, Alexis Guigue, Karen J. B. Martins, Khanh Vu, Scott W. Klarenbach

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Obesity is associated with significant personal impacts on health and has a substantial economic burden on payers due to increased healthcare use. A contemporary estimate of the healthcare costs associated with obesity at the population level are lacking. This evidence may provide further rationale for weight management strategies. Methods: Adults who underwent a medical procedure between 2012 and 2019 in Alberta, Canada were categorized into the investigational cohort (had body mass index [BMI]-defined class 2 or 3 obesity based on a procedure-associated code) and the control cohort (did not have the BMI procedure-associated code); those who had bariatric surgery were excluded. Characteristics were presented and healthcare costs ($CDN) determined over a 1-year observation period (2019/2020). Logistic regression and a generalized linear model with log link and gamma distribution were used to assess total healthcare costs (comprised of hospitalizations, emergency department visits, ambulatory care visits, physician visits, and outpatient prescription drugs); potential confounders included age, sex, region of residence, and whether the medical procedure was performed within 6-months before the observation period in the partial adjustment, and also the type of procedure performed, socioeconomic status, Charlson Comorbidity Index (CCI), and seven obesity-related health conditions in the full adjustment. Cost ratios and estimated cost differences with 95% confidence intervals (CI) were reported; incremental cost differences within the adjusted models represent referent cases. Results: The investigational cohort (n=220,190) was older (mean age: 53 standard deviation [SD]±17 vs 50 SD±17 years), had more females (71% vs 57%), lived in rural areas to a greater extent (20% vs 14%), experienced a higher overall burden of disease (CCI: 0.6 SD±1.3 vs 0.3 SD±0.9), and were less socioeconomically well-off (material/social deprivation was lower [14%/14%] in the most well-off quintile vs 20%/19%) compared with controls (n=1,955,548). Unadjusted total healthcare costs were estimated to be 1.77-times (95% CI: 1.76, 1.78) higher in the investigational versus control cohort; each healthcare resource contributed to the higher cost ratio. After adjusting for potential confounders, the total healthcare cost ratio decreased, but remained higher in the investigational versus control cohort (partial adjustment: 1.57 [95% CI: 1.57, 1.58]; full adjustment: 1.21 [95% CI: 1.20, 1.21]); each healthcare resource contributed to the higher cost ratio. Among urban-dwelling 50-year old females who previously had non-operative procedures, no procedures performed within 6-months before the observation period, a social deprivation index score of 3, a CCI score of 0.32, and no history of select obesity-related health conditions, the predicted cost difference between those living with and without obesity was $386 (95% CI: $376, $397). Conclusions: If these findings hold for the Canadian population, one would expect an estimated additional $3.0 billion per year in healthcare costs nationally related to BMI-defined obesity (based on an adult obesity rate of 26% and an estimated annual incremental cost of $386 [21%]); incremental costs are higher when obesity-related health conditions are not adjusted for. Results of this study provide additional rationale for investment in interventions that are effective in preventing and treating obesity and its complications.

Keywords: administrative data, body mass index-defined obesity, healthcare cost, real world evidence

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Authors: Heather Clark, Jon Kelly

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Burnout among healthcare professionals has been elevated to a high level of concern. The descriptions of the healthcare workplace often include language such as, stressful, long hours, rotating shifts, weekends and holidays, and exhausting. New graduate healthcare professionals are being sent into the workplace with little to no coping skills, knowledge of signs and symptoms of burnout, or resources that are available. The authors of this study created a university course entitled 'coping in your profession' that enrolled registered nurses, licensed practical nurses, EMTs, nurse assistants, and medical assistants. The course addresses burnout, self-analysis, incivility, coping mechanisms, and organizational responsibilities for employee well-being. The students were surveyed using QualtricsXM that included a pre-course and post-course analysis. Pre-course results showed high levels of individual experiences with burnout and limited knowledge of resources to combat burnout. Post-course results included personal growth and that students’ perception of burnout can be prevented at both the individual and the organization levels. Students also indicated that few to no resources to combat burnout existed at their place of employment. Addressing burnout at the educational level helps prepare graduates with the knowledge and tools to combat burnout at the individual and organization level.

