Search results for: emergency obstetric care

Authors: Nagendra P. Luitel, Mark J. D. Jordans

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Globally, there is a significant gap between the number of individuals in need of mental health care and those who actually receive treatment. The evidence is accumulating that mental health services can be delivered effectively by primary health care workers through community-based programs and task-sharing approaches. Changing the role of specialist mental health workers from service delivery to building clinical capacity of the primary health care (PHC) workers could help in reducing treatment gap in low and middle-income countries (LMICs). We developed a comprehensive mental health care plan in 2012 and evaluated its feasibility and effectiveness over the past three years. Initially, a mixed method formative study was conducted for the development of mental health care plan (MHCP). Routine monitoring and evaluation data, including client flow and reports of satisfaction, were obtained from beneficiaries (n=135) during the pilot-testing phase. Repeated community survey (N=2040); facility detection survey (N=4704) and the cohort study (N=576) were conducted for evaluation of the MHCP. The resulting MHCP consists of twelve packages divided over the community, health facility, and healthcare organization platforms. Detection of mental health problems increased significantly after introducing MHCP. Service implementation data support the real-life applicability of the MHCP, with reasonable treatment uptake. Currently, MHCP has been implemented in the entire Chitwan district where over 1400 people (438 people with depression, 406 people with psychosis, 181 people with epilepsy, 360 people with alcohol use disorder and 51 others) have received mental health services from trained health workers. Key barriers were identified and addressed, namely dissatisfaction with privacy, perceived burden among health workers, high drop-out rates and continue the supply of medicines. The results indicated that involvement of PHC workers in detection and management of mental health problems is an effective strategy to minimize treatment gap on mental health care in Nepal.

Keywords: mental health, Nepal, primary care, treatment gap

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Authors: Gokul Pathak, Dilip Kumar Yadav

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Background: Unsafe/unprotected and early sexual relations are highly responsible for the problems of unwanted pregnancy, child birth and other adverse consequences. Emergency contraception (EC) refers to methods that women can use to prevent pregnancy after unprotected sexual intercourse, method failure or incorrect use. Aim and Objective: The objective of this research study was to assess the level of knowledge, attitude and behavior on emergency contraception among youth students of Lekhnath Municipality. Methodology: This institution based descriptive study was carried out in August-October 2012 on Lekhnath Municipality, Nepal. Multistage simple random sampling procedure with pretested semi structured questionnaire following self administered technique was used to collect information. Collected data was coded and entered in the EpiData 3.1 ® and exported to Statistical Package for Social Science (SPSS®) version 20.0 for analysis. Chi-square test and Spearman correlation was applied wherever required. Results: A total of 641 students (87.6 %), youth students participated in this study which incorporates 354 male and 287 female youth students, of them 54.3% were from Higher Secondary level and 45.7% were from Undergraduate level. The awareness of EC among respondents was found only 64.7%. 25.8% respondents were found to have fair knowledge level where as 74.2% had poor knowledge level. Level of knowledge was significantly associated with age, educational level, faculty and educational status of mother. The study showed 82.4% respondent’s favorable attitude towards use of EC. 21.1% respondents were found to be sexually active (29.7% male and 10.5% female) and only 28.1% of sexually active respondents had ever used any method of EC. Conclusion: Knowledge about EC was found quiet low among youth. There was significant lack of knowledge about exact time limit of using devices of EC. Similarly several misconceptions regarding EC were found very high among youth. Health education initiatives should target students as they are more likely to be sexually active.

Keywords: emergency contraception, youth, unsafe/unprotected sexual intercourse, knowledge, attitude and behavior

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Authors: Shiksha Thakur, Rashmi Jain

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Maternal health is the most crucial element in the primary health care delivery system of any healthy society. We aware that the maternal health situation in India has been a cause of concern for us, in spite of the rapidly progressing socio-economic environment overall. India has realized impressive gains in Mother & Child survival over the last two decades. MMR as per 2012-2013 in India is 167 as per MMR bulletin, though there are variations between states in the Country. In 2013, an estimated 2,89,000 women worldwide died from complications arising from pregnancy & childbirth. In view of the above facts, a study was conducted in Indore to analyse the maternal health status among urban slums and non-slums women.

Keywords: antenatal care, postnatal care, JSY, maternal health, child health, reproductive health

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Authors: Tiago Sigal Linhares, Ana Amélia Nascimento da Silva Bones, Juliana Miola, McArthur Alexander Barrow, Airton Tetelbom Stein

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Introduction: As a result of increased globalization and changing migration trends, it is expected that a significant portion of People Living with HIV/AIDS (PLWHA) will change their place of residence over time. In order to provide better health care, monitor the HIV epidemic and plan urban public health care and policies, there is a growing need to formulate a strategy for monitoring PLWHA care, location and migration patterns. The Porto Alegre District is characterized by a high prevalence of PLWHA and is considered one of the epicenters of HIV epidemic in Latin America. Objectives: The aim of this study is to create a digital and easily editable map in order to create a visual representation of the location of PLWHA and to monitor their migration within the city and the country in an effort to promote longitudinal care. Methods: This Experience Report used Google Maps Map Creator to generate an active digital map showing the location and changes in residence of 165 PLWHA who received care at two Primary Health Care (PHC) clinics, which attended an estimated population of five thousand patients, in downtown Porto Alegre over the last four years. Their current addresses were discovered in the unified Brazilian health care system digital records (e-SUS) and updated on the map. Results: A digital map with PLWHA current residence location was created. It was possible to demonstrate visually areas with a large concentration of PLWHA and the migration of the population within the city as wells as other cities, regions and states. Conclusions: An easily reproducible and free map could aid in PLWHA monitoring, urban public health planning, target interventions and situational diagnosis. Moreover, a visual representation of PLWHA location and migration could help bring more attention and investments to areas with geographic inequities or higher prevalence of PLWHA. It also enables notification of local PHC units of monitored patients inside their area, which are in clinical risk or with treatment abandonment through active case findings, improving the care of PLWHA.

