Search results for: mental health status

Authors: Calogero Lo Destro

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Numerous nations around the world are facing exceptional challenges in employing measures to stop the spread of COVID-19. Following the recommendations of the World Health Organization, a series of preventive measures have been adopted. However, individuals must comply with these rules and recommendations in order to make these measures effective. While COVID-19 was climaxing, it seemed of crucial importance to analyze which psychosocial factors contribute to the acceptance of such preventive behavior, thus favoring the management of COVID-19 worldwide health crisis. In particular, the identification of aspects related to obstacles and facilitation of adherence to social distancing has been considered crucial in the containment of the virus spread. Since the virus was firstly detected in China, Asian people could be considered a relevant outgroup targeted for exclusion. We also hypothesized social distance could be influenced by characteristics of the target, such as smiling or coughing. 260 participants participated in this research on a voluntary basis. They filled a survey designed to explore a series of COVID-19 measures (such as exposure to virus and fear of infection). We also assessed participants state and trait anxiety. The dependent variable was social distance, based on a measure of seating distance designed ad hoc for the present work. Our hypothesis that participants could report greater distance in response to Asian people was not confirmed. On the other hand, significantly lower distance in response to smiling compared to coughing targets was reported. Adopting a regression analysis model, we found that participants' social distance, in response to both coughing and smiling targets, was predicted by fear of infection and by the perception COVID-19 could become a pandemic. Social distance in response to the coughing target was also significantly and positively predicted by age and state anxiety. In summary, the present work has sought to identify a set of psychological variables, which may still be predictive of social distancing.

Keywords: COVID-19, social distancing, health, preventive behaviors, risk of infection

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Authors: Lateef Hakim Zai Khyber, Syed Rashid Ali

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In the post 9/11 era, a new trend has developed of terrorist profiling on the basis of the ethnic, religious, political, psychological, social, and economic background of the terrorists to anticipate and assess the possible risk and to prevent and prosecute the suspected before they commit any violent act. The same profiling approach was adopted in different militant or terrorist de-radicalization and rehabilitation programs across the world in order to evaluate and identify the reasons and causes for joining terrorism in terms of push and pull factors. This paper attempts to explore and investigate the profiles of the detainees in the Sabaoon de-radicalization and Emancipation program, which aimed at de-radicalizing the former militants of Tehrik-e-Taliban (TTP) Pakistan in the Swat valley of Pakistan. This research attempted to use qualitative methods for collecting data, including a number of formal and informal open-ended interviews with the former staff members of Sabaoon to explore various aspects of the program, such as various approaches used at Sabaoon for terrorist profiling. It conducts a thorough examination of the profiles of the terrorist through their socioeconomic, ideological, emotional, intellectual, and psychological conditions and orientations, personal details, family issues, social preferences, etc. The study finds out that the majority of the terrorists belonged to the marginalized groups or lower class, including underprivileged tenants and poor laborers, of society having no access to land. They possess almost the same profiles, including low socioeconomic status, absence of a father or strict behavior of parents, large and combined families, lack of education, lack of religious understanding, etc. They also possess some common traits such as anxiety disorder, emotional instability, aggressive impulses and insecurity, depression, inferiority complex, lack of critical thinking and logical reasoning, authority-seeking behavior, and revenge-seeking behavior.

Keywords: terrorist profiling, Sabaoon, de-radicalization, rehabilitation, Swat, Pakistan, juvenile militants

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Authors: Ezekiel Ejiofor Nnadi

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Nigeria construction industry is known for its active construction activities. This has earmarked the industry to be the key to economic growth of the nation. It has largest employer of labour and gives sustenance to other industries like manufacturing industry. While this is a sign of growth and prosperity; the waste generated by the industry has always been a problem and a serious concern. It results in wastage of economic gain and has resultant health effect on the populace apart from injury being sustained on sites. This work provides a platform to learn more about construction waste, its management strategy and how to reduce waste production in Nigeria construction industry. Construction sites, waste management authority and public health institutions in Lagos as the centre of most construction activities in Nigeria were selected, and a set of questionnaire was administered to using the systematic sampling technique. Descriptive statistics and relative importance index (RII) technique were employed for the analysis of the data gathered. The findings of the analysis show that excessive wastes reduce contractors’ profit margin and also that some construction wastes contain hazardous and toxic elements such as lead, asbestos or radioactive materials which required proper handling and effective disposal. The conclusion was drawn that the check on waste on construction sites starts with the designers to the contractors who execute on site.

Keywords: construction cost, construction industry, economic growth, materials wastes

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Authors: David Nkurunziza, Rahman Tafahomi

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The population growth rate of the city of Kigali is increasing annually. In 1960 the population was six thousand, in 1990 it became two hundred thousand and is supposed to be 4 to 5 million incoming twenty years. With the increase in the residents living in the city of Kigali, there is also a need for an increase in social and economic infrastructures connected by the road networks to serve the residents effectively. A road network is a route that connects people to their needs and has to facilitate people to reach the social and economic facilities easily. This research analyzed the social and economic aspects of three selected roads networks passing through all three districts of the city of Kigali, whose center is the city center roundabout, thorough evaluation of the proximity of the social and economic facilities to the road network. These road networks are the city center to nyabugogo to karuruma, city center to kanogo to Rwanda to kicukiro center to Nyanza taxi park, and city center to Yamaha to kinamba to gakinjiro to kagugu health center road network. This research used a methodology of identifying and quantifying the social and economic facilities within a limited distance of 300 meters along each side of the road networks. Social facilities evaluated are the health facilities, education facilities, institution facilities, and worship facilities, while the economic facilities accessed are the commercial zones, industries, banks, and hotels. These facilities were evaluated and graded based on their distance from the road and their value. The total scores of each road network per kilometer were calculated and finally, the road networks were ranked based on their percentage score per one kilometer—this research was based on field surveys and interviews to collect data with forms and questionnaires. The analysis of the data collected declared that the road network from the city center to Yamaha to kinamba to gakinjiro to the kagugu health center is the best performer, the second is the road network from the city center to nyabugogo to karuruma, while the third is the road network from the city center to kanogo to rwandex to kicukiro center to nyaza taxi park.