Keywords: burnout, coping, healthcare workers, incivility, resilience

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Authors: Zakia Hammouni

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Healthcare professionals’ well-being is becoming a priority during this Covid-19 pandemic due to stress, fatigue, and workload. Well before this pandemic, contemporary hospitals are endowed with environmental attributes that contribute to achieving well-being within their environment with the emphasis on the patient. The patient-centered care approach has been followed by the patient-centered design approach. Studies that have focused on the physical environment in hospitals have dealt with the patient's recovery process and his well-being. Prior scientific literature has placed less emphasis on the healthcare professionals’ interactions within the physical environment and to guide hospital designers to make evidence-based design choices to meet the needs and expectations of hospital users by considering, in addition to patients, healthcare professionals. This paper examines these issues related to the daily stress of professionals who provide care in a hospital environment. In this exploratory study, the interest was to grasp the issues related to this environment and explores the current realities of newly built hospitals based on design approaches and what attributes of the physical setting support healthcare professional’s well-being. Within a constructivist approach, this study was conducted in two care units in a new hospital in a big city in Canada before the Covid-19 pandemic (august 2nd to November 2nd 2018). A spatial evaluation of these care units allowed us to understand the interaction of health professionals in their work environment, to understand the spatial behavior of these professionals, and the narratives from 44 interviews of various healthcare professionals. The mental images validated the salient components of the hospital environment as perceived by these healthcare professionals. Thematic analysis and triangulation of the data set were conducted. Among the key attributes promoting the healthcare professionals’ well-being as revealed by the healthcare professionals are the overall light-color atmosphere in the hospital and care unit, particularly in the corridors and public areas of the hospital, the maintenance and cleanliness. The presence of the art elements also brings well-being to the health professionals as well as panoramic views from the staff lounge and corridors of the care units or elevator lobbies. Despite the overall positive assessment of this environment, some attributes need to be improved to ensure the well-being of healthcare professionals and to provide them with a restructuring environment. These are the supply of natural light, softer colors, sufficient furniture, comfortable seating in the restroom, and views, which are important in allowing these healthcare professionals to recover from their work stress. Noise is another attribute that needs to be further improved in the hospital work environment, especially in the nursing workstations and consultant's room. In conclusion, this study highlights the importance of providing healthcare professionals with work and rest areas that allow them to resist the stress they face, particularly during periods of extreme stress and fatigue such as a Covid-19 pandemic.

Keywords: healthcare facilities, healthcare professionals, physical environment, well-being

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Authors: Charlotte Bach, Albrecht Jahn, Mahnaz Motamedi, Maryam Karimi-Ghahfarokhi

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Background: Maternal and infant deaths are most prevalent in the first month after birth, emphasizing the critical need for quality healthcare services during this period. Immigrant women, who are more susceptible to adverse pregnancy outcomes, often face neglect in accessing proper healthcare. The lack of adequate postpartum care significantly contributes to mortality rates. Therefore, utilizing maternal health care services and implementing postpartum care is crucial in reducing maternal and child mortality. Aims: This study aims to evaluate the assessment of pre- and postnatal care among women with and without migration background. In addition, the study explores the impact of COVID-19 procedures on women's experiences during pregnancy, birth, and the postpartum period. Methods: This research employs a cross-sectional Mixed-Method design. Data collection was facilitated through structured questionnaires administered to participants, alongside the utilization of patient bases, including Maternity and child medical records. Following the assumption that the investigator aimed to gain comprehensive insights, qualitative sampling focused on individuals with substantial experiences related to COVID-19, regarded as rich cases. Results: our study highlighted the influence of educational level, marital status, and consensual partnerships on the likelihood of Cesarean deliveries. Regarding breastfeeding practices, migrant women exhibited higher rates of breastfeeding initiation and continuation. Contraception utilization revealed interesting patterns, with non-migrants displaying higher odds of contraceptive use. The qualitative component of our research adds depth to the exploration of women's experiences during the COVID-19 pandemic, revealing nuanced challenges related to anxiety, hospital restrictions, breastfeeding support, and postnatal ward routines. Conclusion: Dissimilarity among studies toward cesarean rate between migrants and non-migrants underscores the importance of targeted interventions considering the diverse needs of distinct population groups. It also acknowledges potential cultural, contextual, and healthcare system influences on the association between mode of delivery and infant feeding practices. Studies acknowledge the influence of contextual variables on contraceptive preferences among migrants and non-migrants, emphasizing the need for tailored healthcare policies. The findings contribute to existing research, highlighting the need for a nuanced understanding of the impact of birth preparation courses on maternal and infant outcomes. Furthermore, they emphasize the universality of certain maternity care experiences, regardless of pandemic contexts, reinforcing the importance of patient-centred approaches in healthcare delivery.

Keywords: migration background, pregnancy outcome, covid-19, postpartum

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Authors: Shilan Rahmani Azr, Siavash Emtiyaz

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Recent development in computing and communicative technologies leads to much easier mobile accessibility to the information. Users can access to the information in different places using various deceives in which the care variety of abilities. Meanwhile, the format and details of electronic documents are changing each day. In these cases, a mismatch is created between content and client’s abilities. Recently the service-oriented content adaption has been developed which the adapting tasks are dedicated to some extended services. In this method, the main problem is to choose the best appropriate service among accessible and distributed services. In this paper, a method for determining the optimal path to the best services, based on the quality control parameters and user preferences, is proposed using max heap tree. The efficiency of this method in contrast to the other previous methods of the content adaptation is related to the determining the optimal path of the best services which are measured. The results show the advantages and progresses of this method in compare of the others.

Keywords: service-oriented content adaption, QoS, max heap tree, web services

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Authors: Umamaheswari Shanmugam, Silvia Ronchi, Radu Vornicu

