Search results for: solution focused group therapy
16923 Effects of Insulin on Osseointegration around Implant in Type 2 Diabetic and Non-Diabetic Rats
Authors: Xing Wang, Lin Feng, Lingling E., Hongchen Liu
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In patients with type 2 diabetes mellitus (DM) there is poorer quality osseointegration than in non-diabetic (n-DM) patients, and the success of dental implants is less. Recent studies have demonstrated that insulin could stimulate bone cells to produce and accelerate implant osseointegration in DM patients.This raised the question whether insulin could provide local bone anabolic effects in non-diabetic patients. In this study,48 SD rats were divided into four groups randomly: DM group, DM+insulin group, n-DM group, n-DM + insulin group. All rats were implanted the titanium implant near the epiphyseal end of tibia, then the DM + insulin and n-DM + insulin group received twice-daily subcutaneous injections of insulin (10U/day).Two,four and eight weeks after implantation, rats were killed in batches. Histomorphometry and immunohistochemistry were used to evaluate bone formation and osseointegration. The amount of newly formed bone, Implant–bone contact and the expression of OCN,RUNX2 in the DM+insulin, n-DM and n-DM+insulin group were significantly more than in the DM group (p<0.05). Compared with the n-DM group,the Implant–bone contact and expression of OCN,RUNX2 were significantly increased in n-DM+insulin group (p< 0.05). Taken together,these observations provide evidence that insulin has the potential to increase bone formation and osseointegration around implant not only in diabetic subjects but also in non-diabetic subject.Keywords: insulin, diabetes mellitus, osseointegration, dental implants
Procedia PDF Downloads 46316922 Effect of Aging Treatment on Tensile Properties of AZ91D Mg Alloy
Authors: Ju Hyun Won, Seok Hong Min, Tae Kwon Ha
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Phase equilibria of AZ91D Mg alloys for nonflammable use, containing Ca and Y, were carried out by using FactSage® and FTLite database, which revealed that solid solution treatment, could be performed at temperatures from 400 to 450 °C. Solid solution treatment of AZ91D Mg alloy without Ca and Y was successfully conducted at 420 °C and supersaturated microstructure with all beta phase resolved into matrix was obtained. In the case of AZ91D Mg alloy with some Ca and Y, however, a little amount of intermetallic particles were observed after solid solution treatment. After solid solution treatment, each alloy was annealed at temperatures of 180 and 200 °C for time intervals from 1 min to 48 hrs and hardness of each condition was measured by micro-Vickers method. Peak aging conditions were deduced as at the temperature of 200 °C for 10 hrs.Keywords: Mg alloy, AZ91D, nonflammable alloy, phase equilibrium, peak aging
Procedia PDF Downloads 42916921 Microstructure and Mechanical Properties of Mg-Zn Alloys
Authors: Young Sik Kim, Tae Kwon Ha
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Effect of Zn addition on the microstructure and mechanical properties of Mg-Zn alloys with Zn contents from 6 to 10 weight percent was investigated in this study. Through calculation of phase equilibria of Mg-Zn alloys, carried out by using FactSage® and FTLite database, solution treatment temperature was decided as temperatures from 300 to 400oC, where supersaturated solid solution can be obtained. Solid solution treatment of Mg-Zn alloys was successfully conducted at 380oC and supersaturated microstructure with all beta phase resolved into matrix was obtained. After solution treatment, hot rolling was successfully conducted by reduction of 60%. Compression and tension tests were carried out at room temperature on the samples as-cast, solution treated, hot-rolled and recrystallized after rolling. After solid solution treatment, each alloy was annealed at temperatures of 180 and 200oC for time intervals from 1 min to 48 hrs and hardness of each condition was measured by micro-Vickers method. Peak aging conditions were deduced as at the temperature of 200oC for 10 hrs. By addition of Zn by 10 weight percent, hardness and strength were enhanced.Keywords: Mg-Zn alloy, heat treatment, microstructure, mechanical properties, hardness
Procedia PDF Downloads 27916920 Methodology: A Review in Modelling and Predictability of Embankment in Soft Ground
Authors: Bhim Kumar Dahal
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Transportation network development in the developing country is in rapid pace. The majority of the network belongs to railway and expressway which passes through diverse topography, landform and geological conditions despite the avoidance principle during route selection. Construction of such networks demand many low to high embankment which required improvement in the foundation soil. This paper is mainly focused on the various advanced ground improvement techniques used to improve the soft soil, modelling approach and its predictability for embankments construction. The ground improvement techniques can be broadly classified in to three groups i.e. densification group, drainage and consolidation group and reinforcement group which are discussed with some case studies. Various methods were used in modelling of the embankments from simple 1-dimensional to complex 3-dimensional model using variety of constitutive models. However, the reliability of the predictions is not found systematically improved with the level of sophistication. And sometimes the predictions are deviated more than 60% to the monitored value besides using same level of erudition. This deviation is found mainly due to the selection of constitutive model, assumptions made during different stages, deviation in the selection of model parameters and simplification during physical modelling of the ground condition. This deviation can be reduced by using optimization process, optimization tools and sensitivity analysis of the model parameters which will guide to select the appropriate model parameters.Keywords: cement, improvement, physical properties, strength
Procedia PDF Downloads 17416919 An Activatable Theranostic for Targeted Cancer Therapy and Imaging
Authors: Sankarprasad Bhuniya, Sukhendu Maiti, Eun-Joong Kim, Hyunseung Lee, Jonathan L. Sessler, Kwan Soo Hong, Jong Seung Kim
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A new theranostic strategy is described. It is based on the use of an “all in one” prodrug, namely the biotinylated piperazine-rhodol conjugate 4a. This conjugate, which incorporates the anticancer drug SN-38, undergoes self-immolative cleavage when exposed to biological thiols. This leads to the tumor-targeted release of the active SN-38 payload along with fluorophore 1a. This release is made selective as the result of the biotin functionality. Fluorophore 1a is 32-fold more fluorescent than prodrug 4a. It permits the delivery and release of the SN-38 payload to be monitored easily in vitro and in vivo, as inferred from cell studies and ex vivo analyses of mice xenografts derived HeLa cells, respectively. Prodrug 4a also displays anticancer activity in the HeLa cell murine xenograft tumor model. On the basis of these findings we suggest that the present strategy, which combines within a single agent the key functions of targeting, release, imaging, and treatment, may have a role to play in cancer diagnosis and therapy.Keywords: theranostic, prodrug, cancer therapy, fluorescence
Procedia PDF Downloads 53716918 The Efficacy of Class IV Diode Laser in the Treatment of Patients with Chronic Neck Pain: A Randomized Controlled Trial
Authors: Mohamed Salaheldien Mohamed Alayat, Ahmed Mohamed Elsoudany, Roaa Abdulghani Sroge, Bayan Muteb Aldhahwani