Keywords: social economical aspect, road network functionality, urban road network, economic and social facilities

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Authors: Maha Ibrahim Mohamed Khalifa

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Background: Dental fear and anxiety lead to avoidance of dental treatment and deterioration of oral health. Aim of the study: To assess the levels of fear and anxiety among school-age children undergoing dental treatment. Setting: The study was conducted in Outpatient Dental Clinics at Benha Teaching Hospital. Research design: A descriptive research design was utilized to conduct the study. Sample: A purposive sample of 60 school-age children and their mothers attending at the previously mentioned setting was included. Tools: Three tools were used: Tool one: A structured interviewing questionnaire for Personal characteristics of children and their mothers. Tool two: Dental Subscale of Children's Fear Survey Schedule (CFSS-DS). Tool three: Modified Dental Anxiety Scale (MDAS). Results: It was illustrated that more than two-fifths (43.3%) of children had maximum fear and more than half of children (53.3%) had maximal anxiety. Conclusion: Many school-age children undergoing dental treatment suffer from high levels of fear and anxiety. Recommendations: The study recommended further research should be conducted to assess levels of fear and anxiety among children undergoing dental treatments and preferable nursing interventions for reducing their fears and anxieties.

Keywords: fear, anxiety, children, dental treatment

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Authors: Chia-Ching Sun, Li-Yin Chien, Chun-Ting Hsiao

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Background: Appropriate gestation weight gain benefits pregnant women and their children; however, excessive weight gain could raise the risk of adverse health outcomes and chronicle diseases. Nevertheless, there is currently limited evidence on the effect of physical activities on pregnant women’s gestational weight gain. Purpose: This study aimed to explore the correlation between the level of physical activity and gestation weight gain during the second and third trimester of pregnancy. Methods: This longitudinal study enrolled 800 healthy pregnant women aged over 20 from six hospitals in northern Taiwan. Structured questionnaires were used to collect data twice for each participant during 14-27 and 28-40 weeks of gestation. Variables included demographic data, maternal health history, and lifestyle. The International Physical Activity Questionnaire-short form was used to measure the level of physical activity from walking and of moderate-intensity and vigorous-intensity before and during pregnancy. Weight recorded at prenatal checkups were used to calculate average weight gain in each trimester of pregnancy. T-tests, ANOVA, chi-squared tests, and multivariable logistic regression models were applied to determine the predicting factors for weight gain during the second and third trimester. Result: Participants who had achieved recommended physical activity level (150 minutes of moderate physical activity or 75 minutes of vigorous physical activity a week) before pregnancy (aOR=1.85, 95% CI=1.27-2.67) or who achieved recommended walking level (150 minutes a week) during the second trimester of pregnancy (aOR=1.43, 95% CI= 1.00-2.04) gained significantly more weight during the second trimester. Compared with those who did not reach recommended level of moderate-intensity physical activity (150 minutes a week), women who had reached that during the second trimester were more likely to be in the less than recommended weight gain group than in the recommended weight gain group (aOR=2.06, CI=1.06-4.00). However, there was no significant correlation between physical activity level and weight gain in the third trimester. Other predicting factors of excessive weight gain included education level which showed a negative correlation (aOR=0.38, CI=0.17-0.88), whereas overweight and obesity before pregnancy showed a positive correlation (OR=3.97, CI=1.23-12.78). Conclusions/implications for practice: Participants who had achieved recommended physical activity level before pregnancy significantly reduced exercise during pregnancy and gained excessive weight during the second trimester. However, women who engaged in the practice of physical activity as recommended could effectively control weight gain in the third trimester. Healthcare professionals could suggest that pregnant women who exercise maintain their pre-pregnancy level of physical activity, given activities requiring physical contact or causing falls are avoided. For those who do not exercise, health professionals should encourage them to gradually increase the level of physical activity. Health promotion strategies related to weight control and physical activity level achievement should be given to women before pregnancy.

Keywords: pregnant woman, physical activity, gestation weight gain, obesity, overweight

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Authors: Rooma Rani

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The education is really important for the improvement of physical and mental well-being of the school students. It is used to express inner potential, acquire knowledge, develop skills, shape habits, attitudes, values, belief, etc. along with providing strengths and resilience to people to changing situations and allowing them to develop all those capacities which will enable individual to control surrounding environment. Education has a significant effect on the behavior of individuals which helps us in the new situations of everyday life. Educating the child is directing the child’s capacities, attitudes interest, urges, and needs into the most desirable channels. We are the part of 21st century and now a day emotional intelligence is considered more important than intelligence in the success of a person. Success depends on several intelligences and on the control of emotions too. Emotional Intelligence, like general intelligence is the product of one’s heredity and its interaction with his environmental forces. There are certain methods evolved in modern researches. Keeping in view the nature and purpose of the study, the descriptive survey method is preferred. This method is one of the important methods in education research because it describes the current position of the phenomenon under study. The term descriptive survey is generally used for the type of research which proposes to condition of practices of the present time. In the present study, a systematically random sampling method was used to select a representative sample. 50 students were selected from 2 schools. Out of 50 students, 25 were boys and 25 were girls. In the study, a) it has been found a significant difference in the level of adjustment between male and female students; b) it has been found a non-significant difference in the level of emotional intelligence between male and female students; c) it has been found a non-significant relationship between adjustment and emotional intelligence among male students; d) it has been found a significant relationship between adjustment and emotional intelligence among male students. The results of the study indicated that amongst the students those who possess high scores on emotional intelligence tests are high in level of adjustment. Measures should be adopted to improve and sustain the emotional intelligence level of students throughout their studies. Adolescent students are prone to many problems like physical, social and psychological. They need a congenial home atmosphere so that they grow into full-fledged citizens of our country. After understanding these, it helps in the development of personality which leads to a better learning situation and better thinking capacities, in turn, enhances adjustment and achievement along with a better perception of self.

Keywords: adjustment, education, emotional intelligence, students

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Authors: Rai Friedman

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The recent migrant crisis has revealed an unmet demand for increased international protection and promotion of migrant rights. Europe has found itself at the centre of the migration crisis, being the recipient to the largest number of asylum-seekers since the conclusion of the second World War. Rather than impart a unified humanitarian lens of offering legal protections, the Schengen territory is devising new, preventative measures to confront the influx of asylum-seekers. This paper will focus on the refugee crisis in Europe as it relates to the Central Mediterranean route. To do so, it will outline the increased need for international protection for migrant rights through analyzing historic human rights treaties and conventions; the formation of the current composition of the Schengen area; the evolutionary changes in policies and legal landscapes throughout Europe and the Central Mediterranean route; the vernacular transformation surrounding refugees, migrants, and asylum-seekers; and expose the gaps in international protection. It will also discuss Europe’s critical position, both geographically and conceptually, critiquing the notion of European victimization. Lastly, it will discuss the increased harm of preventative border measures and argue for tangible sustainability solutions through economic programming models in highly vulnerable countries. To do so, this paper will observe a case study in Algeria that has conceded to an economic programming model for forced migrants. In 2017 amid worker shortages, Algeria announced it would grant African migrants’ legal status to become agriculturalists and construction workers. Algeria is one of the few countries along the Central Mediterranean route that has adopted a law to govern foreign nationals’ conditions of entry, stay and circulation. Thereafter, it will provide recommendations for solutions for forced migration along the Central Mediterranean route and advocate for strengthened protections under international law.