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Software, artificial intelligence, and machine learning can improve healthcare through innovative and advanced technologies that are able to use the large amount and variety of data generated during healthcare services every day. As we read the news, over 500 machine learning or other artificial intelligence medical devices have now received FDA clearance or approval, the first ones even preceding the year 2000. One of the big advantages of these new technologies is the ability to get experience and knowledge from real-world use and to continuously improve their performance. Healthcare systems and institutions can have a great benefit because the use of advanced technologies improves the same time efficiency and efficacy of healthcare. Software-defined as a medical device, is stand-alone software that is intended to be used for patients for one or more of these specific medical intended uses: - diagnosis, prevention, monitoring, prediction, prognosis, treatment or alleviation of a disease, any other health conditions, replacing or modifying any part of a physiological or pathological process–manage the received information from in vitro specimens derived from the human samples (body) and without principal main action of its principal intended use by pharmacological, immunological or metabolic definition. Software qualified as medical devices must comply with the general safety and performance requirements applicable to medical devices. These requirements are necessary to ensure high performance and quality and also to protect patients’ safety. The evolution and the continuous improvement of software used in healthcare must take into consideration the increase in regulatory requirements, which are becoming more complex in each market. The gap between these advanced technologies and the new regulations is the biggest challenge for medical device manufacturers. Regulatory requirements can be considered a market barrier, as they can delay or obstacle the device approval, but they are necessary to ensure performance, quality, and safety, and at the same time, they can be a business opportunity if the manufacturer is able to define in advance the appropriate regulatory strategy. The abstract will provide an overview of the current regulatory framework, the evolution of the international requirements, and the standards applicable to medical device software in the potential market all over the world.

Keywords: artificial intelligence, machine learning, SaMD, regulatory, clinical evaluation, classification, international requirements, MDR, 510k, PMA, IMDRF, cyber security, health care systems.

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Authors: Emanuela Zilli, Antonio Madia, Milvia Marchiori, Paola Anello, Chiara Cabbia, Emanuela Velo, Delia Campagnolo, Michele Scomazzon, Emanuela Salvatico, S. Tikvina, Antonio Miotti

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Hepatitis C is an inflammation of the liver caused by the hepatitis C virus (HCV). Antiviral medicines can cure more than 95% of cases of hepatitis C infection, but access to diagnosis and treatment remains low. The ULSS 6 Euganea – Health Trust has implemented a campaign to eradicate hepatitis C in the province of Padua (North-East of Italy), which can be subdivided into three areas: North (300.000 inhabitants), Centre (400.000) and South (300.000). In September 2021, the project was launched in the Northern area; a set of brochures was distributed in outpatient services, general practitioners’ clinics and offices, community pharmacy services, social health districts, and through social networks. The Hepatology Service contacted 460 patients selected by the Clinical Laboratory (positivity for HCV antibodies): 83 patients (18.0%) had been already cured of HCV infection, missing or deceased; 377 patients (82.0%) met the criteria to be eligible for HCV eradication therapy and were therefore included in a Day Service specific agenda and followed by a multidisciplinary team of healthcare professionals, with a dedicated telephone line. Haemato-chemical tests, general medical check-ups and ultrasound tests with fibroscan were performed. Patients were tested for Sars-CoV-2 positivity; those not yet vaccinated against Covid-19 were encouraged to complete the vaccination scheme. All 377 patients (100%) received HCV eradication therapy at the community pharmacy service; a detailed explanation of how to take their medication was provided. At the end of the first phase, Covid-19 vaccination rate was 100% (377/377), including patients already vaccinated and new-vaccinated. Check-up appointments were arranged after 2 or 3 months, according to the treatment plan. The awareness campaign and the organization of HCV eradication therapy service by ULSS 6 Euganea are proving to be effective; the project is now going to be applied to Central and Southern areas of the province (1.132 patients).

Keywords: public health, HCV-eradication, Covid-19 emergency, health communication strategies

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Authors: Arezoo Fallahi‎

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Background: Exercise behavior (EB) has a significant impact on infertility, but the magnitude of the effect is not easily determined. The aim of the present study was to assess the effect of social support and self-regulation, as external and internal factors, on changes in exercise behavior among infertile women. Methods: For a cross-sectional study conducted in Sanandaj (Iran) in 2020, we recruited infertile women (n=483) from 35 comprehensive healthcare centers by means of convenience sampling. Standardized face-to-face interviews were conducted using established and reliable instruments for the assessment of EB, social support, and self-regulation. Logistic regression models were applied to assess the association between EB, social support and self-regulation. Results: The majority of the participants (56.7%) had secondary infertility, while 70.8% of them did not perform any exercise. Self-regulation and social support were significantly higher in women with secondary infertility than in those with primary infertility (p < 0.01). Self-regulation was significantly lower in women whose height was below 160 centimeters (cm) (p<0.05). Social support was significantly higher among participants aged ≥ 35 years and weighing ≥ 60 kilograms (kg) (p < 0.01). The odds of EB adoption increased with self-regulation and social support (OR=1.05, 95% CI=1.02-1.09, p <0.01), (OR=1.06, 95% CI=1.02-1.11, p <0.01). Conclusion: Social support and self-regulation almost equally influenced EB in infertile women. Designing support and consultation programs can be considered in encouraging infertile women to do exercise in future research.

Keywords: social support, regulation, infertility, women, exercise

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Authors: Gikunda Aloise, Mjema Saida, Barasa Herbert, Wanyungu John, Kimani Maureen

