Search results for: renal access

Authors: Reshma Parvin Nuri, Heather Michelle Aldersey, Setareh Ghahari

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Objectives: Worldwide, it is well known that taking care of children with disabilities (CWD) can have a significant impact on the entire family unit. Over the last few decades, an increased number of studies have been conducted on families of CWD in higher income countries, and much of this research has identified family needs and strategies to meet those needs. However, family needs are incredibly under-studied in developing countries. Therefore, the aims of this study were to: (a) explore the needs of families of children with cerebral palsy (CP) in Bangladesh; (b) investigate how some of the family needs have been met and (c) identify the sources of supports that might help the families to meet their needs in the future. Methods: A face to face, semi-structured in-depth interview was conducted with 20 family members (12 mothers, 4 fathers, 1 sister, 2 grandmothers, and 1 aunt) who visited the Centre for the Rehabilitation of the Paralysed (CRP), Bangladesh between June and August 2016. Constant comparison method of grounded theory approach within the broader spectrum of qualitative study was used to analyze the data. Results: Participants identified five categories of needs: (a) financial needs, (b) access to disability-related services, (c) family and community cohesion, (d) informational needs, and (e) emotional needs. Participants overwhelmingly reported that financial need is their greatest family need. Participants noted that families encountered additional financial expenses for a child with CP, beyond what they would typically pay for their other children. Participants were seeing education as their non-primary need as they had no hope that their children would be physically able to go to school. Some participants also shared their needs for social inclusion and participation and receiving emotional support. Participants further expressed needs to receive information related to the child’s health condition and availability/accessibility of governmental support programs. Besides unmet needs, participants also highlighted that some of their needs have been met through formal and informal support systems. Formal support systems were mainly institution-based and run by non-governmental organizations, whereas participants identified informal support coming from family, friends and community members. Participants overwhelmingly reported that they receive little to no support from the government. However, participants identified the government as the key stakeholder who can play vital role in meeting their unmet needs. Conclusions: In the next phase of this research, the plan is to understand how the Government of the People’s Republic of Bangladesh is working to meet the needs of families of CWD. There is also need for further study on needs of families of children with conditions other than CP and those who live in the community and do not have access to the CRP Services. There is clear need to investigate ways to enable children with CP have better access to education in Bangladesh.

Keywords: Bangladesh, children with cerebral palsy, family needs, support

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Authors: Ali Kassem, Sharf Eldeen-Shazly, Alshemaa Lotfy

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Introduction: Contrast-induced nephropathy (CIN) has been the third leading cause of hospital-acquired renal failure. Patients with cardiac diseases are particularly at risk especially with repeated injections of contrast media. CIN is generally defined as an increase in serum creatinine concentration of > 0.5 mg/dL or 25% above baseline within 48 hours after contrast administration. Aim of work: To examine the frequency of CIN for patients undergoing cardiac catheterization at Sohag University Hospital (Upper Egypt) and to identify possible risk factors for CIN in these patients. Material and methods: The study included 104 patients with mean age 56.11 ±10.03, 64(61.5%) are males while 40(38.5%) are females. 44(42.3%) patients are diabetics, 43(41%) patients are hypertensive, 6(5.7%) patients have congestive heart failure, 69(66.3%) patients on statins, 74 (71.2 %) are on ACEIs or ARBs, 19(15.4%) are on metformin, 6 (5.8%) are on NSAIDs, 30(28.8%) are on diuretics. RESULTS: Patients were classified at the end of the study into two groups: Group A: Included 91 patients who did not develop CIN. Group B: Included 13 patients who developed CIN, of which serum creatinine raised > 0.5mg/dl in 6 patients and raised > 25% from the baseline after the procedure in 13 patients. The overall incidence of CIN was 12.5%. CIN increased with older age. There was an increase in the incidence of CIN in diabetic versus non-diabetic patients (20.5% and 6.7%) respectively. (p< 0.03). There was a highly significant increase in the incidence of CIN in patients with CHF versus those without CHF (100% and 71%) respectively, (P<0001). Patients on diuretics showed a significant increase in the incidence of CIN representing 61.5% of all patients who developed CIN. Conclusion: Older patients, diabetic patients, patients with CHF and patients on diuretics have higher risk of developing CIN during coronary catheterization and should receive reno-protective measures before contrast exposure.

