Search results for: older workers

Authors: Humaira Maheen, Elizabeth Hoban, Catherine Bennette

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Background: Globally, role of Community Health Workers (CHW) as front line disaster health work force is underutilized. Developing countries which are at risk of natural disasters or humanitarian emergencies should lay down effective strategies especially to ensure adequate access to maternity care during crisis situation by using CHW as they are local, trained, and most of them possess a good relationship with the community. The Minimum Initial Service Package (MISP) is a set of universal guidelines that addresses women’s reproductive health needs during the first phase of an emergency. According to the MISP, pregnant women should have access to a skilled birth attendant and adequate transportation arrangements so they can access a maternity care facility. Pakistan is one of the few countries which has been severely affected by a number of natural disaster as well as humanitarian emergencies in last decade. Pakistan has a young and structured National Disaster Management System in place, where District Authorities play a vital role in disaster management. The District Health Department develops the contingency health plan for an emergency situation and implements it under the existing district health human resources (health workers and medical staff at the health facility) and infrastructure (health care facilities). Methods: A mixed methods study was conducted in rural villages of Sindh adjacent to the river Indus, and included in-depth interviews with 15 women who gave birth during the floods, structured interviews with 668 women who were pregnant during 2010-2014, and in-depth interviews with 25 community health workers (CHW) and 30 key informants. Results: Women said that giving birth in the relief camps during the floods was one of the most challenging times of their life. The district health department didn’t make transportation arrangement for labouring women from relief camp to the nearest health care facility. As a result 91.2% women gave birth in temporary shelters with the help of a traditional birth attendant (Dai) with no clean physical space available to birth. Of the 332 women who were pregnant at the time of the floods, 26 had adverse birth outcomes; 10 had miscarriages, 14 had stillbirths and there were four neonatal deaths. Conclusion: The district health department was not able to provide access to adequate maternity care during according to the international standard during the floods in 2011. We propose a model where CHWs will be used as frontline maternity care providers during any emergency or disaster situations in Pakistan. A separate "birthing station" should be mandatory in all district relief camps, managed by CHWs. Community midwives (CMW) would and the Lady Health Workers (LHW) would provide antenatal and postnatal care alongside, vaccination for pregnant women, neonates and children under five. There must be an ambulance facility for emergency obstetric cases and all district health facilities should have at least two medical staff identified and trained for emergency obstetric management. The District Health Department must provide clean birthing kits and regular and emergency contraceptives in the relief camps. Methods: A mixed methods study was conducted in rural villages of Sindh adjacent to the river Indus, and included in-depth interviews with 15 women who gave birth during the floods, structured interviews with 668 women who were pregnant during 2010-2014, and in-depth interviews with 25 community health workers (CHW) and 30 key informants. Results: Women said that giving birth in the relief camps during the floods was one of the most challenging times of their life. Nearly 91.2% women gave birth in temporary shelters with the help of a traditional birth attendant (Dai) with no clean physical space available to birth, and the health camp was mostly accessed by men and always overcrowded. There was no obstetric trained medical staff in the health camps or transportation provided to take women with complications to the nearest health facility. The rate of adverse outcome following disaster was 22.2% (95% CI: 8.62% – 42.2%) amongst 27 women who did not evacuate as compare to 7.91% (95% CI: 5.03% – 11.8%) among 278 women who lived in relief camp study participants. There were 27 women who evacuated on pre-flood warning and had 0% rate of adverse outcome. Conclusion: We propose a model where CHWs will be used as frontline maternity care providers during any emergency or disaster situations in Pakistan. A separate "birthing station" should be mandatory in all district relief camps, managed by CHWs. Community midwives (CMW) would and the Lady Health Workers (LHW) would provide antenatal and postnatal care alongside, vaccination for pregnant women, neonates and children under five. There must be an ambulance facility for emergency obstetric cases and all district health facilities should have at least two medical staff identified and trained for emergency obstetric management. The District Health Department must provide clean birthing kits and regular and emergency contraceptives in the relief camps.

Keywords: natural disaster, maternity care model, rural, Pakistan, community health workers

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Authors: Rafia Hassan, Ali Rizwan, Sadaf Farhan, Bushra Sabir

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The purpose of this study is to compare the conventional crop monitoring system with the satellite based crop monitoring system in Pakistan. This study is conducted for SUPARCO (Space and Upper Atmosphere Research Commission). The study focused on the wheat crop, as it is the main cash crop of Pakistan and province of Punjab. This study will answer the following: Which system is better in terms of cost, time and man power? The man power calculated for Punjab CRS is: 1,418 personnel and for SUPARCO: 26 personnel. The total cost calculated for SUPARCO is almost 13.35 million and CRS is 47.705 million. The man hours calculated for CRS (Crop Reporting Service) are 1,543,200 hrs (136 days) and man hours for SUPARCO are 8, 320hrs (40 days). It means that SUPARCO workers finish their work 96 days earlier than CRS workers. The results show that the satellite based crop monitoring system is efficient in terms of manpower, cost and time as compared to the conventional system, and also generates early crop forecasts and estimations. The research instruments used included: Interviews, physical visits, group discussions, questionnaires, study of reports and work flows. A total of 93 employees were selected using Yamane’s formula for data collection, which is done with the help questionnaires and interviews. Comparative graphing is used for the analysis of data to formulate the results of the research. The research findings also demonstrate that although conventional methods have a strong impact still in Pakistan (for crop monitoring) but it is the time to bring a change through technology, so that our agriculture will also be developed along modern lines.

Keywords: area frame, crop reporting service, CRS, sample frame, SRS/GIS, satellite remote sensing/ geographic information system

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Authors: Juan Carlos Rubio Romero, Francico Salguero Caparros, Virginia Herrera-Pérez

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No one is in the slightest doubt about the high levels of risk involved in work in the construction industry. They are even higher in structural construction work. The Critical Decision Method (CDM) is a semi-structured interview technique that uses cognitive tests to identify the different disturbances that workers have to deal with in their work activity. At present, the vision of safety focused on daily performance and things that go well for safety and health management is facing the new paradigm known as Resilience Engineering. The aim of this study has been to describe the variability in formwork labour on concrete structures in the construction industry and, from there, to find out the resilient attitude of workers to unexpected events that they have experienced during their working lives. For this purpose, a series of semi-structured interviews were carried out with construction employees with extensive experience in formwork labour in Spain by applying the Critical Decision Method. This work has been the first application of the Critical Decision Method in the field of construction and, more specifically, in the execution of structures. The results obtained show that situations categorised as unthought-of are identified to a greater extent than potentially unexpected situations. The identification during these interviews of both expected and unexpected events provides insight into the critical decisions made and actions taken to improve resilience in daily practice in this construction work. From this study, it is clear that it is essential to gain more knowledge about the nature of the human cognitive process in work situations within complex socio-technical systems such as construction sites. This could lead to a more effective design of workplaces in the search for improved human performance.