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Background: Community Health Workforce (CHW) is health care providers at the community level (Level 1) and serves as a bridge between the community and the formal healthcare system. This human resource has enormous potential to extend healthcare services and ensures that the vulnerable, marginalized, and hard-to-reach populations have access to quality healthcare services at the community and primary health facility levels. However, these cadres are neither recognized, remunerated, nor in most instances, registered in a master list. Management and supervision of CHWs is not easy if their individual demographics, training capacity and incentives is not well documented through a centralized registry. Description: In February 2022, Amref supported the Kenya Ministry of Health in developing a community health workforce database called Community Health Workers Master List Registry (CHWML), which is hosted in Kenya Health Information System (KHIS) tracker. CHW registration exercise was through a sensitization meeting conducted by the County Community Health Focal Person for the Sub-County Community Health Focal Person and Community Health Assistants who uploaded information on individual demographics, training undertaken and incentives received by CHVs. Care was taken to ensure compliance with Kenyan laws on the availability and use of personal data as prescribed by the Data Protection Act, 2019 (DPA). Results and lessons learnt: By June 2022, 80,825 CHWs had been registered in the system; 78,174 (96%) CHVs and 2,636 (4%) CHAs. 25,235 (31%) are male, 55,505 (68%) are female & 85 (1%) are transgender. 39,979. (49%) had secondary education and 2500 (3%) had no formal education. Only 27 641 (34%) received a monthly stipend. 68,436 CHVs (85%) had undergone basic training. However, there is a need to validate the data to align with the current situation in the counties. Conclusions/Next steps: The use of CHWML will unlock opportunities for building more resilient and sustainable health systems and inform financial planning, resource allocation, capacity development, and quality service delivery. The MOH will update the CHWML guidelines in adherence to the data protection act which will inform standard procedures for maintaining, updating the registry and integrate Community Health Workforce registry with the HRH system.

Keywords: community health registry, community health volunteers (CHVs), community health workers masters list (CHWML), data protection act

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Authors: Kgabo H. Badimo, Sheryl Buckley

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Knowledge is increasingly recognised in this, the knowledge era, as a strategic resource, by public sector organisations, in view of the public sector reform initiatives. People and knowledge play a vital role in attaining improved organisational performance and high service quality. Many government departments in the public sector have started to realise the importance of knowledge management in streamlining their operations and processes. This study focused on knowledge management in the public healthcare service organisations, where the concept of service provider competitiveness pales to insignificance, considering the huge challenges emanating from the healthcare and public sector reforms. Many government departments are faced with challenges of improving organisational performance and service delivery, improving accountability, making informed decisions, capturing the knowledge of the aging workforce, and enhancing partnerships with stakeholders. The purpose of this paper is to examine the knowledge management practices of the Gauteng Department of Health in South Africa, in order to understand how knowledge management practices influence improvement in organisational performance and healthcare service delivery. This issue is explored through a review of literature on dominant views on knowledge management and healthcare service delivery, as well as results of interviews with, and questionnaire responses from, the general staff of the Gauteng Department of Health. Web-based questionnaires, face-to-face interviews and organisational documents were used to collect data. The data were analysed using both the quantitative and qualitative methods. The central question investigated was: To what extent can the conditions required for successful knowledge management be observed, in order to improve organisational performance and healthcare service delivery in the Gauteng Department of Health. The findings showed that the elements of knowledge management capabilities investigated in this study, namely knowledge creation, knowledge sharing and knowledge application, have a positive, significant relationship with all measures of organisational performance and healthcare service delivery. These findings thus indicate that by employing knowledge management principles, the Gauteng Department of Health could improve its ability to achieve its operational goals and objectives, and solve organisational and healthcare challenges, thereby improving organisational.

Keywords: knowledge management, Healthcare Service Delivery, public healthcare, public sector

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Authors: Qing Wu, Xuchun Ye, Qiuchen Wang, Kirsten Corazzini

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Objective: It’s increasing acknowledged that patient engagement in healthcare and health literacy both have positive impact on patient outcome. Health literacy emphasizes the ability of individuals to understand and apply health information and manage health. Patients' health literacy affected their willingness to participate in decision-making, but its impact on the behavior and willingness of patient engagement in healthcare is not clear, especially in China. Therefore, this study aimed to explore the correlation between the behavior and willingness of patient engagement and health literacy. Methods: A cross-sectional survey was employed using the behavior and willingness of patient engagement in healthcare questionnaire, Chinese version All Aspects of Health Literacy Scale (AAHLS). A convenient sample of 443 patients was recruited from 8 general hospitals in Shanghai, Jiangsu Province and Zhejiang Province, from September 2016 to January 2017. Results: The mean score for the willingness was (4.41±0.45), and the mean score for the patient engagement behavior was (4.17±0.49); the mean score for the patient's health literacy was (2.36±0.29)，the average score of its three dimensions- the functional literacy, the Communicative/interactive literacy and the Critical literacy, was (2.26±0.38), (2.28±0.42), and (2.61±0.43), respectively. Patients' health literacy was positively correlated with their willingness of engagement (r = 0.367, P < 0.01), and positively correlated with patient engagement behavior (r = 0.357, P < 0.01). All dimensions of health literacy were positively correlated with the behavior and willingness of patient engagement in healthcare; the dimension of Communicative/interactive literacy (r = 0.312, P < 0.01; r = 0.357, P < 0.01) and the Critical literacy (r = 0.357, P < 0.01; r = 0.357, P < 0.01) are more relevant to the behavior and willingness than the dimension of basic/functional literacy (r=0.150, P < 0.01; r = 0.150, P < 0.01). Conclusions: The behavior and willingness of patient engagement in healthcare are positively correlated with health literacy and its dimensions. In clinical work, medical staff should pay attention to patients’ health literacy, especially the situation that low literacy leads to low participation and provide health information to patients through health education or communication to improve their health literacy as well as guide them to actively and rationally participate in their own health care.