Keywords: refugees, migrants, human rights, middle east, Africa, mediterranean, international humanitarian law, policy

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Authors: Yogesh Bacchaw, Ashish Dabade

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Nowadays oral health is raising concern in society. Acid producing microorganisms changes the oral pH and creates a favorable environment for microbial growth. This growth not only promotes dental decay but also bad breath. Generally Recognized As Safe (GRAS) listed component was incorporated in chewing gum as an antimicrobial agent. The chewing gum produced exhibited up to 9 hours of antimicrobial activity against oral microflora. The toxicity of GRAS component per RACC value of chewing gum was negligible as compared to actual toxicity level of GRAS component. The antibacterial efficiency of chewing gum was tested by using total plate count (TPC) and colony forming unit (CFU). Nine hours were required to microflora to reach TPC/CFU of before chewing gum consumption. This chewing gum not only provides mouth freshening activity but also helps in lowering dental decay, bad breath, and enamel whitening.

Keywords: colony forming unit (CFU), chewing gum, generally recognized as safe (GRAS), microbial growth, microorganisms, oral health, RACC, total plate count (TPC), antimicrobial agent, enamel whitening, oral pH

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Authors: In Kyong Yi, Yun Jeong Chae, Jihoon Hwang, Sook-Young Lee, Jong-Yeop Kim

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Background: Pentax airway scope (AWS) is a recently developed video laryngoscope for use in both normal and difficult airways, providing a good laryngeal view. The purpose of this randomized noninferior study was to evaluate the efficacy of the Pentax-AWS regarding intubation time, laryngeal view and ease of intubation in pediatric patients with normal airway, compared to Macintosh laryngoscope. Method: A total of 136 pediatric patients aged 1 to 10 with American Society of Anesthesiologists physical status I or II undergoing general anesthesia required orotracheal intubation were randomly allocated into two groups: Macintosh laryngoscope (n =68) and Pentax AWS (n=68). Anesthesia was induced with propofol, rocuronium, and sevoflurane. The primary outcome was intubation time. Cormack-Lehane laryngeal view grade, application of optimal laryngeal external manipulation (OELM), intubation difficulty scale (IDS), intubation failure rate and adverse events were also measured. Result: No significant difference was observed between the two groups regarding intubation time (Macintosh; 23[22-26] sec vs. Pentax; 23.5[22-27.75] sec, p=0.713). As for the laryngeal view grade, the Pentax group showed less number of grade 2a or higher grade cases compared to the Macintosh group (1/2a/2b/3; 52.9%/41.2%/4.4%/1.5% vs. 98.5%/1.5%/0%/0%, p=0.000). No optimal laryngeal external manipulation application was required in the Pentax group (38.2% vs. 0%, p=0.000). Intubation difficulty scale resulted in lower values for Pentax group (0 [0-2] vs. 0 [0-0.55], p=0.001). Failure rate was not different between the two groups (1.5% vs. 4.4%, p=0.619). Adverse event-wise, slightly higher incidence of bleeding (1.5% vs. 5.9%, p=0.172) and teeth injury (0% vs. 5.9%, p=0.042) occurred in the Pentax group. Conclusion: In conclusion, Pentax-AWS provided better laryngeal view, similar intubation time and similar success rate compared with Macintosh laryngoscope in children with normal airway. However, the risk of teeth injury might increase and warrant special attention.

Keywords: Pentax-AWS, pediatric, video laryngoscope, intubation

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Authors: Angela Maria Fenu

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The aim of this study was to better characterize the nature of word association responses in people with aphasia. The participants selected for the experimental group were 4 individuals with mild Broca’s aphasia. The control group consisted of 51 cognitively intact age- and gender-matched individuals. The participants were asked to perform a word association task in which they had to say the first word they thought of when hearing each cue. The cue words (n= 16) were the translation in Italian of the set of English cue words of a published study. The participants from the experimental group were administered the word association test every two weeks for a period of two months when they received speech-language therapy A combination of analytical approaches to measure the data was used. To analyse different patterns of word association responses in both groups, the nature of the relationship between the cue and the response was examined: responses were divided into five categories of association. To investigate the similarity between aphasic and non-aphasic subjects, the stereotypy of responses was examined.While certain stimulus words (nouns, adjectives) elicited responses from Broca’s aphasics that tended to resemble those made by non-aphasic subjects; others (adverbs, verbs) showed the tendency to elicit responses different from the ones given by normal subjects. This suggests that some mechanisms underlying certain types of associations are degraded in aphasics individuals, while others display little evidence of disruption. The high number of paradigmatic associations given in response to a noun or an adjective might imply that the mechanisms, largely semantic, underlying paradigmatic associations are relatively preserved in Broca’s aphasia, but it might also mean that some words are more easily processed depending on their grammatical class (nouns, adjectives). The most significant variation was noticed when the grammatical class of the cue word was an adverb. Unlike the normal individuals, the experimental subjects gave the most idiosyncratic associations, which are often produced when the attempt to give a paradigmatic response fails. In turn, the failure to retrieve paradigmatic responses when the cue is an adverb might suggest that Broca’s aphasics are more sensitive to this grammatical class.The findings from this study suggest that, from research on word associations in people with aphasia, important data can arise concerning the specific lexical retrieval impairments that characterize the different types of aphasia and the various treatments that might positively influence the kinds of word association responses affected by language disruption.

