Search results for: hospital factors

Authors: Destin Kurniawati

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Asthma is one of the deadly diseases in the world. According to the World Health Organization in 2012, 300 million people suffer from asthma of different races and classes. An estimated 250,000 people die because of asthma annually.As well as more than 57% of children and 51% of adults with asthma. There two risk factors for asthma. That risk factors are the host and environmental. One of the environmental factors that can bring asthma is allergens. When an allergen enters the body, the allergen binds to IgE and cause cell granulat- issued several mediators such as histamine, leukotrienes, bradykinin or something like that. This will cause localized edema effect on bronchial walls of small, thick mucous secretions in the bronchioles, and bronchial smooth muscle spasm. Then there will be inflammation of the airways. Methodology this research is by literature. Therefore, to anticipate and cope with asthma is to control environmental factors that serve to minimize allergens and controlling one's intake in the form of antioxidant-rich foods. Foods rich in antioxidants serve to improve lung function and decrease symptoms of the disease of the respiratory tract.

Keywords: asthma, deadly disease, allergen, environmental and food control

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Authors: Cornelius Femi Popoola

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Nigerian manufacturing industry, particularly the flour producing firms play vital roles in Nigerian economy. This sector’s quality management practice is given a little attention along with organizational factors that hinder successful practice of total quality management which needs to be documented. Honeywell Flour Mills Plc operate in Nigeria with an appreciable number of products that serves this sector of the economy. Internal-external disposition of the company and total quality practice of the company deserve some elucidations. Hence, this study examined the influence of organizational factors on total quality management practice of Nigerian manufacturing industry, using Honeywell Flour Mills Plc as a case study. The study employed the correlational type of descriptive survey research design. The population consisted of 656 staff of Honeywell Flour Mills Plc, out of which 235 members were selected through scientific sampling method developed by Paler-Calmorin and Calmorin. A total of 235 copies of questionnaires titled 'Organisational Factors and Total Quality Management Practices (QF-TQM) Questionnaire' were administered with a response rate of 66 copies returned. The following variables were applied internal organisational factors (IOFs), external organizational factors (EOFs) and total quality management (TQM). Data generated were analysed using frequency distribution and regression analysis at 0.05 level. The findings revealed that IOFs positively and significantly related with TQM (r = .147**, N= 64, P(.000) < .01). Also, EOFs negatively and significantly related with TQM (r = -.117, N= 64, P(.000) < .01). Findings showed that internal and external organizational factors jointly influenced TQM practiced in F₍₂,₆₁₎=22.250; R²=.629; Adj.R²=.603; P(.000) < .05). The study concluded that organizational factors are determinants of TQM practice in Nigerian manufacturing industry. It is recommended that both internal and external organizational factors influencing TQM practices should be considered in the development of TQM strategies.

Keywords: external organizational factors, internal organisational factors, Nigerian manufacturing industry, total quality management

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Authors: Ghorbanali Mohammadi

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Background: The objectives of this study were the association between physical and psychological risk factors for occupational lower back and neck pain among industrial workers. Methods: We conducted a cross-sectional study among 400 male workers of an industrial company over the previous 7days and 12 months. Data were collected using Nordic and third version of COPSOO questionnaires and QEC method for assessment of postures during the work. Results: The prevalence of LB and NP in the last 12 months is 58% and 52% respectively. The relationship between risk factors and low back/ neck pain in the last 12 months were cognitive demands (OR 995% CI 1.65) and (OR 995% CI 1.75); Influence at work (OR 995% CI 2.21) and (OR 995% CI 1.85); quality of leadership (OR 995% CI 2.42) and (OR 995% CI 2.09) was strongly correlated with complaints of low back and neck pains. Conclusion: Data of this study showed a higher prevalence of LBP and NP in the subjects. The results revealed that workers with work experience of more than 12 yrs. and who work more than 8 hrs. days with smoking habits had more probability to develop both LBP and NP.

Keywords: low back pain, neck pain, physical risk factors, psychological risk factors, QEC, COPSOQ III

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Authors: Kadiri Kayode Ibrahim

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Small and Medium Enterprises (SMEs) play significant roles in the economic development of Nigeria. However, the performance of these SMEs is influenced by various factors, including cultural factors. Keffi Local Government Area (LGA) in Nasarawa State, Nigeria, has a large number of registered SMEs. Understanding the impact of cultural factors on the performance of these SMEs in Keffi LGA is essential for their growth and sustainability. Therefore, this study aims to investigate the effect of cultural factors on the performance of selected SMEs in Keffi LGA, Nasarawa State. A cross-sectional survey research design was used to collect data from 165 purposefully selected SME owners out of the 283 registered SMEs in Keffi LGA. The data was collected using a questionnaire divided into three sections, and analysed using descriptive and ordinary least square regression (OLS). The results indicate that socio-cultural factors and ethical values have a positive and significant effect on the performance of SMEs in Keffi LGA, while attitude has a negative and significant effect on the performance of SMEs in Keffi LGA. Therefore, the study recommends that SMEs in Keffi LGA should understand the socio-cultural elements of their operating environment, adopt socio-cultural factors as elements to guide their planning and strategizing and take into consideration the ethical values of the business environment when offering new products or services. Additionally, SME Managers should take cognisance of people’s attitudes and use them to gauge their activities and ensure they support the overall performance of the business.