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Background: Neck pain is a common illness that could affect individual’s daily activities. Class IV laser with longer wavelength can stimulate tissues and penetrate more than the classic low-level laser therapy. Objectives: The aim of the study was to investigate the efficacy of class IV diode laser in the treatment of patients with chronic neck pain (CNP). Methods: Fifty-two patients participated and completed the study. Their mean age (SD) was 50.7 (6.2). Patients were randomized into two groups and treated with laser plus exercise (laser + EX) group and placebo laser plus exercise (PL+EX) group. Treatment was performed by Class IV laser in two phases; scanning and trigger point phases. Scanning to the posterior neck and shoulder girdle region with 4 J/cm2 with a total energy of 300 J applied to 75 cm2 in 4 minutes and 16 seconds. Eight trigger points on the posterior neck area were treated by 4 J/cm2 and the time of application was in 30 seconds. Both groups received exercise two times per week for 4 weeks. Exercises included range of motion, isometric, stretching, isotonic resisted exercises to the cervical extensors, lateral bending and rotators muscles with postural correction exercises. The measured variables were pain level using visual analogue scale (VAS), and neck functional activity using neck disability index (NDI) score. Measurements were taken at baseline and after 4 weeks of treatment. The level of statistical significance was set as p < 0.05. Results: There were significant decreases in post-treatment VAS and NDI in both groups as compared to baseline values. Laser + EX effectively decreased VAS (mean difference -6.5, p = 0.01) and NDI scores after (mean difference -41.3, p = 0.01) 4 weeks of treatment compared to PL + EX. Conclusion: Class IV laser combined with exercise is effective treatment for patients with CNP as compared to PL + EX therapy. The combination of laser + EX effectively increased functional activity and reduced pain after 4 weeks of treatment.Keywords: chronic neck pain, class IV laser, exercises, neck disability index, visual analogue scale
Procedia PDF Downloads 31316917 Responsibility Attitude and Interpretation in Obsessive-Compulsive Disorder
Authors: Ryotaro Ishikawa
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Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over. Inflated responsibility attitude and interpretation are central beliefs in a cognitive model of OCD. This study aimed to develop a Japanese version of the Responsibility Attitude Scale (RAS-J) and Responsibility Interpretation Questionnaire (RIQ-J). 98 participants (OCD group = 37; anxiety control group = 24; healthy control group = 37) completed the RAS-J, RIQ-J and other measures to assess the validity of the RAS-J and RIQ-J. As a result of analysis, both scales had adequate concurrent validity, demonstrated by significant correlations with other measures of OCD, anxiety, and depression. Group comparison data using ANOVA with Bonferroni method indicated that RAS-J and RIQ-J scores for the OCD group not only differed from the nonclinical group, but also from the clinically anxious comparison group. In conclusion, this study indicated that the developed RAS-J and RIQ-J effectively measure responsibility attitude and responsibility interpretation in the Japanese population.Keywords: obsessive-compulsive disorder, responsibility, cognitive theory, anxiety disorder
Procedia PDF Downloads 27416916 Effects of Additional Pelvic Floor Exercise on Sexual Function, Quality of Life and Pain Intensity in Subjects with Chronic Low Back Pain
Authors: Emel Sonmezer, Hayri Baran Yosmaoglu
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The negative impact of chronic pain syndromes on sexual function has been reported in several studies; however, the influences of treatment strategies on sexual dysfunction have not been evaluated widely. The aim of this study was to determine the effects of pelvic floor exercise on sexual dysfunction in female patients with chronic low back pain. Forty-two patient with chronic low back pain were enrolled this study. Subjects were divided into two groups. Group 1 received conventional physiotherapy consist of heat therapy, ergonomic education, William flexion exercise during 6 weeks. Group 2 received pelvic floor exercises in addition to conventional physiotherapy. Female Sexual Function Index (FSFI) was used for the assessment of sexual function. Pain intensity was assessed with Visual Analogue Scale. Quality of life was assessed with World Health Organization Quality of Life Scale. All measurements were taken before and after treatment. In conventional physiotherapy group; there were significant improvement in pain intensity (p= 0,003), physical health (p=0,011), psychological health (p=0,042) subscales of quality of life scale, arousal (p=0,042), lubrication (p=0,028) and pain (p= 0,034) subscales of FSFI. In additional pelvic floor exercise group; there were significant improvement in pain intensity (p= 0,005), physical health (p=0,012) psychological health (p=0,039) subscales of quality of life scale, arousal (p=0,024), lubrication (p=0,011), orgasm (p=0,035) and pain (p= 0,015) subscales and total score (p=0,016) of FSFI. Total FSFI score (p=0,025) and orgasm (p=0,017) subscale of FSFI were significantly higher for the additional pelvic floor exercise group than the conventional physiotherapy group.The outcome of this study suggested that conventional physiotherapy may contribute to improve pain, quality of life and some parameters of the sexual function in patients with low back pain. Although additional pelvic floor exercise did not reveal more treatment effect in terms of quality of life and pain intensity, it caused significant improvement in sexual function. It is recommended that pelvic floor exercise should be added to treatment programs in order to manage sexual dysfunction more effectively in patients with chronic low back pain.Keywords: physiotherapy, chronic pain, sexual dysfunction, pelvic floor
Procedia PDF Downloads 26616915 Effectiveness of Computer Video Games on the Levels of Anxiety of Children Scheduled for Tooth Extraction
Authors: Marji Umil, Miane Karyle Urolaza, Ian Winston Dale Uy, John Charle Magne Valdez, Karen Elizabeth Valdez, Ervin Charles Valencia, Cheryleen Tan-Chua
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Objective: Distraction techniques can be successful in reducing the anxiety of children during medical procedures. Dental procedures, in particular, are associated with dental anxiety which has been identified as a significant and common problem in children, however, only limited studies were conducted to address such problem. Thus, this study determined the effectiveness of computer video games on the levels of anxiety of children between 5-12 years old scheduled for tooth extraction. Methods: A pre-test post-test quasi-experimental study was conducted involving 30 randomly-assigned subjects, 15 in the experimental and 15 in the control. Subjects in the experimental group played computer video games for a maximum of 15 minutes, however, no intervention was done on the control. The modified Yale Pre-operative Anxiety Scale (m-YPAS) with a Cronbach’s alpha of 0.9 was used to assess anxiety at two different points: upon arrival in the clinic (pre-test anxiety) and 15 minutes after the first measurement (post-test anxiety). Paired t-test and ANCOVA were used to analyze the gathered data. Results: Results showed that there is a significant difference between the pre-test and post-test anxiety scores of the control group (p=0.0002) which indicates an increased anxiety. A significant difference was also noted between the pre-test and post-test anxiety scores of the experimental group (p=0.0002) which indicates decreased anxiety. Comparatively, the experimental group showed lower anxiety score (p=<0.0001) than the control. Conclusion: The use of computer video games is effective in reducing the pre-operative anxiety among children and can be an alternative non-pharmacological management in giving pre-operative care.Keywords: play therapy, preoperative anxiety, tooth extraction, video games