Keywords: health care, medical public health, theoretical and conceptual innovations, urban public health

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Authors: Isabelle Gobatto

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Based on an anthropological approach, this paper explores the medical profession and the construction of medical practices by considering the multiform articulations between structural poverty and the production of care from a low-resource francophone West African country, Burkina Faso. This country is considered in its exemplary dimension of culturally differentiated countries of the African continent that share the same situation of structural poverty. The objective is to expose the effects of structural poverty on the ways of constructing professional knowledge and thinking about the sense of the medical profession. If doctors are trained to have the same capacities in South and West countries, which are to treat and save lives whatever the cultural contexts of the practice of medicine, the ways of investing their role and of dealing with this context of action fracture the homogenization of the medical profession. In the line of anthropology of biomedicine, this paper outlines the complex effects of structural poverty on health care, care relations, and the moral economy of doctors. The materials analyzed are based on an ethnography including two temporalities located thirty years apart (1990-1994 and 2020-2021), based on long-term observations of care practices conducted in healthcare institutions, interviews coupled with the life histories of physicians. The findings reveal that disabilities faced by doctors to deliver care are interpreted as policy gaps, but they are also considered by physicians as constitutive of the social and cultural characteristics of patients, making their capacities and incapacities in terms of accompanying caregivers in the production of care. These perceptions have effects on know-how, structured around the need to act even when diagnoses are not made so as not to see patients desert health structures if the costs of care are too high for them. But these interpretations of highly individualizing dimensions of these difficulties place part of the blame on patients for the difficulties in using learned knowledge and delivering effective care. These situations challenge the ethics of caregivers but also of ethnologists. Firstly because the interpretations of disabilities prevent caregivers from considering vulnerabilities of care as constituting a common condition shared with their patients in these health systems, affecting them in an identical way although in different places in the production of care. Correlatively, these results underline that these professional conceptions prevent the emergence of a figure of victim, which could be shared between patients and caregivers who, together, undergo working and care conditions at the limit of the acceptable. This dimension directly involves politics. Secondly, structural poverty and its effects on care challenge the ethics of the anthropologist who observes caregivers producing, without intent to arm, experiences of care marked by an ordinary violence, by not giving them the care they need. It is worth asking how anthropologists could get doctors to think in this light in west-African societies.

Keywords: Africa, care, ethics, poverty

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Authors: K. Pankaj, R. K. Chaudhary, B. P. Mishra, S. Kochar

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Introduction: Consultation-Liaison psychiatry is a branch of psychiatry that includes clinical service, teaching and research. A consultation-liaison psychiatrist plays a role in having an expert opinion and linking the patients to other medical professionals and the patient’s bio-psycho-social aspects that may be leading to his/her symptoms. Consultation-Liaison psychiatry has been recognised as 'The guardian of the holistic approach to the patient', underlining its pre-eminent role in the management of patients who are admitted in a tertiary care hospital. Aims/ Objectives: The aim of the study was to analyse the utilization of psychiatric services and reasons for referrals in a tertiary care hospital. Materials and Methods: The study was done in a tertiary care hospital. The study included all the cases referred from different Inpatient wards to the psychiatry department for consultation. The study was conducted on 300 patients over a 3 month period. International classification of diseases 10 was used to diagnose the referred cases. Results: The majority of the referral was from the Medical Intensive care unit (22%) followed by general medical wards (18.66%). Majority of the referral was taken for altered sensorium (24.66%), followed by low mood or unexplained medical symptoms (21%). Majority of the referrals had a diagnosis of alcohol withdrawal syndrome (21%) as per International classification of diseases criteria, followed by unipolar Depression and Anxiety disorder (~ 14%), followed by Schizophrenia (5%) and Polysubstance abuse (2.6%). Conclusions: Our study concludes the importance of utilization of consultation-liaison psychiatric services. Also, the study signifies the need for sensitization of our colleagues regarding psychiatric sign and symptoms from time to time and seek psychiatric consult timely to decrease morbidity.

Keywords: consultation-liaison, psychiatry, referral, tertiary care hospital

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Authors: Jevonte Abioye, Dylan Savary

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The aim of this research is to present a disaggregated geostatistical analysis of the subnational provincial trends of child mortality variation in Zimbabwe from a child health policy perspective. Soon after gaining independence in 1980, the government embarked on efforts towards promoting equitable health care, namely through the provision of primary health care. Government intervention programmes brought hope and promise, but achieving equity in primary health care coverage was hindered by previous existing disparities in maternal health care disproportionately concentrated in urban settings to the detriment of rural communities. The article highlights policies and programs adopted by the government during the millennium development goals period between 1990-2015 as a response to the inequities that characterised the country’s maternal health care. A longitudinal comparative method for a spatial variation on child mortality rates across provinces is developed based on geostatistical analysis. Cross-sectional and time-series data was extracted from the World Health Organisation (WHO) global health observatory data repository, demographic health survey reports, and previous academic and technical publications. Results suggest that although health care policy was uniform across provinces, not all provinces received the same antenatal and perinatal services. Accordingly, provincial rates of child mortality growth between 1994 and 2015 varied significantly. Evidence on the trends of child mortality rates and maternal health policies in Zimbabwe can be valuable for public child health policy planning and public service delivery design both in Zimbabwe and across developing countries pursuing the sustainable development agenda.

Keywords: antenatal care, perinatal care, infant mortality rate, neonatal mortality rate, under-five mortality rate, millennium development goals, sustainable development agenda

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Authors: Nditsheni Ramakuela, Sonto Maputle, Base Khoza, Augustine Tugli

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Inadequate health literacy can cause difficulties in understanding and compliance to treatment plan. With diabetic condition, self-care activities include behaviours of following a diet plan, avoiding high fat foods, increased exercise, self-glucose monitoring, and foot care. Patients with poor health literacy have difficulty interpreting medication warning labels, following directions on a prescription label and identifying their medications. Difficulties in understanding and performing self-care and health-related activities may ultimately lead to poor health outcomes. The study explored and described factors affecting health literacy and self-care to diabetic regimen by female patients at selected hospital in Limpopo Province of South Africa. Qualitative and explorative research design was used. Female patients who were admitted and diagnosed with diabetes in female medical ward constituted the study population. Non-probability, purposive sampling was used to select 20 female patients diagnosed with diabetes, who were above 18 years and admitted during April–November 2014. An in-depth face-to-face, unstructured interview was used to collect data. Data were analysed using open coding method. Measures to ensure trustworthiness and ethical considerations were adhered to. Findings revealed factors affecting health literacy for diabetic self-care activities amongst patients were; patient, family, disease and facility related. Proposed recommendations were; to strengthen diabetes education and patient-provider partnership. This is important and must be transferred to strengthen self-care activities to fully benefit the patient.