Keywords: cultural, factors, performance, SMEs

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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: Maharjan Shree Kumar

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Climate change impacts are observed in all livelihood sectors primarily in agriculture and forestry. Multiple factors have influenced the climate vulnerabilities and adaptations in agricultural at the household level. This study focused on the factors affecting adaptation in agriculture in Madi and Deukhuri valleys of Central and Western Nepal. The systematic random sampling technique was applied to select 154 households in Madi and 150 households in Deukhuri. The main purpose of the study was to analyze the socio-economic factors that either influence or restrain the farmers’ adaptation to climate change at the household level by applying the linear probability model. Based on the analysis, it is revealed that crop diversity, education, training and total land holding (acre) were positively significant for adaptation choices the study sites. Rest of the variables were not significant though indicated positive as expected except age, occupation, ethnicity, family size, and access to credit.

Keywords: adaptation, agriculture, climate, factors, Nepal

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Authors: M. B. Ahmadi, A. A. Kaffash B., B. Mobaraki

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Slump loss, which refers to the gradual reduction of workability and the amount of slump in fresh concrete over time, is one of the significant challenges in the ready-mixed concrete industry. Therefore, having accurate knowledge of the factors affecting slump loss is a crucial solution in this field. In this paper, an attempt was made to investigate the effect of cement produced by different units on the slump of concrete in a laboratory setting. For this purpose, 12 cement samples were prepared from 6 different production units. Physical and chemical tests were performed on the cement samples. Subsequently, a laboratory concrete mix with a slump of 13 ± 1 cm was prepared with each cement sample, and the slump was measured at 0, 15, 30, 45, and 60 minutes. Although the environmental factors, mix design specifications, and execution conditions—factors that significantly influence the slump loss trend—were constant in all 12 laboratory concrete mixes, the slump loss trends differed among them. These trends were categorized based on the results, and the relationship between the slump loss percentage in 60 minutes, the water-cement ratio, and the LOI and K2O values of different cements were introduced.

Keywords: concrete, slump loss, portland cement, efficiency

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Authors: Misagh Faezipour

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This paper explores the effects of screen time on children from a systems engineering perspective. We reviewed literature from several related works on the effects of screen time on children to explore all factors and interrelationships that would impact children that are subjected to using long screen times. Factors such as kids' age, parent attitudes, parent screen time influence, amount of time kids spend with technology, psychosocial and physical health outcomes, reduced mental imagery, problem-solving and adaptive thinking skills, obesity, unhealthy diet, depressive symptoms, health problems, disruption in sleep behavior, decrease in physical activities, problematic relationship with mothers, language, social, emotional delays, are examples of some factors that could be either a cause or effect of screen time. A systems engineering perspective is used to explore all the factors and factor relationships that were discovered through literature. A causal model is used to illustrate a graphical representation of these factors and their relationships. Through the causal model, the factors with the highest impacts can be realized. Future work would be to develop a system dynamics model to view the dynamic behavior of the relationships and observe the impact of changes in different factors in the model. The different changes on the input of the model, such as a healthier diet or obesity rate, would depict the effect of the screen time in the model and portray the effect on the children’s health and other factors that are important, which also works as a decision support tool.

Keywords: children, causal model, screen time, systems engineering, system dynamics

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Authors: Leoba Nyathi, Augustine K. Tugli, Takalani G. Tshitangano

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Use of health care services is an effective way of improving maternal and child health outcomes, especially in the rural areas. The study aimed to find out the perceptions of women on factors that affect the utilisation of antenatal care services (ANC) in Mangwe Rural District, Zimbabwe. The study was conducted in Mabunga village which is situated in Mangwe Rural District, Matabeleland South Province, Zimbabwe. A qualitative approach using explorative and descriptive design was adopted for the study. A sample of ten women were chosen from the target population by means of convenience sampling and data was collected through semi-structured interviews. Interviews and discussions were audio-taped, transcribed and coded into themes and subthemes. The study results showed that access factors, socio-cultural factors, demographic factors, quality of care and knowledge about antenatal care services were the major factors affecting utilisation of ANC services in Mangwe Rural District. It was discovered that the geographical location of the village to the health care centres has a great impact on utilisation of services. All the women did not initiate ANC services as recommended and they also did not adhere to the number of times they were supposed to visit the health care centres. The findings concluded that women have the knowledge about ANC and they all attended at least once during their last pregnancy. However, inconsistencies in attendance were shown due to access, socio-cultural and demographic factors.

Keywords: antenatal care services, women, utilisation, affect, factors, perceptions

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Authors: Yiu K. C. Jacky, Tang S. K. Eric, W. Y. Tsang, C. Y. Li, C. K. Leung