Procedia PDF Downloads 45216914 An Experimental Study of the External Thermal Insulation System’s (ETICS) Efficiency in Buildings during Spring Conditions
Authors: Carmen Viñas Arrebola, Antonio Rodriguez Sanchez, Sheila Varela Lujan, Mariano Gonzalez Cortina, Cesar Porras Amores
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The research group TEMA from the School of Building (UPM) is working in the line of energy efficiency and comfort in building. The need to reduce energy consumption in the building construction implies designing new constructive systems. These systems help to reduce both consumption and energy losses in order to achieve adequate thermal comfort for people in any type of building. In existing buildings the best option is the rehabilitation focused on thermal insulation. The aim of this paper is to design, monitor and analyze the first results of thermal behavior of the ETICS system in façades. This retrofitting solution consists of adding thermal insulation on the outside of the building, helping to create a continuous envelope on the façades. The analysis is done by comparing a rehabilitated part of the building with ETICS system and another part which has not been rehabilitated, and it is taken as reference. Both of them have the same characteristics. Temperature measurements were taken with type K thermocouples according to the previous design of the monitoring and in the same period of time. The pilot building of the study is situated in Benimamet Street, in San Cristobal de Los Ángeles, in the south of Madrid. It was built in the late 50s. The 51st entrance hall, which is restored, and the 47th entrance hall, in original conditions, have been studied.Keywords: comfort in building, energy efficiency in building, ETICS, thermal properties
Procedia PDF Downloads 31516913 Impact of the Dog-Technic for D1-D4 and Longitudinal Stroke Technique for Diaphragm on Peak Expiratory Flow (PEF) in Asthmatic Patients
Authors: Victoria Eugenia Garnacho-Garnacho, Elena Sonsoles Rodriguez-Lopez, Raquel Delgado-Delgado, Alvaro Otero-Campos, Jesus Guodemar-Perez, Angelo Michelle Vagali, Juan Pablo Hervas-Perez
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Asthma is a heterogeneous disease which has always had a drug treatment. Osteopathic treatment that we propose is aimed, seen through a dorsal manipulation (Dog Technic D1-D4) and a technique for diaphragm (Longitudinal Stroke) forced expiratory flow in spirometry changes there are in particular that there is an increase in the volumes of the Peak Flow and Post intervention and effort and that the application of these two techniques together is more powerful if we applied only a Longitudinal (Stroke). Also rating if this type of treatment will have repercussions on breathlessness, a very common symptom in asthma. And finally to investigate if provided vertebra pain decreased after a manipulation. Methods—Participants were recruited between students and professors of the University, aged 18-65, patients (n = 18) were assigned randomly to one of the two groups, group 1 (longitudinal Stroke and manipulation dorsal Dog Technic) and group 2 (diaphragmatic technique, Longitudinal Stroke). The statistical analysis is characterized by the comparison of the main indicator of obstruction of via area PEF (peak expiratory flow) in various situations through the peak flow meter Datospir Peak-10. The measurements were carried out in four phases: at rest, after the stress test, after the treatment, after treatment and the stress test. After each stress test was evaluated, through the Borg scale, the level of Dyspnea on each patient, regardless of the group. In Group 1 in addition to these parameters was calculated using an algometer spinous pain before and after the manipulation. All data were taken at the minute. Results—12 Group 1 (Dog Technic and Longitudinal Stroke) patients responded positively to treatment, there was an increase of 5.1% and 6.1% of the post-treatment PEF and post-treatment, and effort. The results of the scale of Borg by which we measure the level of Dyspnea were positive, a 54.95%, patients noted an improvement in breathing. In addition was confirmed through the means of both groups group 1 in which two techniques were applied was 34.05% more effective than group 2 in which applied only a. After handling pain fell by 38% of the cases. Conclusions—The impact of the technique of Dog-Technic for D1-D4 and the Longitudinal Stroke technique for diaphragm in the volumes of peak expiratory flow (PEF) in asthmatic patients were positive, there was a change of the PEF Post intervention and post-treatment, and effort and showed the most effective group in which only a technique was applied. Furthermore this type of treatment decreased facilitated vertebrae pain and was efficient in the improvement of Dyspnea and the general well-being of the patient.Keywords: ANS, asthma, manipulation, manual therapy, osteopathic
Procedia PDF Downloads 28816912 Evaluation of Some Trace Elements in Biological Samples of Egyptian Viral Hepatitis Patients under Nutrition Therapy
Authors: Tarek Elnimr, Reda Morsy, Assem El Fert, Aziza Ismail
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Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis, cirrhosis or liver cancer. Disease caused by the hepatitis virus, the virus can cause hepatitis infection, ranging in severity from a mild illness lasting a few weeks to a serious, lifelong illness. A growing body of evidence indicates that many trace elements play important roles in a number of carcinogenic processes that proceed with various mechanisms. To examine the status of trace elements during the development of hepatic carcinoma, we determined the iron, copper, zinc and selenium levels in some biological samples of patients at different stages of viral hepatic disease. We observed significant changes in the iron, copper, zinc and selenium levels in the biological samples of patients hepatocellular carcinoma, relative to those of healthy controls. The mean hair, nail, RBC, serum and whole blood copper levels in patients with hepatitis virus were significantly higher than that of the control group. In contrast the mean iron, zinc, and selenium levels in patients having hepatitis virus were significantly lower than those of the control group. On the basis of this study, we identified the impact of natural supplements to improve the treatment of viral liver damage, using the level of some trace elements such as, iron, copper, zinc and selenium, which might serve as biomarkers for increases survival and reduces disease progression. Most of the elements revealed diverse and random distribution in the samples of the donor groups. The correlation study pointed out significant disparities in the mutual relationships among the trace elements in the patients and controls. Principal component analysis and cluster analysis of the element data manifested diverse apportionment of the selected elements in the scalp hair, nail and blood components of the patients compared with the healthy counterparts.Keywords: hepatitis, hair, nail, blood components, trace element, nutrition therapy, multivariate analysis, correlation, ICP-MS
Procedia PDF Downloads 40816911 Enhancing Coping Strategies of Student: A Case Study of 'Choice Theory' Group Counseling
Authors: Warakorn Supwirapakorn