Keywords: cardiac diseases, contrast-induced nephropathy, coronary catheterization, CIN

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Authors: Alaa Abdellatif, Gabrièle Breda

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Background. Advanced therapy medicinal products (ATMPs) are innovative therapies that mainly target orphan diseases and high unmet medical needs. ATMP includes gene therapy medicinal products (GTMP), somatic cell therapy medicinal products (CTMP), and tissue-engineered therapies (TEP). Since legislation opened the way in 2007, 25 ATMPs have been approved in the EU, which is about the same amount as the U.S. Food and Drug Administration. However, not all of the ATMPs that have been approved have successfully reached the market and retained their approval. Objectives. We aim to understand all the factors limiting the market access to very promising therapies in a systemic approach, to be able to overcome these problems, in the future, with scientific, regulatory and commercial innovations. Further to recent reviews that focus either on specific countries, products, or dimensions, we will address all the challenges faced by ATMP development today. Methodology. We used mixed methods and a multi-level approach for data collection. First, we performed an updated academic literature review on ATMP development and their scientific and market access challenges (papers published between 2018 and April 2023). Second, we analyzed industry feedback from cell and gene therapy webinars and white papers published by providers and pharmaceutical industries. Finally, we established a comparative analysis of the regulatory guidelines published by EMA and the FDA for ATMP approval. Results: The main challenges in bringing these therapies to market are the high development costs. Developing ATMPs is expensive due to the need for specialized manufacturing processes. Furthermore, the regulatory pathways for ATMPs are often complex and can vary between countries, making it challenging to obtain approval and ensure compliance with different regulations. As a result of the high costs associated with ATMPs, challenges in obtaining reimbursement from healthcare payers lead to limited patient access to these treatments. ATMPs are often developed for orphan diseases, which means that the patient population is limited for clinical trials which can make it challenging to demonstrate their safety and efficacy. In addition, the complex manufacturing processes required for ATMPs can make it challenging to scale up production to meet demand, which can limit their availability and increase costs. Finally, ATMPs face safety and efficacy challenges: dangerous adverse events of these therapies like toxicity related to the use of viral vectors or cell therapy, starting material and donor-related aspects. Conclusion. As a result of our mixed method analysis, we found that ATMPs face a number of challenges in their development, regulatory approval, and commercialization and that addressing these challenges requires collaboration between industry, regulators, healthcare providers, and patient groups. This first analysis will help us to address, for each challenge, proper and innovative solution(s) in order to increase the number of ATMPs approved and reach the patients

Keywords: advanced therapy medicinal products (ATMPs), product development, market access, innovation

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Authors: Adedoyin Opeyemi Osokoya

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The study assesses the influence of social media on perceived learning outcome of agricultural science students in tertiary institutions in Oyo state, Nigeria. The four-stage sampling procedure was used to select participants. All students in the seven tertiary institutions that offer agriculture science as a course of study in Oyo State was the population. A university, a college of agriculture and a college of education were sampled, and a department from each was randomly selected. Twenty percent of the students’ population in the respective selected department gave a sample size of 165. Questionnaire was used to collect information on respondents’ personal characteristics and information related to access to social media. Data were analysed using descriptive statistics, chi-square, correlation, and multiple regression at the 0.05 confidence level. Age and household size were 21.13 ± 2.64 years and 6 ± 2.1 persons respectively. All respondents had access to social media, majority (86.1%) owned Android phone, 57.6% and 52.7% use social media for course work and entertainment respectively, while the commonly visited sites were WhatsApp, Facebook, Google, Opera mini. Over half (53.9%) had an unfavourable attitude towards the use of social media for learning; benefits of the use of social media for learning was high (56.4%). Removal of information barrier created by distance (x̄=1.58) was the most derived benefit, while inadequate power supply (x̄=2.36), was the most severe constraints. Age (β=0.23), sex (β=0.37), ownership of Android phone (β=-1.29), attitude (β=0.37), constraints (β =-0.26) and use of social media (β=0.23) were significant predictors of influence on perceived learning outcomes.

Keywords: use of social media, agricultural science students, undergraduates of tertiary institutions, Oyo State of Nigeria

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Authors: Michael Nthabiseng Moeti, Makhulu Relebogile Langa, Joey Jansen van Vuuren

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This paper examines the utilization of personal electronic devices like laptops, tablets, and smartphones for professional duties within a financial organization. This phenomenon is known as bring your own device (BYOD). BYOD accords employees the freedom to use their personal devices to access corporate resources from anywhere in the world with Internet access. BYOD arrangements introduce significant security risks for both organizations and users. These setups change the threat landscape for enterprises and demand unique security strategies, as conventional tools tailored for safeguarding managed devices fall short in adequately protecting enterprise assets without active user cooperation. This paper applies protection motivation theory (PMT) to highlight behavioral risks from BYOD users that may impact the security of financial institutions. Thematic analysis was applied to gain a comprehensive understanding of how users perceive this phenomenon. These findings demonstrates that the existence of a security policy does not ensure that all employees will take measures to protect their personal devices. Active promotion of BYOD security policies is crucial for financial institution employees and management. This paper developed a BYOD security model which is useful for understanding compliant behaviors. Given that BYOD security is becoming a major concern across financial sector, it is important. The paper recommends that future research could expand the number of universities from which data is collected.