Keywords: resilience engineering, construction industry, unthought-of situations, critical decision method

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Authors: Samantha Clarke

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The term social justice is central to social work; however, the meaning behind this term is not as simple as defining the term itself. This is because the meaning of social justice is relative since its origin and development is based on evolving political perspectives. Political perspectives provide numerous lenses to view social justice in social work; however, the realities of changing society have meant that social justice has assumed different values, definitions, and understandings over time and in different geopolitical and cultural contexts. There are many competing and convincing theories of social justice that are relevant to social work practice. Exploring the term is not an idle preoccupation because the meaning of the term is not as crucial as the meaning of the worldview, as it is the worldview that positions social justice as crucial in the emancipation of people marginalized from oppression. The many political assumptions that underlie the term social justice are explored and connected to the contemporary discussions about social justice in social work. These connections are then interrogated in the Canadian Social Works Code of Ethics, and in micro, mezzo, and macro approaches. To be remiss in interrogating the underlying political assumptions of the worldview of social justice is to entrench oppression and to preserve oppressive structures in contemporary Canadian social work. The concept of social justice is unable to withstand closer scrutiny about its emancipatory qualities in Canadian social work when we interrogate the many political assumptions that frame its understanding. In order to authenticate social justice as an emancipatory central organizing principle, Canadian social workers must engage in deeper discussions about the political implications of social justice in their everyday practices based on diverse worldviews and geopolitical contexts. Social workers are well positioned to develop an understanding of social justice that is emancipatory based on their everyday practices because as social and political actors they are positioned to work for and with individuals and toward the greater good of those who are marginalized from oppression.

Keywords: Canadian social work, political analysis, social justice, social work practice

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Authors: Kanokwan Tangchitnusorn, Patcharawalai Wongboonsin

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

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

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Authors: Alejandra Letelier, Anja Heilmann, Richard G. Watt, Stephen Jivraj, Georgios Tsakos

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Background: Socioeconomic position (SEP) influences adult health. People who experienced material disadvantages in childhood or adulthood tend to have higher adult disease levels than their peers from more advantaged backgrounds. Even so, life is a dynamic process and contains a series of transitions that could lead people through different socioeconomic paths. Research on social mobility takes this into account by adopting a trajectory approach, thereby providing a long-term view of the effect of SEP on health. Aim: The aim of this research examines the effects of intergenerational social mobility on adult general health, oral health and functioning in a population aged 50 and over in England. Methods: This study is based on the secondary analysis of data from the English Longitudinal Study of Ageing (ELSA). Using cross-sectional data, nine social trajectories were created based on parental and adult occupational socio-economic position. Regression models were used to estimate the associations between social trajectories and the following outcomes: adult self-rated health, self-rated oral health, oral health related quality of life, total tooth loss and grip strength; while controlling for socio-economic background and health related behaviours. Results: Associations with adult SEP were generally stronger than with childhood SEP, suggesting a stronger influence of proximal rather than distal SEP on health and oral health. Compared to the stable high group, being in the low SEP groups in childhood and adulthood was associated with poorer health and oral health for all examined outcome measures. For adult self-rated health and edentulousness, graded associations with social mobility trajectories were observed. Conclusion: Intergenerational social mobility was associated with self-rated health and total tooth loss. Compared to only those who remained in a low SEP group over time reported worse self-rated oral health and oral health related quality of life, and had lower grip strength measurements. Potential limitations in relation to data quality will be discussed.

Keywords: social determinants of oral health, social mobility, socioeconomic position and oral health, older adults oral health

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Authors: Hyeon-Kyo Lim, Hyunjung Kim, Kune-Woo Lee

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Decommissioning process of nuclear facilities can be said to consist of a sequence of problem solving activities, partly because there may exist working environments contaminated by radiological exposure, and partly because there may also exist industrial hazards such as fire, explosions, toxic materials, and electrical and physical hazards. As for an individual hazard factor, risk assessment techniques are getting known to industrial workers with advance of safety technology, but the way how to integrate those results is not. Furthermore, there are few workers who experienced decommissioning operations a lot in the past. Therefore, not a few countries in the world have been trying to develop appropriate counter techniques in order to guarantee safety and efficiency of the process. In spite of that, there still exists neither domestic nor international standard since nuclear facilities are too diverse and unique. In the consequence, it is quite inevitable to imagine and assess the whole risk in the situation anticipated one by one. This paper aimed to find out an appropriate technique to integrate individual risk assessment results from the viewpoint of experts. Thus, on one hand the whole risk assessment activity for decommissioning operations was modeled as a sequence of individual risk assessment steps, and on the other, a hierarchical risk structure was developed. Then, risk assessment procedure that can elicit individual hazard factors one by one were introduced with reference to the standard operation procedure (SOP) and hierarchical task analysis (HTA). With an assumption of quantification and normalization of individual risks, a technique to estimate relative weight factors was tried by using the conventional Analytic Hierarchical Process (AHP) and its result was reviewed with reference to judgment of experts. Besides, taking the ambiguity of human judgment into consideration, debates based upon fuzzy inference was added with a mathematical case study.