Keywords: aphasia therapy, clinical linguistics, word-association behaviour, mental lexicon

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Authors: Libia Jiménez Chávez

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This is a study of freedom riders and their courageous journey for civil rights, but the year was not 1961. It was 2003. This paper chronicles the emergence of a new civil rights movement for immigrant rights through an oral history of the 2003 U.S. Immigrant Workers Freedom Ride (IWFR). During the height of the post-9/11 immigrant repression, a bloc of organizations inspired by the Civil Rights Movement of the 1960s mobilized 900 multinational immigrants and their allies in the fight for legal status, labor protections, family reunification, and civil rights. The activists visited over 100 U.S. cities, met with Congressional leaders in the nation’s capital, and led a rally of over 50,000 people in New York City. This unified effort set the groundwork for the national May Day immigration protests of 2006. Movements can be characterized in two distinct ways: physical movement and social movements. In the past, historians have considered immigrants both as people and as participants in social movements. In contrast, studies of recent migrants tend to say little about their involvement in immigrant political mobilizations. The dominant literature on immigration portrays immigrants as objects of exclusion, border enforcement, detention, and deportation instead of strategic political actors. This paper aims to change this perception. It considers the Freedom Riders both as immigrants who were literally on the move and as participants in a social movement. Through interviews with participants and archival video footage housed at the University of California Los Angeles, it is possible to study this mobile protest as a movement. This contemporary immigrant struggle is an opportunity to explore the makeup and development of a heterogenous immigrant coalition and consider the relationship between population movements and social justice. In addition to oral histories and archival research, the study will utilize social movement literature, U.S. immigration and labor history, and Undocumented Critical Theory to expand the historiography of immigrant social movements in America.

Keywords: civil rights, immigrant social movements, undocumented communities, undocumented critical theory

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Authors: Zhaoqi He

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Research Context: Endurance performance in hot environments is influenced by the interplay of hydration status and physiological responses. This study aims to investigate how dehydration, up to 2.11% body weight loss, affects the 3 km running performance of trained male athletes under conditions mimicking high temperatures. Methodology: In a randomized crossover design, five male athletes participated in two trials – euhydrated (EU) and dehydrated (HYPO). Both trials included a 70-minute preload run at 55-60% VO2max in 32°C and 50% humidity, followed by a 3-kilometer time trial. Fluid intake was restricted in HYPO to induce a 2.11% body weight loss. Physiological metrics, including heart rate, core temperature, and oxygen uptake, were measured, along with perceptual metrics like perceived exertion and thirst sensation. Findings: The 3-kilometer run completion times showed no significant differences between EU and HYPO trials (p=0.944). Physiological indicators, including heart rate, core temperature, and oxygen uptake, did not significantly vary (p>0.05). Thirst sensation was markedly higher in HYPO (p=0.013), confirming successful induction of dehydration. Other perceptual metrics and gastrointestinal comfort remained consistent. Conclusion: Contrary to the hypothesis, the study reveals that dehydration, inducing up to 2.11% body weight loss, does not significantly impair 3 km running performance in trained male athletes under hot conditions. Thirst sensation was notably higher in the dehydrated state, emphasizing the importance of considering perceptual factors in hydration strategies. The findings suggest that trained runners can maintain performance despite moderate dehydration, highlighting the need for nuanced hydration guidelines in hot-weather running.

Keywords: hypohydration, euhydration, hot environment, 3km running time trial, endurance performance, trained athletes, perceptual metrics, dehydration impact, physiological responses, hydration strategies

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Authors: Mahmood Shamshiri

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While visual sensation is the key gate for human-being to understand the world, visual impairment is one of the common cause of disability around the world. There is no doubt about the importance of eye sight in daily life among people, even it is understood the best gift of God to human-beings in many societies. Blind people are admitted to hospital for different health issues. Nurses and other health professionals who provide care for this group of patients need to understand their patients. Understanding the lived experience of blind people helps nurses to expand their knowledge regarding blind patients in order to provide a holistic care and improve the quality of care for blind patients. This phenomenological inquiry aimed to describe the meaning of discipline in daily life of blind people admitted in hospital. An interpretive phenomenology underpinned the philosophical approach of the study. While the interpretive phenomenology played as an umbrella role in the overall point of the study, the six methodical activities which introduced by van Manen helped the researchers to conduct the study. ‘Disciplined care for disciplined patients’ was the main theme emerged from dialogues of blind patients about their daily life in the hospital. Almost all of participants called themselves as disciplined people. The theme ‘disciplined care for disciplined patients’ appeared from four sub-themes including discipline through careful touching and listening, discipline as the ideal way of existence, discipline the preferred way of being independent, desire to take disciplined and detailed care, reactions to the undisciplined caring culture. This phenomenological inquiry to the experiences of patients with blindness in hospital revealed that they commonly are disciplined people and want to be cared in well-organized caring environment. Furthermore, they need to be familiar with the new caring environment. Well-organized and familiar environment help blind patients to increase the level of independency. In addition, blind patients prefer a detail informed and disciplined caring culture. Health professionals have to consider the concept of disciplined care in order to provide a holistic and comprehensive competent care.

Keywords: disciplined people, disciplined care, lived experience, patient with blindness

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Authors: Ahmed Elhussein, Hossam El-Zomor, Adel Alieldin, Mahmoud A. Afifi, Abdullah Elhusseiny, Hala Taha, Amal Refaat, Soha Ahmed, Mohamed S. Zagloul

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Background: A majority of children with retinoblastoma (60%) have a disease in one eye only (unilateral disease). This is a retrospective study to evaluate two different treatment modalities in those patients for saving their lives and vision. Methods: Four hundred and four patients were diagnosed with unilateral intraocular retinoblastoma at Children’s Cancer, Hospital Egypt (CCHE) through the period of July/2007 until December/2017. Management strategies included primary enucleation versus ocular salvage treatment. Results: Patients presented with mean age 24.5 months with range (1.2-154.3 months). According to the international retinoblastoma classification, Group D (n=172, 42%) was the most common, followed by group E (n=142, 35%), group C (n=63, 16%), and group B (n=27, 7%). All patients were alive at the end of the study except four patients who died, with 5-years overall survival 98.3% [CI, (96.5-100%)]. Patients presented with advanced disease and poor visual prognosis (n=241, 59.6%) underwent primary enucleation with 6 cycles adjuvant chemotherapy if they had high-risk features in the enucleated eye; only four patients out of 241 ended-up either with extraocular metastasis (n=3) or death (n=1). While systemic chemotherapy and focal therapy were the primary treatment for those who presented with favorable disease status and good visual prognosis (n=163, 40.4%); seventy-seven patients of them (47%) ended up with a pre-defined event (enucleation, EBRT, off protocol chemotherapy or 2ry malignancy). Ocular survival for patients received primary chemotherapy + focal therapy was [50.9% (CI, 43.5-59.6%)] at 3 years and [46.9% (CI,39.3-56%)] at 5 years. Comparison between upfront enucleation and primary chemotherapy for occurrence of extraocular metastasis revealed that there was no statistical difference between them except in group D (p value). While for occurrence of death, no statistical difference in all classification groups. Conclusion: In retinoblastoma, primary chemotherapy is a reasonable option and has a good probability for ocular salvage without increasing the risk of metastasis in comparison to upfront enucleation except in group D.

