Search results for: population level
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 16982

Search results for: population level

16232 Impure Water, a Future Disaster: A Case Study of Lahore Ground Water Quality with GIS Techniques

Authors: Rana Waqar Aslam, Urooj Saeed, Hammad Mehmood, Hameed Ullah, Imtiaz Younas

Abstract:

This research has been conducted to assess the water quality in and around Lahore Metropolitan area on the basis of three different land uses, i.e. residential, commercial, and industrial land uses. For this, 29 sample sites have been selected on the basis of simple random sampling technique. Samples were collected at the source (WASA tube wells). The criteria for selecting sample sites are to have a maximum concentration of population in the selected land uses. The results showed that in the residential land use the proportion of nitrate and turbidity is at their highest level in the areas of Allama Iqbal Town and Samanabad Town. Commercial land use of Gulberg and Data Gunj Bakhsh Town have highest level of proportion of chlorides, calcium, TDS, pH, Mg, total hardness, arsenic and alkalinity. Whereas in industrial type of land use in Ravi and Wahga Town have the proportion of arsenic, Mg, nitrate, pH, and turbidity are at their highest level. The high rate of concentration of these parameters in these areas is basically due to the old and fractured pipelines that allow bacterial as well as physiochemical contaminants to contaminate the portable water at the sources. Furthermore, it is seen in most areas that waste water from domestic, industrial, as well as municipal sources may get easy discharge into open spaces and water bodies, like, cannels, rivers, lakes that seeps and become a part of ground water. In addition, huge dumps located in Lahore are becoming the cause of ground water contamination as when the rain falls, the water gets seep into the ground and impures the ground water quality. On the basis of the derived results with the help of Geo-spatial technology ACRGIS 9.3 Interpolation (IDW), it is recommended that water filtration plants must be installed with specific parameter control. A separate team for proper inspection has to be made for water quality check at the source. Old water pipelines must be replaced with the new pipelines, and safe water depth must be ensured at the source end.

Keywords: GIS, remote sensing, pH, nitrate, disaster, IDW

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16231 Comparative Analysis of Effecting Factors on Fertility by Birth Order: A Hierarchical Approach

Authors: Ali Hesari, Arezoo Esmaeeli

Abstract:

Regarding to dramatic changes of fertility and higher order births during recent decades in Iran, access to knowledge about affecting factors on different birth orders has crucial importance. In this study, According to hierarchical structure of many of social sciences data and the effect of variables of different levels of social phenomena that determine different birth orders in 365 days ending to 1390 census have been explored by multilevel approach. In this paper, 2% individual row data for 1390 census is analyzed by HLM software. Three different hierarchical linear regression models are estimated for data analysis of the first and second, third, fourth and more birth order. Research results displays different outcomes for three models. Individual level variables entered in equation are; region of residence (rural/urban), age, educational level and labor participation status and province level variable is GDP per capita. Results show that individual level variables have different effects in these three models and in second level we have different random and fixed effects in these models.

Keywords: fertility, birth order, hierarchical approach, fixe effects, random effects

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16230 Association of MIR146A rs2910164 Variation with a Predisposition to Sporadic Breast Cancer in a Pakistani Cohort

Authors: Mushtaq Ahmad, Bashir Rahman, Taqweem-ul-Haq, Fazal Jalil, Aftab Ali Shah

Abstract:

Single nucleotide polymorphisms (SNPs) in genes coding for microRNAs (miRNAs) play a pivotal role in the progression of breast cancer (BC). We investigated the association of miR-146a rs2910164 G/C polymorphism with the risk of BC in the Pakistani population. The miR-146a rs2910164 polymorphism was genotyped in 300 BC-cases and 300 age- and gender-matched healthy controls using T-ARMS-PCR. Genotype and allele frequencies were calculated, and the association between genotypes and the risk of BC was calculated by odds ratios (OR) and confidence intervals (95%). A significant difference in genotypic frequencies (χ2=63.10; p ≤ 0.0001) and allelic frequencies (OR=0.3955 (0.3132-0.4993); p ≤ 0.0001) was observed between cases and controls. Furthermore, we also found that miR-146 rs2910164 CC homozygote increased the risk of breast cancer in the dominant (OR=0.2397 (0.1629-0.3526); p=0.0001; GG vs GC+CC) and recessive (OR=2.803 (1.865- 4.213); P ≤ 0.0001; CC vs GC+GG) inheritance models. In summary, miR-146a rs2910164 G/C is significantly associated with BC in the Pakistani population. To our knowledge, this is the first study that assessed MIR146a rs2910164 G > C SNP in Pakistani population. By analyzing the secondary structure of MIR146A variant, a significant structural modification was noted. Study with a larger sample size is needed to further confirm these findings.

Keywords: breast cancer, MIR146A, microRNA, SNP

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16229 Effectiveness of Laughter Yoga in Reducing Anxiety among Pre-Operative Patients for Scheduled Major Surgery

Authors: Denise Allison D. Garcia, Camille C. Garcia, Keanu Raphael Garrido, Crestita B. Tan

Abstract:

Introduction: Anxiety is a common problem among pre-operative patients. Several methods or interventions are being applied in order to relieve anxiety. Laughter yoga, however, is a method that has been used to relieve anxiety but has not yet been tested to pre-operative patients. Therefore, this study determined the effectiveness of laughter yoga in reducing anxiety among pre-operative middle-aged patients scheduled for major surgery. Methods: After Ethics Review Board approval, a quasi-experimental study was conducted among 40 purposely-selected pre-operative patients in two tertiary hospitals. Anxiety level was measured prior to administration of laughter yoga using the State-Trait Anxiety Inventory with a Cronbach alpha of 0.83. After Laughter yoga, anxiety level was then measured again. Gathered data were analyzed in SPSS version 20 using paired and independent t-test and ANCOVA. Results: After analysis of the data gathered, the results showed that there was a significant decrease in the anxiety level of patients in the experimental group. From an anxiety level of 44.00, the rating went down to 36.85. Meanwhile in the control group, the anxiety level at the pretest at 41.25 went up to 42.50. Laughter yoga was an effective non-pharmacologic intervention for reducing anxiety of pre-operative patients. Conclusion: It is therefore concluded that laughter yoga causes a significant decrease in the anxiety level of patients.