Keywords: compliance, diabetes mellitus, diabetic regimen, health literacy, self activities

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Authors: Rajendra Kumar Kanojia

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Treatment of fracture both bones of leg following trauma is done intially at nearby primary health care center.primary management for shock,pain,control of bleeding,plaster application. These are treated for primay fixation of fracture, debridment of wound. Then, they were refered to tertiary care where they were again and planned for further treatment. This leads to loss of lot of time, money, job, etc.

Keywords: fracture both bones leg, non-union, ilizarov, cost

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Authors: Ewa M. Laskowska, Jorn Vatn

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Industry 4.0 focuses on digital optimization of industrial processes. The idea is to use extracted data in order to build a decision support model enabling use of those data for real time decision making. In terms of predictive maintenance, the desired decision support tool would be a model enabling prognostics of system's health based on the current condition of considered equipment. Within area of system prognostics and health management, a commonly used health indicator is Remaining Useful Lifetime (RUL) of a system. Because the RUL is a random variable, it has to be estimated based on available health indicators. Health indicators can be of different types and come from different sources. They can be process variables, equipment performance variables, data related to number of experienced failures, etc. The aim of this study is the analysis of performance variables of emergency shutdown valves (ESV) used in oil and gas industry. ESV is inspected periodically, and at each inspection torque and time of valve operation are registered. The data will be analyzed by means of machine learning or statistical analysis. The purpose is to investigate whether the available data could be used as a health indicator for a prognostic purpose. The second objective is to examine what is the most efficient way to incorporate the data into predictive model. The idea is to check whether the data can be applied in form of explanatory variables in Markov process or whether other stochastic processes would be a more convenient to build an RUL model based on the information coming from registered data.

Keywords: emergency shutdown valves, health indicator, prognostics, remaining useful lifetime, RUL

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Authors: E. Vazquez-Santacruz, M. Gamboa-Zuniga

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In this paper, we show a methodology for bodies classification in lying state using HOG descriptors and pressures sensors positioned in a matrix form (14 x 32 sensors) on the surface where bodies lie down. it will be done in real time. Our system is embedded in a care robot that can assist the elderly patient and medical staff around to get a better quality of life in and out of hospitals. Due to current technology a limited number of sensors is used, wich results in low-resolution data array, that will be used as image of 14 x 32 pixels. Our work considers the problem of human posture classification with few information (sensors), applying digital process to expand the original data of the sensors and so get more significant data for the classification, however, this is done with low-cost algorithms to ensure the real-time execution.

Keywords: real-time classification, sensors, robots, health care, elderly patients, artificial intelligence

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Authors: V. Emery David Jr., J. Wenchao, D. Mmereki, Y. John, F. Heriniaina

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Healthcare waste management continues to present an array of challenges for developing countries, and Liberia is of no exception. There is insufficient information available regarding the generation, handling, and disposal of health care waste. This face serves as an impediment to healthcare management schemes. The specific objective of this study is to present an evaluation of the current health care management practices in Liberia. It also presented procedures, techniques used, methods of handling, transportation, and disposal methods of wastes as well as the quantity and composition of health care waste. This study was conducted as an investigative case study, covering three different health care facilities; a hospital, a health center, and a clinic in Monrovia, Montserrado County. The average waste generation was found to be 0-7kg per day at the clinic and health center and 8-15kg per/day at the hospital. The composition of the waste includes hazardous and non-hazardous waste i.e. plastic, papers, sharps, and pathological elements etc. Nevertheless, the investigation showed that the healthcare waste generated by the surveyed healthcare facilities were not properly handled because of insufficient guidelines for separate collection, and classification, and adequate methods for storage and proper disposal of generated wastes. This therefore indicates that there is a need for improvement within the healthcare waste management system to improve the existing situation.

Keywords: disposal, healthcare waste, management, Montserrado County, Monrovia

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Authors: Amanda Aliende da Matta

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This communication presents an aspect of phenomenon selection in an applied hermeneutic phenomenology study on care and vulnerability: the need to consider it as a situated universal. For that, we will first present the study and its methodology. Secondly, we will expose the need to understand phenomena as situation-defined, incorporating feminist thought. In an informatics class for 14 year olds, we explained the exercise: students have to make a 5 slide presentation about a topic of their choice. A does it on streetwear, B on Cristiano Ronaldo, C on Marvel, but J did it on Down Syndrome. Introducing it to the class, J explains the physical and cognitive differences caused by trisomy; when asked to explain it further, he says: "they are angels, teacher," and shows us a poster on his cellphone that says: if you laugh at a different child he will laugh with you because his innocence outweighs your ignorance. The anecdote shows, better than any theoretical explanation, something that some vulnerable people have; something beautiful and special but difficult to define. Let's call this something caring. The research has the main objective of accounting for the experience of caregiving in vulnerability, and it will be carried out with Applied Hermeneutic Phenomenology (AHP). The method's objective is to investigate the lived human experience in its pre-reflexive dimension to know its meaning structures. Contrary to other research methods, AHP does not produce theory about a specific context but seeks the meaning of the lived experience, in its characteristic of human experience. However, it is necessary that we understand care as defined in a concrete situation. We cannot start the research with an a priori definitive concept of care, or we would fall into the mistake of closing ourselves to only what we already know, as explained by Levinas. We incorporate, then, the notion of situated universals. Loyal to phenomenology, the definition of the phenomenon should start with an investigation of the word's etymology: the word cura, in its etymological root, means care. And care comes from the Latin word cogitātus/cōgĭto, which means "to pursue something in mind" and "to consider thoroughly." The verb cōgĭto, meanwhile, is composed of co- (altogether) and agitare (to deal with or think committedly about something, to concern oneself with) / ăgĭto (to set in motion, to move). Care, therefore, has in its origin a meditation on something, a concern about something, a verb that has a sense of action and movement. To care is to act out of concern for something/someone. This etymology, though, is not the final definition of the phenomenon, but only its skeleton. It needs to be embodied in the concrete situation to become a possible lived experience. And that means that the lived experience descriptions (LEDs) should be selected by taking into consideration how and if care was engendered in that concrete experience. Defining the phenomenon has to take into consideration situated knowledge.

