Search results for: community-dwelling older adults

Authors: Vasoontara Yiengprugsawan, Sam-ang Seubsman

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As Thais live longer, caregivers will become even more important to social and healthcare systems. Commonly reported in many low and middle‐income countries in Asia, formal social welfare services to support caregivers are lacking and informal family support will be required for all levels of care. In 2005, 87,151 open‐university adults were recruited to the Thai Cohort Study, with the majority aged between 25 and 39 years, and residing nationwide. At the 4‐year follow up in 2009 (n=60569) and the 8‐year follow‐up in 2013 (n=42785), prospective cohort participants were asked if they provide care for chronically ill, disabled, or frail family members. Among Thai cohort members reporting between 2009 and 2013, approximately 56% were not caregivers in either year, 24.5% reported providing care in 2009 only, 8.6% in 2013 only, and 10.6% reported providing care at both time points. Caregivers in the cohort reported providing financial support, help with shopping, emotional support, and assist with daily activities. Kessler 6 psychological distress scale, measured in both 2009 and 2013, was used as the primary outcome of a relationship between caregiving status and mental health. Using multivariate logistic regression, our 4‐year longitudinal findings revealed that cohort members who reported providing care at both time points were 1.4 to 1.6 times more likely to report high psychological distress than non‐caregivers, after accounting for potential covariates. With increasing needs for informal care provided by family members, the future health and social welfare system will need to provide adequate support to caregivers (e.g., respite care, clinical support and information for the family, and awareness of mental health among caregivers).

Keywords: family caregivers, psychological distress, prospective cohort, longitudinal study, Thailand

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Authors: Juyeon Lee, Sungeun You

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Experiential avoidance is one’s tendency to avoid painful internal experience, unwanted adverse thoughts, emotions, and physical sensations. The Multidimensional Experiential Avoidance Questionnaire (MEAQ) is a measure of experiential avoidance, and the original scale consisted of 62 items with six subfactors including behavioral avoidance, distress aversion, procrastination, distraction/suppression, repression/denial, and distress endurance. The purpose of this study was to examine the factor structure of the MEAQ in a Korean sample. Three hundred community adults and university students aged 18 to 35 participated in an online survey assessing experiential avoidance (MEAQ and Acceptance and Action Questionnaire-II; AAQ-II), depression (Patient Health Questionnaire-9; PHQ-9), anxiety (Generalized Anxiety Disoder-7; GAD-7), negative affect (Positive and Negative Affect Scale; PANAS), neuroticism (Big Five Inventory; BFI), and quality of life (Satisfaction with Life Scale; SWLS). Factor analysis with principal axis with direct oblimin rotation was conducted to examine subfactors of the MEAQ. Results indicated that the six-factor structure of the original scale was adequate. Eight items out of 62 items were removed due to insufficient factor loading. These items included 3 items of behavior avoidance (e.g., “When I am hurting, I would do anything to feel better”), 2 items of repression/denial (e.g., “I work hard to keep out upsetting feelings”), and 3 items of distress aversion (e.g., “I prefer to stick to what I am comfortable with, rather than try new activities”). The MEAQ was positively associated with the AAQ-II (r = .47, p < .001), PHQ-9 (r = .37, p < .001), GAD-7 (r = .34, p < .001), PANAS (r = .35, p < .001), and neuroticism (r = .24, p < .001), and negatively correlated with the SWLS (r = -.38, p < .001). Internal consistency was good for the MEAQ total (Cronbach’s α = .90) as well as all six subfactors (Cronbach’s α = .83 to .87). The findings of the study support the multidimensional feature of experiential avoidance and validity of the MEAQ in a sample of Korean adults.

Keywords: avoidance, experiential avoidance, factor structure, MEAQ

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Authors: Raya Kathreen T. Fuentes, Christian Owen P. Domingo, Kaisha V. Durana, Kristine Chelsea Shynne M. Evangelista, Nicole A. Feliciano, Kathleen Patricia Q. Ferido, Christianna Joy J. Ferrer

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Diabetes Mellitus (DM) is a global public health concern. The foot ulcer is one of the most serious and costly complications of DM. Among the components of diabetes self-management (DSM), foot self-care was found to be one of the best preventive measures for foot ulcers yet is seldom performed. Thus, the purpose of this study is to determine how adequate foot self-care practices (FSP) are among Filipino adults with DM with the following objectives: 1) determine their DSM, 2) describe their FSP, 3) determine the relationship between FSP and DSM, and 4) determine the relationship of FSP to sociodemographic characteristics, disease-related characteristics, social support, and knowledge. A descriptive correlational design was utilized. 114 respondents aged 19-65 were selected through purposive sampling from diabetes clinics. A self-administered questionnaire regarding FSP, DSM, sociodemographic and disease-related characteristics, social support, and knowledge on diabetes were used. Pearson's correlation was utilized to determine the relationship between FSP and DSM while simple linear regression was used to determine the relationship of FSP to the factors aforementioned. Results showed that majority of the respondents have desirable DSM but inadequate FSP. FSP and DSM were shown to be positively correlated but not statistically significant (p = 0.8). Disparity among the two suggests that there is less emphasis on foot self-care compared to other components of DSM. Findings further revealed that patients diagnosed with DM for < 5 years demonstrated more adequate FSP compared to patients diagnosed for > 5 years which may suggest that newly diagnosed patients are more receptive to new information about DSM. Health education on DSM should place more emphasis on FSP. Reiteration of health education and continuous motivation should be done to all DM patients, not just to newly diagnosed patients, to improve compliance to FSP and enhance patient empowerment regarding self-care.

Keywords: diabetes mellitus, diabetes self-management, foot self-care practices, foot ulcer

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Authors: Hennie Boeije, Renate Verkaik, Joke Korevaar

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In Dutch national policy, it is promoted that the elderly remain living at home longer. They are less often admitted to a nursing home or only later in life. While living at home, it is important that they experience a good quality of life. Care providers in primary care support this. In this study, it was investigated what quality of life means for the elderly and which characteristics care should have that supports living at home longer with quality of life. To explore this topic, a qualitative methodology was used. Four focus groups were conducted: two with elderly people who live at home and their family caregivers, one with district nurses employed in-home care services and one with elderly care physicians working in primary care. Next to this individual interviews were employed with general practitioners (GPs). In total 32 participants took part in the study. The data were thematically analysed with MaxQDA software for qualitative analysis and reported. Quality of life is a multi-faceted term for elderly. The essence of their description is that they can still undertake activities that matter to them. Good physical health, mental well-being and social connections enable them to do this. Own control over their life is important for some. They are of opinion that how they experience life and manage old age is related to their resilience and coping. Key terms in the definitions of quality of life by GPs are also physical and mental health and social contacts. These are the three pillars. Next, to this elderly care, physicians mention security and safety and district nurses add control over their own life and meaningful daily activities. They agree that with frail elderly people, the balance is delicate and a change in one of the three pillars can cause it to collapse like a house of cards. When discussing what support is needed, professionals agree on access to care with a low threshold, prevention, and life course planning. When care is provided in a timely manner, a worsening of the situation can be prevented. They agree that hospital care often is not needed since most of the problems with the elderly have to do with care and security rather than with a cure per se. GPs can consult elderly care physicians to lower their workload and to bring in specific knowledge. District nurses often signal changes in the situation of the elderly. According to them, the elderly predominantly need someone to watch over them and provide them with a feeling of security. Life course planning and advance care planning can contribute to uniform treatment in line with older adults’ wishes. In conclusion, all stakeholders, including elderly persons, agree on what entails quality of life and the quality of care that is needed to support that. A future challenge is to shape conditions for the right skill mix of professionals, cooperation between the professions and breaking down differences in financing and supply. For the elderly, the challenge is preparing for aging.