Keywords: anxiety, laughter yoga, non-pharmacologic, pre-operative

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16228 Disparity in New Born Care Practices Reducing in Uttar Pradesh: Evidences from NFHS and DLHS

Authors: Gudakesh Yadav

Abstract:

Utter Pradesh, which is one of the largest states of India with unequal distribution of resources and different socioeconomic and cultural characteristics, level of different new born health care indicators varies a lot from one district to another district. State shared more than 21 percent of total live births of India; whereas, it accounts for 28 percent of total infant deaths of the country, with the 53 per thousand infant mortality rate. The present paper attempts to examine tempo-spatial changes in new born care practices during NFHS-1 to NFHS-3 and DLHS-2 to DLHS-3 in Uttar Pradesh and different regions. Descriptive statistics, rate-ratios, concentration index, multivariate and decomposition analysis has been used for the study. Findings of the study reveal that new born care practices have improved over the time in the state and across all the regions because of giving more emphasis on venerable groups like poor, rural, less educated mothers and scheduled caste & tribes but still it did not achieve the desired successes. Regional analysis of third rounds of DLHS shows that, coverage of intuitional delivery was the lowest in the central region. Performance of the southern region was the lowest in terms of initiation of breastfeeding, keeping baby warm and dry after the birth. The study calls for proper follow up of new born children to accelerate new born and child health care service and prioritises increasing antenatal check-ups and institutional delivery, which helps to improve level of other new born care services. At the policy level there is need to reach venerable groups like scheduled caste and tribes, poor and uneducated, and new mother especially in rural areas. High focused district should be allocated for better implementation of new born care promotion programme in low performing districts. Partnership with the private sector health professional is necessary to reach the every part of population.

Keywords: decomposition, inequality, initiation of breastfeeding, institutional delivery

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16227 The Effectiveness of a Six-Week Yoga Intervention on Body Awareness, Warnings of Relapse, and Emotion Regulation among Incarcerated Females

Authors: James D. Beauchemin

Abstract:

Introduction: The incarceration of people with mental illness and substance use disorders is a major public health issue with social, clinical, and economic implications. Yoga participation has been associated with numerous psychological benefits; however, there is a paucity of research examining impacts of yoga with incarcerated populations. The purpose of this study was to evaluate effectiveness of a six-week yoga intervention on several mental health-related variables, including emotion regulation, body awareness, and warnings of substance relapse among incarcerated females. Methods: This study utilized a pre-post, three-arm design, with participants assigned to intervention, therapeutic community, or general population groups. A between-group analysis of covariance (ANCOVA) was conducted across groups to assess intervention effectiveness using the Difficulties in Emotion Regulation Scale (DERS), Scale of Body Connection (SBC), and Warnings of Relapse (AWARE) Questionnaire. Results: ANCOVA results for warnings of relapse (AWARE) revealed significant between-group differences F(2, 80) = 7.15, p = .001; np2 = .152), with significant pairwise comparisons between the intervention group and both the therapeutic community (p = .001) and the general population (p = .005) groups. Similarly, significant differences were found for emotional regulation (DERS) F(2, 83) = 10.521, p = .000; np2 = .278). Pairwise comparisons indicated a significant difference between the intervention and general population (p = .01). Finally, significant differences between the intervention and control groups were found for body awareness (SBC) F(2, 84) = 3.69, p = .029; np2 = .081). Between-group differences were clarified via pairwise comparisons, indicating significant differences between the intervention group and both the therapeutic community (p = .028) and general population groups (p = .020). Implications: Study results suggest that yoga may be an effective addition to integrative mental health and substance use treatment for incarcerated women and contributes to increasing evidence that holistic interventions may be an important component for treatment with this population. Specifically, given the prevalence of mental health and substance use disorders, findings revealed that changes in body awareness and emotion regulation might be particularly beneficial for incarcerated populations with substance use challenges as a result of yoga participation. From a systemic perspective, this proactive approach may have long-term implications for both physical and psychological well-being for the incarcerated population as a whole, thereby decreasing the need for traditional treatment. By integrating a more holistic, salutogenic model that emphasizes prevention, interventions like yoga may work to improve the wellness of this population while providing an alternative or complementary treatment option for those with current symptoms.

Keywords: wellness, solution-focused coaching, college students, prevention

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16226 Influencing Factors of School Enterprise Cooperation: An Exploratory Study in Chinese Vocational Nursing Education

Authors: Xiao Chen, Alice Ho, Mabel Tie, Xiaoheng Xu

Abstract:

Background and Significance of the Study: School-enterprise cooperation has been the cornerstone of vocational education in China and many other countries. Researchers and policymakers have paid much attention to ensuring the implementation and improving the quality of school-enterprise cooperation. However, many problems still exist on the implementation level of the cooperation. On the one hand, the enterprises lack the motivation to participate in the cooperation. On the other hand, there is a lack of effective guidance and management during the cooperation. Furthermore, the current literature focuses greatly on policy recommendations on the national level while failing to provide a detailed practical understanding of how school-enterprise cooperation is carried out on the ground level. With emerging social problems, such as the aging population in China, there is an increasing need for diverse nursing services and better nursing quality. Methodology: To gain a deeper understanding of the influencing factors of the implementation of school-enterprise cooperation, this work conducted 37 exploratory interviews in four Chinese cities spanning first-tier to fourth-tier cities with hospital department directors, vocational school deans, nurses, and vocational students. Multiple critical policy documents that founded the current vocational education system in China were analyzed, along with the data collected from the interviews. Major Findings: Based on the policy and interview analyses, this work reveals a set of influencing factors for school-enterprise cooperation implementation. Findings from each region contribute to an overall model of influencing factors for implementing school-enterprise cooperation in vocational nursing education in China, which leads to practical insights for policy recommendation. The key influencing factors are found based on the policy, hospital, school, and social levels. Following practical policy recommendations were presented. Moving forward, further research on the implementation of school-enterprise cooperation in specific industries will become increasingly critical to improving the effectiveness of educational policies and the quality of vocational education.