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Objectives : (1) To enhance the competence of nurses on using IPMOE for drug administration; (2) To ensure the transition on implementation of IPMOE in safer and smooth way hospital-wide. Methodology: (1) Well-structured Governance: To make provision for IPMOE implementation, multidisciplinary governance structure at Corporate and Local levels are well established. (2) Staff Engagement: A series of staff engagement events were conducted including Staff Forum, IPMOE Hospital Visit, Kick-off Ceremony and establishment of IPMOE Webpage for familiarizing the forthcoming implementation with frontline staff. (3) Well-organized training program: from Workshop to Workplace Two different IPMOE training programs were tailor-made which aimed at introducing the core features of administration module. Fifty-five identical training classes and six train-the-trainer workshops were organized at 2-3Q 2015. Lending Scheme on IPMOE hardware for hands-on practicing was launched and further extended the training from workshop to workplace. (4) Standard Guidelines and Workflow: the related workflow and guidelines are developed which facilitates users to acquire the competence towards IPMOE and fully familiarize with the standardized contingency plan. (5) Facilities and Equipment: The installations of IPMOE hardware were promptly arranged for rollout. Besides, IPMOE training venue was well-established for staff training. (6) Risk Management Strategy: UCH Medication Safety Forum is organized in December 2015 for sharing “Tricks & Tips” on IPMOE which further disseminate at webpage for arousal of medication safety. Hospital-wide annual audit on drug administration was planned to figure out the compliance and deliberate the rooms for improvement. Results: Through the comprehensive training plan, over 1,000 UCH nurses attended the training program with positive feedback. They agreed that their competence on using IPMOE was enhanced. By the end of November 2015, 28 wards (over 1,000 Inpatient-bed) involving departments of M&G, SUR, O&T and O&G have been successfully rolled out IPMOE in 5-month. A smooth and safe transition of implementation of IPMOE was achieved. Eventually, we all get prepared for embedding IPMOE into daily nursing and work altogether for medication safety at UCH.

Keywords: drug administration, inpatient medication order entry system, medication safety, nursing informatics

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Authors: Zairani Zainol, Zulkiflee Daud

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This study employed 86 respondents representing bank officers of Bank XYX (one of the full-fledged Islamic banks in Malaysia) in the northern region of Malaysia to assess the factors that constitute talent in the Islamic financial industries. To test the discriminant factors for talent among bank officers, a factor analysis was performed. The KMO, Bartlett and MSA tests were executed as the prerequisite before performing the factor analysis. The discriminant factors for talent were extracted via eigenvalues and rotated component matrixes. The results show that five factors, namely (1) self-motivation, (2) leadership, (3) teamwork, (4) interpersonal skills, and (5) creativity/innovation constitute talent in the Islamic financial industries. It is hoped that this study could offer guidelines to education providers, specifically those that conduct the Islamic finance and banking program, as to the areas of emphasis for students before graduating. For the Islamic financial institutions, this study is also vital since they could tackle the areas that need to be improved in managing their talents.

Keywords: talent, Islamic financial industries, talent development, bank’s officers

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Authors: Navodita Mishra, T. J. Kamalanabhan

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The primary purpose of this study was to identify the antecedents of sport commitment among cricket players and to understand demographic variables that may impact these factors. Commitment towards one’s sport play a crucial role in determining discipline and efforts of the player. Moreover, demographic variables would seem to play an important role in determining which factors or predictors have the greatest impact on commitment level. This study hypothesized the effect of demographic factors on sport commitment among cricket players. It attempts to examine the extent to which demographic factors can differentially motivate players to exhibit commitment towards their respective sport. Questionnaire survey method was adopted using purposive sampling technique. Using Multiple Regression, ANOVA and t-test, the hypotheses were tested based on a sample of 350 players from Cricket Academy. Our main results from the multivariate analysis indicated that (1) enjoyment and leadership of coach and peer affect the level of commitment to a greater extent whereas (2) personal investment is a significant predictor of commitment among rural background players Moreover, level of sport commitment among players is positively related to household income, the rural background players participate in sports to a greater extent than the urban players, there is no evidence of regional differentials in commitment but age differences (i.e. U-19 vs. U-25) play an important role in the decision to continue the participation in sports.

Keywords: individual sport commitment, social factors, demographic factors, cricket

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Authors: Omran Alharbi, Victor Lally

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The advantages of the adoption of new technology such as learning management systems (LMSs) in education and teaching methods have been widely recognised. This has led a large number of universities to integrate this type of technology into their daily learning and teaching activities in order to facilitate the education process for both learners and teachers. On the other hand, in some developing countries such as Saudi Arabia, educators have seldom used this technology. As a result, this study was conducted in order to investigate the factors that impede teachers’ use of technology (LMSs) in their teaching in Saudi Arabian institutions. This study used a qualitative approach. Eight participants were invited to take part in this study, and they were asked to give their opinions about the most significant factors that prevented them from integrating technology into their daily activities. The results revealed that a lack of LMS skills, interest in and knowledge about the LMS among teachers were the most significant factors impeding them from using technology in their lessons. The participants suggested that incentive training should be provided to reduce these challenges.

Keywords: LMS, factors, KSA, teachers

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Authors: Ramona Zharfpeykan

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The concept of sustainability is generally considered as a key topic in many countries, and sustainability reporting is becoming an important tool for companies to communicate their sustainability plans and performance to their stakeholders. There have been various studies on factors that may influence sustainability reporting in companies. This study examines the possible effect of some of the organisational factors on corporate sustainability reporting. The organisational factors included in this study are a company’s type (public or private), industry, and size as well as managers’ perception of the level of importance of indicators in reporting these indicators. A survey was conducted from 240 Australian and New Zealand companies in various industries. They were asked about their perception of the importance of sustainability indicators in their performance and if they report these indicators. The GRI indicators used to develop the survey. A multiple regression model was developed using reporting strategy score as dependent and type, size, industry categorisation, and managers’ perception of the level of importance of the GRI indicators as independent factors. The results show that among all the factors included in the model, size of a company and the perception of managers of the level of importance of environmental and labour practice indicators can affect the sustainability scores of these companies.