Keywords: elderly living at home, quality of life, quality of care, professional cooperation, life course planning, advance care planning

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Authors: Linda Richter

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Background and Significance: The influence of parents on their children’s attitudes and behaviors is immense, even as children grow out of what one might assume to be their most impressionable years and into teenagers. This study specifically examines the potential that parents have to prevent or reduce the risk of adolescent substance use, even in the face of considerable environmental influences to use nicotine, alcohol, or drugs. Methodology: The findings presented are based on a nationally representative survey of 1,014 teens aged 12-17 living in the United States. Data were collected using an online platform in early 2018. About half the sample was female (51%), 49% was aged 12-14, and 51% was aged 15-17. The margin of error was +/- 3.5%. Demographic data on the teens and their families were available through the survey platform. Survey items explored adolescent respondents’ exposure to addictive substances; the extent to which their sources of information about these substances are reliable or credible; friends’ and peers’ substance use; their own intentions to try substances in the future; and their relationship with their parents. Key Findings: Exposure to nicotine, alcohol, or other drugs and misinformation about these substances were associated with a greater likelihood that adolescents have friends who use drugs and that they have intentions to try substances in the future, which are known to directly predict actual teen substance use. In addition, teens who reported a positive relationship with their parents and having parents who are involved in their lives had a lower likelihood of having friends who use drugs and of having intentions to try substances in the future. This relationship appears to be mediated by parents’ ability to reduce the extent to which their children are exposed to substances in their environment and to misinformation about them. Indeed, the findings indicated that teens who reported a good relationship with their parents and those who reported higher levels of parental monitoring had significantly higher odds of reporting a lower number of risk factors than teens with a less positive relationship with parents or less monitoring. There also were significantly greater risk factors associated with substance use among older teens relative to younger teens. This shift appears to coincide directly with the tendency of parents to pull back in their monitoring and their involvement in their adolescent children’s lives. Conclusion: The survey findings underscore the importance of resisting the urge to completely pull back as teens age and demand more independence since that is exactly when the risks for teen substance use spike and young people need their parents and other trusted adults to be involved more than ever. Particularly through the cultivation of a healthy, positive, and open relationship, parents can help teens receive accurate and credible information about substance use and also monitor their whereabouts and exposure to addictive substances. These findings, which come directly from teens themselves, demonstrate the importance of continued parental engagement throughout children’s lives, regardless of their age and the disincentives to remaining involved and connected.

Keywords: adolescent, parental monitoring, prevention, substance use

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Authors: Monika Dmitrzak-Weglarz, Aleksandra Rajewska-Rager, Maria Skibinska, Natalia Lepczynska, Piotr Sibilski, Joanna Pawlak, Pawel Kapelski, Joanna Hauser

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Epidermal growth factor (EGF) is a well-known neurotrophic factor that involves in neuronal growth and synaptic plasticity. The proteomic research provided in order to identify novel candidate biological markers for mood disorders focused on elevated EGF serum level in patients during depression episode. However, the EGF association with mood disorder spectrum among adolescents and young adults has not been studied extensively. In this study, we aim to investigate the serum levels of EGF in adolescents and young adults during hypo/manic, depressive episodes and in remission compared to healthy control group. In our study, we involved 80 patients aged 12-24 years in 2-year follow-up study with a primary diagnosis of mood disorder spectrum, and 35 healthy volunteers matched by age and gender. Diagnoses were established according to DSM-IV-TR criteria using structured clinical interviews: K-SADS for child and adolescents, and SCID for young adults. Clinical and biological evaluations were made at baseline and euthymic mood (at 3th or 6th month of treatment and after 1 and 2 years). The Young Mania Rating Scale and Hamilton Rating Scale for Depression were used for assessment. The study protocols were approved by the relevant ethics committee. Serum protein concentration was determined by Enzyme-Linked Immunosorbent Assays (ELISA) method. Human EGF (cat. no DY 236) DuoSet ELISA kit was used (R&D Systems). Serum EGF levels were analysed with following variables: age, age under 18 and above 18 years old, sex, family history of affective disorders, drug-free vs. medicated. Shapiro-Wilk test was used to test the normality of the data. The homogeneity of variance was calculated with Levene’s test. EGF levels showed non-normal distribution and the homogeneity of variance was violated. Non-parametric tests: Mann-Whitney U test, Kruskall-Wallis ANOVA, Friedman’s ANOVA, Wilcoxon signed rank test, Spearman correlation coefficient was applied in the analyses The statistical significance level was set at p<0.05. Elevated EGF level at baseline (p=0.001) and at month 24 (p=0.02) was detected in study subjects compared with controls. Increased EGF level in women at month 12 (p=0.02) compared to men in study group have been observed. Using Wilcoxon signed rank test differences in EGF levels were detected: decrease from baseline to month 3 (p=0.014) and increase comparing: month 3 vs. 24 (p=0.013); month 6 vs. 12 (p=0.021) and vs. 24 (p=0.008). EGF level at baseline was negatively correlated with depression and mania occurrence at 24 months. EGF level at 24 months was positively correlated with depression and mania occurrence at 12 months. No other correlations of EGF levels with clinical and demographical variables have been detected. The findings of the present study indicate that EGF serum level is significantly elevated in the study group of patients compared to the controls. We also observed fluctuations in EGF levels during two years of disease observation. EGF seems to be useful as an early marker for prediction of diagnosis, course of illness and treatment response in young patients during first episode od mood disorders, which requires further investigation. Grant was founded by National Science Center in Poland no 2011/03/D/NZ5/06146.

Keywords: biological marker, epidermal growth factor, mood disorders, prediction

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Authors: Ilyasu G., Ogoina D., Otu AA, Muhammed FD, Ebenso B., Otokpa D., Rotifa S., Tuduo-Wisdom O., Habib AG

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Background: The 2014 Ebola Virus Disease (EVD) outbreak was characterized by fear, misconceptions and irrational behaviors. We conducted a knowledge attitude and practice survey of EVD in Nigeria to inform the institution of effective control measures. Methods: Between July 30th and September 30th 2014, a cross-sectional study on knowledge, attitude and practice (KAP) of Ebola Virus Disease (EVD) was undertaken among adults of the general population and healthcare workers (HCW) in three states of Nigeria, including Kano, Cross River and Bayelsa states. Demographic information and data on KAP were obtained using a self-administered standardized questionnaire. The percentage KAP scores were categorized as good and poor. Independent predictors of good knowledge of EVD were ascertained using a binary logistic regression model. Results: Out of 1035 study participants with a median age of 32 years, 648 (62.6%) were males, 846 (81.7%) had tertiary education and 441 (42.6%) were HCW. There were 218, 239 and 578 respondents from Bayelsa, Cross Rivers, and Kano states, respectively. The overall median percentage KAP scores and interquartile ranges (IQR) were 79.46% (15.07%), 95.0% (33.33%), and 49.95% (37.50%), respectively. Out of the 1035 respondents, 470 (45.4%), 544(52.56%), and 252 (24.35%) had good KAP of EVD defined using 80%, 90%, and 70% score cut-offs, respectively. Independent predictors of good knowledge of EVD were a HCW (Odds Ratio-OR-2.89, 95% Confidence interval-CI of 1.41-5.90), reporting ‘moderate to high fear of EVD’ (OR-2.15, 95% CI-1.47-3.13) and ‘willingness to modify habit’ (OR-1.68, 95% CI-1.23-2.30). Conclusion: Our results reveal suboptimal EVD-related knowledge, attitude and practice among adults in Nigeria. To effectively control future outbreaks of EVD in Nigeria, there is a need to institute public sensitization programs that improve understanding of EVD and address EVD-related myths and misconceptions, especially among the general population.