Keywords: nursing, policy recommendation, school-enterprise cooperation, vocational education

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16225 Food Intake Patterns in Omani University Students

Authors: Nasiruddin Khan, Saud Iqbal

Abstract:

Arabian Gulf region has undergone enormous development due to oil boom resulting in overwhelming changes in the lifestyle of the population over the past few decades. This study focused on food consumption patterns of Omani university students. Information, on anthropometric measurements, dietary intakes (measured by a food frequency questionnaire) of students was recorded. Anthropometric data revealed 62.5% of the subjects to be of normal weight and approximately 25% being overweight. Female students appeared to be more weight conscious than males. Dietary intakes in terms of servings (Mean ± S.D) per day among normal weight (BMI 18.5 – 24.9) males vs. females were approximately; cereals (7.5 ± 5.9 vs. 4.9 ± 2.9 servings), meat and alternatives (1.9 ± 0.9 vs. 1.5 ± 0.9 servings), dairy foods (0.9 ± 0.8 vs. 1.1 ± 0.9 servings) per day, respectively. Overall 55.3% of both males (average 1.9 servings) as well as females (average 1.7 servings) had severely inadequate intakes of vegetables on a daily basis as per the food guide pyramid recommendations. Only the fruit group intakes were adequate in about 70% of the population. Adequate intakes of dairy and meat and alternatives group were found in only 22% and 32% of the subjects, respectively. These results indicate a significant influence of a modern lifestyle on dietary habits and food selection of the target population.

Keywords: dietary pattern, food guide pyramid, lifestyle, Oman

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16224 Telepsychiatry for Asian Americans

Authors: Jami Wang, Brian Kao, Davin Agustines

Abstract:

COVID-19 highlighted the active discrimination against the Asian American population easily seen through media, social tension, and increased crimes against the specific population. It is well known that long-term racism can also have a large impact on both emotional and psychological well-being. However, the healthcare disparity during this time also revealed how the Asian American community lacked the research data, political support, and medical infrastructure for this particular population. During a time when Asian American fear for safety with decreasing mental health, telepsychiatry is particularly promising. COVID-19 demonstrated how well psychiatry could integrate with telemedicine, with psychiatry being the second most utilized telemedicine visits. However, the Asian American community did not utilize the telepsychiatry resources as much as other groups. Because of this, we wanted to understand why the patient population who was affected the most by COVID-19 mentally did not seek out care. To do this, we decided to study the top top telepsychiatry platforms. The current top telepsychiatry companies in the United States include Teladoc and BetterHelp. In the Teladoc mental health sector, they only had 4 available languages (English, Spanish, French, and Danis,) with none of them being an Asian language. In a similar manner, Teladoc’s top competitor in the telepsychiatry space, BetterHelp, only listed a total of 3 Asian languages, including Mandarin, Japanese, and Malaysian. However, this is still a short list considering they have over 20 languages available. The shortage of available physicians that speak multiple languages is concerning, as it could be difficult for the Asian American community to relate with. There are limited mental health resources that cater to their likely cultural needs, further exacerbating the structural racism and institutional barriers to appropriate care. It is important to note that these companies do provide interpreters to comply with the nondiscrimination and language assistance federal law. However, interactions with an interpreter are not only more time-consuming but also less personal than talking directly with a physician. Psychiatry is the field that emphasizes interpersonal relationships. The trust between a physician and the patient is critical in developing patient rapport to guide in better understanding the clinical picture and treating the patient appropriately. The language barrier creates an additional barrier between the physician and patient. Because Asian Americans are one of the largest growing patient population bases, these telehealth companies have much to gain by catering to the Asian American market. Without providing adequate access to bilingual and bicultural physicians, the current system will only further exacerbate the growing disparity. The healthcare community and telehealth companies need to recognize that the Asian American population is a severely underserved population in mental health and has much to gain from telepsychiatry. The lack of language is one of many reasons why there is a disparity for Asian Americans in the mental health space.

Keywords: telemedicine, psychiatry, Asian American, disparity

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16223 Employability Skills: The Route to Achieve Demographic Dividend in India

Authors: Malathi Iyer, Jayesh Vaidya

Abstract:

The demographic dividend of India will last for thirty years from now. However, reduction in birth rate, an increase in working population, improvements in medicine and better health practices lead to an ever-expanding elderly population, bringing additional burden to the economy and putting an end to the demographic dividend. To reap the dividend India needs to train the youth for employability. The need of the hour is to improve their life skills which lead the youth to become industrious and have continuous employment. The study will be conducted in perceiving the skill gaps that exist in commerce students for employability. The analysis results indicate the relation between the core study and the right skills for the workforce, with the steps that are taken to open the window for the demographic dividend.

Keywords: demographic dividend, life skills, employability, workforce

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16222 Translation and Validation of the Pain Resilience Scale in a French Population Suffering from Chronic Pain

Authors: Angeliki Gkiouzeli, Christine Rotonda, Elise Eby, Claire Touchet, Marie-Jo Brennstuhl, Cyril Tarquinio

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Resilience is a psychological concept of possible relevance to the development and maintenance of chronic pain (CP). It refers to the ability of individuals to maintain reasonably healthy levels of physical and psychological functioning when exposed to an isolated and potentially highly disruptive event. Extensive research in recent years has supported the importance of this concept in the CP literature. Increased levels of resilience were associated with lower levels of perceived pain intensity and better mental health outcomes in adults with persistent pain. The ongoing project seeks to include the concept of pain-specific resilience in the French literature in order to provide more appropriate measures for assessing and understanding the complexities of CP in the near future. To the best of our knowledge, there is currently no validated version of the pain-specific resilience measure, the Pain Resilience scale (PRS), for French-speaking populations. Therefore, the present work aims to address this gap, firstly by performing a linguistic and cultural translation of the scale into French and secondly by studying the internal validity and reliability of the PRS for French CP populations. The forward-translation-back translation methodology was used to achieve as perfect a cultural and linguistic translation as possible according to the recommendations of the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) group, and an online survey is currently conducted among a representative sample of the French population suffering from CP. To date, the survey has involved one hundred respondents, with a total target of around three hundred participants at its completion. We further seek to study the metric properties of the French version of the PRS, ''L’Echelle de Résilience à la Douleur spécifique pour les Douleurs Chroniques'' (ERD-DC), in French patients suffering from CP, assessing the level of pain resilience in the context of CP. Finally, we will explore the relationship between the level of pain resilience in the context of CP and other variables of interest commonly assessed in pain research and treatment (i.e., general resilience, self-efficacy, pain catastrophising, and quality of life). This study will provide an overview of the methodology used to address our research objectives. We will also present for the first time the main findings and further discuss the validity of the scale in the field of CP research and pain management. We hope that this tool will provide a better understanding of how CP-specific resilience processes can influence the development and maintenance of this disease. This could ultimately result in better treatment strategies specifically tailored to individual needs, thus leading to reduced healthcare costs and improved patient well-being.