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The purpose of this research was to study the effects of choice theory in group counseling on coping strategies of students. The sample consisted of 16 students at a boarding school, who had the lowest score on the coping strategies. The sample was divided into two groups by random assignment and then were assigned into the experimental group and the control group, with eight members each. The instruments were the Adolescent Coping Scale and choice theory group counseling program. The data collection procedure was divided into three phases: The pre-test, the post-test, and the follow-up. The data were analyzed by repeated measure analysis of variance: One between-subjects and one within-subjects. The results revealed that the interaction between the methods and the duration of the experiment was found statistically significant at 0.05 level. The students in the experimental group demonstrated significantly higher at 0.05 level on coping strategies score in both the post-test and the follow-up than in the pre-test and the control group. No significant difference was found on coping strategies during the post-test phase and the follow-up phase of the experimental group.Keywords: coping strategies, choice theory, group counseling, boarding school
Procedia PDF Downloads 21316910 Establishment and Evaluation of a Nutrition Therapy Guide and 7-Day Menu for Educating Hemodialysis Patients: A Case Study of Douala General Hospital, Cameroon
Authors: Ngwa Lodence Njwe
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This study investigated the response of hemodialysis patients to an established nutrition therapy guide accompanied by a 7-day menu plan administered for a month. End Stage Renal Disease (ESRD), also known as End Stage Kidney Disease (ESKD), is a non-communicable disease primarily caused by hypertension and diabetes, posing significant challenges in both developed and developing nations. Hemodialysis is a key treatment for these patients. In this experimental study, 100 hemodialysis patients from Douala General Hospital in Cameroon participated. A questionnaire was used to collect data on sociodemographic and anthropometric characteristics, health status, and dietary intake, while medical records provided biomedical data. The levels of the biochemical parameters (Phosphorus, calcium and hemoglobin) were determined before and one month after the distribution of the nutrition education guide and the use of a 7-day menu plan. The Phosphorus and Calcium levels were measured using an LTCC03 semi-automatic chemistry analyzer. Blood was collected from each patient into a test tube, allowed to clot and centrifuged. 50µl of the serum was aspirated by the analyzer for Ca and P level analysis, and results were read from the display. The hemoglobin level was measured using the URIT–12 hemoglobin Meter. The blood sample was collected by hand prick and placed in a strip, and the results were read from the screen. The means of the biochemical parameters were then computed. The most prevalent age group was 40-49 years, with males constituting 70% and females 30% of respondents. Among these patients, 80% were hypertensive, 3% had both hypertension and diabetes, 9% were hypertensive, diabetic, and obese, and 1% suffered from hypertension and heart failure. Analysis of anthropometric parameters revealed a high prevalence of underweight, overweight, and obesity, highlighting the urgent need for targeted nutrition interventions to modify cooking methods, enhance food choices, and increase dietary variety for improved quality of life. Before the nutrition therapy guide was implemented, average calcium levels were 73.05 mg/L for males and 89.44 mg/L for females; post-implementation, these values increased to 77.55 mg/L and 91.44 mg/L, respectively. Conversely, average phosphorus levels decreased from 42.05 mg/L for males and 43.55 mg/L for females to 41.05 mg/L and 39.3 mg/L, respectively, after the intervention. Additionally, average hemoglobin levels increased from 8.35 g/dL for males and 8.5 g/dL for females to 9.2 g/dL and 8.95 g/dL, respectively. The findings confirm that the nutrition therapy guide and the 7-day menu significantly impacted the biomedical parameters of hemodialysis patients, underscoring the need for ongoing nutrition education and counseling for this population.Keywords: end stage kidney disease, nutrition therapy guide, nutritional status, anthropometric parameters, food frequency, biomedical data
Procedia PDF Downloads 2716909 The Students' Mathematical Competency and Attitude towards Mathematics Using the Trachtenberg Speed Math System
Authors: Marlone D. Severo
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A pre- and post-test quasi-experimental design was used to test the intervention of Trachtenberg Speed Math on the mathematical competency of sixty (60) matched-paired students with a poor performing grade in Mathematics from one of the biggest public national high school at the South of Metro Manila. Both control and experimental group were administered with the Attitude Towards Mathematics Inventory (ATMI) before the pretest were given and both group showed high dislike for Mathematics. Pretest showed a 53 percent accuracy for the control group and 51 percent for the experimental group using a 15-item long multiplication test without any aid of a computing device. The experimental group were taught how to use the Trachtenberg number-keys and techniques in multiplication between October 2014 to March 2015. Post-test showed an improvement in the experimental group with 96 percent accuracy for the control group and a dismal 57 percent for the control group in long-multiplication. Post-test ATMI were administered. The control group showed a great dislike towards Mathematics, while the experimental group showed a positive attitude towards the subject.Keywords: attitude towards mathematics, mathematical competency, number-keys, trachtenberg speed math
Procedia PDF Downloads 36716908 Pragmatic Development of Chinese Sentence Final Particles via Computer-Mediated Communication
Authors: Qiong Li
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This study investigated in which condition computer-mediated communication (CMC) could promote pragmatic development. The focal feature included four Chinese sentence final particles (SFPs), a, ya, ba, and ne. They occur frequently in Chinese, and function as mitigators to soften the tone of speech. However, L2 acquisition of SFPs is difficult, suggesting the necessity of additional exposure to or explicit instruction on Chinese SFPs. This study follows this line and aims to explore two research questions: (1) Is CMC combined with data-driven instruction more effective than CMC alone in promoting L2 Chinese learners’ SFP use? (2) How does L2 Chinese learners’ SFP use change over time, as compared to the production of native Chinese speakers? The study involved 19 intermediate-level learners of Chinese enrolled at a private American university. They were randomly assigned to two groups: (1) the control group (N = 10), which was exposed to SFPs through CMC alone, (2) the treatment group (N = 9), which was exposed to SFPs via CMC and data-driven instruction. Learners interacted with native speakers on given topics through text-based CMC over Skype. Both groups went through six 30-minute CMC sessions on a weekly basis, with a one-week interval after the first two CMC sessions and a two-week interval after the second two CMC sessions (nine weeks in total). The treatment group additionally received a data-driven instruction after the first two sessions. Data analysis focused on three indices: token frequency, type frequency, and acceptability of SFP use. Token frequency was operationalized as the raw occurrence of SFPs per clause. Type frequency was the range of SFPs. Acceptability was rated by two native speakers using a rating rubric. The results showed that the treatment group made noticeable progress over time on the three indices. The production of SFPs approximated the native-like level. In contrast, the control group only slightly improved on token frequency. Only certain SFPs (a and ya) reached the native-like use. Potential explanations for the group differences were discussed in two aspects: the property of Chinese SFPs and the role of CMC and data-driven instruction. Though CMC provided the learners with opportunities to notice and observe SFP use, as a feature with low saliency, SFPs were not easily noticed in input. Data-driven instruction in the treatment group directed the learners’ attention to these particles, which facilitated the development.Keywords: computer-mediated communication, data-driven instruction, pragmatic development, second language Chinese, sentence final particles