Keywords: sustainability reporting, global reporting initiative, sustainability reporting strategy, organisational features

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Authors: Sedigheh Zarei

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The aim of this research is to identify the key factors in shipping company’s port selection in order to providing their requirement. To identify and rank factors that are play the main role in selecting port for providing the ship supplies. At the first step, Data were collected via Semi-structured interviews, The aim was to generate knowledge on how shipping company select the port and suppliers for providing their needs. 37 port selection factors were chosen from the previous researches and field interviews and have been categorized into two groups of port's factor and the factors of services of suppliers companies. The current study adopts a questionnaire survey to the main shipping companies' operators in Iran. Their responses reveal that level of services of supplying companies and customs rules play the important role in selecting the ports. Our findings could affect decisions made by port authorities to consider that supporting the privet sections for ship chandelling business could have the best result in attracting ships.

Keywords: ship supplier, port selection, ship chandler, provision

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Authors: Hui-Chi Huang, Su-Ju Yang, Ching-Wei Lin, Jui-Yao Tsai, Liang-Yiang

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Background: Evidence exists that pneumonia is a frequently encountered complication after stroke which is associated with a higher rate of mortality and increased long-term disability Purpose: To determine the predictors associated with the risk of one-year disability in acute stroke. Methods: Data for this longitudinal follow-up study were extracted from a tertiary referral medical center’s stroke registry database in Northern Taipei. Eligible patients with acute stroke admitted to the hospital and completed a one-year follow up were recruited for analysis. Favorable outcome was defined as a modified Rankin Scale score ≤ 2. SAS version 9.2 was used for the multivariable regression analyses to examine the factors correlated with the one-year disability in stroke patients. Results: From January 2012 to December 2013, a total of 1373 (mean age: 70.49±15.4 years, 913(66.5%) males) consecutively administered acute stroke patients were recruited. Overall, the rate of one-year disability was 37.20%(404/1086) in those without post-stroke pneumonia. It increased to 82.93 %(238/287) in patients developed post-stroke pneumonia. Factors associated with increased risk of disability were age ≧ 75(OR= 4.845, p<.0001), female /gender (OR=1.568, p =.0062), previous stroke (OR= 1.868, p = <. 0001) ,dementia (OR= 2.872, p =.0047), ventilator use (OR= 4.653, p <. 0001),age ≧ 75 /pneumonia (OR=1.236, p <. 0001) , ICU admission (OR=3.314, p <.0001) , nasogastric tube insertion (OR= 4.28, p <.0001), speech therapy (OR= 1.79, p =.0142), urinary tract infection (OR= 1.865, p =.0018), estimated glomerular filtration rate (eGFR > 60 )(OR= 0.525, p= .0029), Admission NIHSS >11 (OR= 2.101, p = .0099), Length of hospitalization > 30(d) (OR= 5.182, p <.0001). Conclusion: Older age, severe neurological deficit, complications, rehabilitation intervention, length of hospitalization >30(d), and cognitive impairment were significantly associated with Post-stroke functional impairment, especially those with post-stroke pneumonia. These findings could open new avenues in the management of stroke patients.

Keywords: stroke, risk, pneumonia, disability

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Authors: Yoshitaka Ooya, Daishuke Furuya, Manabu Nemoto

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Some countries such as Canada and Australia have mandatory bicycle helmet laws for all citizens and age groups. As of 2008 Japan has also adopted a helmet law but it is restricted to people 13 years old and under. People over 13 years of age are not required to wear helmets in Japan. Currently, the rate that people 0-13 years old actually wear helmets is low. In 2013 a number of patients came to Saitama University Hospital International Medical Center for treatment due to bicycle-related trauma. The total number of patients was 89 (55 male and 34 female). The average age of the patients was 40.9 years old (eldest; 83 y/o, median; 40 y/o, youngest; 1 y/o with a standard deviation ± 2.8). 54 of these patients (61%) experienced head trauma as well as some experiencing multiple injuries associated with their accident. 13 patients were wearing helmets, 50 patients were not wearing helmets and it is unknown if the remaining 26 patients were wearing helmets. This information was acquired from the patient`s medical charts. Only one patient who was wearing a helmet had a severe head injury, and this patient also experienced other multiple injuries. 17 patients who were not wearing helmets had severe head injuries and out of the 17, two had multiple injuries. The mechanism for injury varied. 12 patients were injured in an accident with a vehicle, only one of which was wearing a helmet. This patient also had multiple injuries. Of the other 11 patients, two had multiple injuries. The remaining patient`s injuries were caused by other accidents (3; fell over while riding, 2; crashed into an inanimate object, 1; collided with a motorcycle). The ladder of which had a severe head injury. All of these patients had light energy accidents and were all over 13 years of age. In Japan it is not mandatory for people over the age of 13 years to wear a bicycle helmet. Research shows that light energy accidents were mostly present in people over the age of 13, to which the law does not require the wearing of helmets. It is important that all people in all age groups be required to wear helmets when operating a bicycle to reduce the rate of light energy severe head injuries.