Keywords: chronic pain, pain measure, pain resilience, questionnaire adaptation

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16221 Study on the Characteristics of Victims and Victimizers of Intimate Partner Violence in Spain and Its Impact on Criminal Intervention

Authors: María José Benitez Jimenez

Abstract:

This research is based on the hypothesis that, despite being found that the problem of violence against the female partner occurs in all social classes, the criminal intervention falls, above all, on victims and aggressors with sociodemographic characteristics of the most excluded social groups. The methodology used in this study has been a collection of information through Spanish official statistics from 2004 to 2016: population, police, judicial and penitentiary data from Ministry of Interior, Ministry of Justice and statistics National Institute. The data provided show that women victims and aggressors who come into contact with criminal intervention bodies for filing a complaint or having been reported, respectively, show a very high percentage, usually well above 50%, only primary studies or even that. Their employment situation is also precarious, in a percentage that could also be around 70%. The percentage distribution of these two variables is clearly above that which occurs in the whole of the Spanish population, in a particularly marked way as regards the employment situation. Immigrants triple, as victims or as aggressors of gender violence, the percentages of the Spanish population in terms of their contact with the organs of criminal intervention. Also the rate of foreign inmates in prisons for violence against the female couple doubles that of Spanish inmates.

Keywords: inmigrants, intimate partner violence, Spain, sociodemographic characteristics

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16220 Optimal Operation of Bakhtiari and Roudbar Dam Using Differential Evolution Algorithms

Authors: Ramin Mansouri

Abstract:

Due to the contrast of rivers discharge regime with water demands, one of the best ways to use water resources is to regulate the natural flow of the rivers and supplying water needs to construct dams. Optimal utilization of reservoirs, consideration of multiple important goals together at the same is of very high importance. To study about analyzing this method, statistical data of Bakhtiari and Roudbar dam over 46 years (1955 until 2001) is used. Initially an appropriate objective function was specified and using DE algorithm, the rule curve was developed. In continue, operation policy using rule curves was compared to standard comparative operation policy. The proposed method distributed the lack to the whole year and lowest damage was inflicted to the system. The standard deviation of monthly shortfall of each year with the proposed algorithm was less deviated than the other two methods. The Results show that median values for the coefficients of F and Cr provide the optimum situation and cause DE algorithm not to be trapped in local optimum. The most optimal answer for coefficients are 0.6 and 0.5 for F and Cr coefficients, respectively. After finding the best combination of coefficients values F and CR, algorithms for solving the independent populations were examined. For this purpose, the population of 4, 25, 50, 100, 500 and 1000 members were studied in two generations (G=50 and 100). result indicates that the generation number 200 is suitable for optimizing. The increase in time per the number of population has almost a linear trend, which indicates the effect of population in the runtime algorithm. Hence specifying suitable population to obtain an optimal results is very important. Standard operation policy had better reversibility percentage, but inflicts severe vulnerability to the system. The results obtained in years of low rainfall had very good results compared to other comparative methods.

Keywords: reservoirs, differential evolution, dam, Optimal operation

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16219 Slum Dwellers Residential Location Choices Decision: A Determinant of Slum Growth in Lagos Mega City

Authors: Olabisi Badmos, Daniel Callo-Concha, Babatunde Agbola, Andreas Rienow, Klaus Greve, Carsten Jurgens

Abstract:

Slums are important components of city development planning, especially in Africa where slum growth is on par with urban growth. Purposefully, our knowledge on the residential choice of slum dwellers, which contributes to population growth in slums, is limited. This is the case in Lagos, a megacity reportedly dominated by slum dwellers. Thus, this study aims to disclose the factors influencing the residential choices and causes of people to remain in Lagos slums. Data was collected through questionnaire administration and focus group discussions. Descriptive statistics were used to analyze and describe the factors influencing residential location choice; logistic regression was utilized to determine the extent to which the neighborhood and household attributes, influence slum dwellers decisions to remain in the slums. Results showed that movement to Lagos was the main cause of population growth in slums; most of the migrants were from closer geopolitical zones (in Nigeria). Further, the movement patterns observed support two theories of human mobility in slums: slum as a sink, and as a final destination. Also, the factors that brought most of the slum dwellers to the slums (cheap housing, proximity to work etc.) differs from the ones that made them stay (Gender, employment status, housing status etc.). This study concludes that residential choice and intention to stay are the major contributors to population growth in a slum. It is therefore important for Lagos state Government to incorporate these elements of residential choices of slum dwellers in their slum management policies if the city aims to be free of slums by 2030

Keywords: Lagos, population growth, residential decision choices, slum

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16218 Experimental Study on Aerodynamic Noise of Radiator Cooling Fan with Different Diameter in Hemi-Anechoic Chamber

Authors: Malinda Sabrina, F. Andree Yohanes, Khoerul Anwar

Abstract:

There are many sources that cause noise in a car, one of them is noise from radiator cooling fan. This part is used to control engine temperature by ensuring adequate airflow through radiator. Radiator cooling fan noise is a very important matter especially for vehicle manufacturers. This can affect brand image of the car and their customer satisfaction. Therefore, some experiments to measure noise level of the fan are required. Sound pressure level measurements for two axial fans with different diameter have been investigated in a hemi-anechoic chamber based on standard JIS-B8346, focusing on aerodynamic noise. Both fans have the same profile and shape with diameter respectively 43 cm and 49 cm. The measurement was performed in hemi-anechoic chamber in order to obtain a background noise at measuring point as low as possible. Noise characterizations of these radiator cooling fans were measured in five different rotating speed and the results were compared. The measurement result shows that the sound pressure level increases with increasing rotational speed of the fan. In comparison with a smaller diameter, it is shown that fan with larger diameter produces higher noise level at the same rotational speed.