Procedia PDF Downloads 41816907 Evaluation of Progesterone and Estradiol17-ß Levels in Ewes Induced with Different Methods
Authors: E. Sinem Ozdemir Salci, Nazmiye Gunes, Guven Ozkaya, Gulsen Goncagul, Kamil Seyrek Intas
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The aim of this study was to show the effects of progesterone and estrogen concentrations in ewes induced with different induction of parturition methods. Twenty-four healthy ewes (n=24) on 138th gestation day were randomly separated according to induction methods (group I (n=6), (0.09% NaCl), group II (n=6) (dexamethasone, 16 mg im.), group III (n=6) (aglepristone 5mg/kg sc.) and group IV (n=6) (aglepristone, 2,5 mg/kg sc.+dexamethasone 8 mg im.). The blood samples of the ewes were collected at 12 hours intervals from induction time to the postpartum 2nd day in order to determine progesterone and estradiol 17-ß levels. These hormone concentrations were determined by ELISA, and obtained results were statistically analyzed with Kruskal Wallis and Dunn tests between the groups, and Friedman and Wilcoxon test within the groups. The results pointed out that there was no significant difference within the groups in terms of estradiol 17-ß (group 1, p=0.508; group 2, p=0.054; group 3, p=0.672; group 4, p=0,170). And there was only a significant difference at 138th day (p=0,019) between groups II and IV (p=0,010). There was a significant difference in terms of progesterone concentration within group 1, 2 and 4 (p=0.000). And there was a significant difference at all times except 138th day between the groups (p<0.05). As a conclusion, the induction of parturition methods could be performed successfully. These methods have no effect on estradiol 17-ß concentration but also make changings on progesterone concentrations as in groups 3 and 4.Keywords: ewe, estradiol 17-ß, induction of parturition, progesterone
Procedia PDF Downloads 21616906 Smart Help at the Workplace for Persons with Disabilities (SHW-PWD)
Authors: Ghassan Kbar, Shady Aly, Ibrahim Alsharawy, Akshay Bhatia, Nur Alhasan, Ronaldo Enriquez
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The Smart Help for persons with disability (PWD) is a part of the project SMARTDISABLE which aims to develop relevant solution for PWD that target to provide an adequate workplace environment for them. It would support PWD needs smartly through smart help to allow them access to relevant information and communicate with other effectively and flexibly, and smart editor that assist them in their daily work. It will assist PWD in knowledge processing and creation as well as being able to be productive at the work place. The technical work of the project involves design of a technological scenario for the Ambient Intelligence (AmI) - based assistive technologies at the workplace consisting of an integrated universal smart solution that suits many different impairment conditions and will be designed to empower the Physically disabled persons (PDP) with the capability to access and effectively utilize the ICTs in order to execute knowledge rich working tasks with minimum efforts and with sufficient comfort level. The proposed technology solution for PWD will support voice recognition along with normal keyboard and mouse to control the smart help and smart editor with dynamic auto display interface that satisfies the requirements for different PWD group. In addition, a smart help will provide intelligent intervention based on the behavior of PWD to guide them and warn them about possible misbehavior. PWD can communicate with others using Voice over IP controlled by voice recognition. Moreover, Auto Emergency Help Response would be supported to assist PWD in case of emergency. This proposed technology solution intended to make PWD very effective at the work environment and flexible using voice to conduct their tasks at the work environment. The proposed solution aims to provide favorable outcomes that assist PWD at the work place, with the opportunity to participate in PWD assistive technology innovation market which is still small and rapidly growing as well as upgrading their quality of life to become similar to the normal people at the workplace. Finally, the proposed smart help solution is applicable in all workplace setting, including offices, manufacturing, hospital, etc.Keywords: ambient intelligence, ICT, persons with disability PWD, smart application, SHW
Procedia PDF Downloads 42316905 The Improved Therapeutic Effect of Trans-Cinnamaldehyde on Adipose-Derived Stem Cells without Chemical Induction
Authors: Karthyayani Rajamani, Yi-Chun Lin, Tung-Chou Wen, Jeanne Hsieh, Yi-Maun Subeq, Jen-Wei Liu, Po-Cheng Lin, Horng-Jyh Harn, Shinn-Zong Lin, Tzyy-Wen Chiou
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Assuring cell quality is an essential parameter for the success of stem cell therapy, utilization of various components to improve this potential has been the primary goal of stem cell research. The aim of this study was not only to demonstrate the capacity of trans-cinnamaldehyde (TC) to reverse stress-induced senescence but also improve the therapeutic abilities of stem cells. Because of the availability and the promising application potential in regenerative medicine, adipose-derived stem cells (ADSCs) were chosen for the study. We found that H2O2 treatment resulted in the expression of senescence characteristics in the ADSCs, including decreased proliferation rate, increased senescence-associated- β-galactosidase (SA-β-gal) activity, decreased SIRT1 (silent mating type information regulation 2 homologs) expression and decreased telomerase activity. However, TC treatment was sufficient to rescue or reduce the effects of H2O2 induction, ultimately leading to an increased proliferation rate, a decrease in the percentage of SA-β-gal positive cells, upregulation of SIRT1 expression, and increased telomerase activity of the senescent ADSCs at the cellular level. Further recently it was observed that the ADSCs were treated with TC without induction of senescence, all the before said positives were observed. Moreover, a chemically induced liver fibrosis animal model was used to evaluate the functionality of these rescued cells in vivo. Liver dysfunction was established by injecting 200 mg/kg thioacetamide (TAA) intraperitoneally into Wistar rats every third day for 60 days. The experimental rats were separated into groups; normal group (rats without TAA induction), sham group (without ADSC transplantation), positive control group (transplanted with normal ADSCs); H2O2 group (transplanted with H2O2 -induced senescent ADSCs), H2O2+TC group (transplanted with ADSCs pretreated with H2O2 and then further treated with TC) and TC group (ADSC treated with TC without H2O2 treatment). In the transplantation group, 1 × 106 human ADSCs were introduced into each rat via direct liver injection. Based on the biochemical analysis and immunohistochemical staining results, it was determined that the therapeutic effects on liver fibrosis by the induced senescent ADSCs (H2O2 group) were not as significant as those exerted by the normal ADSCs (the positive control group). However, the H2O2+TC group showed significant reversal of liver damage when compared to the H2O2 group 1 week post-transplantation. Further ADSCs without H2O2 treatment but with just TC treatment performed much better than all the groups. These data confirmed that the TC treatment had the potential to improve the therapeutic effect of ADSCs. It is therefore suggested that TC has potential applications in maintaining stem cell quality and could possibly aid in the treatment of senescence-related disorders.Keywords: senescence, SIRT1, adipose derived stem cells, liver fibrosis