Keywords: patient engagement, health literacy, healthcare, correlation

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Authors: Adama Sow, Abdoulaye Guiss´e, Oumar Niang

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To assist medical diagnosis, we propose a federation of several existing and open medical ontologies and terminologies. The goal is to merge the strengths of all these resources to provide clinicians the access to a variety of shared knowledges that can facilitate identification and association of human diseases and all of their available characteristic signs such as symptoms and clinical signs. This work results to an integration model loaded from target known ontologies of the bioportal platform such as DOID, MESH, and SNOMED for diseases selection, SYMP, and CSSO for all existing signs.

Keywords: medical decision, medical ontologies, ontologies integration, linked data, knowledge engineering, e-health system

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Authors: A. W. Chalmers, O. M. van den Broek

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This article examines the relationship between the global financial crisis and corporate social responsibility activities of financial services firms. It challenges the general consensus in existing studies that firms, when faced with economic hardship, tend to jettison CSR commitments. Instead, and building on recent insights into the institutional determinants of CSR, it is argued that firms are constrained in their ability to abandon CSR by the extent to which they are subject to intense public scrutiny by regulators and the news media. This argument is tested in the context of the European sovereign debt crisis drawing on a unique dataset of 170 firms in 15 different countries over a six-year period. Controlling for a battery of alternative explanations and comparing financial service providers to firms operating in other economic sectors, results indicate considerable evidence supporting the main argument. Rather than abandoning CSR during times of economic hardship, financial industry firms ramp up their CSR commitments in order to manage their public image and foster public trust in light of intense public scrutiny.

Keywords: corporate social responsibility (CSR), public scrutiny, global financial crisis, financial services firms

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Authors: Adji Achmad Rinaldo Fernandes

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Path analysis is an analytical technique to study the causal relationship between independent and dependent variables. In this study, the integration of Clusters in the Ward Linkage method was used in a variety of clusters with path analysis. The variables used are character (x₁), capacity (x₂), capital (x₃), collateral (x₄), and condition of economy (x₄) to on time pay (y₂) through the variable willingness to pay (y₁). The purpose of this study was to compare the Ward Linkage method cluster integration in various clusters with path analysis to classify willingness to pay (y₁). The data used are primary data from questionnaires filled out by customers of Bank X, using purposive sampling. The measurement method used is the average score method. The results showed that the Ward linkage method cluster integration with path analysis on 2 clusters is the best method, by comparing the coefficient of determination. Variable character (x₁), capacity (x₂), capital (x₃), collateral (x₄), and condition of economy (x₅) to on time pay (y₂) through willingness to pay (y₁) can be explained by 58.3%, while the remaining 41.7% is explained by variables outside the model.

Keywords: cluster integration, linkage, path analysis, compliant paying behavior

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Authors: Wan-I Lee, Nelio Mendoza Figueredo

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The impact of COVID-19 has a significant effect on all sectors of society globally. Health information technology (HIT) has become an effective health strategy in this age of distancing. In this regard, Mobile Health (mHealth) plays a critical role in managing patient and provider workflows during the COVID-19 pandemic. Therefore, the users' perception of service quality about mHealth services plays a significant role in shaping confidence and subsequent behaviors regarding the mHealth users' intention of use. This study's objective was to explore levels of user attributes analyzed by a qualitative method of how health practitioners and patients are satisfied or dissatisfied with using mHealth services; and analyzed the users' intention in the context of Taiwan during the COVID-19 pandemic. This research explores the experienced usability of a mHealth services during the Covid-19 pandemic. This study uses qualitative methods that include in-depth and semi-structured interviews that investigate participants' perceptions and experiences and the meanings they attribute to them. The five cases consisted of health practitioners, clinic staff, and patients' experiences using mHealth services. This study encourages participants to discuss issues related to the research question by asking open-ended questions, usually in one-to-one interviews. The findings show the positive and negative attributes of mHealth service quality. Hence, the significant importance of patients' and health practitioners' issues on several dimensions of perceived service quality is system quality, information quality, and interaction quality. A concept map for perceptions regards to emergency uses' intention of mHealth services process is depicted. The findings revealed that users pay more attention to "Medical care", "ease of use" and "utilitarian benefits" and have less importance for "Admissions and Convenience" and "Social influence". To improve mHealth services, the mHealth providers and health practitioners should better manage users' experiences to enhance mHealth services. This research contributes to the understanding of service quality issues in mHealth services during the COVID-19 pandemic.

Keywords: COVID-19, mobile health, service quality, use intention

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Authors: Filiz Celik, Rachel Harrad, Rob Keasley, Paul Bennett

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The COVID-19 pandemic has posed a significant challenge to many, with some groups with particular vulnerability to adverse psychological impacts. These include those disadvantaged by mental ill health, either pre-existing or occurring during pregnancy or post-partum. Using a qualitative approach, the research aimed to identify the challenges posed by COVID-19 to women, their infants and families during the perinatal period and to suggest what further support can help alleviate the adverse mental health impact of COVID-19. 21 expectant and new mothers who were currently receiving support via a peri-natal mental health service participated in semi-structured interviews. In these interviews, participants explored the impact of changes in social circumstances and healthcare providers as a result of COVID-19 restrictions, with the resultant audio recordings transcribed and analyzed using Reflexive Thematic Analysis (RTA). Based on these accounts, it was concluded that women, their partners and potentially their infants experienced heightened peri-natal distress, and their experience at this time increased their risk for future mental health problems. Women described emerging as more vulnerable, owing to their role as primary caregivers during the perinatal period and also explained how social isolation and limited access to services meant protective buffers against mental health deterioration were reduced and the resources they needed in order to develop resilience were weakened. Although partners were invited to take part in the research, a sizeable volume of data could not be generated to fully assess the impact of the pandemic on a partner’s mental well-being. However, women expressed concerns about the paternal mental health of partners and husbands which invites us to be further vigilant to paternal mental health and associated experiences. Overall, these interviews serve to highlight and provide a voice to these women and their families who describe experiencing disadvantage at an already vulnerable time in their lives, as well as illustrating the need for services to prioritize the needs of this population when acute events strike, be those future pandemics or other disasters.