Keywords: Ebola, health care worker, knowledge, attitude

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Authors: Magdy Abouzeid

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Introduction: Physical activity has been shown to have a positive effect on bone mineral density (BMD) and bone mineral content (BMC) among children, adolescents, and adults. Sports characterized by little or moderate weight bearing or impact have a low osteogenic effect. However, the action of such sports on bone turnover remains unclear. Swimming, as a non-weight-bearing sport, has been considered to be insignificant in the maintenance of bone mass. Purpose: To examine this issue we measured (BMD) and(BMC) of the lumbar spine, proximal femur via dual energy x-ray absorptiometry in the group of elite male swimmers, and determine the effect of swimming training on bone health and compared the results with matched controls group in age, body weight and height. Materials and Methods: Twenty-five male swimmers (age 20.7+/-0.8 years) training for 12-15 hours/week; and the controls group consisted of 25 non-active male (age 21.3 +/-1.3 years) were studied BMD and BMC of lumbar spine, femur were assessed via (DXA) absorptiometry. Results: There was significant difference between swimmers and control group in BMD and BMC, BMD of Swimmers was significantly greater than controls at all sites. The lumbar spine (1, 08 +/-0.202 vs., 0717+0.57 gxcm (-2), right proximal femur (1, 02 +/-, 044 vs., 771+/-, 027 gxcm (-2), and left proximal femur (1.374+/-0.212 vs. 1.01 +/-0.141 gxcm (-2). Swimmers were significantly taller, and had greater BMC and BMD compared to the controls group (P<0.001). Conclusions: These results suggest that swimming training may be beneficial in the prevention or therapy of OSTEOPENIA, and may lead to increased (BMD) and (BMC) for male swimmers. Swimming may be an effective non-pharmacological intervention for the adults and adolescent. Further research with younger athletes of another type of aquatics sport is warranted to better identify the periods of BMD development during which Aquatics sport has the greatest impact on bone health.

Keywords: bone mineral density, lumbar spine, femur, swimming, DXA absorptiometry

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Authors: Elaine Wong

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Introduction: The Singapore Physical Activity and Nutrition Study (SPANS) aimed to assess the effects of a community-based intervention on physical activity (PA) and nutrition behaviours as well as chronic disease risk factors for Singaporean women aged above 50 years. This article examines the participation, dose, fidelity, reach, satisfaction and reasons for completion and non-completion of the SPANS. Methods: The SPANS program integrated constructs of Social Cognitive Theory (SCT) and is composed of PA activities; nutrition workshops; dietary counselling coupled with motivational interviewing (MI) through phone calls; and text messages promoting healthy behaviours. Printed educational resources and health incentives were provided to participants. Data were collected via a mixed-method design strategy from a sample of 295 intervention participants. Quantitative data were collected using self-completed survey (n = 209); qualitative data were collected via research assistants’ notes, post feedback sessions and exit interviews with program completers (n = 13) and non-completers (n = 12). Results: Majority of participants reported high ‘satisfactory to excellent’ ratings for the program pace, suitability of interest and overall program (96.2-99.5%). Likewise, similar ratings for clarity of presentation; presentation skills, approachability, knowledge; and overall rating of trainers and program ambassadors were achieved (98.6-100%). Phone dietary counselling had the highest level of participation (72%) at less than or equal to 75% attendance rate followed by nutrition workshops (65%) and PA classes (60%). Attrition rate of the program was 19%; major reasons for withdrawal were personal commitments, relocation and health issues. All participants found the program resources to be colourful, informative and practical for their own reference. Reasons for program completion and maintenance were: desired health benefits; social bonding opportunities and to learn more about PA and nutrition. Conclusions: Process evaluation serves as an appropriate tool to identify recruitment challenges, effective intervention strategies and to ensure program fidelity. Program participants were satisfied with the educational resources, program components and delivery strategies implemented by the trainers and program ambassadors. The combination of printed materials and intervention components, when guided by the SCT and MI, were supportive in encouraging and reinforcing lifestyle behavioural changes. Mixed method evaluation approaches are integral processes to pinpoint barriers, motivators, improvements and effective program components in optimising the health status of Singaporean women.

Keywords: process evaluation, Singapore, older adults, lifestyle changes, program challenges

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Authors: Amani Jaber-Awida

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This study examines two bilingual phenomena in the narratives of Arabic Hebrew and Hebrew-English bilingual adults in Israel: CO memories and code-switching (CS). The study examined these phenomena in the context of autobiographical memory, using a cue word technique. Student experimenters held two sessions in the homes of the participants. In separate language sessions, the participant was asked to look first at each of 16 cue words and then to state a concrete memory. After stating the memory, participants reported whether their memories were in the same language of the experiment session or different. Memories were classified as ‘Crossovers’ (CO) or ‘Same Language’ (SL) according to participants' self-reports. Participants were also required to elaborate about the setting, interlocutors and other languages involved in the specific memory. Beyond replicating the procedure of cuing technique, one memory from a specific lifespan period was chosen per participant, and the participant was required to provide further details about it. For the more detailed memories, CS count was conducted. Both bilingual groups confirmed the Reminiscence Bump phenomenon, retrieving more memories in the 10-30 age period. CO memories prevailed in second language sessions (L2). Same language memories were more abundant in first language sessions (L1). Higher CS frequency was found in L2 sessions. Finally, as predicted, 'individual' CS was prevalent in L2 sessions, but 'community-based' CS was not higher in L1 sessions. The two bilingual measures in this study, crossovers, and CS came from different research traditions, the former from an experimental paradigm in the psychology of autobiographical memory based on self-reported judgments, the latter a behavioral measure from linguistics. This merger of approaches offers new insight into the field of bilingual autobiographical memory. In addition, the study attempted to shed light on the investigation of motivations for CS, beginning with Walters’ SPPL Model and concluding with a distinction between ‘community-based’ and individual motivations.

Keywords: bilinguals, code-switching, crossover memories, narratives

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Authors: Ana Maria Reis d'Azevedo Breda, Catarina Maria Neto da Cruz

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The role of images/illustrations in communicating meanings and triggering emotions assumes an increasingly relevant role in contemporary texts, regardless of the age group for which they are intended or the nature of the texts that host them. It is no coincidence that children's books are full of illustrations and that the image/text ratio decreases as the age group grows. The vast majority of children's books can be considered multimodal texts containing text and images/illustrations interacting with each other to provide the young reader with a broader and more creative understanding of the book's narrative. This interaction is very diverse, ranging from images/illustrations that are not essential for understanding the storytelling to those that contribute significantly to the meaning of the story. Usually, these books are also read by adults, namely by parents, educators, and teachers who act as mediators between the book and the children, explaining aspects that are or seem to be too complex for the child's context. It should be noted that there are books labeled as children's books that are clearly intended for both children and adults. In this work, following a qualitative and interpretative methodology based on written productions, participant observation, and field notes, we will describe the perceptions of future teachers of the 1st cycle of basic education, attending a master's degree at a Portuguese university, about the role of the image in literary and non-literary texts, namely in mathematical texts, and how these can constitute precious resources for emotional regulation and for the design of creative didactic situations. The analysis of the collected data allowed us to obtain evidence regarding the evolution of the participants' perception regarding the crucial role of images in children's literature, not only as an emotional regulator for young readers but also as a creative source for the design of meaningful didactical situations, crossing other scientific areas, other than the mother tongue, namely mathematics.