Keywords: applied hermeneutic phenomenology, care ethics, hermeneutics, phenomenology, situated universalism

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Authors: Joanna Grzybowska, Magdalena Igras, Mariusz Ziółko

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Association rule learning is an approach for discovering interesting relationships in large databases. The analysis of relations, invisible at first glance, is a source of new knowledge which can be subsequently used for prediction. We used this data mining technique (which is an automatic and objective method) to learn about interesting affects associations in a corpus of emergency phone calls. We also made an attempt to match revealed rules with their possible situational context. The corpus was collected and subjectively annotated by two researchers. Each of 3306 recordings contains information on emotion: (1) type (sadness, weariness, anxiety, surprise, stress, anger, frustration, calm, relief, compassion, contentment, amusement, joy) (2) valence (negative, neutral, or positive) (3) intensity (low, typical, alternating, high). Also, additional information, that is a clue to speaker’s emotional state, was annotated: speech rate (slow, normal, fast), characteristic vocabulary (filled pauses, repeated words) and conversation style (normal, chaotic). Exponentially many rules can be extracted from a set of items (an item is a previously annotated single information). To generate the rules in the form of an implication X → Y (where X and Y are frequent k-itemsets) the Apriori algorithm was used - it avoids performing needless computations. Then, two basic measures (Support and Confidence) and several additional symmetric and asymmetric objective measures (e.g. Laplace, Conviction, Interest Factor, Cosine, correlation coefficient) were calculated for each rule. Each applied interestingness measure revealed different rules - we selected some top rules for each measure. Owing to the specificity of the corpus (emergency situations), most of the strong rules contain only negative emotions. There are though strong rules including neutral or even positive emotions. Three examples of the strongest rules are: {sadness} → {anxiety}; {sadness, weariness, stress, frustration} → {anger}; {compassion} → {sadness}. Association rule learning revealed the strongest configurations of affects (as well as configurations of affects with affect-related information) in our emergency phone calls corpus. The acquired knowledge can be used for prediction to fulfill the emotional profile of a new caller. Furthermore, a rule-related possible context analysis may be a clue to the situation a caller is in.

Keywords: data mining, emergency phone calls, emotional profiles, rules

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Authors: Sigrid James

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Purpose and Background: Despite a global policy push for deinstitutionalization, residential care for children and youth remains a relevant and highly utilized out-of-home care option in many countries, fulfilling functions of care and accommodation as well as education and treatment. While many youths are placed in residential care programs temporarily or during times of transition, some still spend years in programs that range from small group homes to large institutions. How residential care is used and what function it plays in child welfare systems is influenced by a range of factors. Among them are sociocultural and historical developments, available resources for child welfare, cultural notions about family, a lack of family-based placement alternatives as well as a belief that residential care can be beneficial to children. As part of a larger study that examined differences in residential care across 16 countries along a range of dimensions, this paper reports findings on utilization rates of residential care, i.e., the proportion of out out-of-home care dedicated to residential care relative to forms of family-based foster care. Method: Using an embedded multiple-case design study approach where a country represents a case, residential care in 16 countries was studied and compared. The comparison was focused on countries with developed social welfare systems and included Spain, Denmark, Germany, Ireland, the Netherlands, England, Scotland, Australia, Italy, Israel, Argentina, Portugal, Finland, France, the United States and Canada. Experts from each country systematically collected data on residential care based on a common matrix developed by the author. A range of sources were accessed depending on the information sought, including administrative data, government reports, research studies, etc. Utilization rates were mostly drawn from administrative data or government reports. While denominators may slightly differ, available data allowed for meaningful comparisons. Beyond descriptive data on utilization rates, analysis allowed to also capture trends in utilization (increasing, decreasing, stable) as well as the rate change. Results: Results indicate high variability in the utilization of residential care, covering the entire spectrum from a low of 7% to a high of 97%, with most countries falling somewhere in between. Three utilization categories were identified: high-users of residential care (Portugal, Argentina and Israel), medium-users (Denmark, France, Italy, Finland, Spain, Netherlands, Germany), and low-users (England, Scotland, Ireland, Canada, Australia, the United States). A number of countries experienced drastic reductions in residential care during the past few years (e.g. US), while others have seen stable rates (e.g., Portugal) or even increasing rates (e.g., Spain). Conclusions: Multiple contextual factors have to be considered when interpreting findings. For instance, countries with low residential care rates have, in most cases, undergone recent legislative changes to drastically reduce residential care. In medium-utilization countries, residential care reforms seem to be primarily focused on improving standards and, thus, the quality of care. High utilization countries generally face serious obstacles to implementing alternative family-based forms of out-of-home care. Cultural acceptance of residential or foster care and notions of professionalism also appear to play an important role in explaining variability in utilization.

Keywords: residential youth care, child welfare, case study, cross-national comparative research

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Authors: Abdelghani Leghouchi

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This study aims to predict the consequences associated with the propagation of the flood wave that may occur after the failure of the Taksebt dam and suggest an efficient emergency action plan (EAP) for mitigation purposes. To achieve the objectives of this study, the hydrodynamic model HEC-RAS 2D was used for the flood routing of the dam break wave, which gave an estimate of the hydraulic characteristics downstream the Taksebt dam. Geospatial analysis of the simulation results conducted in a Geographic information system (GIS) environment showed that many residential areas are considered to be in danger in case of the Taksebt dam break event. Based on the obtained results, an emergency actions plan was suggested to moderate the causalities in the downstream area at risk. Overall, the present study showed that the integration of 2D hydraulic modeling and GIS provides great capabilities in providing realistic view of the dam break wave propagation that enhances assessing the associated risks and proposing appropriate mitigation measures.