Keywords: decommissioning, risk assessment, analytic hierarchical process (AHP), fuzzy inference

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Authors: Aanh Eduardo Dimate-Garcia, Diana Carolina Rodriguez-Romero, Edna Yuliana Gonzalez Rincon, Diana Marcela Pardo Lopez, Yessica Garibello Cubillos

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Musculoskeletal disorders (MD) are the new epidemic of chronic diseases, are multifactorial and affect the different productive sectors. Although there are multiple instruments to evaluate the static and dynamic load, the method of repetitive occupational action (OCRA) seems to be an attractive option. Objective: It is aimed to analyze the use of the OCRA method and the prevalence of MD in workers of various productive sectors according to the literature (2007-2018). Materials and Methods: A literature review (following the PRISMA statement) of studies aimed at assessing the level of biomechanical risk (OCRA) and the prevalence of MD in the databases Scielo, Science Direct, Scopus, ProQuest, Gale, PubMed, Lilacs and Ebsco was realized; 7 studies met the selection criteria; the majority are quantitative (cross section). Results: it was evidenced (gardening and flower-growers) in this review that 79% of the conditions related to the task require physical requirements and involve repetitive movements. In addition, of the high appearance of DM in the high-low back, upper and lower extremities that are produced by the frequency of the activities carried out (footwear production). Likewise, there was evidence of 'very high risks' of developing MD (salmon industry) and a medium index (OCRA) for repetitive movements that require special care (U-Assembly line). Conclusions: the review showed the limited use of the OCRA method for the detection of MD in workers from different sectors, and this method can be used for the detection of biomechanical risk and the appearance of MD.

Keywords: checklist, cumulative trauma disorders, musculoskeletal diseases, repetitive movements

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Authors: Noorulaine Maqsood, Saeed Khan

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Background: Concern regarding incident reporting and bio-safety training in clinical laboratories in Pakistan has increased remarkably in the last few years due to rapid increase in diagnosis and research on infectious organisms. In order to ensure the safety of employees, this issue needs to be addressed immediately. Bio-safety training sessions and lectures are necessary for the protection of laboratory workers in order to ensure safe practices and minimize the count of incident reporting in the lab. Objective: To carry out an inter-departmental survey in lab regarding the awareness of bio-safety practices among lab employees before and after conducting bio-safety training sessions. Methodology: We conducted a 30 questions survey of laboratory workers in June 2013 (before training session) to gather information related to bio-safety awareness. Afterwards, we conducted another survey after training sessions and workshops related to bio-safety. Result: The survey regarding bio-safety level showed that before the training session 32% of the participants were aware of bio-safety level being used in their lab whereas after the session this percentage increased to 72%. 48% of the participants had information about the proper usage of PPE which increased to 76%. Awareness regarding proper management of hazardous waste increased from 32% to 64%. The incident reporting practice, sample handling and hand hygiene awareness was previously reported to be 40%, 65%, and 52% that increased to 80%, 85% and 88% respectively after the training session was completed. Conclusion: The first survey results showed lack of awareness that suggest nearly all senior scientists, faculty, medical technologist, lab attendant and housekeeping staff working in laboratories are required to have bio-safety training, and required inspection at least twice a year by a bio-safety officer and also required to renew their bio-safety training. After the training session, significant changes in awareness level and attitude of the participants regarding biosafety practices were observed. Therefore, such bio-safety sessions should be carried out regularly in clinical laboratories.

Keywords: biosafety practices, clinical laboratory, Pakistan, survey

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Authors: S. Bellagamba, S. Malinconico, P. De Simone, F. Paglietti

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Until the 1990s, Italy was among the world’s leading producers of raw asbestos fibres and Asbestos Containing Materials (ACM) and one of the most contaminated Countries in Europe. To reduce asbestos-related health effects, Italy has adopted many laws and regulations regarding exposure thresholds, limits, and remediation tools. The Italian Environmental Ministry (MASE) has identified 42 Italian Superfund sites, 11 of which are mainly contaminated by Asbestos. The highest levels of exposure occur during remediation activities in the 42 superfund-sites and during the management of asbestos containing waste in landfills, which requires specific procedures. INAIL-DIT play a role as MASE scientific consultant on issues concerning pollution, remediation, and Asbestos Containing Waste (ACW) management. The aim is to identify the best Emergency Safety Measures, to suggest specific best pratics for remediation through occupational on site monitorings and laboratory analysis. Moreover, the aim of INAIL research is testing the available technologies for working activities and analytical methodologies. This paper describes the remediation of Bagnoli industrial facility (Naples), an Eternit factory which produced asbestos cement products. The remediation has been analyzed, considering a first phase focused on the demolition of structures and plants and a second phase regarding the characterization, screening, removal, and disposal of polluted soils. The project planned the complete removal of all the asbestos dispersed in the soil and subsoil and the recovery of the clean fraction. This work highlights the remediation techniques used and the prevention measures provide for workers and daily life areas protection. This study, considering the high number of asbestos cement factories in the world, can to serve as an important reference for similar situation at European or international scale.

Keywords: safety, asbestos, workers, contaminated sites, hazardous waste

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Authors: Bibire Abdulkareem Hussein

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Job satisfaction and motivation are considered as major tools in sustaining institutional development, they are also the machinery used to achieve an institutional goals and objectives. However, it has been observed that some institutions failed in motivating and stimulating their workers; in contrast, workers may be motivated but not satisfied with the job and failed to perform efficiently and effectively. It is hoped that the study of this nature would be of significance value to all stakeholders in education specifically, lecturers in higher institutions in Nigeria. Also it significances will enhance lecturers’ effectiveness and performance in discharging their duties. It is against this backdrop that, this study investigated whether job satisfaction and motivation predict lecturers’ effectiveness in Nigeria Police Academy, Wudil, KanoState. The correlational research method was adopted for the study while purposive sampling technique was used to choose the institution and the sampled lectures (70). Simple random sampling technique was used to select one hundred cadets across the academy. Two instruments were used to elicit information from both lecturers and cadets. These were job satisfaction and motivation; and lecturers’ effectiveness Questionnaires. The instruments were subjected to pilot testing and found to have reliability coefficient of 0.69 and 0.71 respectively. The results of the study revealed that there was a significance relationship among job satisfaction, motivation and lecturers effectiveness in Nigeria Police Academy, Job satisfaction had a Beta weight (β) of .125, t = 3.253, p<0.05, Job motivation had a Beta weight (β) of .185, t = 3.849, p<0.05. There was a significance relationship between job satisfaction and lecturers’ effectiveness in Nigeria Police Academy the cal r is 0.21 while the crt r is 0.19. at p<0.05 and; there was a significance relationship between job motivation and lecturers effectiveness in Nigeria Police Academy the cal r is 0.20 while the crt r is 0.19 at p<0.05This study therefore concluded that there was a significance relationship among job satisfaction, motivation and lecturers effectiveness in Nigeria Police Academy s,In view of the findings of this study, the paper recommends that lecturers should be more pro-active and more effective in their primary assignment (teaching) in order to make meaningful impacts and inputs in the life of cadets and boost the standard of the academy. In the same vein, it is recommended that management should intensify efforts to improve lecturers’ welfares by providing more motivational techniques to enhance more productivity.