Keywords: children’s literature, emotions, multimodal texts, soft skills

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Authors: Abraham Addo-Bediako

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Many freshwater ecosystems are facing immense pressure from anthropogenic activities, such as agricultural, industrial and mining. Trace metal pollution in freshwater ecosystems has become an issue of public health concern due to its toxicity and persistence in the environment. Trace elements pose a serious risk not only to the environment and aquatic biota but also humans. Chromium is one of such trace elements and its pollution in surface waters and groundwaters represents a serious environmental problem. In South Africa, agriculture, mining, industrial and domestic wastes are the main contributors to chromium discharge in rivers. The common forms of chromium are chromium (III) and chromium (VI). The latter is the most toxic because it can cause damage to human health. The aim of the study was to assess the contamination of chromium in the water and sediments of two rivers in the Steelpoort River sub-catchment of the Olifants River Basin, South Africa and human health risk. The concentration of Cr was analyzed using inductively coupled plasma–optical emission spectrometry (ICP-OES). The concentration of the metal was found to exceed the threshold limit, mainly in areas of high human activities. The hazard quotient through ingestion exposure did not exceed the threshold limit of 1 for adults and children and cancer risk for adults and children computed did not exceed the threshold limit of 10-4. Thus, there is no potential health risk from chromium through ingestion of drinking water for now. However, with increasing human activities, especially mining, the concentration could increase and become harmful to humans who depend on rivers for drinking water. It is recommended that proper management strategies should be taken to minimize the impact of chromium on the rivers and water from the rivers should properly be treated before domestic use.

Keywords: land use, health risk, metal pollution, water quality

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Authors: Ferruh Taspinar, Ismail Saracoglu, Emrah Afsar, Eda O. Okur, Gulce K. Seyyar, Gamze Kurt, Betul Taspinar

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Although it is thought that abdominal adiposity is one of the risk factor for postural deviation, such as increased lumbar lordosis, the body mass index is not sufficient to indicate effects of abdominal adiposity on spinal alignment and postural changes. The aim of this study was to investigate the correlation with detailed body composition and spine alignment in healthy young adults. This cross-sectional study was conducted with sixty seven healthy volunteers (37 men and 30 women) whose ages ranged between 19 and 27 years. All participants’ sagittal spinal curvatures of lumbar and thoracic region were measured via Spinal mouse® (Idiag, Fehraltorf, Switzerland). Also, body composition analysis (whole body fat ratio, whole body muscle ratio, abdominal fat ratio, and trunk muscle ratio) estimation by means of bioelectrical impedance was evaluated via Tanita Bc 418 Ma Segmental Body Composition Analyser (Tanita, Japan). Pearson’s correlation was used to analysis among the variables. The mean lumbar lordosis and thoracic kyphosis angles were 21.02°±9.39, 41.50°±7.97, respectively. Statistically analysis showed a significant positive correlation between whole body fat ratio and lumbar lordosis angle (r=0.28, p=0.02). Similarly, there was a positive correlation between abdominal fat ratio and lumbar lordosis angle (r=0.27, p=0.03). The thoracic kyphosis angle showed also positive correlation with whole body fat ratio (r=0.33, p=0.00) and abdominal fat ratio (r=0.40, p=0.01). The whole body muscle ratio showed negative correlation between lumbar lordosis (r=-0.28, p=0.02) and thoracic kyphosis angles (r=-0.33, p=0.00), although there was no statistically correlation between trunk muscle ratio, lumbar and thoracic curvatures (p>0.05). The study demonstrated that an increase of fat ratio and decrease of muscle ratio in abdominal region or whole body shifts the spinal alignment which may adversely affect the spinal loading. Therefore, whole body composition should be taken into account in spine rehabilitation.

Keywords: body composition, lumbar lordosis, spinal alignment, thoracic kyphosis

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Authors: B. Philip, J. Littlewood, R. Radford, N. Evans, T. Whyman, D. P. Jones

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UK buildings and energy infrastructures are heavily dependent on natural gas, a large proportion of which is used for domestic space heating. However, approximately half of the gas consumed in the UK is imported. Improving energy security and reducing carbon emissions are major government drivers for reducing gas dependency. In order to do so there needs to be a wholesale shift in the energy provision to householders without impacting on thermal comfort levels, convenience or cost of supply to the end user. Heat pumps are seen as a potential alternative in modern well insulated homes, however, can the same be said of older homes? A large proportion of housing stock in Britain was built prior to 1919. The age of the buildings bears testimony to the quality of construction; however, their thermal performance falls far below the minimum currently set by UK building standards. In recent years significant sums of money have been invested to improve energy efficiency and combat fuel poverty in some of the most deprived areas of Wales. Increasing energy efficiency of older properties remains a significant challenge, which cannot be achieved through insulation and air-tightness interventions alone, particularly when alterations to historically important architectural features of the building are not permitted. This paper investigates the energy demand of pre-1919 dwellings in a former Welsh mining village, the feasibility of meeting that demand using water from the disused mine workings to supply a district heat network and potential barriers to success of the scheme. The use of renewable solar energy generation and storage technologies, both thermal and electrical, to reduce the load and offset increased electricity demand, are considered. A wholistic surveying approach to provide a more accurate assessment of total household heat demand is proposed. Several surveying techniques, including condition surveys, air permeability, heat loss calculations, and thermography were employed to provide a clear picture of energy demand. Additional insulation can bring unforeseen consequences which are detrimental to the fabric of the building, potentially leading to accelerated dilapidation of the asset being ‘protected’. Increasing ventilation should be considered in parallel, to compensate for the associated reduction in uncontrolled infiltration. The effectiveness of thermal performance improvements are demonstrated and the detrimental effects of incorrect material choice and poor installation are highlighted. The findings show estimated heat demand to be in close correlation to household energy bills. Major areas of heat loss were identified such that improvements to building thermal performance could be targeted. The findings demonstrate that the use of heat pumps in older buildings is viable, provided sufficient improvement to thermal performance is possible. Addition of passive solar thermal and photovoltaic generation can help reduce the load and running cost for the householder. The results were used to predict future heat demand following energy efficiency improvements, thereby informing the size of heat pumps required.