Keywords: taksebt dam, dam break, wave propagation time, HEC-RAS 2D

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Authors: Han Gul Lee

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When water treatments utilities are designed, an initial construction site risk assessment is conducted. This helps us to understand general safety risks that each utility needs to be complemented in the designing stage. Once it’s built, an additional risk reassessment process secures and supplements its disaster management and response plan. Because of its constantly changing surroundings with city renovation and developments, the degree of various risks that each facility has to face changes. Therefore, to improve the preparedness for spill incidents or disasters, emergency managers should run spill simulations with the available scientific technologies. This research used a two-dimensional flow routing model to simulate its spill disaster scenario based on its digital elevation model (DEM) collected with drone technologies. The results of the simulations can help emergency managers to supplement their response plan with concrete situational awareness in advance. Planning based on this simulation model minimizes its potential loss and damage when an incident like earthquakes man-made disaster happens, which could eventually be a threat in a public health context. This pilot research provides an additional paradigm to increase the preparedness to spill disasters. Acknowledgment: This work was supported by Korea Environmental Industry & Technology Institute (KEITI) through Environmental R&D Project on the Disaster Prevention of Environmental Facilities Program funded by Korea Ministry of Environment (MOE) (No.202002860001).

Keywords: risk assessment, disaster management, water treatment utilities, situational awareness, drone technologies

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Authors: Nelson Igaba, C. Onaga, S. Hlongwane

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Background: Medical Male Circumcision (MMC) is part of a comprehensive HIV prevention strategy. The quality of MMC done at Right To Care (RtC) sites is maintained by Continuous Quality Improvement (CQI) based on findings of assessments by internal and independent external assessors who evaluate such parameters as the quality of the surgical procedure, infection control, etc. There are 12 RtC MMC teams in Mpumalanga, two of which are headed by Medical Officers and 10 by Clinical Associates (Clin A). Objectives: To compare the quality (i) of care rendered at doctor headed sites (DHS) versus Clin A headed sites (CHS); (ii) of CQI assessments (external versus internal). Methodology: A retrospective review of data from RightMax™ (a novel RtC data management system) and CQI reports (external and internal) was done. CQI assessment scores of October 2015 and October 2016 were taken as the baseline and latest respectively. Four sites with 745-810 circumcisions per annum were purposively selected; the two DHS (group A) and two CHS (group B). Statistical analyses were conducted using R (2017 version). Results: There were no significant difference in latest CQI scores between the two groups (DHS and CHS) (Anova, F = 1.97, df = 1, P = 0.165); between internal and external CQI assessment scores (Anova, F = 2.251, df = 1, P = 0.139) or among the individual sites (Anova, F = 1.095, df = 2, P = 0.341). Of the total of 16 adverse events reported by the four sites in the 12 months reviewed (all were infections), there was no statistical evidence that the documented severity of the infection was different for DHS and CHS (Fisher’s exact test, p-value = 0.269). Conclusion: At RtC VMMC sites in Mpumalanga, internal and external/independent CQI assessments are comparable, and quality of care of VMMC is standardized with the performance of well-supervised clinical associates comparing well with those of medical officers.

Keywords: adverse events, Right to Care, male medical circumcision, continuous quality improvement

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Authors: Robert John Godby

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To be responsive now and in the future, workplaces must address the demands of multicultural teams as they become more common elements of the global labor force. This is especially the case for aged care due to the aging population, industry growth and migrant recruitment. This research identifies influences on and improvements for learning in these environments. Its unique contribution is to illuminate how culturally diverse workplaces can work and learn together more effectively. A mixed-methods approach was used to gather data about this topic in two phases. Firstly, the research methods included a survey of 102 aged care workers around Australia from two multi-site aged care organisations. The questionnaire elicited both quantitative and qualitative data about worker characteristics and perspectives on working and learning in aged care. Secondly, a case study of one aged care worksite was formulated drawing on worksite information and interviews with workers. A review of the literature suggests that learning in multicultural work environments is influenced by three main factors: 1) the individual workers themselves, 2) their interaction with each other and 3) the environment in which they work. There are various accounts of these three factors, how they are manifested and how they lead to a change in workers’ disposition, knowledge, or expertise when confronted with new circumstances. The study has found that a key individual factor influencing learning is cultural background. Their unique view of the world was shown to affect their approach to both their work and co-working. Interactional factors suggest that the high requirement for collaboration in aged care positively supports learning in this context; however, it can be hindered by cultural bias and spoken accent. The study also found that environmental factors, such as disruptions caused by the pandemic, were another key influence. For example, the need to wear face masks hindered the communication needed for workplace learning. This was especially challenging due to the diverse language backgrounds and abilities within the teams. Potential improvements for learning in multicultural aged care work environments were identified. These include more frequent and structured inter-peer learning (e.g. buddying), communication training (e.g. English language usage for both native and non-native speaking workers) and support for cross-cultural habitude (e.g. recognizing and adapting to cultural differences). Workplace learning in cross-cultural aged care environments is an area that is not extensively dealt with in the literature. This study addresses this gap and holds the potential to contribute practical insights to aged care and other diverse industries.

Keywords: cross-cultural learning, learning in aged care, migrant learning, workplace learning

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Authors: Yu-Ching Liu

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Background: Family numbers usually take responsibility for taking care of their elderly relatives, especially parents. Caring for a patient with chronic diseases is a stressful experience, which makes carers suffer physical and mental health stress, difficulties maintaining family relationships and issues in participating in the labor market, which may lower their quality of life (QoL). The issue of providing care to relatives with chronic illness has been widely explored in Taiwan, but most studies focus on the need for full-time caregivers. Objective: The main goal of this study was to examine the topic of working carers involved in the decision-making process of LTC services and to explore what affects working carers considering when they choose the care services for their disabled, elderly relatives. Method: A total of 7 working caregivers were enrolled in this study. A face-to-face and semi-structured in-depth qualitative interview study were conducted to explore the caregivers' perspectives. Results: Working carers have a positive experience of using LTC service because it allows them to kill two birds with one stone, continue employment, and care for an elderly disabled relative. However, working carers have still been struggling to find friendly community-based LTC services. There were no longer available community services that could be used with the illness condition of patients getting worse. As such, patients have to be cared for at home, which might increase the caregiver burden of carers. Conclusion: Working family caregivers suffer from heavy physical and psychological burdens as they not only have to maintain their employment but care for elderly disabled relatives; however, the current support provided is insufficient. The design of services should consider working carers' employment situation and need rather than the only caring situation of patients at home.