Keywords: BYOD, information security, protection motivation theory, security risks, thematic analysis

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Authors: Yosi Maria Wijaya, Florisma Arista Riti Tegu

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Background: Hypertension in pregnancy can be prevented by controlling the lifestyle. However, the majority of research on this topic has been conducted on lifestyle in women with normal pregnancy. Few studies of lifestyle have focused on Indonesian pregnant women with hypertension. Aim: The purpose of this study is to determine the association of demographic characteristics and the lifestyle of pregnant women who have hypertension. Methods: In this cross-sectional study, 76 women with hypertension during pregnancy were recruited from primary health care, West Java, Indonesia. Inclusion criteria were gestational age ≥ 28 weeks with the blood pressure systole ≥ 140 mmHg and diastole ≥ 90 mmHg. Data were collected using two instruments: demographic data and Health Promoting Life Style Profile (HPLP II). Data were analyzed with descriptive statistic and linear regression analysis. Results: The majority of participants were married, mean age was 27.96 years old (SD=6.77) with the mean of gestational age 33.21 (SD=3.49), most of them unemployed (94.7%) and more than a half participants have an education less than twelve years (59.2%). The total score of lifestyle was 2.44 (SD=0.34), more than a half participants experience unhealthy lifestyle (59.2%). Lifestyle was predicted by income, education years, occupation, and access to health care services, accounting for 20.8% of the total variance. Conclusion: Pregnant women with hypertension with low income, low level of education, non-occupational and hard to access health care services were related to unhealthy lifestyle. Understanding the lifestyle and associated factors contributes to health care providers ability to design effective interventions intended to improve healthy lifestyle among pregnant women with hypertension.

Keywords: demographic characteristics, hypertension, lifestyle, pregnancy

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Authors: Oduntan Oluwakemi, Obisesan Adekemi Adebisola, Ayo-Bello Taofeeq Ayodeji

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The study examined the factors influencing the adoption of climate-smart agricultural practices among maize farmers in Ondo State, Nigeria. A Multi-stage sampling procedure was used to randomly select one hundred respondents for the study. Primary data were collected from the respondents with the aid of a structured questionnaire and analysed using descriptive statistics and a probit regression model. The results of this study showed that crop diversification was the most adopted climate-smart agricultural practice by the respondents, and adoption of Climate Smart Agricultural practices is still very low among the respondents. Results of probit regression revealed that marital status, access to extension services, farming experience, membership of farmers’ association, and access to credit had a positive influence on the adoption of climate-smart agricultural practices, while age, farm size, and total income had a negative influence. Based on the findings of the study, it was recommended that government should develop suitable policies that will encourage farmers, especially rural farmers, to adopt and utilize Climate Smart Agricultural Practices (CSAP). Equally, the study also recommended government should be geared towards supporting improved extension services, providing on-farm demonstration training, disseminating information about climate-smart agricultural practices, and providing credit facilities through the Agricultural Credit Guarantee Scheme Fund and bank credit to farmers in order to enhance the adoption.

Keywords: adoption, agriculture, climate-smart, farmers, maize, Nigeria

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Authors: Victor Emery David Jr., Jiang Wenchao, Daniel Mmereki, Yasinta John

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The fundamentals of public health are access to safe and clean drinking water. The presence of arsenic and other contaminants in drinking water leads to the potential risk to public health and the environment particularly in most developing countries where there’s inadequate access to safe and clean water and adequate sanitation. Liberia has taken steps to improve its drinking water status so as to achieve the Sustainable Development Goals (SDGs) target of ensuring clean water and effective sanitation but there is still a lot to be done. The Sustainable Development Goals are a United Nation initiative also known as transforming our world: The 2030 agenda for sustainable development. It contains seventeen goals with 169 targets to be met by respective countries. Liberia is situated within in the gold belt region where there exist the presence of arsenic and other contaminants in the underground water due to mining and other related activities. While there are limited or no epidemiological studies conducted in Liberia to confirm illness or death as a result of arsenic contamination in Liberia, it remains a public health concern. This paper assesses the drinking water quality, the presence of arsenic in groundwater/drinking water in Liberia, and proposes strategies for mitigating contaminants in drinking water and suggests options for improvement with regards to achieving the Sustainable Development Goals of ensuring clean water and effective sanitation in Liberia by 2030.