Keywords: heat demand, heat pump, renewable energy, retrofit

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Authors: Marit D. Murry, Amy K. Marks

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The transition to college is a critical period that affords abundant opportunities for growth in conjunction with novel challenges for emerging adults. During this time, emerging adults are garnering experiences and acquiring hosts of new information that they are required to synthesize and use to inform life-shaping decisions. This stage is characterized by instability and exploration, which necessitates a diverse set of coping skills to successfully navigate and positively adapt to their evolving environment. However, important sociocultural factors result in differences that occur developmentally for minority emerging adults (i.e., emerging adults with an identity that has been or is marginalized). While the transition to college holds vast potential, not all are afforded the same chances, and many individuals enter into this stage at varying degrees of readiness. Understanding the nuance and diversity of student preparedness for college and contextualizing these factors will better equip systems to support incoming students. Emerging adulthood for ethnic, racial minority students presents itself as an opportunity for growth and resiliency in the face of systemic adversity. Ethnic, racial identity (ERI) is defined as an identity that develops as a function of one’s ethnic-racial group membership. Research continues to demonstrate ERI as a resilience factor that promotes positive adjustment in young adulthood. Adaptive coping responses (e.g., engaging in help-seeking behavior, drawing on personal and community resources) have been identified as possible mechanisms through which ERI buffers youth against stressful life events, including discrimination. Additionally, trait mindfulness has been identified as a significant predictor of general psychological health, and mindfulness practice has been shown to be a self-regulatory strategy that promotes healthy stress responses and adaptive coping strategy selection. The current study employed a person-centered approach to explore emerging patterns across ethnic identity development and psychological well-being criterion variables among college freshmen. Data from 283 incoming college freshmen at Northeastern University were analyzed. The Brief COPE Acceptance and Emotional Support scales, the Five Factor Mindfulness Questionnaire, and MIEM Exploration and Affirmation measures were used to inform the cluster profiles. The TwoStep auto-clustering algorithm revealed an optimal three-cluster solution (BIC = 848.49), which classified 92.6% (n = 262) of participants in the sample into one of the three clusters. The clusters were characterized as ‘Mixed Adjustment’, ‘Lowest Adjustment’, and ‘Moderate Adjustment.’ Cluster composition varied significantly by ethnicity X² (2, N = 262) = 7.74 (p = .021) and gender X² (2, N = 259) = 10.40 (p = .034). The ‘Lowest Adjustment’ cluster contained the highest proportion of students of color, 41% (n = 32), and male-identifying students, 44.2% (n = 34). Follow-up analyses showed higher ERI exploration in ‘Moderate Adjustment’ cluster members, also reported higher levels of psychological distress, with significantly elevated depression scores (p = .011), psychological diagnoses of depression (p = .013), anxiety (p = .005) and psychiatric disorders (p = .025). Supporting prior research, students engaging with identity exploration processes often endure more psychological distress. These results indicate that students undergoing identity development may require more socialization and different services beyond normal strategies.

Keywords: adjustment, coping, college, emerging adulthood, ethnic-racial identity, psychological well-being, resilience

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Authors: Anindita Banik, Anjali Kant, Aninda Duti Banik, Arun Banik

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Speech is a complex, dynamic unique motor activity through which we express thoughts and emotions and respond to and control our environment. The aim was based to compare select Motor Speech parameters and their sub parameters across typical Marathi speaking adults and children. The subjects included a total of 300 divided into Group I, II, III including males and females. Subjects included were reported of no significant medical history and had a rating of 0-1 on GRBAS scale. The recordings were obtained utilizing three stimuli for the acoustic analysis of Diadochokinetic rate (DDK), Second Formant Transition, Voice and Tremor and its sub parameters. And these aforementioned parameters were acoustically analyzed in Motor Speech Profile software in VisiPitch IV. The statistical analyses were done by applying descriptive statistics and Two- Way ANOVA.The results obtained showed statistically significant difference across age groups and gender for the aforementioned parameters and its sub parameters.In DDK, for avp (ms) there was a significant difference only across age groups. However, for avr (/s) there was a significant difference across age groups and gender. It was observed that there was an increase in rate with an increase in age groups. The second formant transition sub parameter F2 magn (Hz) also showed a statistically significant difference across both age groups and gender. There was an increase in mean value with an increase in age. Females had a higher mean when compared to males. For F2 rate (/s) a statistically significant difference was observed across age groups. There was an increase in mean value with increase in age. It was observed for Voice and Tremor MFTR (%) that a statistically significant difference was present across age groups and gender. Also for RATR (Hz) there was statistically significant difference across both age groups and gender. In other words, the values of MFTR and RATR increased with an increase in age. Thus, this study highlights the variation of the motor speech parameters amongst the typical population which would be beneficial for comparison with the individuals with motor speech disorders for assessment and management.

Keywords: adult, children, diadochokinetic rate, second formant transition, tremor, voice

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Authors: Majeda S. Hammoud

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

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

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Authors: Nathalie Bolding, Marta Montero, Joaquim Cevallos, Juan F. Martin-Lazaro

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Background: Inhaled epoprostenol (iEPO) have been shown to improve PaO2:FiO2 (PF) in combination with bronchodilators (BD). However, there is not an available device to deliver these two therapies concomitantly. We describe a new method to provide this therapy successfully. Objective: To evaluate the response to continuous nebulization of iEPO and intermittent nebulization of Salbutamol/Ipratropium bromide in adults with severe respiratory failure through a double mesh nebulisation in tandem. Methods: This observational study included two mechanical ventilated adults under hourly ventilatory, gasometrical and clinical measurements during 48h. Both had severe respiratory failure treated with continuous iEPO (50 – 200 micrograms/h) and BD (Salbutamol 2.5 mg and Ipratropium bromide 500 mcg every 6 hours) through double mesh nebulisation (Aerogen solo®) placed in tandem in the dry side of the humidificator. The primary endpoints were the variables associated with a positive response to this tandem nebulised therapy (PaFiO2 index, ROX index). Secondary endpoints were laboratory (ABG) clinical and ventilatory variables. Statistical analysis (SPSS v29) included linear regression and ANOVA. Results: The patients included (n=2) survived, both extubated, one after ECMO therapy. Severe acute respiratory failure had a positive response rate to continuous iEPO and intermittent BD: PaFiO2 increased (7.40 to 30.91; P75: 27%) as well as ROX index (2.91 to 11.43; P75: 33%). There was a linear correlation of improvement between iEPO with PaFiO2 (ANOVA, r=0.393, p<0.002) and ROX (r=0.419, p<0.001). iEPO+BD therapy did not show any complications. Conclusion: Continuous and intermittent mesh tandem nebulisation can be effectively delivered with this method with a positive effect in ventilatory parameters without observed complications. Randomised studies will be able to provide reassurance in this new therapy.

Keywords: tandem, mesh, nebulisers, pulmonary, vasoldilators, bronchodilators, respiratory, failure

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Authors: Reinzo Vittorio B. Cardenas, Heather Venice L. Abogado, Andrea Therese V. Afable, Rhea D. Avillanoza, Marie Abegail P. Ayagan, Catherine D. Bantayan

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As the Internet provides fast and reliable health-related information, the tendency to self-diagnose increases to further understand medical jargon in a diagnosis with a physician and decreases costly consultation fees. The study aimed to explore and understand the factors affecting online health-seeking behaviors in middle-income class adults in Metro Manila. The study was conducted from March to April of 2021 with a sample size of 200 individuals aged 20 to 49 years old. The study was delivered via an online survey that used a questionnaire adapted from the research of Lee et al. (2015). Specifically, the survey consisted of three sections: assessing web-based health-seeking behaviors, consultation with health professionals, and participants' hesitancy to consult with physicians, which used a mix of a 5-point Likert-type scale with multiple responses and multiple-choice options. The results showed that the age and educational attainment of the respondents had a negative effect while presenting a positive effect of socio-economic status on health-seeking behavior. Lastly, there was a significant effect of participant’s hesitancy for professional consultation on their health-seeking behavior. The results gleaned from the study indicated that various individual and socio-economic factors might significantly affect one’s health-seeking behaviors. Although hesitancy had a significant effect on the spectrum of health-seeking behaviors, this does not imply that certain factors are specifically related to an individual’s tendency to seek health information. This information instead becomes essential in understanding the patient-physician relationship and giving patients a more holistic treatment.