Keywords: family caregiver, Long-term care, work-life balance, decision-making

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Authors: Wint Wint Thu, Htet Ko Ko Win, Myat Mon San, Zaw Lin Tun, Nandar Than Aye, Khin Nyein Myat, Hayman Nyo Oo, Nay Aung Lin, Kusum Thapa, Kyaw Htet Aung

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Background: In Myanmar, the intense political instability happened to start in Feb-2021, while the COVID-19 pandemic waves are also threatening the public health system, which subsequently led to severe health sector crisis, including difficulties in accessing maternal and newborn health care for vulnerable women and children. The Remote Pregnant and Newborn Care (RPNC) uses a telehealth approach United States Agency for International Development (USAID)-funded Essential Health Project. Implementation: The Remote Pregnant and Newborn Care (RPNC) service has adapted to the MNCH needs of vulnerable pregnant women and was implemented to mitigate the risk of limited access to essential quality MNH care in Yangon, Myanmar, under women, and the project trained 13 service providers on a telehealth care package for pregnancy and newborn developed Jhpiego to ensure understanding of evidence-based MNCH care practices. The phone numbers of the pregnant women were gathered through the preexisting and functioning community volunteers, who reach the most vulnerable pregnant women in the project's targeted area. A total of 212 pregnant women have been reached by service providers for RPNC during the implementation period. The trained service providers offer quality antenatal and postnatal care, including newborn care, via telephone calls. It includes 24/7 incoming calls and time-allotted outgoing calls to the pregnant women during antenatal and postnatal periods, including the newborn care. The required data were collected daily in time with the calls, and the quality of the medical services is made assured with the track of the calls, ensuring data privacy and patient confidentiality. Lessons learned: The key lessons are 1) cost-effectiveness: RPNC service could reduce out of pocket expenditure of pregnant women as it only costs 1.6 United States dollars (USD) per one telehealth call while it costs 8 to 10 USD per one time in-person care service at private service providers, including transportation cost, 2) network of care: telehealth call could not replace the in-person antenatal and postnatal care services, and integration of telehealth calls with in-person care by local healthcare providers with the support of the community is crucial for accessibility to essential MNH services by poor and vulnerable women, and 3) sharing information on health access points: most of the women seem to have financial barriers in accessing private health facilities while public health system collapse and telehealthcare could provide information on low-cost facilities and connect women to relevant health facilities. These key lessons are important for future efforts regarding the implementation of remote pregnancy and newborn care in Myanmar, especially during the political crisis and COVID-19 pandemic situation.

Keywords: telehealth, accessibility, maternal care, newborn care

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Authors: Md. Abdul Karim, Syed Imran Ahmed, Pandora T. Hardtman

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Informed consent is one of the basic human and ethical rights for childbearing women. It plays a central role in promoting informed decision making between patients and service providers during the labor process. It gives mothers rights to accept or reject any examination and/or procedure, increases the respect and dignity of the mother during pregnancy, delivery and postpartum care. To assess the practices of this right during normal vaginal delivery and immediate postpartum care in tertiary level hospital setting in Bangladesh, a quantitative study with cross-sectional design was conducted in Dhaka Medical College & Hospital (DMCH) and Sir Salimullah Medical College & Mitford Hospital (SSMCH) in Dhaka in November 2015. A prevalence-based sample size of 190 was calculated where prevalence, confidence interval and level of significance were at 9.7%, 98% and 5% respectively. The respondents were the mothers who gave normal vaginal childbirth within past 24 hours and received postpartum care there. They were selected through systematic random sampling technique and their face-to-face interview of 190 mothers was done using a structured questionnaire. Data were entered into the spreadsheet (MS Excel 2013 version) and descriptive analysis of findings was done. The result shows the complete absence of informed consent practices and mostly absence of consented care such as right to information, respect for choices of preferences for examination and/or procedure of childbearing women. Although 95% of the mothers were informed that they were being proceeded with normal vaginal delivery, their choice of preference was absent during the process. Only consent (not informed consent) was taken from 50%-72% mothers for examination (except breast examination ‘0%’) and 8%-83% for any procedures during postpartum care. Only one-ninth (11%) of the mothers could ask service providers regarding the services they received. No consent was taken from 3% of the mothers- neither in the labor process nor in postpartum care. This current practice doesn’t comply with the Respectful Maternity Care (RMC) Charter 2011. The issue is not even clarified in the current Standard Clinical Management Protocols of the country. So, improvement of the existing protocol and increased awareness are essential to address this right of child-bearing women and to practice it during normal vaginal delivery and postpartum care.

Keywords: informed consent, normal vaginal delivery, respectful maternity care, tertiary level hospital

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Authors: Cherrie Lowe

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The TrendCare Patient Dependency System is currently utilized by a large number of Maternity Services across Australia, New Zealand and Singapore. In 2012, 2013, and 2014 validation studies were initiated in all three countries to validate the acuity tools used for Women in Labour, and Postnatal Mothers and Babies. This paper will present the findings of the validation study. Aim: The aim of this study was to; Identify if the care hours provided by the TrendCare Acuity System was an accurate reflection of the care required by Women and Babies. Obtain evidence of changes required to acuity indicators and/or category timings to ensure the TrendCare acuity system remains reliable and valid across a range of Maternity care models in three countries. Method: A non-experimental action research methodology was used across four District Health Boards in New Zealand, two large public Australian Maternity services and a large tertiary Maternity service in Singapore. Standardized data collection forms and timing devices were used to collect Midwife contact times with Women and Babies included in the study. Rejection processes excluded samples where care was not completed/rationed. The variances between actual timed Midwife/Mother/Baby contact and actual Trend Care acuity times were identified and investigated. Results: 87.5% (18) of TrendCare acuity category timings matched the actual timings recorded for Midwifery care. 12.5% (3) of TrendCare night duty categories provided less minutes of care than the actual timings. 100% of Labour Ward TrendCare categories matched actual timings for Midwifery care. The actual times given for assistance to New Zealand independent Midwives in Labour Ward showed a significant deviation to previous studies demonstrating the need for additional time allocations in Trend Care. Conclusion: The results demonstrated the importance of regularly validating the Trend Care category timings with the care hours required, as variances to models of care and length of stay in Maternity units have increased Midwifery workloads on the night shift. The level of assistance provided by the core labour ward staff to the Independent Midwife has increased substantially. Outcomes: As a consequence of this study changes were made to the night duty TrendCare Maternity categories, additional acuity indicators developed and times for assisting independent Midwives increased. The updated TrendCare version was delivered to Maternity services in 2014.