Keywords: academy, lecturers effectiveness, motivation, satisfaction

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Authors: Sara Santos, Maria João Santos

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Thisarticleanalyzesthethemeofwork-family conflict and professional stress among financial workers and their relationships with burnout syndrome. This also studieshowthesocio demographicandworkingcharacteristicsoftheseprofessionalsinfluencetheirlevelsofburnout. Weadopted a mixedmethodbasedontheanalysisof 255 surveysand 24 interviewscarriedoutwith financial sector professionals. Thekeyresultsincludeverificationofhowtheseprofessionalsregister a positive relationshipbetweenwork-familyconflictandburnoutsyndrome as well as betweenprofessional stress andburnout. Thestudycontributes to a betterunderstandingoftheimpactsthatwork-familyconflictsandprofessional stress haveon financial professionalsandhowtheycontribute to thevariationsprevailingintheirrespectivelevelsofburnout.

Keywords: burnout syndrome, financial area, conflict, stres

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Authors: Mohd Afif Md Nasir, Mohd Faizal Amin Nur, Jamaluddin Hasim, Abd Samad Hasan Basari, Mohd Halim Sahelan

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This study is aimed to investigate the suitability of Computer-Based Training (CBT) as one of the approaches in skills competency development at the Centre of Instructor and Advanced Skills Training (CIAST) Shah Alam Selangor and National Youth Skills Institute (NYSI) Pagoh Muar Johor. This study has also examined the perception among trainees toward Virtual Learning Environment (VLE) as to realize the development of skills in Welding Technology. The significance of the study is to create a computer-based skills development approach in welding technology among new trainees in CIAST and IKBN as well as to cultivate the element of general skills among them. This study is also important in elevating the number of individual knowledge workers (K-Workers) working in manufacturing industry in order to achieve the national vision which is to be an industrial nation in the year 2020. The design is a survey of research which using questionnaires as the instruments and is conducted towards 136 trainees from CIAST and IKBN. Data from the questionnaires is proceeding in a Statistical Package for Social Science (SPSS) in order to find the frequency, mean and chi-square testing. The findings of the study show the welding technology skills have developed in the trainees as a result of the application of the Virtual Reality simulator at a high level (mean=3.90) and the respondents agreed the skills could be embedded through the application of the Virtual Reality simulator (78.01%). The Study also found that there is a significant difference between trainee skill characteristics through the application of the Virtual Reality simulator (p<0.05). Thereby, the Virtual Reality simulator is suitable to be used in the development of welding skills among trainees through the skills training institute.

Keywords: computer-based training, virtual learning environment, welding technology, virtual reality simulator, virtual learning environment

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Authors: Abiodun O. Ibude

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Several organizations have devised the strategy of engaging the services of staff not directly employed by them in their production and service delivery. Some organizations also engage on contracting another organization to carry out a part of service or production process on their behalf. Outsourcing is becoming an important alternative employment option for most organizations. This paper attempts an exposition on the rights of workers within the more specific context of outsourcing as a human resource management phenomenon. Outsourced employees and their rights are treated conceptually and analytically in a generic sense as a mere subset of the larger whole, that is, labor. Outsourced employees derive their rights, like all workers, from their job context as well as the legal environment (municipal and global) in which they operate. The dynamics of globalization and the implications of this development for labor practices receive considerable attention in this exposition. In this regard, a guarded proposition is made, to examine the practice and effect of engaging outsourcing as an economic decision designed primarily to cut down on operational costs rather than a Human Resources Management decision to improve worker welfare. The population of the study was selected from purposive and simple random sampling techniques. Data obtained were analyzed through a simple percentage, Pearson product-moment correlation, and cross-tabulation. From the research conducted, it was discovered that, although outsourcing possesses opportunities for organizations, there are drawbacks arising from its implementation of job securities. It was also discovered that some employees are being exploited through this strategy. This gives rise to lower motivation and thereby decline in performance. In conclusion, there is need for examination of Human Resource Managers’ strategies that can serve as management policy tools for the protection of the rights of outsourced employees.

Keywords: legal environment, operational cost, outsourcing, protection

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

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

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

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Authors: Stephanie Giordano, Rosa Plasencia

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In the USA, in 2013, public service systems such as Medicaid, aging, and disability systems undertook an effort to measure the quality of service delivery by examining the experiences and outcomes of those receiving public services. The goal of this effort was to develop a survey to measure the experiences and outcomes of those receiving public services, with the goal of measuring system performance for quality improvement. The performance indicators were developed through with input from directors of state aging and disability service systems, along with experts and stakeholders in the field across the United States. This effort, National Core Indicators –Aging and Disabilities (NCI-AD), grew out of National Core Indicators –Intellectual and Developmental Disabilities, an effort to measure developmental disability (DD) systems across the States. The survey tool and administration protocol underwent multiple rounds of testing and revision between 2013 and 2015. The measures in the final tool – called the Adult Consumer Survey (ACS) – emphasize not just important indicators of healthcare access and personal safety but also includes indicators of system quality based on person-centered outcomes. These measures indicate whether service systems support older adults and people with disabilities to live where they want, maintain relationships and engage in their communities and have choice and control in their everyday lives. Launched in 2015, the NCI-AD Adult Consumer Survey is now used in 23 states in the US. Surveys are conducted by NCI-AD trained surveyors via direct conversation with a person receiving public long-term services and supports (LTSS). Until 2020, surveys were only conducted in person. However, after a pilot to test the reliability of videoconference and telephone survey modes, these modes were adopted as an acceptable practice. The nature of the survey is that of a “guided conversation” survey administration allows for surveyor to use wording and terminology that is best understand by the person surveyed. The survey includes a subset of questions that may be answered by a proxy respondent who knows the person well if the person is receiving services in unable to provide valid responses on their own. Surveyors undergo a standardized training on survey administration to ensure the fidelity of survey administration. In addition to the main survey section, a Background Information section collects data on personal and service-related characteristics of the person receiving services; these data are typically collected through state administrative record. This information is helps provide greater context around the characteristics of people receiving services. It has also been used in conjunction with outcomes measures to look at disparity (including by race and ethnicity, gender, disability, and living arrangements). These measures of quality are critical for public service delivery systems to understand the unique needs of the population of older adults and improving the lives of older adults as well as people with disabilities. Participating states may use these data to identify areas for quality improvement within their service delivery systems, to advocate for specific policy change, and to better understand the experiences of specific populations of people served.