Keywords: aerodynamics noise, hemi-anechoic chamber, radiator cooling fan, sound pressure level

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16217 Health Transformation Program and Effects on Health Expenditures

Authors: Zeynep Karacor, Rahime Hulya Ozturk

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In recent years, the rise of population density and the problem of aging population took attention to the health expenditures. In Turkey, some regulations and infrastructure changes in health sector have occurred. These changes are called Health Transformation Program. The productivity of health services, patient satisfaction, quality of services are tried to be improved with this program. Some radical changes are applied in Turkish economy in this context. The aim of this paper is to present the effects of Health Transformation Program on health expenditures. In the first part of the paper, some information’s about health system and applications in Turkey are discussed. In the second part, the aims of Health Transformation Program are explained. And in the third part the effects of Health Transformation Program on health expenditures are examined.

Keywords: health transformation program, Turkey, health services, health expenditures

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16216 Influence of Cucurbitacin-Containing Phytonematicides on Nematode Biocontrol Agent: Trichoderma harzianum

Authors: Jacqueline T. Madaure, Phatu W. Mashela

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Cucurbitacin-containing phytonematicides consistently suppress root-knot (Meloidogyne species) nematode population densities. However, the impact of these products on nematode biocontrol agents is not documented. The objective of this study was to determine the influence of Nemarioc-AL and Nemafric-BL phytonematicides on growth of Trichoderma harzianum under in vitro conditions. The two phytonematicides were separately prepared to concentrations of 3% and used in poison plate assays. After exposure at different times from 0 to 72 h, there was 100% mycelial growth of T. harzianum. In conclusion, at the recommended concentrations of phytonematicides used in managing nematode population densities, there was no evidence of suppressive effects on growth of T. harzianum by the two phytonematicides.

Keywords: botanicals, crude extracts, cucumis africanus, cucumis myriocarpus, cucurbitacin a, cucurbitacin b, ethnomedicinal plants

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16215 On Pooling Different Levels of Data in Estimating Parameters of Continuous Meta-Analysis

Authors: N. R. N. Idris, S. Baharom

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A meta-analysis may be performed using aggregate data (AD) or an individual patient data (IPD). In practice, studies may be available at both IPD and AD level. In this situation, both the IPD and AD should be utilised in order to maximize the available information. Statistical advantages of combining the studies from different level have not been fully explored. This study aims to quantify the statistical benefits of including available IPD when conducting a conventional summary-level meta-analysis. Simulated meta-analysis were used to assess the influence of the levels of data on overall meta-analysis estimates based on IPD-only, AD-only and the combination of IPD and AD (mixed data, MD), under different study scenario. The percentage relative bias (PRB), root mean-square-error (RMSE) and coverage probability were used to assess the efficiency of the overall estimates. The results demonstrate that available IPD should always be included in a conventional meta-analysis using summary level data as they would significantly increased the accuracy of the estimates. On the other hand, if more than 80% of the available data are at IPD level, including the AD does not provide significant differences in terms of accuracy of the estimates. Additionally, combining the IPD and AD has moderating effects on the biasness of the estimates of the treatment effects as the IPD tends to overestimate the treatment effects, while the AD has the tendency to produce underestimated effect estimates. These results may provide some guide in deciding if significant benefit is gained by pooling the two levels of data when conducting meta-analysis.

Keywords: aggregate data, combined-level data, individual patient data, meta-analysis

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16214 Strengthening Service Delivery to Improving Cervical Cancer Screening in Southwestern Nigeria: A Pilot Project

Authors: Afolabi K. Esther, Kuye Tolulope, Babafemi, L. Olayemi, Omikunle Yemisi

Abstract:

Background: Cervical cancer is a potentially preventable disease of public significance. All sexually active women are at risk of cervical cancer; however, the uptake and coverage are low in low-middle resource countries. Hence, the programme explored the feasibility of demonstrating an innovative and low-cost system approach to cervical cancer screening service delivery among reproductive-aged women in low–resource settings in Southwestern Nigeria. This was to promote the uptake and quality improvement of cervical cancer screening services. Methods: This study was an intervention project in three senatorial districts in Osun State that have primary, secondary and tertiary health facilities. The project was in three phases; Pre-intervention, Intervention, and Post-intervention. The study utilised the existing infrastructure, facilities and staff in project settings. The study population was nurse-midwives, community health workers and reproductive-aged women (30-49 years). The intervention phase entailed using innovative, culturally appropriate strategies to create awareness of cervical cancer and preventive health-seeking behaviour among women in the reproductive-aged group (30-49) years. Also, the service providers (community health workers, Nurses, and Midwives) were trained on screening methods and treatment of pre-cancerous lesions, and there was the provision of essential equipment and supplies for cervical cancer screening services at health facilities. Besides, advocacy and engagement were made with relevant stakeholders to integrate the cervical cancer screening services into related reproductive health services and greater allocation of resources. The expected results compared the pre and post-intervention using the baseline and process indicators and the effect of the intervention phase on screening coverage using a plausibility assessment design. The project lasted 12 months; visual Inspection with Acetic acid (VIA) screening for the women for six months and follow-up in 6 months for women receiving treatment. Results: The pre-intervention phase assessed baseline service delivery statistics in the previous 12 months drawn from the retrospective data collected as part of the routine monitoring and reporting systems. The uptake of cervical cancer screening services was low as the number of women screened in the previous 12 months was 156. Service personnel's competency level was fair (54%), and limited availability of essential equipment and supplies for cervical cancer screening services. At the post-intervention phase, the level of uptake had increased as the number of women screened was 1586 within six months in the study settings. This showed about a 100-%increase in the uptake of cervical cancer screening services compared with the baseline assessment. Also, the post-intervention level of competency of service delivery personnel had increased to 86.3%, which indicates quality improvement of the cervical cancer screening service delivery. Conclusion: the findings from the study have shown an effective approach to strengthening and improving cervical cancer screening service delivery in Southwestern Nigeria. Hence, the intervention promoted a positive attitude and health-seeking behaviour among the target population, significantly influencing the uptake of cervical cancer screening services.