Keywords: bicycle helmet, head trauma, hospital, traumatic situation

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Authors: Chi-Feng Lai, Wen-Chun Liao Liao

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Many people are bothered by sleep difficulties in Taiwan’s society. However, majority of patients get medical treatments without a comprehensive sleep assessment. It is still a big challenge to formulate a comprehensive assessment of sleep difficulties in clinical settings, even though many assessment tools have existed in literature. This study tries to implement reliable and effective ‘comprehensive sleep assessment scales’ in a medical center and to explore differences in sleep-related factors between clinic clients with or without sleep difficulty complaints. The comprehensive sleep assessment (CSA) scales were composed of 5 dimensions: ‘personal factors’, ‘physiological factors’, ‘psychological factors’, ‘social factors’ and ‘environmental factors, and were first evaluated by expert validity and 20 participants with test-retest reliability. The Content Validity Index (CVI) of the CSA was 0.94 and the alpha of the consistency reliability ranged 0.996-1.000. Clients who visited sleep clinic due to sleep difficulties (n=32, 16 males and 16 females, ages 43.66 ±14.214) and gender-and age- matched healthy subjects without sleep difficulties (n=96, 47 males and 49 females, ages 41.99 ±13.69) were randomly recruited at a ratio of 1:3 (with sleep difficulties vs. without sleep difficulties) to compare their sleep and the CSA factors. Results show that all clinic clients with sleep difficulties did have poor sleep quality (PSQI>5) and mild to moderate daytime sleepiness (ESS >11). Personal factors of long working hours (χ2= 10.315, p=0.001), shift workers (χ2= 8.964, p=0.003), night shift (χ2=9.395, p=0.004) and perceived stress (χ2=9.503, p=0.002) were disruptors of sleep difficulties. Physiological factors from physical examination including breathing by mouth, low soft palate, high narrow palate, Edward Angle, tongue hypertrophy, and occlusion of the worn surface were observed in clinic clients. Psychological factors including higher perceived stress (χ2=32.542, p=0.000), anxiety and depression (χ2=32.868, p=0.000); social factors including lack of leisure activities (χ2=39.857, p=0.000), more drinking habits (χ2=1.798, p=0.018), irregular amount and frequency in meals (χ2=5.086, p=0.024), excessive dinner (χ2=21.511, p=0.000), being incapable of getting up on time due to previous poor night sleep (χ2=4.444, p=0.035); and environmental factors including lights (χ2=7.683, p=0.006), noise (χ2=5.086, p=0.024), low or high bedroom temperature (χ2=4.595, p=0.032) were existed in clients. In conclusion, the CSA scales can work as valid and reliable instruments for evaluating sleep-related factors. Findings of this study provide important reference for assessing clinic clients with sleep difficulties.

Keywords: comprehensive sleep assessment, sleep-related factors, sleep difficulties

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Authors: Muhammad Dawood Idrees, Arsalan Ansari

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Construction industry is considered as one of the most dangerous industry because workers' safety is always a major concern due to extensive number of accidents, injuries, and casualties at worksites. There are various causes of accidents at construction sites, several factors are influencing on the perception of safety of workers and psychological factors are one of them. Perception of safety varies from region to region and it also varies by demographics of workers, such as gender, age, education, job level, etc. However, research on different level of workers, such as labor and managerial staff to evaluate the impact of psychological factor is limited. Objective of this research is to evaluate the effect of psychological factors with different job level of workers. An extensive literature review was conducted to find the casual relationship between psychological factors and perception of safety, and a hypothetical structure model was developed based upon literature review. A survey instrument based upon psychological factors was developed and data was obtained from several construction sites. Structure Equation Modeling (SEM) technique was adopted in order to examine the effect of psychological factors on the perception of safety of workers with different job levels of workers. The results of this analysis reveal that job security and organizational relationships are most affecting factors in labor staff, therefore job satisfaction, mental stress, and workload are dominant in managerial staff.

Keywords: accidents, job level of workers, perception of safety, structural equation modeling

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Authors: Sabina Akter, Osiris Valdez Banda, Pentti Kujala, Jani Romanoff

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This paper examines the relationship between on-board environmental factors and customer overall satisfaction in the context of the cruise on-board experience. The on-board environmental factors considered are ambient, layout/design, social, product/service and on-board enjoyment factors. The study presents a data-driven framework and model for the on-board cruise experience. The data are collected from 893 respondents in an application of a self-administered online questionnaire of their cruise experience. This study reveals the cruise passengers’ on-board experience through the customer decision journey based on the publicly available data. Pearson correlation and regression analysis have been applied, and the results show a positive and a significant relationship between the environmental factors and on-board experience. These data help understand the cruise passengers’ on-board experience, which will be used for the ultimate decision-making process in cruise ship design.

Keywords: cruise behavior, customer activities, on-board environmental factors, on-board experience, user or customer satisfaction