Keywords: quality of life, long term services and supports, person-centered practices, aging and disability research, survey methodology

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Authors: Farida Habib, Haya Alfozan, Eman Miligi, Najla Alotaibi

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Background: Women’s satisfaction with maternity services, especially care during labor and birth, has become highly significant to healthcare providers, administrators, and policymakers. Purpose: The aims of this study were to assess maternal satisfaction regarding the quality of care during labor and to compare the level of maternal satisfaction between women who delivered by physicians and those delivered by midwives. Methodology: A descriptive, cross-sectional, correlational design was used. A convenient sample of 180 low-risk cases of immediate postpartum women who delivered at King Abdul-Aziz medical city was recruited. Women whose babies were diagnosed with serious health problems were excluded from the study. Data were collected using a self-administered questionnaire. The validity and reliability of the questionnaire were ensured. The questionnaire included three parts, namely: demographics data, medical history, and obstetrical history, and the last part is the satisfaction assessment tool. Ethical confederations were ensured. Maternal satisfaction during labor was classified in terms of health care, health workers' communication, and the environment. Results: Regarding health care, women were highly satisfied with care received from nurse (M = 4.21 + 0.88), medical care received (M = 4.17 + 0.79), and comfort techniques (M = 4.04 + 0.91). Regarding health workers' communication, women were highly satisfied with the provider to treat with dignity and respect (M = 4.03 + 0.91) and orientation to the toilet, bathroom, washing area (M = 4.00 + 0.93). Regarding the environment, women were highly satisfied with the experience of their baby's birth (M = 4.18 + 0.98) and supplies with drugs and supplies (M = 4.09 + 0.97). There was no statistically significant difference in maternal satisfaction between women who delivered by physicians and those delivered by midwives. Conclusion: Women were generally satisfied with their labor and delivery experience. There was no difference in maternal satisfaction on the labor process between women who delivered by physicians and those delivered by midwives.

Keywords: maternity, satisfaction, labor, delivery

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Authors: Lamia Bouzgarrou, Irtyah Merchaoui, Amira Omrane, Salma Kammoun, Amine Daafa, Neila Chaari

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Backgrounds: Currently, low back pain (LBP) is one of the most prevalent public health problems, which caused severe morbidity among a large portion of the adult population. It is also associated with heavy direct and indirect costs, in particular, related to absenteeism and early retirement. Health care workers are one of most occupational groups concerned by LBP, especially because of biomechanical and psycho-organizational risk factors. Our current study aims to investigate risk factors associated with chronic low back pain among Tunisian caregivers in university-hospitals. Methods: Cross-sectional study conducted over a period of 14 months, with a representative sample of caregivers, matched according to age, sex and work department, in two university-hospitals in Tunisia. Data collection included items related to socio-professional characteristics, the evaluation of the working capacity index (WAI), the occupational stress (Karazek job strain questionnaire); the quality of life (SF12), the musculoskeletal disorders Nordic questionnaire, and the examination of the spine flexibility (distance finger-ground, sit-stand maneuver and equilibrium test). Results: Totally, 293 caregivers were included with a mean age equal to 42.64 ± 11.65 years. A body mass index (BMI) exceeding 30, was noted in 20.82% of cases. Moreover, no regular physical activity was practiced in 51.9% of cases. In contrast, domestic activity equal or exceeding 20 hours per week, was reported by 38.22%. Job strain was noted in 19.79 % of cases and the work capacity was 'low' to 'average' among 27.64% of subjects. During the 12 months previous to the investigation, 65% of caregivers complained of LBP, with pain rated as 'severe' or 'extremely severe' in 54.4% of cases and with a frequency of discomfort exceeding one episode per week in 58.52% of cases. During physical examination, the mean distance finger-ground was 7.10 ± 7.5cm. Caregivers assigned to 'high workload' services had the highest prevalence of LBP (77.4%) compared to other categories of hospital services, with no statistically significant relationship (P = 0.125). LBP prevalence was statistically correlated with female gender (p = 0.01) and impaired work capacity (p < 10⁻³). Moreover, the increase of the distance finger-ground was statistically associated with LBP (p = 0.05), advanced age (p < 10⁻³), professional seniority (p < 10⁻³) and the BMI ≥ 25 (p = 0.001). Furthermore, others physical tests of spine flexibility were underperformed among LBP suffering workers with a statistically significant difference (sit-stand maneuver (p = 0.03); equilibrium test (p = 0.01)). According to the multivariate analysis, only the domestic activity exceeding 20H/week, the degraded quality of physical life, and the presence of neck pain were significantly corelated to LBP. The final model explains 36.7% of the variability of this complaint. Conclusion: Our results highlighted the elevate prevalence of LBP among caregivers in Tunisian public hospital and identified both professional and individual predisposing factors. The preliminary analysis supports the necessity of a multidimensional approach to prevent this critical occupational and public health problem. The preventive strategy should be based both on the improvement of working conditions, and also on lifestyle modifications, and reinforcement of healthy behaviors in these active populations.

Keywords: health care workers, low back pain, prevention, risk factor

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Authors: Ibrahim Umar, S Chindo, A Rajab

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Background: TB remains a disease of public health concern in Nigeria with an estimated incidence rate of 219/100,000. Kano has the second highest TB burden in Nigeria and is the leading state with the highest consistent yearly TB notification. House-to-house (H2H) active case search in the community was found to have major contribution to the total TB notification in the state. Aims and Objective: To showcase the impact of H2H community active TB case search (ACF) to yearly TB notification in Kano State, Northern Nigeria from 2012 to 2022. Methodology: This is a retrospective descriptive study based on the analysis of data collected during the routine quarterly and yearly TB data collected in the state. Data was analyzed using the Power BI with statistical alpha level of significance <0.05. Results: Between 2012 and 2013 there was no House-to-house active TB case search in Nigeria and Kano had zero contribution to TB notification from the community in those years. However, in 2014 with the introduction of H2H Active TB Case Search Kano notified 6,014 TB cases out of which 113 came from the community ACF that translated to 2% contribution to total TB notification. From 2014 to 2022 there was progressive increase in community contribution to TB case notification from 113 out of 6,014 total TB patients notified (2012) to 11,799 out of 26,371 TB patients notified (2022) in Kano State. This translated to 45% increase in community contribution to total TB case notification. Discussion: Remarkable increase in community contribution to total TB case notification in Kano State was achieved in 2022 with 11,799 TB cases notified from the community Active TB case search to the total of 26,731 TB cases notified in Kano State, Nigeria. Conclusion: in research has shown that Community-based H2H Active TB Case Search through Community TB Workers (CTWs) is an excellent strategy in finding the missing TB cases towards Ending TB in the world.