Keywords: cervical cancer, screening, nigeria, health system strengthening

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16213 Effect of Pulmonary Rehabilitation towards Length of Stay and IL-6 Level on Community-Acquired Pneumonia Patients

Authors: Santony Santony, Teguh Rahayu Sartono, Iin Noor Chozin

Abstract:

Introduction: Pneumonia is acute inflammation on lung parenchyma which is caused by bacteria, virus, fungi, or parasite. In Indonesia, Pneumonia is among the ten inpatient cases. Length of stay is related to the increased morbidity rate, nosocomial infection, and costs. The aim of this study is to assess the effect of pulmonary rehabilitation on the difference in length of stay and the level of Interleukin 6 (IL-6) as an inflammation biomarker for community-acquired pneumonia (CAP) patients in non-intensive rooms. Therefore, pulmonary rehabilitation as adjunctive therapy can be routinely exercised in order to shorten the length of stay, along with the decrease in IL-6 level. Methods: This study was conducted from May to October 2019 at Saiful Anwar General Hospital, Malang. 40 community-acquired pneumonia patients in non-intensive rooms were divided into two groups. 20 patients in the treatment group and 20 patients in the control group, all of them were selected through both inclusion and exclusion criteria. This study used simple consecutive random sampling. In the treatment group, pulmonary rehabilitation performed was composed of breathing exercise, effective coughing technique, clapping (percussion), postural drainage, as well as respiratory muscle training using incentive spirometry device. Pulmonary rehabilitation was conducted twice over five days with a minimum duration of 15 minutes. Blood samples were taken both on the first and the fifth day of the treatment to measure IL-6 level as an inflammation biomarker. Result: For the treatment group, the length of stay was 5.35 days whereas the control group 7.6 days. It can be seen that the treatment group had a shorter length of stay by 2.25 days (P<0,001). The IL-6 level on the first day for the treatment group was 36.27 pg/ml, whereas on the fifth day was 34.36 pg/ml. There was a decrease in IL-6 level on the fifth day of treatment even though it was not statistically significant (P=0.628). IL-6 level on the control group for the first day was 67.76 pg/ml, and after the fifth day, the level decreased to 54.43 pg/ml. There seemed to be a decrease in the IL-6, but it was not statistically significant (P=0.502). On the fifth day, the treatment group showed an average IL-6 level of 34.36 pg/ml. This value was lower than that of the control group which did not receive pulmonary rehabilitation having an IL-6 level of 54.43 pg/ml, even though it was not statistically significant (p=0.221). Conclusion: This study concluded that pulmonary rehabilitation as an adjunctive therapy shortened length of stay by 2.25 days for community-acquired pneumonia patients in a non-intensive room. Both groups experienced a decrease in IL-6 level on the fifth day in comparison with the first day even though it was not statistically significant P>0,05. IL-6 level as an inflammation biomarker decreased on the fifth day of treatment which was in accordance with improvement on pneumonia patients.

Keywords: community-acquired pneumonia, interleukin-6, length of stay, pulmonary rehabilitation

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16212 Internet Health: A Cross-Sectional Survey Exploring Identified Risks and Online Safety Measures in Parent and Children with Neurodevelopmental Disorders

Authors: Abdirahim Mohamed, Sarita Rana Chhetri, Michael Sleath, Nadia Saleem

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Rationale: Internet usage has been very much integrated into our daily lives. Internet usage within a neurodevelopmental disorder population is also on the increase. Nevertheless, there is very little empirical research on how this population virtually protect themselves; along with how their parents can keep them safe online. This topic was an ever-growing concern to the parents within our services and in many cases would add to the stresses and mental health of parents. This ignited an idea within our team to conduct research to explore the perceived online risks within this population and how they keep themselves safe. In conjunction, we also explored how parents and caregivers monitor and safeguard their young people to the potential threats online. Our hypothesis was that the perceived risks will heavily outnumber the safeguarding measures implemented by this population. Method: Within the Coventry and Warwickshire NHS Partnership Trust Child and Adolescent Mental Health Service (CAMHS), we distributed qualitative questionnaires to all the clinical bases (N=80). Questions explored topics such as daily internet usage, safeguarding measures, and perceived threats. The researchers requested for all CAMHS clinicians to identify participants. Participants in this study were accessing CAMHS for neurodevelopmental specific interventions. Results: The data were analysed using both Excel and SPSS. Within SPSS, a MANOVA was conducted and found a significant difference between safeguarding measures and perceived online risks within responses (p ≤ 0.5). This supports our hypothesis that participants in this population are well versed in the safeguarding issues of the internet; however, struggle to implement appropriate preventative measures. Data were also screened using Excel and found that all parents and carers stated they 'monitored their child’s internet use'. Conclusion: Data suggest that parents/carers may require more specific intervention to equip them with preventative measures due to the clear discrepancy between perceived risks and safeguarding measures. More research may also need to be conducted around this area to determine appropriate methodology to explore this topic further.

Keywords: Internet, health , how safe are we , internet health check

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16211 Associations Between Psychological Distress and COVID-19 Disease Course: A Retrospective Cohort Study of 3084 Cases in Belgium

Authors: Gwendy Darras, Mattias Desmet

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Previous research showed that psychological distress has a negative impact on the disease course of viral infections. For COVID-19, the same association was observed in small samples of specific segments of the population (e.g. health care workers). The present study presents a more refined analysis of this association, measuring a broader spectrum of psychological distress in a large sample (n=3084) of the general Flemish population. Several types of psychological distress (state, trait and health anxiety, depression, intra-, and interpersonal stress) are registered throughout three periods: one year before the contamination, one week before the contamination, and during the contamination. In doing so, validated scales such as DASS-21, IIP-32, and FCV-19S are used. Furthermore, the course of COVID-19 is registered in several ways: number of symptoms, number of days sick leave due to COVID-19, and number of days the symptoms have lasted. Also, different control variables such as vaccination status, medical and psychological history are taken into account. Statistical analysis shows that all types of psychological distress are positively correlated with the severity of the COVID-19 disease course. Anxiety during the contamination shows the strongest correlation, but psychological distress one year before the onset of COVID-19 was still significantly associated with the worsening of the disease course. As the assessment of the latter type of distress happened before the onset of the COVID-19 disease course, retrospective bias resulting in artificial associations between self-reported stress and COVID-19 severity is unlikely to have impacted the observations. In view of possible future pandemics, it is important to focus on general stress and anxiety reduction in the general population as soon as possible. It is also advisable to minimize the use of stress-inducing messages to encourage the population to adhere to the measures issued during a pandemic.