Keywords: arsenic, action plan, contaminants, environment, groundwater, sustainable development goals (SDGs), Monrovia, Liberia, public health, drinking water

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Authors: Amna Beshir Medani Ahmed, Samia Mohammed Ali El Badwi, Ahmed El Amin Mohammed

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This work has been managed to yield toxicity information on water treatment agents in the Sudan namely polyDADMAC, using New Zealand rabbits at multiple daily oral doses for a period of 10 weeks. Thirty-three heads of New Zealand rabbits were divided into 11 groups, each of three. Group 1 animals were the undosed controls. Test groups of either species were given polyDADMAC at similar dose rates of 0.5, 2.5, 4.5, 10, 15, 20, 25, 50, 100 and 150 mg/kg body weight respectively for groups 2,3,4,5,6,7,8,9,10 and 11. Clinical signs were closely observed with postmortem and histopathological examinations. Chemical investigations included enzymatic concentrations of ALP, GOT, CK, GPT and LDH together with hematological changes in Hb, PCV, RBCs and WBCs. Mortalities occurred to variable degrees irrespective of the dose level. On polyDADMAC challenge, the test species showed clinical signs of dullness, loss of weight, anorexia, diarrhea, difficulty in respiration, hind limb paralysis and recumbency. Notably oral dosing with polyDADMAC caused lung emphysema, hepatic and renal dysfunctions, irregularity in enzymatic activities and serum metabolites, sloughing of intestinal epithelium, decreased electrolytes in serum, and splenic haemosiderosis. On evaluation of the above results, polyDADMAC was considered toxic to New Zealand rabbits at all dose rates tried. Practical implications of the results were highlighted and suggestions for future work were put forward.

Keywords: polydiallyldiethylaluminiumchloride (polyDADMAC), nubian goats, toxicity of drinking water, treatment of drinking water using chemicals

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Authors: H. Scholz, P. Kuehne, G. Heckenberger

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Dietary Anion-Cation Balance (DCAB) in grazing systems under German conditions has a tendency to decrease from May until September and often are measured DCAB lower than 100 meq per kg dry matter. Lower DCAB in grass feeding system can change the metabolic status of suckler cows and often are results in acidotic metabolism. Measurement of acid-base excretion in dairy cows has been proved to a method to evaluate the acid-base status. The hypothesis was that metabolic imbalances could be identified by urine measurement in suckler cows. The farm study was conducted during the grazing seasons 2017 and 2018 and involved 7 suckler cow farms in Germany. Suckler cows were grazing during the whole time of the investigation and had no access to other feeding components. Cows had free access to water and salt block and free access to minerals (loose). The dry matter of the grass was determined at 60 °C and were then analysed for energy and nutrient content and for the Dietary Cation-Anion Balance (DCAB). Urine was collected in 50 ml-glasses and analysed for net acid-base excretion (NSBA) and the concentration of creatinine and urea in the laboratory. Statistical analysis took place with ANOVA with fixed effects of farms (1-7), month (May until September), and number of lactations (1, 2, and ≥ 3 lactations) using SPSS Version 25.0 for windows. An alpha of 0.05 was used for all statistical tests. During the grazing periods of years 2017 and 2018, an average DCAB was observed in the grass of 167 meq per kg DM. A very high mean variation could be determined from -42 meq/kg to +439 meq/kg. Reference values in relation to DCAB were described between 150 meq and 400 meq per kg DM. It was found the high chlorine content with reduced potassium level led to this reduction in DCAB at the end of the grazing period. Between the DCAB of the grass and the NSBA in urine of suckler cows was a correlation according to PEARSON of r = 0.478 (p ≤ 0.001) or after SPEARMAN of r = 0.601 (p ≤ 0.001) observed. For the control of urine values of grazing suckler cows, the wide spread of the values poses a challenge of the interpretation, especially since the DCAB is unknown. The influence of several feeding components such as chlorine, sulfur, potassium, and sodium (ions for the DCAB) and dry matter feed intake during the grazing period of suckler cows should be taken into account in further research. The results obtained show that up a decrease in the DCAB is related to a decrease in NSBA in urine of suckler cows. Monitoring of metabolic disturbances should include analysis of urine, blood, milk, and ruminal fluid.