Keywords: tuberculosis(TB), active case search (ACF), house-to-house (H2H), community TB workers (CTWs)

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Authors: Boularas El-Alia, Arbi Raja, Bachir Bouiadjra Sara, Rezk-Kallah Haciba, Rezkkallah Baghdad

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Objectives : To determine the handling practices of cytotoxic drugs and to describe clinical manifestations expressed by hospital personnel of Sidi Bel Abbes during the year 2014. Methods: Sectional descriptive study conducted in 3 center university hospital units (Hematology, Oncology and Urology) and Gynecology of EHS Sidi Bel Abbes. A questionnaire was administered to hospital workers regulary exposed to cytotoxic drugs. A work-place visit was performed to have an overview about working conditions. The Cytotoxic Contact Index (CCI) was calculated for each nurse on a period of 15 working days. Treatment of the results was done using SPSS software. Results: The survey reveals that 22 men and 58 women are exposed to cytotoxic drugs for an average of 7 years. Many symptoms such as ocular irritation (38,75%), throat irritation (56,25%), headache (68,75%), dizziness (43,75%), nausea (37,5%), metallic taste (30%), were reported with high frequency. Are noted in the offspring, 3 congenital anomalies,2 diaphragmatic hernia and a cleft palate. The Cytotoxic Contact Index (CCI) was higher than 3 among Oncology nurses and higher than 1 for most of the nurses of Hematology and Gynecology service. The wearing of personal protective clothing was not respected by all workers: (22/23) wear gloves and (20/23) wear a mask,(5/23) wear a cap, (2/23) wear glasses. Only 3 nurses have benefited from continuous training on handling cytotoxic drugs. Conclusion: This study shows a high occupational exposure risk to cytotoxic drugs among persons handling these drugs and the necessity to apply rigorously all measures related to personal protection awareness and training of personnel to minimize these exposure.

Keywords: cytotoxic drugs, handling, clinical manifestations, hospital staff

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Authors: Gunjita Shami, Noopur Anand

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The pilot run of 50 days was undertaken to test employability potential of people with visual and hearing & speech impairment. Various roles in an apparel manufacturing set up like spreading of fabric for cutting, folding, sealing and labeling cartons, pasting size barcode stickers on packed garments, removing tickets from the garments in the finishing stage were studied. Their performance was quantified basis timesheets for all the days and improvement per day was quantified. Their final day output was compared to that of the able-bodied worker. For example in the carton making activity on day one visually impaired worker was making one box every three minutes which improved to four boxes per minute on day 28 displaying 91.6% improvement compared or an improvement of 3.6% per day which was comparable to the able-bodied seasoned workers, who were making 5 boxes per minute. The performance of persons with hearing and speech impairment in the finishing department was 10% higher than that of able-bodied seasoned workers in the same process. Overall in all the activities the differently abled showed day to day improvement of 65% while able bodied displayed improvement of 52%. On the first day performance of able-bodied worker was 75% better than that of differently abled while on the 50th day it was only 20% better. Therefore the performance of persons with disabilities was found comparable to the able bodied person. The results, though on a small scale, showed a big promise of employment of persons with disability in the apparel industry. Armed with the promising result a full-scale study has been undertaken to identify the roles suitable for certain kind of disability in apparel production, work-aids required to assist the differently abled to improve performance and measures to be undertaken to make production floor 'friendlier' for them. The results have been discussed in this paper which opens doors for integrating differently abled into the world projected and assumed for only able-bodied.

Keywords: apparel sector, differently abled, employability, performance, work-aid

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Authors: Saja Al Zoubi, Humam Wardeh

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This study aims to shed light on the work conditions of female refugees and the most important constraints and challenges preventing them from accessing good earning work. The study was conducted in the Syrian refugee camps in Bekaa province, Lebanon, with a field survey carried out between 2016-2017 through face-to-face interviews of 69 female refugee workers, in addition to 4 focus groups. The results show that 97% of the Syrian female refugees are agricultural workers, they form more than 53% of the agricultural labor work among the refugees. Women predominantly perform all agricultural activities (Planting, weeding, fertilization, irrigation, compacting, cutting, sorting, packaging), except the carriage of heavy objects and sometimes irrigation are exclusive for men. The female child labor is 66% of the child labor. To maintain the livelihoods of their families, women accept to be paid for 4-8 $/day with gender gap around 6 $/day. Women’s acceptance of these low wages is one of the main reasons for landowners’ preference of hiring women under bad work conditions. The less educated and skilled (40% of the women are illiterate, and 2% have some skills) women are more likely to be limited to farm work. In addition, there are other reasons as traditions, labor market demand and other challenges related to security and legal issues. This study finds that enhancing the women capacities (for both refugees and host community) through vocational training and cooperative micro enterprises matched with income generating activities and opening new market channels for local manufactured products can play important role to improve the work skills and conditions, and that can improve the livelihood of their families. The study also recommends to adopt a strategy by all humanitarian agencies to make the aid on educating children condition.