Keywords: anxiety, COVID-19, depression, psychoneuroimmunology, psychological distress, stress

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16210 Firm Level Productivity Heterogeneity and Export Behavior: Evidence from UK

Authors: Umut Erksan Senalp

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The aim of this study is to examine the link between firm level productivity heterogeneity and firm’s decision to export. Thus, we test the self selection hypothesis which suggests only more productive firms self select themselves to export markets. We analyze UK manufacturing sector by using firm-level data for the period 2003-2011. Although our preliminary results suggest that exporters outperform non-exporters when we pool all manufacturing industries, when we examine each industry individually, we find that self-selection hypothesis does not hold for each industries.

Keywords: total factor productivity, firm heterogeneity, international trade, decision to export

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16209 Factors Affecting Cost Efficiency of Municipal Waste Services in Tuscan Municipalities: An Empirical Investigation by Accounting for Different Management

Authors: María Molinos-Senante, Giulia Romano

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This paper aims at investigating the effect of ownership in the efficiency assessment of municipal solid waste management. In doing so, the Data Envelopment Analysis meta-frontier approach integrating unsorted waste as undesirable output was applied. Three different clusters of municipalities have been created on the basis of the ownership type of municipal waste operators. In the second stage of analysis, the paper investigates factors affecting efficiency, in order to provide an outlook of levers to be used by policy and decision makers to improve efficiency, taking into account different management models in force. Results show that public waste management firms have better performance than mixed and private ones since their efficiency scores are significantly larger. Moreover, it has been demonstrated that the efficiency of waste management firms is statistically influenced by the age of population, population served, municipal size, population density and tourism rate. It evidences the importance of economies of scale on the cost efficiency of waste management. This issue is relevant for policymakers to define and implement policies aimed to improve the long-term sustainability of waste management in municipalities.

Keywords: data envelopment analysis, efficiency, municipal solid waste, ownership, undesirable output

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16208 The Relationship of Lean Management Principles with Lean Maturity Levels: Multiple Case Study in Manufacturing Companies

Authors: Alexandre D. Ferraz, Dario H. Alliprandini, Mauro Sampaio

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Companies and other institutions are constantly seeking better organizational performance and greater competitiveness. In order to fulfill this purpose, there are many tools, methodologies and models for increasing performance. However, the Lean Management approach seems to be the most effective in terms of achieving a significant improvement in productivity relatively quickly. Although Lean tools are relatively easy to understand and implement in different contexts, many organizations are not able to transform themselves into 'Lean companies'. Most of the efforts in its implementation have shown single benefits, failing to achieve the desired impact on the performance of the overall enterprise system. There is also a growing perception of the importance of management in Lean transformation, but few studies have empirically investigated and described the 'Lean Management'. In order to understand more clearly the ideas that guide Lean Management and its influence on the maturity level of the production system, the objective of this research is analyze the relationship between the Lean Management principles and the Lean maturity level in the organizations. The research also analyzes the principles of Lean Management and its relationship with the 'Lean culture' and the results obtained. The research was developed using the case study methodology. Three manufacturing units of a German multinational company from industrial automation segment, located in different countries were studied, in order to have a better comparison between the practices and the level of maturity in the implementation. The primary source of information was the application of a research questionnaire based on the theoretical review. The research showed that higher the level of Lean Management principles, higher are the Lean maturity level, the Lean culture level, and the level of Lean results obtained in the organization. The research also showed that factors such as time for application of Lean concepts and company size were not determinant for the level of Lean Management principles and, consequently, for the level of Lean maturity in the organization. The characteristics of the production system showed much more influence in different evaluated aspects. The present research also left recommendations for the managers of the plants analyzed and suggestions for future research.

Keywords: lean management, lean principles, lean maturity level, lean manufacturing

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16207 Risk Assessment of Lead Element in Red Peppers Collected from Marketplaces in Antalya, Southern Turkey

Authors: Serpil Kilic, Ihsan Burak Cam, Murat Kilic, Timur Tongur

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Interest in the lead (Pb) has considerably increased due to knowledge about the potential toxic effects of this element, recently. Exposure to heavy metals above the acceptable limit affects human health. Indeed, Pb is accumulated through food chains up to toxic concentrations; therefore, it can pose an adverse potential threat to human health. A sensitive and reliable method for determination of Pb element in red pepper were improved in the present study. Samples (33 red pepper products having different brands) were purchased from different markets in Turkey. The selected method validation criteria (linearity, Limit of Detection, Limit of Quantification, recovery, and trueness) demonstrated. Recovery values close to 100% showed adequate precision and accuracy for analysis. According to the results of red pepper analysis, all of the tested lead element in the samples was determined at various concentrations. A Perkin- Elmer ELAN DRC-e model ICP-MS system was used for detection of Pb. Organic red pepper was used to obtain a matrix for all method validation studies. The certified reference material, Fapas chili powder, was digested and analyzed, together with the different sample batches. Three replicates from each sample were digested and analyzed. The results of the exposure levels of the elements were discussed considering the scientific opinions of the European Food Safety Authority (EFSA), which is the European Union’s (EU) risk assessment source associated with food safety. The Target Hazard Quotient (THQ) was described by the United States Environmental Protection Agency (USEPA) for the calculation of potential health risks associated with long-term exposure to chemical pollutants. THQ value contains intake of elements, exposure frequency and duration, body weight and the oral reference dose (RfD). If the THQ value is lower than one, it means that the exposed population is assumed to be safe and 1 < THQ < 5 means that the exposed population is in a level of concern interval. In this study, the THQ of Pb was obtained as < 1. The results of THQ calculations showed that the values were below one for all the tested, meaning the samples did not pose a health risk to the local population. This work was supported by The Scientific Research Projects Coordination Unit of Akdeniz University. Project Number: FBA-2017-2494.