Keywords: CCHE, chemotherapy, enucleation, retinoblastoma

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Authors: Dammar Bahadur Adhikari

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Community forestry in Nepal has got disproportionately high level of support from government and other actors in forestry sector. Even though master plan for forestry sector (1989) has highlighted community and private forestry as one component, the government policies and other intervention deliberately left out private forestry in its structure and programs. The study aimed at providing the pathway for formulating appropriate policies to address need of different kind of forest management regimes in Rautahat district, Nepal. The key areas the research focused were assessment of current status of private forestry, community forest users' understanding on private forestry; criteria for choosing species of private forestry and factors affecting establishment of private forestry in the area. Qualitative and quantitative data were collected employing questionnaire survey, rapid forest assessment and key informant interview. The study found out that forest policies are imposed due to intense pressure of exogenous forces than due to endogenous demand. Most of the local people opine that their traditional knowledge and skills are not sufficient for private forestry and hence need training on the matter. Likewise, local use, market value and rotation dictate the choice of species for plantation in private forests. Currently district forest office is the only government institution working in the area of private forestry all other governmental and non-governmental organizations have condoned. private forestry. Similarly, only permanent settlers in the area are found to establish private forests other forest users such as migrants and forest encroachers follow opportunistic behavior to meet their forest product need from community and national forests. In this regard, the study recommends taking appropriate step to support other forest management system including private forestry provide community forestry the benefits of competition as suggested by Darwin in 18th century, one and half century back and to help alleviate poverty by channelizing benefits to household level.

Keywords: community forest, forest management, poverty, private forest, users’ group

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Authors: Rodlyn Remina Hines

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Males and Females respond differently to life situations, including transnational living. Being in a transnational marriage relationship may put a strain on the relationship requiring partners to adjust their behaviors and expectancies of the other partner to accommodate the disruptions in the relationship. More so, when one partner is an immigrant to a new geographic location with the other in the native country, these disruptions may be intensive. This qualitative study examined gender differences in how married Ghanaian couples respond to making a life together as a couple while living across international borders. The study asked two questions: (1) What are the perceptions of males and females on transnational living? and (2) how do married males and females respond to transnational living situations? To answer these questions, semi-structured interviews were conducted with 24 married couples- with one partner living in the United States (U.S.) and the other spouse in Ghana via purposive and snowball sampling techniques. Participants were aged 26 to 59 years with an average age of 40; the average age of relationship: 10.41; and average years of living apart: 6.7. Induction and deduction hybrid analysis strategies were used to derive emerging themes. The results highlight significant gender differences in response to transnational living status and practices. The data indicate that transnational couples with the male spouse residing in the U.S. experience more relationship strains than is the case when the female partner is the immigrant. Three couples who were in divorce proceedings at the time of the interview had the male partner residing in the U.S. and the female spouse in Ghana. These gender differences also reflected spousal visitation frequency, duration of spousal reunification, amount of and frequency of spousal remittance(s), and immigration processing procedures. Finally, the data show female immigrant partners as better managers of transnational living stresses and strains than their male counterparts. Findings from this study have implications for marriage and family practitioners and immigration policy makers.

Keywords: gender differences, , ghanaian couples, ghanaian immigrants, transnational living

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Authors: Sicheng Liu

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Zhang Ming is a never-A-listed writer-director in China who is famous for his poetic art-house filmmaking in mainland China, and his complex to spectacles of tiny places in south China. Entirely, Zhang’s works concentrate on the interconnection amongst settlement images, desirable fictional storytelling, and the dilemma of alienated interpersonal relationships. Zhang uses his pendulous camerawork to reconstruct the spectacles of his hometown and detached places in northern China, such as hometown Wushan county, lower-tier cities or remote areas that close to nature, where the old spectacles are experiencing great transformation and vanishment. Under his camera, the cities' geo-cultural and geopolitical implications which are not only a symbolic meaning that these places are not only settlements for residents to live but also representations to the abstraction of time-lapse, dimensional disorientation and revealment to people’s innerness. Zhang Ming is good at creating the essay-like expression, poetic atmosphere and vague metaphors in films, so as to show the sensitivity, aimlessness and slight anxiety of Chinese wenren (intellectuals), whose unique and objective experiences to a few aspects inside or outside their the living circumstance, typically for example, transformation of the environment, obscure expression to inner desire and aspirations, personal loneliness because of being isolated, slight anxiety to the uncertainty of life, and other mental dilemma brought by maladjustment. Also, Zhang’s works impressed the audience as slow cinemas, via creating stillness, complicity and fluidity of images and sound, by decompressing liner time passing and wandering within the enclosed loopback-space with his camera, so as to produce poeticized depiction and mysterious dimensions in films. This paper aims to summarize these mentioned features of Zhang’s films, by analyzing filmic texts and film-making styles, in order to prove an outcome that as a wenren-turned-filmmaker, Zhang Ming is good at use metaphor to create an artistic situation to depict the poetry in films and portray characteristics. In addition to this, Zhang Ming’s style relatively reflects some aesthetic features of Chinese wenren cinema.

Keywords: Chinese wenren cinema, intellectuals’ awareness, slow cinema,  slowness and dampness, people and environment

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Authors: Matthew Scott Lau

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This study addresses the research question: How effective has the Community Health Assist Scheme (CHAS) been in reducing market failure in Singapore’s healthcare sector? The CHAS policy, introduced in 2012 in Singapore, aims to improve accessibility and affordability of healthcare by offering subsidies to low and middle-income groups and elderly individuals for general practice consultations and healthcare. The investigation was undertaken by acquiring and analysing primary and secondary research data from 3 main sources, including handwritten survey responses of 334 individuals who were valid CHAS subsidy recipients (CHAS cardholders) from 5 different locations in Singapore, interview responses from two established general practitioner doctors with working knowledge of the scheme, and information from literature available online. Survey responses were analysed to determine how CHAS has affected the affordability and consumption of healthcare, and other benefits or drawbacks for CHAS users. The interview responses were used to explain the benefits of healthcare consumption and provide different perspectives on the impacts of CHAS on the various parties involved. Online sources provided useful information on changes in healthcare consumerism and Singapore’s government policies. The study revealed that CHAS has been largely effective in reducing market failure as the subsidies granted to consumers have improved the consumption of healthcare. This has allowed for the external benefits of healthcare consumption to be realized, thus reducing market failure. However, the study also revealed that CHAS cannot be fully effective in reducing market failure as the scope of CHAS prevents healthcare consumption from fully reaching the socially optimal level. Hence, the study concluded that CHAS has been effective to a large extent in reducing market failure in Singapore’s healthcare sector, albeit with some benefits to third parties yet to be realised. There are certain elements of the investigation, which may limit the validity of the conclusion, such as the means used to determine the socially optimal level of healthcare consumption, and the survey sample size.