Keywords: agricultural work conditions, gender wage gap, women refugees, work constraints

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Authors: Yetunde M. Dairo, Johnny Collett, Helen Dawes

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Background and Aim: Engagement with physical activity (PA) research is poor among adults with intellectual disabilities (ID), particularly in those from residential homes. This study explored why, by asking managers of residential homes, adults with ID and their carers. Methods: Participants: A convenient sample of 23 individuals from two UK local authorities, including a group of ID residential home managers, adults with ID and their support staff. Procedures: A) Residential home managers (n=6) were asked questions about their willingness to allow their residents to participate in PA research; B) eleven adults with ID and their support workers (n=6) were asked questions about their willingness to accept 7-day accelerometer monitoring and/or the International Physical Activity Questionnaire-short version (IPAQ-s) as PA measures. The IPAQ-s was administered by the researcher and they were each provided with samples of accelerometers to try on. Results: A) Five out of six managers said that the burden of wearing the accelerometer for seven days would be too high for the people they support, the majority of whom might be unable to express their wishes. They also said they would be unwilling to act as proxy respondents for the same reason. Additionally, they cited time pressure, understaffing, and reluctance to spend time on the research paperwork as further reasons for non-participation. B) All 11 individuals with ID completed the IPAQ-s while only three accepted the accelerometer, one of whom was deemed inappropriate to wear it. Reasons for rejecting accelerometers included statements from participants of: ‘too expensive’, ‘too heavy’, ‘uncomfortable’, and two people said they would not want to wear it for more than one day. All adults with ID (11) and their support workers (6) provided information about their physical activity levels through the IPAQ-s. Conclusions: Care home managers are a barrier to research participation. However, adults with ID would be happy for the IPAQ-s as a PA measure, but less so for the 7-day accelerometer monitoring. In order to improve participation in this population, the choice of PA measure is considered important. Moreover, there is a need for studies exploring how best to engage ID residential home managers in PA research.

Keywords: intellectual disability, physical activity measurement, research engagement, research participation

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Authors: Balázs Ádám, Randi Nørgaard Fløe Pedersen, Jørgen Riis Jepsen

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Volatile chemicals that accumulate and release from freight containers constitute significant health risks. Fumigation to prevent spread of pests and off-gassing of freight are sources of hazardous chemicals. The aim of our study was to investigate the regulation and practice of container handling with focus on preventive measures applied against chemical exposures in Denmark. A comprehensive systematic search of scientific literature and organizational domains of international and Danish regulatory bodies was performed to explore regulations related to safe work with transport containers. The practice of container work was investigated in a series of semi-structured interviews with managers and health and safety representatives of organizations that handle transport containers. Although there are several international and national regulations and local safety instructions that relate to container handling, the provided information is not specific or up-to-date enough to conduct safe practice in many aspects. The interviewees estimate high frequency of containers with chemical exposure and deem that they can potentially damage health, although recognizable health effects are rare. Knowledge is limited about the chemicals and most of them cannot be measured by available devices. Typical preventive measures are passive ventilation and personal protective equipment but their use is not consistent and may not provide adequate protection. Hazardous chemicals are frequently present in transport containers; however, managers, workers and even occupational health professionals have limited knowledge about the problem. Detailed risk assessment and specific instructions on risk management are needed to provide safe conditions for work with containers.

Keywords: chemical exposure, fumigation, occupational health and safety regulation, transport container

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Authors: K. Sekulová, M. Šimon

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This article focuses on upper-extremity musculoskeletal disorders risk assessment model at workplace. In this model are used risk factors that are responsible for musculoskeletal system damage. Based on statistic calculations the model is able to define what risk of MSD threatens workers who are under risk factors. The model is also able to say how MSD risk would decrease if these risk factors are eliminated.

Keywords: ergonomics, musculoskeletal disorders, occupational diseases, risk factors

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Authors: Betül Sönmez, Aytolan Yıldırım

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Objective: This systematic review aims to methodically analyze studies regarding mobbing behavior prevalence, individuals performing this behavior and the effects of mobbing on Turkish nurses. Background: Worldwide reports on mobbing cases have increased in the past years, a similar trend also observable in Turkey. It has been demonstrated that among healthcare workers, mobbing is significantly widespread in nurses. The number of studies carried out in this regard has also increased. Method: The main criteria for choosing articles in this systematic review were nurses located in Turkey, regardless of any specific date. In November 2014, a search using the keywords 'mobbing, bullying, psychological terror/violence, emotional violence, nurses, healthcare workers, Turkey' in PubMed, Science Direct, Ebscohost, National Thesis Centre database and Google search engine led to 71 studies in this field. 33 studies were not met the inclusion criteria specified for this study. Results: The findings were obtained using the results of 38 studies carried out in the past 13 years in Turkey, a large sample consisting of 8,877 nurses. Analysis of the incidences of mobbing behavior revealed a broad spectrum, ranging from none-slight experiences to 100% experiences. The most frequently observed mobbing behaviors include attacking personality, blocking communication and attacking professional and social reputation. Victims mostly experienced mobbing from their managers, the most common consequence of these actions being psychological effects. Conclusions: The results of studies with various scales indicate exposure of nurses to similar mobbing behavior. The high frequency of exposure of nurses to mobbing behavior in such a large sample highlights the importance of considering this issue in terms of individual and institutional consequences that adversely affect the performance of nurses.

Keywords: mobbing, bullying, workplace violence, nurses, Turkey

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Authors: A. Olivi, P. Reyes Cabrera

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Ageing and urbanization are two of the main trends that characterize the twenty-first century. Its trending is especially accelerated in the emerging countries of Asia and Latin America. Chile is one of the countries in the Latin American region, where the demographic transition to ageing is becoming increasingly visible. The challenges that the new demographic scenario poses to urban administrators call for searching innovative solutions to maximize the functional and psycho-social benefits derived from the relationship between older people and the environment in which they live. Although mobility is central to people's everyday practices and social relationships, it is not distributed equitably. On the contrary, it can be considered another factor of inequality in our cities. Older people are a particularly sensitive and vulnerable group to mobility. In this context, based on the ageing in place strategy and following the social innovation approach within a spatial context, the "Community Observatory of Territorial Information Control and Management" project aims at the collective search and validation of solutions for the satisfaction of mobility and accessibility specific needs of urban aged people. Specifically, the Observatory intends to: i) promote the direct participation of the aged population in order to generate relevant information on the territorial situation and the satisfaction of the mobility needs of this group; ii) co-create dynamic and efficient mechanisms for the reporting and updating of territorial information; iii) increase the capacity of the local administration to plan and manage solutions to environmental problems at the neighborhood scale. Based on a participatory mapping methodology and on the application of digital technology, the Observatory designed and developed, together with aged people, a crowdsourcing platform for smartphones, called DIMEapp, for reporting environmental problems affecting mobility and accessibility. DIMEapp has been tested at a prototype level in two neighborhoods of the city of Valparaiso. The results achieved in the testing phase have shown high potential in order to i) contribute to establishing coordination mechanisms with the local government and the local community; ii) improve a local governance system that guides and regulates the allocation of goods and services destined to solve those problems.