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Authors: Tamrat Girma Biru

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Multidrug-resistant tuberculosis (MDR-TB) is defined as resistant to at least Refampicin and Isoniazed: the most two power full TB drugs. It is a leading cause of high rates of morbidity and mortality, and increasing psychosocial challenges to patients, especially when co-infected with Human Immunodeficiency Virus (HIV). Ethiopia faces the highest rates of MDR-TB infection in the world. Objectives: The main objective of this study was to identify the psychosocial challenges of MDR-TB patients, to investigate the extent of the psychosocial challenges on (self-esteem, depression, and stigma) that MDR-TB patients encounter, to examine whether there is a sex difference in experiencing psychosocial challenges and assess the counseling needs of MDR-TB patients. Methodology: A cross-sectional study was conducted at St. Peter TB Specialized Hospital, Addis Ababa on 40 patients (25 males and 15 females) who are hospitalized for treatment. The patients were identified by using purposive sampling and made fill a questionnaire measuring their level of self-esteem, depression and stigma. Besides, data were collected from 16 participants, 28 care providers and 8 guardians, using semi-structured interview. The obtained data were analyzed using SPSS statistical program, descriptive statistics, independent t-test, and qualitative description. Results and Discussion: The results of the study showed that the majority (80%) of the respondents had suffered psychological challenges and social discriminations. Thus, the significance of MDR-TB and its association with HIV/AIDS problems is considered. Besides the psychosocial challenges, various aggravating factors such as length of treatment, drug burden and insecurity in economy together highly challenges the life of patients. In addition, 60% of participants showed low level of self-esteem. The patients also reported that they experienced high self-stigma and stigma by other members of the society. The majority of the participants (75%) showed moderate and severe level of depression. In terms of sex there is no difference between the mean scores of males and females in the level of depression and stigmatization by others and by themselves. But females showed lower level of self-esteem than males. The analysis of the t-test also shows that there were no statistically significant sex difference on the level of depression and stigma. Based on the qualitative data MDR-TB patients face various challenges in their life sphere such as: Psychological (depression, low self value, lowliness, anxiety), social (stigma, isolation from social relations, self-stigmatization,) and medical (drug side effect, drug toxicity, drug burden, treatment length, hospital stays). Recommendations: Based on the findings of this study possible recommendations were forwarded: develop and extend MDR-TB disease awareness creation through by media (printing and electronic), school net TB clubs, and door to door community education. Strengthen psychological wellbeing and social relationship of MDR-TB patients using proper and consistent psychosocial support and counseling. Responsible bodies like Ministry of Health (MOH) and its stakeholders and Non Governmental Organizations (NGOs) need to assess the challenges of patients and take measures on this pressing issue.

Keywords: psychosocial challenges, counseling, multi-drug resistant tuberculosis (MDR-TB), tuberculosis therapy

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Authors: Daniel Afolayan, Christina Olawepo, Francis Olowookanga, Nguhemen Tingir, Olawale Fadare, John Oko

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In Nigeria, traditional birth attendants (TBAs) can play an important role in the prevention of mother-to-child transmission of HIV. However, their role in improving access to antiretroviral therapy (ART) is unclear. Catholic Caritas Foundation of Nigeria (Caritas Nigeria) is an implementing agency supporting increased access to HIV testing and treatment services in Lagos state through health facilities including Mother Theresa Hospital. Despite intra-facility testing and community outreaches, ART uptake at Mother Theresa Hospital, Lagos was low with 6 individuals on antiretroviral drugs 3 months post-activation. This study explored improving access to ART through linkages with TBAs for ART uptake at the facility. Plan-Do-Study-Act model was used. The goal was to improve uptake of ART from 6 to 80 in 5 months (end of project year). Scanning revealed a network of 15 TBAs with potential as satellites for HIV testing. Caritas Nigeria linked the facility with 15 TBAs who were provided with HIV test kits and trained on HIV testing services for provider-initiated testing and outreaches. Weekly reports and referrals of positives were received, tracked and feedback given on testing yield. These TBAs serve individuals of various age and gender at their trado-medical centres. At the end of 5 months, HIV testing increased by 10,575 (78% from TBAs) and HIV positives obtained improved by 77 (44.2% from TBAs). 55 new individuals were enrolled and commenced on ART (61.8% from TBAs). There was a successful linkage of all clients with escort services due to incentives. Total uptake of ART was 61 (76.3% of target). Structured partnerships between TBAs and HIV care and treatment centers should be strengthened to improve access to ART.

Keywords: access improvement, antiretroviral therapy, traditional birth attendants, uptake

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Authors: Douglas Arthur, Oluwayemisi Ekor, Ernest Obese, Andrew Kissi Agyei, Elvis Ofori Ameyaw

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bjective: Pain negatively impacts every aspect of health, and patients with pain disorders create enormous demands on healthcare systems globally, costing economies up to $635 billion annually. The study was therefore conducted at the Cape Coast Teaching Hospital (CCTH), the only Tertiary Hospital in the Central Region of Ghana and was designed to assess pain disorders in patients between 18 and 90 years attending Urology Clinic. Methods: The study employed a descriptive cross-sectional design, and 149 subjects (16-24, 25-34, 35-44, 45-54, 55-64, 65-90 years) were conveniently selected. The McGill Pain Questionnaire (MPQ), a multidimensional instrument that assesses several aspects of pain by the use of words (descriptors) that the patient chooses to express his/her pain, was used as the primary instrument for data collection. A patient profile form (PPF) was also designed to document the demographics and history of patients. Results: The prevalence of pain disorders was higher among females compared to males. The univariate and multivariate analysis showed that females were more likely to experience pain while being married correlated with a lower likelihood of pain. Again, the 45-54 age group exhibited the highest prevalence of pain disorders. Results from the MPQ showed that half of the patients experienced pain on a daily basis, 15.91% had experienced pain for 3-6 months and 37% experienced pain for more than one year. Pain intensity was described by 25% of the subjects as excruciating for their worst pain experience, followed by 21% for the distressing experience. The most frequently reported area of pain was the abdominal region (22.72%). The co-administration of NSAIDs and opioid compounds was provided for 17.46% of the patients with chronic pain. Conclusion: The treatment interventions improved the pain and associated symptoms such as nausea, improved daily activities and ability to sleep. However, attention and resources should be devoted to 45-54 age group.