Keywords: healthcare consumption, health economics, market failure, subsidies

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Authors: Bih-O Lee, Hsiu-Wan Hsieh, Hsiu-Chen Liu, Mer Yu Pan

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Background: Illness perceptions are developed when people face health-threatening situations. Previous research suggests that understanding discrepancies between illness perceptions of patients and caregivers may need to improve quality of health care. Objective: This study examined the differences between illness perceptions of injured patients and those of their caregivers. Methods: Comparative study design was used. The study setting was the surgical wards of a teaching hospital in Taiwan. Participants were 127 pairs of injured patients and their caregivers. The participants completed socio-demographic data and completed the Chinese Illness Perception Questionnaire Revised-Trauma, which comprises eight subscales. Clinical data of the injured patients was obtained from medical records. Results: This study found that injured patients were more pessimistic than their caregivers about the injury. There were significant differences between patients and caregivers insofar as patients perceived more physical symptoms, scored higher in terms of reasons for their injury, had more negative emotions and experienced more consequences than caregivers. Elderly caregivers and caregivers for patients who were over 65, severely injured and admitted to an ICU perceived more negative perceptions about the injury. Conclusions: This study indicated that patients and caregivers had negative illness representations several months after injury although the intensity of their perceptions was different. The interventions should highlight the need to assist patients and caregivers after injury.

Keywords: illness representations, injury, caregivers, comparative study

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Authors: Amao Funmilayo Lanrewaju, T. Ogunlade

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The paper examines the causes and characteristics of informal settlements and outdoor advertisement in the evaluation of quality of environment. The paper identifies the problems that have aided informal settlements to: Urbanization, poverty, growth of informal sector, non-affordability of land and housing shortage. The paper asserts that the informal settlements have serious adverse effects on the people’s health, their built environment and quality of life. The secondary data was obtained from books, journals and seminar papers. The paper argues that, although the urban upgrading possesses great potential for improving quality of built environment in informal settlements, there is a need to repackage the upgrading exercise so that majority can benefit from it. It is necessary to incorporate community participation into the urban upgrading in order to assist the very poor that cannot take care of their housing consumption needs. Therefore, government is encouraged to see informal settlements as a solution to new city planning rather than problem to the urban areas. This paper suggests the implementation of policies and planning, physical infrastructural development, social economic improvement, environment and health improvement. Government, private and communities interventions on informal settlements are required in order to prevent further decay for sustainable development.

Keywords: quality of environment, informal settlements, urban upgrading, outdoor advertisement

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Authors: Simon B. N. Thompson

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Cortisol is essential to the regulation of the immune system and yawning is a pathological symptom of multiple sclerosis (MS). Electromyography activity (EMG) in the jaw muscles typically rises when the muscles are moved and with yawning is highly correlated with cortisol levels in healthy people. Saliva samples from 59 participants were collected at the start and after yawning, or at the end of the presentation of yawning-provoking stimuli, in the absence of a yawn, together with EMG data and questionnaire data: Hospital Anxiety and Depression Scale, Yawning Susceptibility Scale, General Health Questionnaire, demographic, health details. Exclusion criteria: chronic fatigue, diabetes, fibromyalgia, heart condition, high blood pressure, hormone replacement therapy, multiple sclerosis, stroke. Significant differences were found between the saliva cortisol samples for the yawners, t (23) = -4.263, p = 0.000, as compared with the non-yawners between rest and post-stimuli, which was non-significant. Significant evidence was found to support the Thompson Cortisol Hypothesis suggesting that rises in cortisol levels are associated with yawning. Further research is exploring the use of cortisol as an early diagnostic tool for MS. Ethics approval granted and professional code of conduct, confidentiality, and safety issues are approved therein.

Keywords: cortisol, multiple sclerosis, yawning, thompson cortisol hypothesis

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Authors: Alexandru Grigorescu, Alexandra Protesanu

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Background: Approximately 34-67 percent of cancer patients experience an episode of uncontrolled pain during the course of their disease, depending on the stage. The aim is to provide evidence-based data for pain prevalence, diagnosis and treatment recommendations on an integrative model of medical oncology and palliative care for patients with cancer diagnostic in a day hospital. Patients and method: Consultation registers and electronic records of 166 Patients (Pts) were studied from April 2022 to March 2023. Pts with pain syndrome were selected. The pain was objectified by the visual pain scale. To elucidate the causes of the pain, investigations were carried out: bone scintigraphy, CT scan, and PET-CT. The analgesic treatments were represented by weak and strong morphine, radiotherapy, and bisphosphonates. Result: During the mentioned period, 166 oncological patients (74 women and 92 men) were treated in the oncology day hospitalization service. There were 1,500 consultations, 40 of which were only for pain. The neoplastic locations were: gynecological, malignant melanoma, breast, gastric, bronchopulmonary, colorectal, liver, pancreatic, bladder, and kidney. 70 Pts presented pain syndrome. The causes of the pain were represented by bone metastases, compressive tumors, and post-surgical status. Drug treatment: Tramadol 47 Pts, of which 10 switched to a major opioid (Oxycodonum, Morphine sulfate), 20 Pts were treated with Oxycodonum as the first intention. In 5 patients ry to rotated morphine, 20 Pts received palliative radiotherapy, 10 Pts were treated with bisphosphonates. 2 Pts required neurosurgery consultation for an antalgic intervention. 5 Pts had important adverse reactions to morphine. All patients and their families were advised by a medical oncologist and psychologist for a lifestyle change. Conclusions: The prevalence of pain was similar to that described in the literature. In most cases, the pain could be managed in the day hospital. Weak and strong morphine represented the main pain therapy. Palliative radiotherapy was the second most effective therapy. Treatment with bisphosphonates was useful. Surgical interventions were rarely indicated. Discussions with patients and their families regarding the lifestyle change were important.