Procedia PDF Downloads 25816904 Efficiency of Nutritional Support Treatments in Children With Failure to Thrive
Authors: Mehves Isiklar Ekici, Ceyda Tuna Kirsaclioglu, Zarife Kuloglu, Aydan Kansu
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Malnutrition is an important cause of morbidity and mortality as it accounts for 45% of child deaths under the age of 5 worldwide. Therefore, early recognition and effective treatment of failure to thrive and malnutrition are important. In this study, it was aimed to retrospectively evaluate the nutritional support treatment approaches (nutrition education and diet enrichment / use of enteral nutrition products) applied in children followed up with growth failure without underlying organic causes, and to compare the efficacy of nutritional support treatments. In this study, children aged 1 month to 18 years diagnosed with growth failure who were followed up for at least 12 months between January 2011 and February 2020, were included. Anthropometric measurements at baseline and during follow-up, type of nutritional support therapy and treatment compliance were evaluated based on the retrospective records. 119 children (median age:3.2, 69 girls) were included in the study. Nutrition education and dietary enrichment were provided to 28% of the patients (Group 1). In addition to dietary education and recommendations, enteral nutrition supplements was given in 78% of them (Group 2). Compliance to the treatment rates of the patients in Group 1 and Group 2 were not significantly different at both 6th and 12th month controls. At the end of the follow up children who comply with the treatment in Group 1 had significant increase in weight for age z scores (-1.74 vs 0.05, respectively, p=0.019) and body mass index z scores (-1.47 vs -0.53, respectively, p=0.034) compared with baseline measurements. Similar to Group 1, in Group 2 children with treatment compliance, had a significant increase in weight for age z scores (-2.24 vs. -0.54, respectively, p=0.00) and body mass index z scores (-2.27 vs. -1.06, respectively, p=0.00) compared with baseline measurements. The rate of patients with severe malnutrition decreased from 15% to 12%, for moderate malnutrition decreased from 54% to 33%. Moreover, it was observed that this decrease in the rate of patients with both severe and moderate malnutrition was more prominent in patients under 3 years of age. Although there was a significant increase in anthropometric measurements with treatment in both groups, there was no significant difference in between two groups terms of change in anthropometric measurements (p>0.05), therefore effectiveness. Failure to thrive and malnutrition in infancy and childhood cause health problems that can affect adult life. To conclude, nutritional education - dietary enrichment. recommendations and use of enteral nutrition supplements were both proven beneficial in this study. Researchers are willing to underline that the most important part of the treatment is to include the family to the process to ensure the treatment compliance.Keywords: enteral nutrition supplements, failure to thrive, malnutrition, nutritional education
Procedia PDF Downloads 11016903 Effects of Intensive Rehabilitation Therapy on Sleep in Children with Developmental Disorders
Authors: Sung Hyun Kim
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Introduction: Sleep disturbance is common in children with developmental disorders (D.D.). Sleep disturbance has a variety of negative effects, such as behavior problems, medical problems, and even developmental problems in children with D.D. However, to our best knowledge, there has been no proper treatment for sleep disorders in children with D.D. Therefore, we conduct this study to know the positive effects of intensive rehabilitation therapy in children with D.D. on the degree of sleep disturbance. Method: We prospectively recruited 22 patients with a diagnosis of D.D. during the period of January 2022 through May 2022. The inclusion criteria were as follows: 1) a patient who would participate in the intensive rehabilitation therapy of our institution; 2) the age participant under 18 years at the time of assessment; 3) a child who has consented to participate in the study by signing the consent form by the legal guardian. We investigated the clinical characteristics of participants by the medical record, including sex, age, underlying diagnosis of D.D., and Gross Motor Function Measures (GMFM). Before starting the intensive rehabilitation therapy, we conducted a Sleep disturbance scale for children (SDSC). It contains 26 questions about children’s sleep, and those questions are grouped into six subscales, such as Disorders of initiating and maintaining sleep (DIMS), Sleep Breathing Disorders(SBD), Disorders of arousal(DOA), Sleep-Wake Transition Disorders(SWTD), Disorders of excessive somnolence(DOES) and Sleep Hyperhydrosis(SHY). We used the t-score, which was calculated by comparing the scores of normal children. Twenty two patients received 8 weeks of intensive rehabilitation, including daily physical and occupational therapy. After that, we did follow up with SDSC. The comparison between SDSC before and after intensive rehabilitation was calculated using the paired t-test, and P< 0.05 was considered statistically significant. Results: Demographic data and clinical characteristics of 22 patients are enrolled. Patients were 4.03 ± 2.91 years old, and of the total 22 patients, 14 (64%) were male, and 8 (36%) were female. Twelve patients(45%) were diagnosed with Cerebral palsy(C.P.), and the mean value of participants’ GMFM was 47.82 ± 20.60. Each mean value of SDSC’s subscales was also calculated. DIMS was 62.36 ± 13.72, SBD was 54.18 ± 8.39, DOA was 49.59 ± 7.01, SWTD was 58.95 ± 9.20, DOES was 53.09 ± 15.15, SHY was 52.14 ± 8.82, and the total was 59.86 ± 13.18. These values suggest that children with D.D. have sleep disorders. After 8 weeks of intensive rehabilitation treatment, the score of DIMS showed improvement(p=0.016), but not the other subscale and total score of SDSC. Conclusion: This result showed that intensive rehabilitation could be helpful to patients of D.D. with sleep disorders. Especially intensive rehabilitation therapy itself can be a meaningful treatment in inducing and maintaining sleep.Keywords: sleep disorder, developmental delay, intensive rehabilitation therapy, cerebral palsy
Procedia PDF Downloads 8616902 Numerical Solution of Two-Dimensional Solute Transport System Using Operational Matrices
Authors: Shubham Jaiswal
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In this study, the numerical solution of two-dimensional solute transport system in a homogeneous porous medium of finite-length is obtained. The considered transport system have the terms accounting for advection, dispersion and first-order decay with first-type boundary conditions. Initially, the aquifer is considered solute free and a constant input-concentration is considered at inlet boundary. The solution is describing the solute concentration in rectangular inflow-region of the homogeneous porous media. The numerical solution is derived using a powerful method viz., spectral collocation method. The numerical computation and graphical presentations exhibit that the method is effective and reliable during solution of the physical model with complicated boundary conditions even in the presence of reaction term.Keywords: two-dimensional solute transport system, spectral collocation method, Chebyshev polynomials, Chebyshev differentiation matrix
Procedia PDF Downloads 23216901 Leadership, A Toll to Support Innovations and Inventive Education at Universities