Keywords: patient experience, perinatal mental health, covid-19 pandemic, heightened anxiety, birth trauma, post-natal well-being

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Authors: David P. Horton, Gary Lynch-Wood

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Western populations are aging, prone to various lifestyle health problems, and increasing their demand for health and social care services. This demand has created enormous fiscal and regulatory challenges. In response, government institutions have deployed strategies of behavior modification to encourage people to exercise greater personal responsibility over their health and care needs (i.e., welfare responsibilisation). Policy strategies are underpinned by the assumption that people if properly supported, will make better health and lifestyle selections. Not only does this absolve governments of the responsibility for meeting all health and care needs, but it also enables government institutions to assert fiscal control over welfare spending. Looking at the regulation of health and social care in the UK, the authors identify and outline a suite of regulatory tools that are designed to extract and manage the resources of health and social care services users and to encourage them to make (‘better’) use of these resources. This is important for our understanding of how health and social care regulation is responding to ongoing social and economic challenges. It is also important because there has been a failure to systematically examine the relevance of resources for regulation, which is surprising given that resources are crucial to how and whether regulation succeeds or fails. In particular, drawing from the regulatory welfare state concept, the authors analyse the key legal and regulatory changes and mechanisms that have been introduced since the 2008 financial crisis, focusing on critical measures such as the Health and Social Care Act and regulations introduced under the National Health Service Act. The authors show how three types of user resources (i.e., tangible, labor, and data) are being used to assert fiscal control and increase welfare responsibilisation. Amongst other things, the paper concludes that service users have become more than rule followers and targets of behavioral modification; rather, they are producers of resources that regulatory systems have come to rely on.

Keywords: health care, regulation, resources, social care

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Authors: Umedov Mekhroz, Griaznova Svetlana

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The quality of life and well-being of patients, staff and visitors are central to the delivery of health care. Architecture and design are becoming an integral part of the healing and recovery approach. The most significant point that can be implemented in hospital buildings is the therapeutic value of the artificial environment, the design and integration of plants to bring the natural world into the healthcare environment. The hospital environment should feel like home comfort. The techniques that therapeutic architecture uses are very cheap, but provide real benefit to patients, staff and visitors, demonstrating that the difference is not in cost but in design quality. The best environment is not necessarily more expensive - it is about special use of light and color, rational use of materials and flexibility of premises. All this forms innovative concepts in modern hospital architecture, in new construction, renovation or expansion projects. The aim of the study is to identify the methods and principles of therapeutic architecture. The research methodology consists in studying and summarizing international experience in scientific research, literature, standards, methodological manuals and project materials on the research topic. The result of the research is the development of graphic-analytical tables based on the system analysis of the processed information; 3d visualization of hospital interiors based on processed information.

Keywords: therapeutic architecture, healthcare interiors, sustainable design, materials, color scheme, lighting, environment.

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Authors: Richa Rai

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The purpose of this study is to analyze the role of the services sector in economic development of Indian economy, especially in the post reform period. Due to adoption of liberalization policy in developing economy like India, international transaction in services has been increased at a rapid pace which compensated to the current account of Balance of Payment which was in a pitiable condition. But this increased share of services in GDP is not commensurate with share in employment, which is a matter of great concern for Indian economy. Although the increased share of service in GDP indicates the advanced stage of growth of the economy, but this theory is not applicable in context of Indian economy completely. In the preliminary stage, this study finds a positive correlation between growth of services and export earnings and gross domestic product and this growth of services is not equal in terms of all aspects on Indian economy, and also all components of services has not been increased at an equal rate. This paper seeks to examine the impact of liberalization in post reform era on the growth of services in India. The analysis is done for the period of 1991 to 2013. Data has been collected from the secondary sources, especially from the website of Reserve Bank of India, World Trade Organization, and United Nation Conference on Trade and Development. The data has been analyzed with the help of appropriate statistical tools (Causality Relation and Group t-test).