Keywords: cancer pain, opioids, medical oncology, palliative care

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Authors: Sania Bashir

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A promising approach to healthcare delivery, telemedicine makes use of communication technology to reach out to remote regions of the world, allowing for beneficial interactions between diabetic patients and healthcare professionals as well as the provision of affordable and easily accessible medical care. The emergence of contemporary care models, fueled by the pervasiveness of mobile devices, provides better information, offers low cost with the best possible outcomes, and is known as digital health. It involves the integration of collected data using software and apps, as well as low-cost, high-quality outcomes. The goal of this study is to assess how well telemedicine works for diabetic patients and how it impacts their HbA1c levels. A questionnaire-based survey of 300 diabetics included 150 patients in each of the groups receiving usual care and via telemedicine. A descriptive and observational study that lasted from September 2021 to May 2022 was conducted. HbA1c has been gathered for both categories every three months. A remote monitoring tool has been used to assess the efficacy of telemedicine and continuing therapy instead of the customary three monthly meetings like in-person consultations. The patients were (42.3) 18.3 years old on average. 128 men were outnumbered by 172 women (57.3% of the total). 200 patients (66.6%) have type 2 diabetes, compared to over 100 (33.3%) candidates for type 1. Despite the average baseline BMI being within normal ranges at 23.4 kg/m², the mean baseline HbA1c (9.45 1.20) indicates that glycemic treatment is not well-controlled at the time of registration. While patients who use telemedicine experienced a mean percentage change of 10.5, those who visit the clinic experienced a mean percentage change of 3.9. Changes in HbA1c are dependent on several factors, including improvements in BMI (61%) after 9 months of research and compliance with healthy lifestyle recommendations for diet and activity. More compliance was achieved by the telemedicine group. It is an undeniable reality that patient-physician communication is crucial for enhancing health outcomes and avoiding long-term issues. Telemedicine has shown its value in the management of diabetes and holds promise as a novel technique for improved clinical-patient communication in the twenty-first century.

Keywords: diabetes, digital health, mobile app, telemedicine

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Authors: Anna Wszołek

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For a very long time, the doctor-patient relationship had a paternalistic character. The events of the II World War, as well as fast development of the biotechnology and medicine caused an important change in that relationship. Human beings and their dignity were put in the centre of philosophical and legal debate. The increasing frequency of clinical trials led to the emergence of bioethics, which dealt with the topic of the possibilities and boundaries of such research in relation to individual’s autonomy. Thus, there was a transformation from a paternalistic relationship to a more collaborative one in which the patient has more room for self-determination. Today, patients are more and more aware of their rights and the obligations placed on doctors and the health care system, which is linked to an increase in medical malpractice claims. Unfortunately, these claims are not always justified. There is a strong concentration around the topic of patient’s good, however, at the other side there are doctors who feel, on the example of Poland, they might be easily accused and sued for medical malpractice even though they fulfilled their duties. Such situation may have a negative impact on the quality of health care services and patient’s interests. This research is going to present doctor’s perspective on the topic of medical malpractice allegations. It is supposed to show possible damage to a doctor’s reputation caused by frivolous and weakly justified medical malpractice accusations, as well as means to protect this reputation.

Keywords: doctor's reputation, medical malpractice, personal rights, unjustified allegations

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Authors: Mohammad Julhas Sujan, Md. Ferdous Alam

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Maternal, neonatal, and child health (MNCH) holds one of the prime focuses in Bangladesh’s national healthcare system. To save the lives of mothers and children, knowing the stock of MNCH medicines in different healthcare facilities and when to replenish them are essential. A robust information system not only facilitates efficient management of the essential MNCH medicines but also helps effective allocation of scarce resources. In Bangladesh, Supply chain management of the 25-essential life-saving medicines are currently tracked and monitored via an electronic logistics management information system (eLMIS). Our aim was to conduct a cross-sectional study with a year (2020) worth of data from 24 districts of Bangladesh to evaluate how eLMIS is helping the Government and other stakeholders in efficient supply chain management. Data were collected from 4711 healthcare facilities ranging from primary to secondary levels within a district. About 90% (4143) are community clinics which are considered primary health care facilities in Bangladesh. After eLMIS implementation, the average reporting rate across the districts has been increased (> 97%). The month of stock (MOS) of zinc is an average 6 months compared to Inj. Magnesium Sulphate which will take 2.5 years to consume according to the current average monthly consumption (AMC). Due to first approaching expiry, Tab. Misoprostol, 7.1% Chlorhexidine and Inj. Oxytocin may become unusable. Moreover, Inj. Oxytocin is temperature sensitive and may reduce its efficacy if it is stocked for a longer period. In contrast, Zinc should be sufficiently stocked to prevent sporadic stockouts. To understand how data are collected, transmitted, processed, and aggregated for MNCH medicines in a faster and timely manner, an electronic logistics management information system (eLMIS) is necessary. We recommend the use of such a system in developing countries like Bangladesh for efficient supply chain management of essential MNCH medicines.

Keywords: adaption, eLMIS, MNCH, live-saving medicines

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Authors: Mukesh A. Modi

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High-nitrate concentration in groundwater of unconfined aquifers has been a serious issue for public health risk at a global scale. Various anthropogenic activities in agricultural land and urban land of alluvial soil have been observed to be responsible for the increment of nitrate in groundwater. The present study was designed to identify suitable denitrification strategies to minimize the effects of high nitrate in groundwater near the Mahi River of Vadodara block, Gujarat. There were 11 wells of Jal Jeevan Mission, Ministry of Jal Shakti, along with 3 observation wells of Gujarat Water Resources Development Corporation have been used for the duration of 21 years. MODFLOW and MT3DMS codes have been used to simulate solute transport phenomena along with attempted effectively for optimization. Current research is one step ahead by optimizing various denitrification strategies with the simulation of the model. The in-situ and ex-situ denitrification strategies viz. NAS (No Action Scenario), CAS (Crop Alternation Scenario), PS (Phytoremediation Scenario), and CAS + PS (Crop Alternation Scenario + Phytoremediation Scenario) have been selected for the optimization. The groundwater model simulates the most suitable denitrification strategy considering the hydrogeological characteristics at the targeted well.