Keywords: maternity, acuity, research, nursing workloads

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Authors: Chang Yu Chuan

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Background and Aim: Pressure sore is not only the consequence of any gradual damage of the skin leading to tissue defects but also an important indicator of clinical care. If hospitalized patients develop pressure sores without proper care, it would result in delayed healing, wound infection, increase patient physical pain, prolonged hospital stay and even death, which would have a negative impact on the quality of care and also increase nursing manpower and medical costs. This project is aimed at decreasing the incidence of pressure sore in one ward of internal medicine. Our data showed 53 cases (0.61%) of pressure sore in 2015, which exceeded the average (0.5%) of Taiwan Clinical Performance Indicator (TCPI) for medical centers. The purpose of this project is to reduce the incidence rate of pressure sore in the ward. After data collection and analysis from January to December 2016, the reasons of developing pressure sore were found: 1. Lack of knowledge to prevent pressure among nursing staffs; 2. No relevant courses about preventing pressure ulcers and pressure wound care being held in this unit; 3. Low complete rate of pressure sore care education that family members should receive from nursing staffs; 4. Decompression equipment is not enough; 5. Lack of standard procedures for body-turning and positioning care. After team members brainstorming, several strategies were proposed, including holding in-service education, pressure sore care seed training, purchasing decompression mattress and memory pillows, designing more elements of health education tools, such as health education pamphlet, posters and multimedia films of body-turning and positioning demonstration, formulation and promotion of standard operating procedures. In this way, nursing staffs can understand the body-turning and positioning guidelines for pressure sore prevention and enhance the quality of care. After the implementation of this project, the pressure sore density significantly decreased from 0.61%(53 cases) to 0.45%(28 cases) in this ward. The project shows good results and good example for nurses working at the ward and helps to enhance quality of care.

Keywords: body-turning and positioning, incidence density, nursing, pressure sore

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Authors: Ayse Gul Bilen

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Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed antidepressants that are used clinically for the treatment of anxiety disorders, obsessive-compulsive disorder (OCD), panic disorders and eating disorders. The first SSRI, fluoxetine (sold under the brand names Prozac and Sarafem among others), had an adverse effect profile better than any other available antidepressant when it was introduced because of its selectivity for serotonin receptors. They have been considered almost free of side effects and have become widely prescribed, however questions about the safety and tolerability of SSRIs have emerged with their continued use. Most SSRI side effects are dose-related and can be attributed to serotonergic effects such as nausea. Continuous use might trigger adverse effects such as hyponatremia, tremor, nausea, weight gain, sleep disturbance and sexual dysfunction. Moderate toxicity can be safely observed in the hospital for 24 hours, and mild cases can be safely discharged (if asymptomatic) from the emergency department once cleared by Psychiatry in cases of intentional overdose and after 6 to 8 hours of observation. Although fluoxetine is relatively safe in terms of overdose, it might still be cardiotoxic and inhibit platelet secretion, aggregation, and plug formation. There have been reported clinical cases of seizures, cardiac conduction abnormalities, and even fatalities associated with fluoxetine ingestions. While the medical literature strongly suggests that most fluoxetine overdoses are benign, emergency physicians need to remain cognizant that intentional, high-dose fluoxetine ingestions may induce seizures and can even be fatal due to cardiac arrhythmia. Our case is a 35-year old female patient who was sent to ER with symptoms of confusion, amnesia and loss of orientation for time and location after being found wandering in the streets unconsciously by police forces that informed 112. Upon laboratory examination, no pathological symptom was found except sinus tachycardia in the EKG and high levels of aspartate transaminase (AST) and alanine transaminase (ALT). Diffusion MRI and computed tomography (CT) of the brain all looked normal. Upon physical and sexual examination, no signs of abuse or trauma were found. Test results for narcotics, stimulants and alcohol were negative as well. There was a presence of dysrhythmia which required admission to the intensive care unit (ICU). The patient gained back her conscience after 24 hours. It was discovered from her story afterward that she had been using fluoxetine due to post-traumatic stress disorder (PTSD) for 6 months and that she had attempted suicide after taking 3 boxes of fluoxetine due to the loss of a parent. She was then transferred to the psychiatric clinic. Our study aims to highlight the need to consider toxicologic drug use, in particular, the abuse of selective serotonin reuptake inhibitors (SSRIs), which have been widely prescribed due to presumed safety and tolerability, for diagnosis of patients applying to the emergency room (ER).

Keywords: abuse, amnesia, fluoxetine, intoxication, SSRI

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Authors: Paulo Rocha

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Once in touch with the Criminal Justice System, offenders with mental disorder tend to return to custody more often than nondisordered individuals, which suggests they have not been receiving appropriate treatment in prison. In this scenario, diverting individuals into care as early as possible in their trajectory seems to be the appropriate approach to rehabilitate mentally unwell offenders and alleviate overcrowded prisons. This paper builds on an ethnographic research investigating the challenges encountered by practitioners working to divert offenders into care while attempting to establish cross-boundary interactions with professionals in the Criminal Justice System and Mental Health Services in the UK. Drawing upon the findings of the study, this paper suggests the development of adequate tools to enable liaison between agencies which ultimately results in successful interventions.