Keywords: pain, opioids, distressing, excruciating

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Authors: Mariem Meddeb Sidhom, Souhayel Hedfi, Rjaibia Houda, Mehdi Dridi, Mohamed Ali Yousfi, Sâadia Gargouri

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Considering the important increase in costs of caspofungin treatments and ahead the evolution of its indication, pharmacy department was prompted to realize a review of the adequacy of prescriptions in the medical intensive care units (ICU). A retrospective observational study was conducted in Tunis military hospital concerning ICU prescriptions of caspofungin from 2008 until 2013. A pharmacist had returned to the patient’s medical records to collect data and to the microbiology department for parasitological results. The adequacy of prescriptions was evaluated by a pharmacist and an infectiologist parasitologist, referring to predefined scale of criteria resuming the indications of the marketing authorization (MA) and grade AI-AII of the guidelines of the Infectious Diseases Society of America (IDSA). Sixty two ICU patients have been treated with caspofungin during the period of study; however, 8 files were lost. Thus, 54 patients were included in the study having received 55 prescriptions of caspofungin. Males were a majority with 64.8% of the population. Mean age was 51 years. Caspofungin was indicated in accordance with the IDSA recommendations in 43.6% of the cases. The most case of non respect to the guidelines was the indication of caspofungin as empirical treatment in non neutropenic patients. Caspofungin was utilized as a first line treatment in 9 cases where it was possible to give fluconazole first, as germs were fluconazole- sensitive. Caspofungin was indicated in 2 patients with good renal function and in which nor amphotericin B, liposomal ampho B neither itraconazole had been previously used, as indicates the MA. The posology of caspofungin was respected in all prescriptions with a loading dose of 70 mg in the first day and a maintenance dose of 50 mg daily. Seven patients had received a daily dose of 70 mg, the recommended dose for people weighing more than 80 Kg. Caspofungin prescriptions are far to be adequately done. There is a clear need of optimization in indicating this molecule and that must be done in collaboration between the pharmacy department, the ICUs and parasitology department.

Keywords: caspofungin, prescription, intensive care units, marketing authorization, Tunisian hospital cohort

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Authors: Latif Duran, Erdem Aydin, Ahmet Baydin, Ali Kemal Erenler, Iskender Aksoy

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Aim: In this retrospective study, we aim to contribute to the literature by presenting the proposals for taking measures to reduce the mortality by examining the demographic characteristics of the pediatric age group patients presenting with trauma and the factors that may cause mortality Material and Method: This study has been performed by retrospectively investigating the data obtained from the patient files and the hospital automation registration system of the pediatric trauma patients who applied to the Adult Emergency Department of the Ondokuz Mayıs University Medical Faculty between January 1, 2016, and December 31, 2016. Results: 289 of 415 patients involved in our study, were males. The median age was 11.3 years. The most common trauma mechanism was falling from the high. A significant statistical difference was found on the association between trauma mechanisms and gender. An increase in the number of trauma cases was found especially in the summer months. The study showed that thoracic and abdominal trauma was relevant to the increased mortality. Computerized tomography was the most common diagnostic imaging modality. The presence of subarachnoid hemorrhage has increased the risk of mortality by 62.3 fold. Eight of the patients (1.9%) died. Scoring systems were statistically significant to predict mortality. Conclusion: Children are vulnerable to trauma because of their unique anatomical and physiological differences compared to adult patient groups. It will be more successful in the mortality rate and in the post-traumatic healing process by administering the patient triage fast and most appropriate trauma centers in the prehospital period, management of the critical patients with the scoring systems and management with standard treatment protocols

Keywords: emergency service, pediatric patients, scoring systems, trauma, age groups

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Authors: Foster Chilufya

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This study sought to determine factors that affect academic performance of mature age students in Science Education at University of Zambia. It was guided by Maslow’s Hierarchy of Needs. The theory provided relationship between achievement motivation and academic performance. A descriptive research design was used. Both Qualitative and Quantitative research methods were used to collect data from 88 respondents. Simple random and purposive sampling procedures were used to collect from the respondents. Concerning factors that motivate mature-age students to choose Science Education Programs, the following were cited: need for self-actualization, acquisition of new knowledge, encouragement from friends and family members, good performance at high school and diploma level, love for the sciences, prestige and desire to be promoted at places of work. As regards factors that affected the academic performance of mature-age students, both negative and positive factors were identified. These included: demographic factors such as age and gender, psychological characteristics such as motivation and preparedness to learn, self-set goals, self esteem, ability, confidence and persistence, student prior academic performance at high school and college level, social factors, institutional factors and the outcomes of the learning process. In order to address the factors that negatively affect academic performance of mature-age students, the following measures were identified: encouraging group discussions, encouraging interactive learning process, providing a conducive learning environment, reviewing Science Education curriculum and providing adequate learning materials. Based on these factors, it is recommended that, the School of Education introduces a program in Science Education specifically for students training to be teachers of science. Additionally, introduce majors in Physics Education, Biology Education, Chemistry Education and Mathematics Education relevant to what is taught in high schools.