Keywords: health-seeking behavior, health information, Internet, physician consultation

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Authors: Alison Brown

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Through stories, children make sense of their world, see themselves through the eyes of another, and process emotions and lived experiences in a non-threatening and indirect manner. Building on research around the use of narrative techniques with adults and families, this research looked directly at the use of narratives as a therapeutic technique with children in counseling. Based on individual therapy sessions with children over a six-year period, this work of collective case studies tells the story of a practice incorporating children’s narratives, of children’s experiences in writing and sharing their narratives, and of the clinical impact of the use of narratives with children. Not all stories were narratives of success or happiness. Children documented their fears and anger as well as their achievements and hope for the future. What emerged through this study was an awareness of recurring themes in the way children responded to the narrative process and in the benefits and limitations of story writing with children. Consistent with previous studies focusing on narrative work with adults and families, the use of narratives with children provided opportunities for healing, acceptance, developing greater understanding, externalizing, and re-authoring a preferred future. In terms of the children’s experiences in writing and sharing their narratives, consistent themes emerged again, with many children finding the experience cathartic and liberating, empowering and hopeful, but most importantly, an opportunity that allowed them to feel and understand that they were not alone. Whilst a small collection of case studies tells the stories of a limited number of children, it is hoped that this research provides both a model and inspiration for others to explore similar uses of narratives with children. As a greater number of children’s narratives are created, the potential to share and benefit from the many rich stories and experiences of other children becomes more of a reality. Across cultures, economic and social settings, rural and urban environments, and varying family structures, it is important that we hear the voices of our children – ‘In their own words’.

Keywords: narrative therapy children counselling, social, emotional, zone of proximal development, scaffolding

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Authors: Parvin Mirmiran, Zahra Bahadoran, Sahar Mirzae, Fereidoun Azizi

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Background and aim: Lifestyle factors, especially dietary intakes play an important role in metabolism of lipids and lipoproteins. In this study, we assessed the association between dietary factors and 3-year changes of serum triglycerides (TG), HDL-C and the atherogenic index of plasma among Iranian adults. This longitudinal study was conducted on 1938 subjects, aged 19-70 years, who participated in the Tehran Lipid and Glucose Study. Demographics, anthropometrics and biochemical measurements including serum TG were assessed at baseline (2006-2008) and after a 3-year follow-up (2009-2011). Dietary data were collected by using a 168-food item, validated semi-quantitative food frequency questionnaire at baseline. The risk of hypertriglyceridemia in the quartiles of dietary factors was evaluated using logistic regression models with adjustment for age, gender, body mass index, smoking, physical activity and energy intakes. Results: Mean age of the participants at baseline was 41.0±13.0 y. Mean TG and HDL-C at baseline was 143±86 and 42.2±10.0 mg/dl, respectively. Three-year change of serum TG were inversely related energy intake from phytochemical rich foods, whole grains, and legumes (P<0.05). Higher intakes compared to lower ones of dietary fiber and phytochemical-rich foods had similar impact on decreased risk of hyper-triglyceridemia (OR=0.58, 95% CI=0.34-1.00). Higher- compared to lower-dietary sodium to potassium ratios (Na/K ratio) increased the risk of hypertriglyceridemia by 63% (OR=0.1.63, 95% CI= 0.34-1.00). Conclusion: Findings showed that higher intakes of fiber and phytochemical rich foods especially whole grain and legumes could have protective effects against lipid disorders; in contrast higher sodium to potassium ratio had undesirable effect on triglycerides.

Keywords: lipid disorders, hypertriglyceridemia, diet, food science

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Authors: Kanokwan Tangchitnusorn, Patcharawalai Wongboonsin

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Following the ‘Golden Age of Welfare’ which enabled post-war prosperity to European citizens in 1950s, the world has witnessed the increasing mobility across borders of older citizens of First World countries. Then, in 1990s, the international retirement migration (IRM) of older persons has become a prominent trend, in which, it requires the integration of several fields of knowledge to explain, i.e. migration studies, tourism studies, as well as, social gerontology. However, while the studies of the IRM to developed destinations in Europe (e.g. Spain, Malta, Portugal, Italy), and the IRM to developing countries like Mexico, Panama, and Morocco have been largely studied in recent decades due to their massive migration volume, the study of the IRM to remoter destinations has been far more relatively sparse and incomplete. Developing countries in Southeast Asia have noticed the increasing number of retired expats, particularly to Thailand, where the number of foreigners applying for retirement visa increased from 10,709 in 2005 to 60,046 in 2014. Additionally, it was evident that the majority of Thailand’s retirement visa applicants were Westerners, i.e. citizens of the United Kingdom, the United States, Germany, and the Nordic countries, respectively. As such trend just becoming popular in Thailand in recent decades, little is known about the IRM populations, their well-being, and their future migration plans. This study aimed to examine the subjective wellbeing or the self-evaluations of own well-being among Western retirees in Thailand, as well as, their future migration plans as whether they planned to stay here for life or otherwise. The author employed a mixed method to obtain both quantitative and qualitative data during October 2015 – May 2016, including 330 self-administered questionnaires (246 online and 84 hard-copied responses), and 21 in-depth interviews of the Western residents in Nan (2), Pattaya (4), and Chiang Mai (15). As derived from the integration of previous subjective well-being measurements (i.e. Personal Wellbeing Index (PWI), Global AgeWatch Index, and OECD guideline on measuring subjective wellbeing), this study would measure the subjective well-being of Western retirees in Thailand in 7 dimensions, including standard of living, health status, personal relationships, social connections, environmental quality, personal security and local infrastructure.

Keywords: international retirement migration, ageing, mobility, wellbeing, Western, Thailand

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Authors: Rukia Yosuf

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Diabetes is a national healthcare crisis related to both macrovascular and microvascular complications. We hypothesized that higher levels of physical activity are associated with lower total and visceral fat mass, lower systolic blood pressure, and increased insulin sensitivity. Participant inclusion criteria: 21-50 years old, BMI ≥ 30 kg/m2, hemoglobin A1C 5.7-6.4, fasting glucose 100-125 mg/dL, and HOMA IR ≥ 2.5. Exclusion criteria: history of diabetes, hypertension, HIV, renal disease, hearing loss, alcoholic intake over four drinks daily, use of organic nitrates or PDE5 inhibitors, and decreased cardiac function. Total physical activity was measured using accelerometers, body composition using DXA, and insulin resistance via fsIVGTT. Clinical and biochemical cardiometabolic risk factors, blood pressure and heart rate were obtained using a calibrated sphygmomanometer. Anthropometric measures, fasting glucose, insulin, lipid profile, C-reactive protein, and BMP were analyzed using standard procedures. Within our study, we found correlations between levels of physical activity in a heterogeneous group of prediabetic adults. Patients with more physical activity had a higher degree of insulin sensitivity, lower blood pressure, total visceral adipose tissue, and overall lower total mass. Total physical activity levels showed small, but significant correlations with systolic blood pressure, visceral fat, lean mass and insulin sensitivity. After normalizing for the race, age, and gender using multiple regression, these associations were no longer significant considering our small sample size. More research into prediabetes will decrease the population of diabetics overall. In the future, we could increase sample size and conduct cross sectional and longitudinal studies in various populations with prediabetes.