Keywords: lead analyses, red pepper, risk assessment, daily exposure

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16206 Computer Aided Diagnostic System for Detection and Classification of a Brain Tumor through MRI Using Level Set Based Segmentation Technique and ANN Classifier

Authors: Atanu K Samanta, Asim Ali Khan

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Due to the acquisition of huge amounts of brain tumor magnetic resonance images (MRI) in clinics, it is very difficult for radiologists to manually interpret and segment these images within a reasonable span of time. Computer-aided diagnosis (CAD) systems can enhance the diagnostic capabilities of radiologists and reduce the time required for accurate diagnosis. An intelligent computer-aided technique for automatic detection of a brain tumor through MRI is presented in this paper. The technique uses the following computational methods; the Level Set for segmentation of a brain tumor from other brain parts, extraction of features from this segmented tumor portion using gray level co-occurrence Matrix (GLCM), and the Artificial Neural Network (ANN) to classify brain tumor images according to their respective types. The entire work is carried out on 50 images having five types of brain tumor. The overall classification accuracy using this method is found to be 98% which is significantly good.

Keywords: brain tumor, computer-aided diagnostic (CAD) system, gray-level co-occurrence matrix (GLCM), tumor segmentation, level set method

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16205 Modelling Strategy Planning in Multi Business Companies

Authors: Gelareh Changizi, Mahsa Khajavi, Ladan Shahhosseini

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Corporate-level strategy, or simply ‘parent strategy’, is a topic that has received much attention since the very early days of the strategic planning field. Since the multi level enterprises have different sub enterprises which deal with different business environments, we cannot define the same strategic perspective for all of them. Therefore, the determination of a perspective to manage and deal with affiliates of such enterprises is the main challenge. The parent strategy in mother enterprises' level has been analyzed in this research. A case study has been carried to comprehensively describe the proposed model.

Keywords: parent strategy, multi-business companies, performance evaluation, lifecycle

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16204 Community Policing Interventions in the Tribal Hamlets as a Positive Criminal Justice and Social Justice Strategy: A Study Based on the Community Policing Project of the Government of Kerala

Authors: Bharathadas Sandhya

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Janamaithri Suraksha Project is the community policing project of Kerala police, fully sponsored by the Government of Kerala and in vogue in Kerala for the last ten years. The socio-economically weaker areas in the hilly terrains consisting of tribal hamlets are given special importance under the project. These hamlets are visited by the beat police officers, and they intervene in various issues in the hamlets. This study is based on data collected from 350 respondents living in the tribal hamlets of the Nilambur area in the District of Malappuram. The respondents were personally interviewed by the research team using a questionnaire consisting of 183 questions, seeking the details regarding their interaction with beat police officers, their ability to prevent or detect crimes, the menace of Maoists (extremist) presence, their interventions in other socio-economic problems like alcoholism, school dropout issues, lack of facilities for preparation for competitive examinations for educated youth, etc. The perception of the tribal population regarding the effectiveness of police intervention in their criminal justice complaints, the attitude of the police officers towards the tribal population when they approach the police station with a criminal complaint, are also studied. The general socio-economic problems of the tribal population as perceived by them are also brought out. Being the visible agency of the government, the police person coming on beat duty to the hamlet is generally seen by the tribal population as a representative to whom they can communicate the issues, even if it’s solution rests with another department like the forest or agriculture. The analysis of the primary data is carried out using computer applications. The amount of social justice benefits the tribal hamlets received through various government schemes, and their deficiencies are brought out in the study. From the conclusions of the study, certain suggestions for positive criminal justice and social justice intervention strategies are made out. The need for various government departments to work in tandem with each other so as to bring out more effectiveness in the socio-economic projects is evident from the study. Whether it is the need to obtain a transport to go to school or problem of drinking water or even opening a bank account, at least occasionally, the visiting beat police officer is of help to the tribal population. Mostly the tribal population feels free to approach the police with a criminal complaint without any inhibitions.

Keywords: community policing, beat police officer, criminal justice, social justice

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16203 The Effect of Technology on Skin Development and Progress

Authors: Haidy Weliam Megaly Gouda

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Dermatology is often a neglected specialty in low-resource settings despite the high morbidity associated with skin disease. This becomes even more significant when associated with HIV infection, as dermatological conditions are more common and aggressive in HIV-positive patients. African countries have the highest HIV infection rates, and skin conditions are frequently misdiagnosed and mismanaged because of a lack of dermatological training and educational material. The frequent lack of diagnostic tests in the African setting renders basic clinical skills all the more vital. This project aimed to improve the diagnosis and treatment of skin disease in the HIV population in a district hospital in Malawi. A basic dermatological clinical tool was developed and produced in collaboration with local staff and based on available literature and data collected from clinics. The aim was to improve diagnostic accuracy and provide guidance for the treatment of skin disease in HIV-positive patients. A literature search within Embassy, Medline and Google Scholar was performed and supplemented through data obtained from attending 5 Antiretroviral clinics. From the literature, conditions were selected for inclusion in the resource if they were described as specific, more prevalent, or extensive in the HIV population or have more adverse outcomes if they develop in HIV patients. Resource-appropriate treatment options were decided using Malawian Ministry of Health guidelines and textbooks specific to African dermatology. After the collection of data and discussion with local clinical and pharmacy staff, a list of 15 skin conditions was included, and a booklet was created using the simple layout of a picture, a diagnostic description of the disease and treatment options. Clinical photographs were collected from local clinics (with full consent of the patient) or from the book ‘Common Skin Diseases in Africa’ (permission granted if fully acknowledged and used in a not-for-profit capacity). This tool was evaluated by the local staff alongside an educational teaching session on skin disease. This project aimed to reduce uncertainty in diagnosis and provide guidance for appropriate treatment in HIV patients by gathering information into one practical and manageable resource. To further this project, we hope to review the effectiveness of the tool in practice.

Keywords: prevalence and pattern of skin diseases, impact on quality of life, rural Nepal, interventions, quality switched ruby laser, skin color river blindness, clinical signs, circularity index, grey level run length matrix, grey level co-occurrence matrix, local binary pattern, object detection, ring detection, shape identification

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