Authors: Peter Balco, Miriam Filipova
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The university education is generally concentrated on acquiring theoretical as well as professional knowledge. The right mix of these knowledges is key in creating innovative as well as inventive solutions. Despite the understanding of their importance by the professional community, these are promoted with problems and misunderstanding. The reason for the failure of many non-traditional, innovative approaches is the ignorance of Leadership in the process of their implementation, ie decision-making. In our paper, we focused on the role of Leadership in the educational process and how this knowledge can support decision-making, the selection of a suitable, optimal solution for practice.Keywords: leadership, soft skills, innovation, invention, knowledge
Procedia PDF Downloads 18916900 Extending Smart City Infrastructure to Cover Natural Disasters
Authors: Nina Dasari, Satvik Dasari
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Smart city solutions are being developed across the globe to transform urban areas. However, the infrastructure enablement for alerting natural disasters such as floods and wildfires is deficient. This paper discusses an innovative device that could be used as part of the smart city initiative to detect and provide alerts in case of floods at road crossings and wildfires. An Internet of Things (IoT) smart city node was designed, tested, and deployed with collaboration from the City of Austin. The end to end solution includes a 3G enabled IoT device, flood and fire sensors, cloud, a mobile app, and IoT analytics. The real-time data was collected and analyzed using IoT analytics to refine the solution for the past year. The results demonstrate that the proposed solution is reliable and provides accurate results. This low-cost solution is viable, and it can replace the current solution which costs tens of thousands of dollars.Keywords: analytics, internet of things, natural disasters, smart city
Procedia PDF Downloads 22416899 Parents, Carers and Young Persons’ Views Regarding Nursing ‘Workarounds’ Within Clinical Electronic Patient Record Systems
Authors: Patrick Nurse, Professor Neil Sebire, Polly Livermore
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The use of digital systems in healthcare is now highly prevalent. With further advancement of technology, these systems will become increasingly utilised within the healthcare sector. Therefore understanding how clinicians (for example, doctors, nurses) interact with technology and digital systems is critical to making care safer. Seven members from the Parent/Carers’ Research Advisory Group and the Young-Persons’ Research Group at a healthcare Trust in London and three staff members contributed to an engagement workshop to assess the impact of digital systems on the practice of nurses. The group also advised on the viability of a research study to investigate this further. A wide range of issues within digital system implementation in healthcare were raised, such as ‘workarounds’, system’s training, and upkeep and regulation of usage, which all emerged as early themes during the discussion. Further discussion focused on the subject of escalation of issues, ‘workarounds’, and problem solving. While challenging to implement, digital systems are hugely beneficial to healthcare providers. The workshop indicated that there is scope for investigation of the prevalence, nature, and escalation of ‘workarounds’, this was of key interest to the advisory group. An interesting concern of the group was their worry from a patient and parental perspective regarding how nurses might feel when needing to complete a ‘workaround’ during a busy shift. This is especially relevant if the reasons to complete the ‘workaround’ were outside the nurse’s control, driven by clinical need and urgency of care. This showed the level of insight that those using healthcare services have into the reality of workflows of those providing care. Additionally, it reflects the desire for patients and families to understand more about the administration and methodology of their care. Future study should be dedicated to understanding why nurses deploy ‘workarounds’, as well as their perspective and experience of them and subsequent escalation through leadership hierarchiesKeywords: patient engagement/involvement, workarounds, medication-administration, digital systems
Procedia PDF Downloads 9016898 Comparative Study of Gonadotropin Hormones and Sperm Parameters in Two Age Groups
Authors: G. Murtaza, H. Faiza, M. Rafiq, S. Gul, F. Raza, Sarwat Anjum
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Our objective was to investigate whether and how extensively there is a correlation between aging in men, gonadotropin hormone regulation, and a decline in sperm parameters and whether it is possible to identify an age limit beyond which the decrease in sperm feature and hormonal regulation reaches statistical significance. A total of one hundred and twenty men (age: 20–50 years) were divided into two groups; each group contained 60 males (Group A with a young age of 20–35 years and Group B with an older age of 36–50 years) who visited the Center for Reproductive Medicine (CRM) in Peshawar General Hospital (PGH) Peshawar, Pakistan. Clinical assessment and sperm analysis were investigated. Hormone testing and semen analysis were carried out in accordance with World Health Organization (WHO) guidelines. Hormone tests, sperm morphology, and the total motile spermatozoa count (TMS) were computed. SPSS 20.0 (SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. It was observed that the testosterone levels in Group A (mean = 3.770) and Group B (mean = 3.995) were comparable, with a significant P-value <0.005 in both age groups. Furthermore, similar levels are shown by follicle-stimulating hormone (FSH) (Group A mean = 19.73, Group B mean = 15.64) and luteinizing hormone (LH) (Group A mean = 12.25, Group B mean = 11.93) in both groups, with a significant P = <0.005. Sperm concentrations were most similar in Group A, with a mean of 4.44, and in Group B, with a mean of 4.42 and a significant P value of 0.005 in both groups. Additionally, it was discovered that sperm motility was higher in Group A, with a mean of 22.40 and a P-value of 0.052, which was non-significant when compared to Group B. Morphological differences were also observed in both age groups. This research found that advancing in male age does not affect sex hormone regulation; in contrast, the fraction of motile and morphologically normal spermatozoa decreases as male age increases, with the strongest evidence being when the age exceeds 40 years. To clarify the causes and clinical implications of these correlations, more research is necessary.Keywords: gonadotropins, motility, spermatozoa, testosterone
Procedia PDF Downloads 3216897 Changes in Postural Stability after Coordination Exercise
Authors: Ivan Struhár, Martin Sebera, Lenka Dovrtělová
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The aim of this study was to find out if the special type of exercise with elastic cord can improve the level of postural stability. The exercise programme was conducted twice a week for 3 months. The participants were randomly divided into an experimental group and a control group. The electronic balance board was used for testing of postural stability. All participants trained for 18 hours at the time of experiment without any special form of coordination programme. The experimental group performed 90 minutes plus of coordination exercise. The result showed that differences between pre-test and post-test occurred in the experimental group. It was used the nonparametric Wilcoxon t-test for paired samples (p=0.012; the significance level 95%). We calculated effect size by Cohen´s d. In the experimental group d is 1.96 which indicates a large effect. In the control group d is 0.04 which confirms no significant improvement.Keywords: balance board, balance training, coordination, stability