Keywords: accessibility, ageing, city, digital technology, local governance

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Authors: E. Omanya, E. Mueni, G. Makau, M. Kariuki

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HIV infection is the strongest risk factor for a person to develop TB. Isoniazid preventive therapy (IPT) for People Living with HIV (PLWHIV) not only reduces the individual patients’ risk of developing active TB but mitigates cross infection. In Kenya, IPT for six months was recommended through the National TB, Leprosy and Lung Disease Program to treat latent TB. In spite of this recommendation by the national government, uptake of IPT among PLHIV remained low in Kenya by the end of 2015. The USAID/Kenya and East Africa Afya Jijini project, which supports 42 TBHIV health facilities in Nairobi County, began addressing low uptake of IPT through Quality Improvement (QI) teams set up at the facility level. Quality is characterized by WHO as one of the four main connectors between health systems building blocks and health systems outputs. Afya Jijini implements the Kenya Quality Model for Health, which involves QI teams being formed at the county, sub-county and facility levels. The teams review facility performance to identify gaps in service delivery and use QI tools to monitor and improve performance. Afya Jijini supported the formation of these teams in 42 facilities and built the teams’ capacity to review data and use QI principles to identify and address performance gaps. When the QI teams began working on improving IPT uptake among PLHIV, uptake was at 31.8%. The teams first conducted a root cause analysis using cause and effect diagrams, which help the teams to brainstorm on and to identify barriers to IPT uptake among PLHIV at the facility level. This is a participatory process where program staff provides technical support to the QI teams in problem identification and problem-solving. The gaps identified were inadequate knowledge and skills on the use of IPT among health care workers, lack of awareness of IPT by patients, inadequate monitoring and evaluation tools, and poor quantification and forecasting of IPT commodities. In response, Afya Jijini trained over 300 health care workers on the administration of IPT, supported patient education, supported quantification and forecasting of IPT commodities, and provided IPT data collection tools to help facilities monitor their performance. The facility QI teams conducted monthly meetings to monitor progress on implementation of IPT and took corrective action when necessary. IPT uptake improved from 31.8% to 61.2% during the second year of the Afya Jijini project and improved to 80.1% during the third year of the project’s support. Use of QI teams and root cause analysis to identify and address service delivery gaps, in addition to targeted program interventions and continual performance reviews, can be successful in increasing TB related service delivery uptake at health facilities.

Keywords: isoniazid, quality, health care workers, people leaving with HIV

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Authors: Hengameh Hosseini

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Design of large healthcare facilities – such as hospitals, multi-service line clinics, and nursing facilities - that can accommodate patients with wide-ranging disabilities is a challenging endeavor and one that is poorly understood among healthcare facility managers, administrators, and executives. An even less-understood extension of this problem is the implications of weakly or insufficiently accommodative design of facilities for healthcare workers in physically-intensive jobs who may also suffer from a range of disabilities and who are therefore at increased risk of workplace accident and injury. Combine this reality with the vast range of facility types, ages, and designs, and the problem of universal accommodation becomes even more daunting and complex. In this study, we focus on the implication of facility design for healthcare workers suffering with low vision who also have physically active jobs. The points of difficulty are myriad and could span health service infrastructure, the equipment used in health facilities, and transport to and from appointments and other services can all pose a barrier to health care if they are inaccessible, less accessible, or even simply less comfortable for people with various disabilities. We conduct a series of surveys and interviews with employees and administrators of 7 facilities of a range of sizes and ownership models in the Northeastern United States and combine that corpus with in-facility observations and data collection to identify five major points of failure common to all the facilities that we concluded could pose safety threats to employees with vision impairments, ranging from very minor to severe. We determine that lack of design empathy is a major commonality among facility management and ownership. We subsequently propose three methods for remedying this lack of empathy-informed design, to remedy the dangers posed to employees: the use of an existing open-sourced Augmented Reality application to simulate the low-vision experience for designers and managers; the use of a machine learning model we develop to automatically infer facility shortcomings from large datasets of recorded patient and employee reviews and feedback; and the use of a computer vision model fine tuned on images of each facility to infer and predict facility features, locations, and workflows, that could again pose meaningful dangers to visually impaired employees of each facility. After conducting a series of real-world comparative experiments with each of these approaches, we conclude that each of these are viable solutions under particular sets of conditions, and finally characterize the range of facility types, workforce composition profiles, and work conditions under which each of these methods would be most apt and successful.

Keywords: artificial intelligence, healthcare workers, facility design, disability, visually impaired, workplace safety

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Authors: Mahfoudha Sid'Elemine

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The refugee resettlement process profoundly shapes the trajectories of individuals in their new host countries, exerting lasting effects on their long-term integration. Prevailing literature underscores the pivotal role of trust in facilitating successful refugee resettlement. However, this research challenges the notion of trust as universally paramount, contending that its significance is contingent upon variables such as the nature of resettlement programs and the diverse backgrounds and perspectives of refugees. Rather than advocating for a blanket approach to trust-building, this research contends that for certain resettlement programs, trust may prove counterproductive amidst resource constraints and tight service timelines. Moreover, trust may not uniformly emerge as a primary requisite for all refugees, presenting formidable challenges in its establishment. Focusing specifically on resettlement in the United States, this study illustrates how the temporal constraints of resettlement services, coupled with refugees' varied cultural experiences, can impede the cultivation of trust between aid workers and refugees. As an alternative paradigm, this research proposes an approach centered on fostering opportunities for reciprocal engagement, positioning refugees as active contributors within their newfound communities. Embracing reciprocity as the cornerstone of burgeoning relationships promises to fortify refugees' ties with the broader community, bolster their autonomy, and facilitate sustained integration over time. The research draws upon qualitative analyses of in-depth interviews conducted with a subset of resettled refugees, as well as aid workers and volunteers involved in refugee resettlement endeavors within Hampton Roads, Virginia, over the past decade. Through this nuanced examination, the study offers insights into the complexities of trust dynamics in refugee resettlement contexts and advocates for a paradigm shift towards reciprocal integration strategies.

Keywords: Resettlement programs, Trust dynamics, Reciprocity, Long-term integration

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