Keywords: groundwater, high nitrate, MODFLOW, MT3DMS, optimization, denitrification strategy

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Authors: Mary M. Park

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Hollywood has had a long and enduring history of showcasing the United States military to civilian audiences, and the portrayals of soldiers in films have had a definite impact on the civilian perception of the US military. The growing gap between the civilian population and the military in the US has led to certain stereotypes of military personnel to proliferate, especially in the area of militarized masculinity, which has often been harmful to the psychological and spiritual wellbeing of military personnel. Examining Hollywood's portrayal of soldiers can serve to enhance our understanding of how civilians may be influenced in their perception of military personnel. Moreover, it can provide clues as to how male military personnel may also be influenced by Hollywood films as they form their own military identity. The post 9/11 era has seen numerous high budget films lionizing a particular type of soldier, the 'warrior-hero', who adheres to a traditional form of hegemonic masculinity and exhibits traits such as physical strength, bravery, stoicism, and an eagerness to fight. This paper examines how the portrayal of the 'warrior-hero' perpetuates a negative stereotype that soldiers are a blend of superheroes and emotionless robots and, therefore, inherently different from civilians. This paper examines the portrayal of militarized masculinity in three of the most successful war films of the post-9/11 era; Black Hawk Down (2001), The Hurt Locker (2008), and American Sniper (2014). The characters and experiences of the soldiers depicted in these films are contrasted with the lived experiences of soldiers during the Iraq and Afghanistan wars. Further, there is an analysis of popular films depicting ancient warriors, such as Troy (2004) and 300 (2007), which were released during the early years of the War on Terror. This paper draws on the concept of hegemonic militarised masculinity by leading scholars and feminist international relations theories on militarized masculinity. This paper uses veteran testimonies collected from a range of public sources, as well as previous studies on the link between traditional masculinity and war-related mental illness. This paper concludes that the seemingly exclusive portrayal of soldiers as 'warrior-heroes' in films in the post-9/11 era is misleading and damaging to civil-military relations and that the reality of the majority of soldiers' experiences is neglected in Hollywood films. As civilians often believe they are being shown true depictions of the US military in Hollywood films, especially in films that portray real events, it is important to find the differences between the idealized fictional 'warrior-heroes' and the reality of the soldiers on the ground in the War on Terror.

Keywords: civil-military relations, gender studies, militarized masculinity, social pyschology

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Authors: Kinneret Segal

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Background: The work of a midwife is emotionally challenging, both positively and negatively. Midwives share moments of joy when a baby is welcomed into the world and also attend difficult events of loss and trauma. The relationship that develops with the maternity is the essence of the midwife's care, and it is a fundamental source of motivation and professional satisfaction. This close relationship with the maternity may be used as a double-edged sword in cases of exposure to traumatic events at birth. Birth problems, exposure to emergencies and traumatic events, and loss can affect the professional quality of life and the Compassion satisfaction of the midwife. It seems that the issue of traumatic experiences in the work of midwives has not been sufficiently explored. Aim: The present study examined the associations between exposure to traumatic events, personal resilience and post-traumatic symptoms, professional quality of life, and organizational commitment among midwifery nurses in Israeli hospitals. Methods: 131 midwives from three hospitals in the country's center in Israel participated in this study. The data were collected during 2021 using a self-report questionnaire that examined sociodemographic characteristics, the degree of exposure to traumatic events in the delivery room, personal resilience, post-traumatic symptoms, professional quality of life, and organizational commitment. Results: The three most difficult traumatic events for the midwives were death or fear of death of a newborn, death or fear of the death of a mother, and a quiet birth. The higher the frequency of exposure to traumatic events, the more numerous and intense the onset of post-trauma symptoms. The more numerous and powerful the post-trauma symptoms, the higher the level of professional burnout and/or compassion fatigue, and the lower the level of compassion satisfaction. High levels of compassion satisfaction and/or low professional burnout were expressed in a heightened sense of organizational commitment. Personal resilience, country of birth, traumatic symptoms, and organizational commitment predicted satisfaction from compassion. Conclusions: Midwives are exposed to traumatic events associated with dissatisfaction and impairment of the professional quality of life that accompanies burnout and compassion fatigue. Exposure to traumatic events leads to the appearance of traumatic symptoms, a decrease in organizational commitment, and psychological and mental well-being. The issue needs to be addressed by implementing training programs, organizational support, and policies to improving well-being and quality of care among midwives.

Keywords: organizational commitment, traumatic experiences, personal resilience, quality of life

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Authors: Giuliana Murfet, Heidi Behrens

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Chronic disease is Australia’s biggest health concern and obesity the leading risk factor for many. Obesity and chronic disease have a higher representation in rural Tasmania, where levels of socio-disadvantage are also higher. People living outside major cities have less access to health services and poorer health outcomes. To help primary healthcare professionals manage obesity, the Australian NHMRC evidence-based clinical practice guidelines for management of overweight and obesity in adults were developed. They include recommendations for practice and models for obesity management. To our knowledge there has been no research conducted that investigates translation of these guidelines into practice in rural-regional areas; where implementation can be complicated by limited financial and staffing resources. Also, the systematic review that informed the guidelines revealed a lack of evidence for chronic disease models of obesity care. The aim was to establish and evaluate a multidisciplinary model for obesity management in a group of adult people with type 2 diabetes in a dispersed rural population in Australia. Extensive stakeholder engagement was undertaken to both garner support for an obesity clinic and develop a sustainable model of care. A comprehensive nurse practitioner-led outpatient model for obesity care was designed. Multidisciplinary obesity clinics for adults with type 2 diabetes including a dietitian, psychologist, physiotherapist and nurse practitioner were set up in the north-west of Tasmania at two geographically-rural towns. Implementation was underpinned by the NHMRC guidelines and recommendations focused on: assessment approaches; promotion of health benefits of weight loss; identification of relevant programs for individualising care; medication and bariatric surgery options for obesity management; and, the importance of long-term weight management. A clinical pathway for adult weight management is delivered by the multidisciplinary team with recognition of the impact of and adjustments needed for other comorbidities. The model allowed for intensification of intervention such as bariatric surgery according to recommendations, patient desires and suitability. A randomised controlled trial is ongoing, with the aim to evaluate standard care (diabetes-focused management) compared with an obesity-related approach with additional dietetic, physiotherapy, psychology and lifestyle advice. Key barriers and enablers to guideline implementation were identified that fall under the following themes: 1) health care delivery changes and the project framework development; 2) capacity and team-building; 3) stakeholder engagement; and, 4) the research project and partnerships. Engagement of not only local hospital but also state-wide health executives and surgical services committee were paramount to the success of the project. Staff training and collective development of the framework allowed for shared understanding. Staff capacity was increased with most taking on other activities (e.g., surgery coordination). Barriers were often related to differences of opinions in focus of the project; a desire to remain evidenced based (e.g., exercise prescription) without adjusting the model to allow for consideration of comorbidities. While barriers did exist and challenges overcome; the development of critical partnerships did enable the capacity for a potential model of obesity care for rural regional areas. Importantly, the findings contribute to the evidence base for models of diabetes and obesity care that coordinate limited resources.

Keywords: diabetes, interdisciplinary, model of care, obesity, rural regional

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