Procedia PDF Downloads 39216896 Impact of Preksha Meditation on Academic Anxiety of Female Teenagers
Authors: Neelam Vats, Madhvi Pathak Pillai, Rajender Lal, Indu Dabas
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The pressure of scoring higher marks to be able to get admission in a higher ranked institution has become a social stigma for school students. It leads to various social and academic pressures on them, causing psychological anxiety. This undue stress on students sometimes may even steer to aggressive behavior or suicidal tendencies. Human mind is always surrounded by the some desires, emotions and passions, which usually disturbs our mental peace. In such a scenario, we look for a solution that helps in removing all the obstacles of mind and make us mentally peaceful and strong enough to be able to deal with all kind of pressure. Preksha meditation is one such technique which aims at bringing the positive changes for overall transformation of personality. Hence, the present study was undertaken to assess the impact of Preksha Meditation on the academic anxiety on female teenagers. The study was conducted on 120 high school students from the capital city of India. All students were in the age group of 13-15 years. They also belonged to similar social as well as economic status. The sample was equally divided into two groups i.e. experimental group (N = 60) and control group (N = 60). Subjects of the experimental group were given the intervention of Preksha Meditation practice by the trained instructor for one hour per day, six days a week, for three months for the first experimental stage and another three months for the second experimental stage. The subjects of the control group were not assigned any specific type of activity rather they continued doing their normal official activities as usual. The Academic Anxiety Scale was used to collect data during multi-level stages i.e. pre-experimental stage, post-experimental stage phase-I, and post-experimental stage phase-II. The data were statistically analyzed by computing the two-tailed-‘t’ test for inter group comparison and Sandler’s ‘A’ test with alpha = or p < 0.05 for intra-group comparisons. The study concluded that the practice for longer duration of Preksha Meditation practice brings about very significant and beneficial changes in the pattern of academic anxiety.Keywords: academic anxiety, academic pressure, Preksha, meditation
Procedia PDF Downloads 13116895 The Effects of Ellagic Acid on Rat Liver Induced Tobacco Smoke
Authors: Nalan Kaya, Elif Erdem, Mehmet Ali Kisacam, Gonca Ozan, Enver Ozan
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Tobacco smokers continuously inhale thousands of carcinogens and free radicals. It is estimated that about 1017 oxidant molecules are present in each puff of tobacco smoke. It is known that smoking has adverse effects on the structure and functions of the liver. Ellagic acid (EA) has antioxidant, antiapoptotic, anticarcinogenic, antibacterial and antiinflammatory effects. The aim of our study was to investigate the possible protective effect of ellagic acid against tobacco smoke-mediated oxidative stress in the rat liver. Twenty-four male adult (8 weeks old) Spraque-Dawley rats were divided randomly into 4 equal groups: group I (control), group II (tobacco smoke), group III (tobacco smoke + corn oil) and group IV (tobacco smoke + ellagic acid). The rats in group II, III and IV, were exposed to tobacco smoke 1 hour twice a day for 12 weeks. In addition to tobacco smoke exposure, 12 mg/kg ellagic acid (dissolved in corn oil), was applied to the rats in group IV by oral gavage. An equal amount of corn oil used in solving ellagic acid was applied to the rats by oral gavage in group III. At the end of the experimental period, rats were decapitated, and liver tissues were removed. Histological and biochemical analyzes were performed. Sinusoidal dilatation, inflammatory cell infiltration in portal area, increased Kuppfer cells were examined in tobacco smoke group and tobacco smoke+ corn oil groups. The results, observed in tobacco smoke and tobacco smoke+corn oil groups, were found significantly decreased in tobacco smoke+EA group. Group-II and group-III MDA levels were significantly higher, and GSH activities were not different than group-I. Compared to group-II, group-IV MDA level was decreased, and GSH activities was increased significantly. The results indicate that ellagic acid could protect the liver tissue from the tobacco smoke harmful effects.Keywords: ellagic acid, liver, rat, tobacco smoke
Procedia PDF Downloads 30016894 Recognising the Importance of Smoking Cessation Support in Substance Misuse Patients
Authors: Shaine Mehta, Neelam Parmar, Patrick White, Mark Ashworth
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Patients with a history of substance have a high prevalence of comorbidities, including asthma and chronic obstructive pulmonary disease (COPD). Mortality rates are higher than that of the general population and the link to respiratory disease is reported. Randomised controlled trials (RCTs) support opioid substitution therapy as an effective means for harm reduction. However, whilst a high proportion of patients receiving opioid substitution therapy are smokers, to the author’s best knowledge there have been no studies of respiratory disease and smoking intensity in these patients. A cross sectional prevalence study was conducted using an anonymised patient-level database in primary care, Lambeth DataNet (LDN). We included patients aged 18 years and over who had records of ever having been prescribed methadone in primary care. Patients under 18 years old or prescribed buprenorphine (because of uncertainty about the prescribing indication) were excluded. Demographic, smoking, alcohol and asthma and COPD coding data were extracted. Differences between methadone and non-methadone users were explored with multivariable analysis. LDN contained data on 321, 395 patients ≥ 18 years; 676 (0.16%) had a record of methadone prescription. Patients prescribed methadone were more likely to be male (70.7% vs. 50.4%), older (48.9yrs vs. 41.5yrs) and less likely to be from an ethnic minority group (South Asian 2.1% vs. 7.8%; Black African 8.9% vs. 21.4%). Almost all those prescribed methadone were smokers or ex-smokers (97.3% vs. 40.9%); more were non-alcohol drinkers (41.3% vs. 24.3%). We found a high prevalence of COPD (12.4% vs 1.4%) and asthma (14.2% vs 4.4%). Smoking intensity data shows a high prevalence of ≥ 20 cigarettes per day (21.5% vs. 13.1%). Risk of COPD, adjusted for age, gender, ethnicity and deprivation, was raised in smokers: odds ratio 14.81 (95%CI 11.26, 19.47), and in the methadone group: OR 7.51 (95%CI: 5.78, 9.77). Furthermore, after adjustment for smoking intensity (number of cigarettes/day), the risk was raised in methadone group: OR 4.77 (95%CI: 3.13, 7.28). High burden of respiratory disease compounded by the high rates of smoking is a public health concern. This supports an integrated approach to health in patients treated for opiate dependence, with access to smoking cessation support. Further work may evaluate the current structure and commissioning of substance misuse services, including smoking cessation. Regression modelling highlights that methadone as a ‘risk factor’ was independently associated with COPD prevalence, even after adjustment for smoking intensity. This merits further exploration, as the association may be related to unexplored aspects of smoking (such as the number of years smoked) or may be related to other related exposures, such as smoking heroin or crack cocaine.Keywords: methadone, respiratory disease, smoking cessation, substance misuse
Procedia PDF Downloads 145