Keywords: academic, performance, in-service, science

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Authors: Ronit Chakraborty, Sugata Banerji

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There has been a marked increase in the reported prevalence of Autism Spectrum Disorder (ASD) among children in the US over the past two decades. This research has analyzed the growth in state-level ASD prevalence against 45 different potentially explanatory factors, including socio-economic, demographic, healthcare, public policy, and political factors. The goal was to understand if these factors have adequate predictive power in modeling the differential growth in ASD prevalence across various states and if they do, which factors are the most influential. The key findings of this study include (1) the confirmation that the chosen feature set has considerable power in predicting the growth in ASD prevalence, (2) the identification of the most influential predictive factors, (3) given the nature of the most influential predictive variables, an indication that a considerable portion of the reported ASD prevalence differentials across states could be attributable to over and under diagnosis, and (4) identification of Florida as a key outlier state pointing to a potential under-diagnosis of ASD there.

Keywords: autism spectrum disorder, clustering, machine learning, predictive modeling

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Authors: Arefeh Lotfi, Mahdi Babaei, Ayda Mashhadizadeh, Samira Nikpour, Morteza Bagheri

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The main objective of this study is to investigate the key factors in accidents’ severity at rail-road level crossings. The data required for this study is obtained from both accident and inventory database of Iran Railways during 2009-2015. The Ordered Probit model is developed using SPSS software to identify the significant factors in the accident severity at rail-road level crossings. The results show that 'train speed', 'vehicle type' and 'weather' are the most important factors affecting the severity of the accident. The results of these studies assist to allocate resources in the right place. This paper suggests mandating the regulations to reduce train speed at rail-road level crossings in bad weather conditions to improve the safety of rail-road level crossings.

Keywords: rail-road level crossing, ordered probit model, accidents’ severity, significant factors

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Authors: Taonga Temwani Chibaka

Abstract:

This qualitative research study was conducted to identify the common risk factors that affect the construction industry in Malawi in the building and infrastructure (civil works) projects. The study then evaluates the possible risk responses that are done to mitigate the various risk factors that were identified. I addition the research also established the barriers to risk management implementation with lastly mapping out as where the identified risk factors fall on which stage of the project and then also map out the knowledge areas that need to be worked on the cases on Malawian construction industry in order to mitigate most of the identified risk factors. The study involved the interviewing the professionals from the construction industry in Malawi where insights and ideas were collected, analysed and interpreted. The key study findings show that risks related to clients group are perceived as most critical followed by the contractor related, consultant related and then external group related factors respectively where preventive measures are the most applied risk response technique where the aim to avoid most of the risk factors from happening. Most of the risk factors identified were internal risks and in managerial category which suggested that risk planning was to be emphasized at pre-contract stage to minimize these risks since a bigger percentage of the risk factors were mapped out at implementation stage. Furthermore, barriers to risk management were identified and the key barriers were lack of awareness; lack of knowledge; lack of formal policies in place; regarded as costly and limited time which resulted in proposing that regulating authorities to purposefully introduce intense training on risk management to make known of this new knowledge area. The study then recommends that organisation should formally implement risk management where policies should be introduced to enforce all parties to undertake this. Risk planning was regarded as paramount and this to be done from pre-contract phase so as to mitigate 80% of the risk factors. Finally, training should be done on all project management knowledge areas.

Keywords: risk management, risk factors, risks, malawi

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Authors: Michael Adebayo, Saheed Lawal

Abstract:

The Comprehensive Geriatric Assessment (CGA) is the multidimensional tool used to assess elderly, frail patients either on admission to hospital care or at a community level in primary care. It is a tool designed with the aim of using a holistic approach to managing patients. A Cochrane review of CGA use in 2011 found that the likelihood of being alive and living in their own home rises by 30% post-discharge. RCTs have also discovered 10–15% reductions in readmission rates and reductions in institutionalization, and resource use and costs. Past audit cycles at King’s College Hospital, Denmark Hill had shown inconsistent evidence of CGA completion inpatient discharge summaries (less than 50%). Junior Doctors in the Health and Ageing (HAU) wards have struggled to sustain the efforts of past audit cycles due to the quick turnover in staff (four-month placements for trainees). This 7th cycle created a multi-faceted approach to solving this problem amongst staff and creating lasting change. Methods: 1. We adopted multidisciplinary team involvement to support Doctors. MDT staff e.g. Nurses, Physiotherapists, Occupational Therapists and Dieticians, were actively encouraged to fill in the CGA document. 2. We added a CGA Document Pro-forma to “Sunrise EPR” (Trust computer system). These CGAs were to automatically be included the discharge summary. 3. Prior to assessing uptake, we used a spot audit questionnaire to assess staff awareness/knowledge of what a CGA was. 4. We designed and placed posters highlighting domains of CGA and MDT roles suited to each domain on geriatric “Health and Ageing Wards” (HAU) in the hospital. 5. We performed an audit of % discharge summaries which include CGA and MDT role input. 6. We nominated ward champions on each ward from each multidisciplinary specialty to monitor and encourage colleagues to actively complete CGAs. 7. We initiated further education of ward staff on CGA's importance by discussion at board rounds and weekly multidisciplinary meetings. Outcomes: 1. The majority of respondents to our spot audit were aware of what a CGA was, but fewer had used the EPR document to complete one. 2. We found that CGAs were not being commenced for nearly 50% of patients discharged on HAU wards and the Frailty Assessment Unit.

Keywords: comprehensive geriatric assessment, CGA, multidisciplinary team, quality of life, mortality

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