Keywords: export earnings, GDP, gross domestic product, liberalization, services

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Authors: Richard Okyere Boadu, Godwin Adzakpah, Nathan Kumasenu Mensah, Kwame Adu Okyere Boadu, Jonathan Kissi, Christiana Dziyaba, Rosemary Bermaa Abrefa

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Information and communication technology (ICT) has significantly advanced global healthcare, with electronic health (e-Health) applications improving health records and delivery. These innovations, including electronic health records, strengthen healthcare systems. The study investigates healthcare professionals' perceptions of health information applications and their associated factors in the Cape Coast Metropolis of Ghana's health facilities. Methods: We used a descriptive cross-sectional study design to collect data from 632 healthcare professionals (HCPs), in the three purposively selected health facilities in the Cape Coast municipality of Ghana in July 2022. Shapiro-Wilk test was used to check the normality of dependent variables. Descriptive statistics were used to report means with corresponding standard deviations for continuous variables. Proportions were also reported for categorical variables. Bivariate regression analysis was conducted to determine the factors influencing the Benefits of Information Technology (BoIT); Barriers to Information Technology Use (BITU); and Motives of Information Technology Use (MoITU) in healthcare delivery. Stata SE version 15 was used for the analysis. A p-value of less than 0.05 served as the basis for considering a statistically significant accepting hypothesis. Results: Healthcare professionals (HCPs) generally perceived moderate benefits (Mean score (M)=5.67) from information technology (IT) in healthcare. However, they slightly agreed that barriers like insufficient computers (M=5.11), frequent system downtime (M=5.09), low system performance (M=5.04), and inadequate staff training (M=4.88) hindered IT utilization. Respondents slightly agreed that training (M=5.56), technical support (M=5.46), and changes in work procedures (M=5.10) motivated their IT use. Bivariate regression analysis revealed significant influences of education, working experience, healthcare profession, and IT training on attitudes towards IT utilization in healthcare delivery (BoIT, BITU, and MoITU). Additionally, the age of healthcare providers, education, and working experience significantly influenced BITU. Ultimately, age, education, working experience, healthcare profession, and IT training significantly influenced MoITU in healthcare delivery. Conclusions: Healthcare professionals acknowledge moderate benefits of IT in healthcare but encounter barriers like inadequate resources and training. Motives for IT use include staff training and support. Bivariate regression analysis shows education, working experience, profession, and IT training significantly influence attitudes toward IT adoption. Targeted interventions and policies can enhance IT utilization in the Cape Coast Metropolis, Ghana.

Keywords: health information application, utilization of information application, information technology use, healthcare

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Authors: Julia Wimmers Klick

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Interprofessional Education (IPE) is widely recognized as a valuable approach in healthcare education, despite the challenges it presents. This study explores IP surface anatomy lab sessions, with a focus on fostering trust and collaboration among healthcare students. The research is conducted within the context of rural healthcare settings in British Columbia (BC), where a medical school and a physical therapy (PT) program operate under the Faculty of Medicine at the University of British Columbia (UBC). While IPE sessions addressing soft skills have been implemented, the integration of hard skills, such as Anatomy, remains limited. To address this gap, a pilot feasibility study was conducted with a positive outcome, a follow-up study involved these IPE sessions aimed at exploring the influence of bonding and trust between medical and PT students. Data were collected through focus groups comprising participating students and faculty members, and a structured SWOC (Strengths, Weaknesses, Opportunities, and Challenges) analysis was conducted. The IPE sessions, 3 in total, consisted of a 2.5-hour lab on surface anatomy, where PT students took on the teaching role, and medical students were newly exposed to surface anatomy. The focus of the study was on the relationship-building process and trust development between the two student groups, rather than assessing the acquisition of surface anatomy skills. Results indicated that the surface anatomy lab served as a suitable tool for the application and learning of soft skills. Faculty members observed positive outcomes, including productive interaction between students, reversed hierarchy with PT students teaching medical students, practicing active listening skills, and using a mutual language of anatomy. Notably, there was no grade assessment or external pressure to perform. The students also reported an overall positive experience; however, the specific impact on the development of soft skill competencies could not be definitively determined. Participants expressed a sense of feeling respected, welcomed, and included, all of which contributed to feeling safe. Within the small group environment, students experienced becoming a part of a community of healthcare providers that bonded over a shared interest in health professions education. They enjoyed sharing diverse experiences related to learning across their varied contexts, without fear of judgment and reprisal that were often intimidating in single professional contexts. During a joint Christmas party for both cohorts, faculty members observed students mingling, laughing, and forming bonds. This emphasized the importance of early bonding and trust development among healthcare colleagues, particularly in rural settings. In conclusion, the findings emphasize the potential of IPE sessions to enhance trust and collaboration among healthcare students, with implications for their future professional lives in rural settings. Early bonding and trust development are crucial in rural settings, where healthcare professionals often rely on each other. Future research should continue to explore the impact of content-concentrated IPE on the development of soft skill competencies.

Keywords: interprofessional education, rural healthcare settings, trust, surface anatomy

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Authors: Aliyaa Zaidan, Rayan Bahabri

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The twenty-first century revealed an accelerating change and intensifying complexity of communication technology. Online social networking engines have gained astounding recognition worldwide. The influence of those social media platforms on dentistry and dental students is not well established. Therefore, this study aimed to evaluate the impact of using social media on professional and profile level among dental students in Saudi Arabia. A cross-sectional study developed via online questionnaire concerning on social media usage and its effect on professional and profile level of dental students and dental interns from several universities in Saudi Arabia. A total of 296 dental students and dental interns in Saudi Arabia responded to the questionnaire. Ninety-eight percent of the participants usually use the social media on a regular basis. Most social media sites used among the participants were Snapchat, Instagram, and YouTube by 85%, 81%, 77% respectively. Forty-one percent of the participants agreed that using social media in the dental field is a necessity nowadays. Thirty-eight percent of participants agreed that using social media is an easy way to gain a reliable knowledge, while 43% agreed that social media will improve the quality of healthcare. Furthermore, 65% of the students deemed using social media for academic purposes will improve their performance. Fifty-five percent of the respondents often use social media tools to obtain information about subject or procedures related to the dental field. Regarding profile reputation of dental students, 40% of the respondents agreed that their profile information published on social networking websites, could be used by others to judge their level of professionalism. Male and female dental students both agreed that their reputation would be adversely affected by 37%,63%, respectively, if their social networking activity were viewed by members of the public. The discrepancy among student levels reveals that social media profile positively influence the acceptance to postgraduate programs (P= 0.01).