Keywords: diabetes, kidney disease, nephrology, prediabetes

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Authors: Muhammad Farooq, Muhammad Idrees

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The present study has been designed to explore the causes and effects of Youth Bulge in Pakistan. However, youth bulge is a part of population segment which create problem for the whole society. The youth bulge is a common phenomenon in many developing countries, and in particular, in the least developed countries. It is often due to a stage of development where a country achieves success in reducing infant mortality but mothers still have a high fertility rate. The result is that a large share of the population is comprised of children and young adults, and today’s children are tomorrow’s young adults. Youth often play a prominent role in political violence and the existence of a “youth bulge” has been associated with times of political crisis. The population pyramid of Pakistan represents a large youth proportion and our government did not use that youth in positive way and did not provide them opportunity for development, this situation creates frustration in youth that leads them towards conflict, unrest and violence. This study will be focus on the opportunity and motives of the youth bulge situation in Pakistan in the lens of youth bulge theory. Moreover, it will give some suggestions to utilize youth in the development activities and avoid youth bulge situation in Pakistan. The present research was conducted in the metropolitan entities of Punjab, Pakistan. A sample of 300 respondents was taken from three randomly selected metropolitan entities (Faisalabad, Lahore and Rawalpindi) of Punjab Province of Pakistan. Information regarding demography, household, locality and other socio-cultural variables related to causes and effects of youth bulge in the state was collected through a well structured interview schedule. Mean, Standard Deviation and frequency distribution were used to check the measure of central tendency. Multiple linear regression was also applied to measure the influence of various independent variables on the response variable.

Keywords: youth bulge, violence, conflict, social unrest, crime, metropolitan entities, mean, standard deviation, multiple linear regression

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Authors: Mohammad Emran, Colton Wayne, Shannon M Koehler, P. Stephen Almond, Haroon Patel

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Purpose: Assessment of anastomotic perfusion in Hirschsprung disease using Indocyanine Green (ICG)-near-infrared (NIR) fluorescence angiography. Introduction: Anastomotic stricture and leak are well-known complications of Hirschsprung pull-through procedures. Complications are due to tension, infection, and/or poor perfusion. While a surgeon can visually determine and control the amount of tension and contamination, assessment of perfusion is subject to surgeon determination. Intraoperative use of ICG-NIR enhances this decision-making process by illustrating perfusion intensity and adequacy in the pulled-through bowel segment. This technique, proven to reduce anastomotic stricture and leak in adults, has not been studied in children to our knowledge. ICG, an FDA approved, nontoxic, non-immunogenic, intravascular (IV) dye, has been used in adults and children for over 60 years, with few side effects. ICG-NIR was used in this report to demonstrate the adequacy of perfusion during transanal pullthrough for Hirschsprung’s disease. Method: 8 patients with Hirschsprung disease were evaluated with ICG-NIR technology. Levels of affected area ranged from sigmoid to total colonic Hirschsprung disease. After leveling, but prior to anastomosis, ICG was administered at 1.25 mg (< 2 mg/kg) and perfusion visualized using an NIR camera, before and during anastomosis. Video and photo imaging was performed and perfusion of the bowel was compared to surrounding tissues. This showed the degree of perfusion and demarcation of perfused and non-perfused bowel. The anastomosis was completed uneventfully and the patients all did well. Results: There were no complications of stricture or leak. 5 of 8 patients (62.5%) had modification of the plan based on ICG-NIR imaging. Conclusion: Technologies that enhance surgeons’ ability to visualize bowel perfusion prior to anastomosis in Hirschsprung’s patients may help reduce post-operative complications. Further studies are needed to assess the potential benefits.

Keywords: colonic anastomosis, fluorescence angiography, Hirschsprung disease, pediatric surgery, SPY

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Authors: Mary A. Lindell

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Adults with intellectual disabilities (ID) are increasingly attending postsecondary institutions, including inclusive residential programs at four-year universities. The legislation, national organizations, and researchers support developing postsecondary education (PSE) options for this historically underserved population. Simultaneously, researchers are assessing the quality of life indicators (QOL) for people with ID. This study explores the quality of life characteristics for individuals with ID entering a two-year PSE program. A survey aligned with the PSE program was developed and administered to participants before they began their college program (in future studies, the same survey will be administered 6 months and 1 year after graduating). Employment, income, and housing are frequently cited QOL measures. People with disabilities, and especially people with ID, are more likely to experience unemployment and low wages than people without disabilities. PSE improves adult outcomes (e.g., employment, income, housing) for people with and without disabilities. Similarly, adults with ID who attend PSE are more likely to be employed than their peers who do not attend PSE; however, adults with ID are least likely among their typical peers and other students with disabilities to attend PSE. There is increased attention to providing individuals with ID access to PSE and more research is needed regarding the characteristics of students attending PSE. This study focuses on the participants of a fully residential two-year program for individuals with ID. Students earn an Applied Skills Certificate while focusing on five benchmarks: self-care, home care, relationships, academics, and employment. To create a QOL measure, the goals of the PSE program were identified, and possible assessment items were initially selected from the National Core Indicators (NCI) and the National Transition Longitudinal Survey 2 (NTLS2) that aligned with the five program goals. Program staff and advisory committee members offered input on potential item alignment with program goals and expected value to students with ID in the program. National experts in researching QOL outcomes of people with ID were consulted and concurred that the items selected would be useful in measuring the outcomes of postsecondary students with ID. The measure was piloted, modified, and administered to incoming students with ID. Research questions: (1) In what ways are students with ID entering a two-year PSE program similar to individuals with ID who complete the NCI and NTLS2 surveys? (2) In what ways are students with ID entering a two-year PSE program different than individuals with ID who completed the NCI and NTLS2 surveys? The process of developing a QOL measure specific to a PSE program for individuals with ID revealed that many of the items in comprehensive national QOL measures are not relevant to stake-holders of this two-year residential inclusive PSE program. Specific responses of students with ID entering an inclusive PSE program will be presented as well as a comparison to similar items on national QOL measures. This study explores the characteristics of students with ID entering a residential, inclusive PSE program. This information is valuable for, researchers, educators, and policy makers as PSE programs become more accessible for individuals with ID.

Keywords: intellectual disabilities, inclusion, post-secondary education, quality of life

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Authors: Kiran Datta, Daniella Holland-Hart, Anthony Byrne