Keywords: criminogenic needs, interagency collaboration, liaison and diversion, recidivism

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Authors: Lee Boudreau, Ash Kumar Khaitu, Laura A. S. MacDonald

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In April 2015, a magnitude 7.8 earthquake struck Nepal, killing, injuring, and displacing thousands of people. The earthquake also damaged water and sanitation service networks, leading to a high risk of diarrheal disease and the associated negative health impacts. In response to the disaster, the Environment and Public Health Organization (ENPHO), a Kathmandu-based non-governmental organization, worked with the Centre for Affordable Water and Sanitation Technology (CAWST), a Canadian education, training and consulting organization, to develop two training programs to educate volunteers on water, sanitation, and hygiene (WASH) needs. The first training program was intended for acute response, with the second focusing on longer term recovery. A key focus was to equip the volunteers with the knowledge and skills to formulate useful WASH advice in the unanticipated circumstances they would encounter when working in affected areas. Within the first two weeks of the disaster, a two-day acute response training was developed, which focused on enabling volunteers to educate those affected by the disaster about local WASH issues, their link to health, and their increased importance immediately following emergency situations. Between March and October 2015, a total of 19 training events took place, with over 470 volunteers trained. The trained volunteers distributed hygiene kits and liquid chlorine for household water treatment. They also facilitated health messaging and WASH awareness activities in affected communities. A three-day recovery phase training was also developed and has been delivered to volunteers in Nepal since October 2015. This training focused on WASH issues during the recovery and reconstruction phases. The interventions and recommendations in the recovery phase training focus on long-term WASH solutions, and so form a link between emergency relief strategies and long-term development goals. ENPHO has trained 226 volunteers during the recovery phase, with training ongoing as of April 2016. In the aftermath of the earthquake, ENPHO found that its existing pool of volunteers were more than willing to help those in their communities who were more in need. By training these and new volunteers, ENPHO was able to reach many more communities in the immediate aftermath of the disaster; together they reached 11 of the 14 earthquake-affected districts. The collaboration between ENPHO and CAWST in developing the training materials was a highly collaborative and iterative process, which enabled the training materials to be developed within a short response time. By training volunteers on basic WASH topics during both the immediate response and the recovery phase, ENPHO and CAWST have been able to link immediate emergency relief to long-term developmental goals. While the recovery phase training continues in Nepal, CAWST is planning to decontextualize the training used in both phases so that it can be applied to other emergency situations in the future. The training materials will become part of the open content materials available on CAWST’s WASH Resources website.

Keywords: water and sanitation, emergency response, education and training, building resilience

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Authors: Itsaree Padphai, Jiranan Pakpeian, Suksun Niponchai

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This study is a descriptive research which aims to: 1) Compare the difference of knowledge before and after using the e-Learning program entitled “Basic Cardiopulmonary Resuscitation for Students in an Emergency Medical Technician Diploma Program”, and 2) Assess the students’ satisfaction after using the said program. This research is a kind of teaching and learning management supplemented with the e-Learning system; therefore, the purposively selected samples are 44 first-year and class-16 students of an emergency medical technician diploma program who attend the class in a second semester of academic year 2012 in Sirindhorn College of Public Health, Khon Kaen province. The research tools include 1) the questionnaire for general information of the respondents, 2) the knowledge tests before and after using the e-Learning program, and 3) an assessment of satisfaction in using the e-Learning program. The statistics used in data analysis percentage, include mean, standard deviation, and inferential statistics: paired t-test. 1. The general information of the respondents was mostly 37 females representing 84.09 percent. The average age was 19.5 years (standard deviation was 0.81), the maximum age was 21 years, and the minimum age was 19 years respectively. Students (35 subjects) admitted that they preferred the methods of teaching and learning by using the e-Learning systems. This was totally 79.95 percent. 2. A comparison on the difference of knowledge before and after using the e-Learning program showed that the mean before an application was 6.64 (standard deviation was 1.94) and after was 18.84 (standard deviation 1.03), which was higher than the knowledge of students before using the e-Learning program with the statistical significance (P value < 0.001). 3. For the satisfaction after using the e-Learning program, it was found that students’ satisfaction was at a very good level with the mean of 4.93 (standard deviation was 0.11).

Keywords: e-Learning, cardiopulmonary resuscitation, diploma program, Khon Kaen Province

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Authors: Hadeer Hegazy, Wael Ewieda, Ranin Soliman, Samah Elway, Asmaa Tawfik, Ragaa Sayed, Sahar Mousa

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The current healthcare system is facing major challenges in terms of cost, quality of care, and access to services. In response, the concept of value-based healthcare has emerged as a new approach to healthcare delivery. This concept puts the focus on patient values rather than on the traditional medical model of care. To achieve this, healthcare organizations must be agile and able to anticipate and respond quickly to changing needs. Agile management is essential for healthcare organizations to achieve value-based care, as it allows them to rapidly adjust their strategies to changing circumstances. Additionally, it is argued that agile management can help healthcare organizations gain a better understanding of the needs of their patients and develop better care delivery models. Besides, it can help healthcare organizations develop new services, innovate, and become more efficient. The authors provide evidence to support their argument, drawing on examples from successful value-based healthcare initiatives at children’s cancer hospital Egypt-57357. The paper offers insight into how agile management can be used to facilitate the shift towards value-based healthcare and how it can be used to maximize value in the healthcare system.

Keywords: value-based healthcare, agility in healthcare, nursing department, patients outcomes

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Authors: Louise Elizabeth Bolton

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Statement of the problem: There are an estimated 328 million cases of COPD worldwide. It is likely to become the third biggest cause of death by 2030. The impact of living with palliative care needs arising from COPD disrupts an individual’s existential situation. Understandings of individuals' existential situations within COPD are limited within the research literature and are rarely addressed within clinical practice, yet existential suffering has been linked to poor health-related quality of life for those living with other chronic conditions. The purpose of this integrative review is to provide a synthesis of existing evidence on existential suffering for those living with palliative care needs arising from COPD. Methods: This is an integrative review undertaken in accordance with PRISMA guidelines. Nine electronic databases were searched from April 2019 to January 2021. Thirty-five empirical research papers of both qualitative and quantitative methodologies, alongside systematic literature reviews, were included. Data analysis was undertaken using an integrative thematic analysis approach. Findings: Identified themes of existential suffering when living with palliative care needs arising from COPD are as follows: Liminality, Lamented Life, Loss of Personal Liberty, Life Meaning and Existential isolation. The absence of life meaning and purpose was of most importance to patients. Conclusion and Significance: This integrative review provides a synthesis of international evidence upon the presence of existential suffering. It is present and of significant impact within the daily lives of those living with palliative care needs arising from COPD. The absence of life meaning has the most significant impact, requiring further exploration of both its physical and psychological impact. Rediscovery of life meaning diminishes feelings of worthlessness and hopelessness in daily life and facilitates feelings of inner peace. For those with COPD living with such a relentless symptom burden, a positive existential situation is desirable.

Keywords: palliative care, COPD, existential suffering, end of life care

Procedia PDF Downloads 127