Keywords: dental students, professional, reputation, social media

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Authors: M. Mohemmed Sha Mohamed Kunju, Abdalla A. Al-Ameen Abdurahman, T. Manesh Thankappan, A. Mohamed Mustaq Ahmed Hameed

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Web service composition is an effective approach to complete the web based tasks with desired quality. A single web service with limited functionality is inadequate to execute a specific task with series of action. So, it is very much required to combine multiple web services with different functionalities to reach the target. Also, it will become more and more challenging, when these services are from different providers with identical functionalities and varying QoS, so while composing the web services, the overall QoS is considered to be the major factor. Also, it is not true that the expected QoS is always attained when the task is completed. A single web service in the composed chain may affect the overall performance of the task. So care should be taken in different aspects such as functionality of the service, while composition. Dynamic and automatic service composition is one of the main option available. But to achieve the actual functionality of the task, quality of the individual web services are also important. Normally the QoS of the individual service can be evaluated by using the non-functional parameters such as response time, throughput, reliability, availability, etc. At the same time, the QoS is not needed to be at the same level for all the composed services. So this paper proposes a framework that allows composing the services in terms of QoS by setting the appropriate weight to the non-functional parameters of each individual web service involved in the task. Experimental results show that the importance given to the non-functional parameter while composition will definitely improve the performance of the web services.

Keywords: composition, non-functional parameters, quality of service, web service

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Authors: Flevy Lasrado

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Purpose: The purpose of this paper is to show the relationship between the service quality dimensions and model them to propose quality improvements using interpretive structural modelling (ISM). Methodology: This paper used an interpretive structural modelling (ISM). The data was collected from the expert opinions that included a questionnaire. The detailed method of using ISM is discussed in the paper. Findings: The present research work provides an ISM based model to understand the relationships among the service quality dimensions. Practical implications or Original Value: An ISM based model has been developed for healthcare facility for improving customer satisfaction and increasing market share. Although there is lot of research on SERVQUAL model adapted to healthcare sector, no study has been done to understand the interactions among these dimensions. So the major contribution of this research work is the development of contextual relationships among identified variables through a systematic framework. The present research work provides an ISM based model to understand the relationships among the service quality dimensions.

Keywords: SERQUAL, healthcare, quality, service quality

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Authors: Les Paul Valdez, Rowena Manzarate, Joseph Carl Lunizo, Mary Thereze Mabaquiao, Mary Deo Luigi Mabunay

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Background: Across the literature, varying definitions of successful aging can be found. As a result, several determinants have been associated with successful aging. However, there is a paucity of literature exploring the relationship between successful aging and factors such as spiritual experience, gerotranscendence, and social engagement. Objective: Thus, this study purports to ascertain the relationship between and among spiritual experience, gerotranscendence, social engagement and successful aging. Methods: The Daily Spiritual Experience Scale (DSES), Social Engagement Scale (SES), Gerotranscendence Scale Revised (GS-R) and Expectations Regarding Aging (ERA) were fielded to 349 incarcerated elderly to measure spiritual experience, social engagement, gerotranscendence and successful aging respectively. Data was analyzed using Structural Equation Modelling through AMOS 21. The hypothesized model was evaluated using the goodness of fit and parsimony indices. Results: Social engagement (β= .179, p=.128) and spiritual experience (β= .375, p=.262) contribute to successful aging through the mediating effect of gerotranscendence (β= .973, p=.718). Conclusion: Today more than ever, healthcare providers in penal institutions are challenged to ensure that incarcerated elderly are socially and spiritually engaged; and have high levels of gerotranscendence.

Keywords: elderly, Filipino, gerotranscendence, social engagement, spiritual experience, successful aging

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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: Stephen Hernandez, Nikita Sharma

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The Coronavirus disease (COVID-19) emerged as a worldwide pandemic at the beginning of 2020. The pandemic and its impact reached the shores of the United States by the second week of March. Once infections started to grow in numbers, early intervention programs, including those providing home-based services, recognized that to reduce the spread of the virus, many traditional in-person therapeutic interventions were going to be impossible due to social distancing and self-quarantine requirements. Initially, infants, toddlers, and their families were left without any services from their educators and therapists, but within a few weeks of the public health emergency, various states, including New York, approved the use of teletherapy/virtual visits for early intervention service provision. This paper will detail the results of a survey from over 400 E.I. service providers about their experiences utilizing teletherapy to deliver services to children in early intervention programs. The survey questions focused on how did COVID-19 stay-at-home orders impact E.I. services for young children with special needs? Sub-questions included topics such as availability of the parents, the amount of time that babies remained engaged, as well as the perceived success of teletherapy as a viable option to provide service by both parent and professional. The results of this study found that therapists found teletherapy to be a viable manner of providing services and could be very effective on a case by case basis.

Keywords: early intervention, teletheraphy, telehealth, COVID-19

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