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Introduction: Oesophago-gastric (OG) cancers are the fifth commonest in the UK, accounting for over 12,000 deaths each year. Most patients will present at later stages of the disease, with only 21% of patients with stage 4 disease surviving longer than a year. As a result, many patients are unsuitable for curative surgery and instead receive palliative treatment to improve prognosis and symptom burden. However, palliative chemotherapy can result in significant toxicity: almost half of the patients are unable to complete their chemotherapy regimen, with this proportion rising significantly in older and frailer patients. In addition, clinical trials often exclude older and frailer patients due to strict inclusion criteria, meaning there is limited evidence to guide which patients are most likely to benefit from palliative chemotherapy. Inappropriate chemotherapy administration is at odds with the goals of palliative treatment and care, which are to improve quality of life, and this also represents a significant resource expenditure. This literature review aimed to examine and appraise evidence regarding treatment resilience in order to guide clinicians in identifying the most suitable candidates for palliative chemotherapy. Factors influencing treatment resilience were assessed, as measured by completion rates, dose reductions, and toxicities. Methods: This literature review was conducted using rapid review methodology, utilising modified systematic methods. A literature search was performed across the MEDLINE, EMBASE, and Cochrane Library databases, with results limited to papers within the last 15 years and available in English. Key inclusion criteria included: 1) participants with either oesophageal, gastro-oesophageal junction, or gastric cancers; 2) patients treated with palliative chemotherapy; 3) available data evaluating the association between baseline participant characteristics and treatment resilience. Results: Of the 2326 papers returned, 11 reports of 10 studies were included in this review after excluding duplicates and irrelevant papers. Treatment resilience factors that were assessed included: age, performance status, frailty, inflammatory markers, and sarcopenia. Age was generally a poor predictor for how well patients would tolerate chemotherapy, while poor performance status was a better indicator of the need for dose reduction and treatment non-completion. Frailty was assessed across one cohort using multiple screening tools and was an effective marker of the risk of toxicity and the requirement for dose reduction. Inflammatory markers included lymphopenia and the Glasgow Prognostic Score, which assessed inflammation and hypoalbuminaemia. Although quick to obtain and interpret, these findings appeared less reliable due to the inclusion of patients treated with palliative radiotherapy. Sarcopenia and body composition were often associated with chemotherapy toxicity but not the rate of regimen completion. Conclusion: This review demonstrates that there are numerous measures that can estimate the ability of patients with oesophago-gastric cancer to tolerate palliative chemotherapy, and these should be incorporated into clinical assessments to promote personalised decision-making around treatment. Age should not be a barrier to receiving chemotherapy and older and frailer patients should be included in future clinical trials to better represent typical patients with oesophago-gastric cancers. Decisions regarding palliative treatment should be guided by these factors identified as well as patient preference.

Keywords: frailty, oesophago-gastric cancer, palliative chemotherapy, treatment resilience

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Authors: A. Sainvil, J. Mallela, L. M. Pereira

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Adolescents and young adults (AYA) diagnosed with cancer are tasked with managing their health through treatment, a time when reliance on and independence from parents may change in unexpected ways. Resilience allows patients to cope and manage their own health through treatment, promoting motivation and a healthier lifestyle. The film acts as a source of reflection through the cancer journey, which may have an impact on how patients cope. The current research investigated relationships between resilient linguistic qualities of the video narratives and attitudes toward personal health management. N=24 patients diagnosed between ages 11-18 were recruited. First, participants provided demographic information, then made a video testimonial about their cancer experience. After filming, participants then completed a questionnaire on the perceived benefits for themselves and others for making the video. Videos were transcribed and analyzed for thematic content via codebook and for linguistic qualities, indicating resilience with the use of the Linguistic Inquiry and Word Count Analysis Program (LIWC). Linear regressions were then calculated to explore relationships between resilient qualities, thematic content, and participants’ perceptions of their medical team and willingness to care for themselves. Participants who spoke with greater narrator connectedness were more likely to change their view of their medical team (β=.628 p=.034). When a participant believed that providers were likely to view their video, they were marginally more likely to want to take better care of themselves (β=.367, p=.078). Participants who spoke in depth about their health reported higher intention to take better care of themselves (β=.785, p=.033). AYAs with cancer who showcased certain resilient qualities within their narrative were more likely to consider taking better care of themselves. Additionally, the more patients reflected on their health, the more they wanted to take better care of themselves. These relationships were stronger when a patient believed that a provider would watch their video. Study findings highlight the utility of film in uncovering aspects of resilience and coping that may lead to healthier behaviors in AYAs with cancer.

Keywords: adolescents, cancer, resilience, health management

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Authors: Obinna Benedict Duru

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This study focuses on the elderly and the challenges that confront them. The elderly are that particular segment of our population who by virtue of the aging process have attained the stage in most cases where they are confronted with the challenges of economic dependency and social marginality. These challenges are as a result of the physical and biological decline occasioned by social myths and realities which portray the elderly as a dependent population whose members could not and should not work and who need social assistance that the younger population is obliged to provide. From the moment of birth to the moment of death, our bodies are constantly changing. We are all enmeshed in the process of growing old, a transition from youthfulness to elderliness. In youth-oriented modern societies like ours, we tend to attach positive importance and significance to the biological changes that occur early in life and define later physical changes in negative terms. Children growing up and young adults receive more attention, greater responsibilities and more legal rights to reward them on their way. But few people are congratulated on getting old. We commiserate with people who are getting old and make jokes about their supposedly physical, mental and biological decline. Wrinkles, loss of weight and vitality are all parts of the aging process. In almost all parts of the world, earlier researches have shown that about fifty percent of the elderly who suffer from stroke, arthritis, senility and other age related diseases are the disengaged and neglected elderly. Rapid technological changes render the knowledge and skills of the elderly obsolete; education is geared toward the young and the generational competition for jobs leads to pressures on the elderly to retire. Control of initial resources are shifted to the middle-aged and older workers are pushed into positions of economic dependency. This study therefore, among other things tend to discover how some government policies have affected the elderly particularly in Africa. To discover the prospects and possibilities of the elderly for a better living. To make a comparison of the advances in healthcare giving made in the advanced western societies to the practice in Sub Saharan Africa etc. The hypotheses of this study include: that the elderly in Sub Saharan Africa are more vulnerable than their counterparts in Europe and America. The elderly are more prone to social isolation, and that the elderly are mostly affected by age-related sickness etc. With a survey method as the research design, and sample size of about 500 respondents,probability sampling technique was used. Data which were analyzed using chi-square and tables were collected through primary and secondary sources. The findings made include: that the elderly suffer pains of old age especially when disengaged from work or social activity. That loss of income condemn the elderly to a life of vegetable existence, and that those who do not have other means of re-integration usually see old age with regret and despair. It is therefore, recommended among other things that social welfare scheme and the process of re-integration at old age be introduced for the non pensionable elderly in Africa.

Keywords: elderly, social isolation, dependency, re-integration

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Authors: Gyorgy Deak, Marius C. Raischi, Lucian P. Georgescu, Tiberius M. Danalache, Elena Holban, Madalina G. Boboc, Monica Matei, Catalina Iticescu, Marius V. Olteanu, Stefan Zamfir, Gabriel Cornateanu

Abstract:

At present, on the Lower Danube, different types of pressures have been identified that affect the anadromous sturgeons stocks with an impact that leads to their decline. This paper presents techniques and procedures used by Romanian experts in the tagging and monitoring of anadromous sturgeons, as well as unique results at international level obtained on the basis of an informational volume collected in over 7 years of monitoring on these species behavior (both for adults as well as for ultrasonically tagged juveniles) on the Lower Danube. The local impact of hydrotechnical constructions (bottom sill, maritime navigation channel), the global impact of the poaching phenomenon and the impact of the restocking programs with sturgeon juveniles were assessed. Thus, the bottom sill impact on the Bala branch, the Bastroe Channel (cross-border impact) and the poaching phenomenon at the level of the Lower Danube was analyzed on the basis of a unique informational volume obtained through the use of patented monitoring systems by the Romanian experts (DKTB respectively, DKMR-01T). At the same time, the results from the monitoring of ultrasonically tagged sturgeon juveniles from the 2015 repopulation program are presented. Conclusions resulting from research can ensure favorable premises for finding some conservation solutions for CITES-protected sturgeon species that have survived for millions of years, currently being 1 species on the brink of extinction - Russian sturgeon, 2 species in danger of extinction - Beluga sturgeon and Stellate sturgeon and 2 species already extinct from the Lower Danube, namely common sturgeon and ship sturgeon.

Keywords: Lower Danube, sturgeons monitoring (adults and juveniles), tagging, impact on conservation

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