Keywords: dietary anion-cation balance, DCAB, net acid-base excretion, NSBA, suckler cow, grazing period

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Authors: Tulsi Ram Bhusal

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Global climate change is known to have a huge impact on agriculture due to changing in rainfall pattern and elevated air temperature that lead to drought and/or flooding. This systematic study has focused on agriculture in Nepal. The study has shown that the trend of current climatic change is affecting rice production, while the farmers with technological access have tried to adapt to the changing conditions at their level. There is insufficient intervention from the government side in terms of policies and schemes. The lack of sufficient funds is one of the significant reasons in terms of governance. The climatic trends and the way it is affecting the annual riceyieldinNepal has been discussed in this study thoroughly. This study has reviewed published studies and ferred important points regarding the Nepal’s status on rice production. Mainly due to the increasing graph of average temperature and other physical conditions needed for the proper cultivation of ricearechanging due to which there is significant dropofannual rice production. Although from corners of the country, many farmers have attempted to adapt the methods of cultivation to the changing climatic conditions, lack of access to technologies, and fund allocation from the governmental level, it is difficult for the mtobringchanges in rice production by the crown without any institutional help. This systematic study effectively presents the magnitude of the impact on rice cultivation due to climatic changes inrecenttimesinNepal. This review aims to bring the current scenarioofNepal’sricefarming, and it impacts due to changing climate, which can subsequently contribute in devising plans for proper governance, formulating policies, and allocation of funds for the betterment.

Keywords: rice, climate change, rice production, nepal, agriculture

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Authors: Lefteris Tsipis, Demosthenes Vouyioukas, George Loumos, Antonis Kargas, Dimitris Varoutas

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The employment of technology and digitization is crucial for cultural organizations to establish and sustain digital repositories for their cultural heritage artefacts. This utilization is also essential in facilitating the presentation of cultural works and exhibits to a broader audience. Consequently, in this work, we propose a digital repository that functions as Software as a Service (SaaS), primarily promoting the safe storage, display, and sharing of cultural materials, enhancing accessibility, and fostering a deeper understanding and appreciation of cultural heritage. Moreover, the proposed digital repository service is designed as a multitenant architecture, which enables organizations to expand their reach, enhance accessibility, foster collaboration, and ensure the preservation of their content. Specifically, this project aims to assist each cultural institution in organizing its digital cultural assets into collections and feeding other digital platforms, including educational, museum, pedagogical, and games, through appropriate interfaces. Moreover, the creation of this digital repository offers a cutting-edge and effective open-access laboratory solution. It allows organizations to have a significant influence on their audiences by fostering cultural understanding and appreciation. Additionally, it facilitates the connection between different digital repositories and national/European aggregators, promoting collaboration and information sharing. By embracing this solution, cultural institutions can benefit from shared resources and features, such as system updates, backup and recovery services, and data analytics tools, that are provided by the platform.

Keywords: cultural technologies, gaming technologies, web sharing, digital repository

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Authors: Sepideh Jabbari Behnam, Shadabeh Gashtasbi Iraei, Elnaz Mohsenin, MohammadAli Aghajani

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Urban neighborhoods, as important urban forming cells, play a key role in creating urban texture and integrated form. Nowadays, most of neighborhood divisions are based on urban management systems but without considering social issues and the other aspects of urban life. This can cause problems such as providing inappropriate services for city dwellers, the loss of local identity and etc. In this regard for regenerating of such neighborhoods, it is essential to locate neighborhood centers with appropriate access and services for all residents. The main objective of this article is reaching to the location of neighborhood centers in a way that, most of issues relating to the physical features (such as the form of access network and texture permeability and etc.) and other qualities such as land uses, densities and social and economic features can be done simultaneously. This paper attempts to use methods of spatial analysis in order to surveying spatial structure and space syntax of urban textures and Urban Network Analysis Systems. This can be done by one of GIS toolbars which is named UNA (Urban Network Analysis) with the use of its five functions (include: Reach, Betweenness, Gravity, Closeness, Straightness).These functions were written according to space syntax theory and offer its relating output. This paper tries to locate and evaluate the optimal location of neighborhood centers in order to create local centers. This is done through weighing of each of these functions and taking into account of spatial features.

Keywords: evaluate optimal location, Local centers, location of neighborhood centers, Spatial analysis, Urban network

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Authors: Shin-Pin Tseng

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Nowadays, numerous spectral amplitude coding (SAC) fiber-optic code-division-multiple-access (FO-CDMA) techniques were appealing due to their capable of providing moderate security and relieving the effects of multiuser interference (MUI). Nonetheless, the performance of the previous network is degraded due to fixed in-phase cross-correlation (IPCC) value. Based on the above problems, a new SAC FO-CDMA network using partial M-sequence (PMS) code is presented in this study. Because the proposed PMS code is originated from M-sequence code, the system using the PMS code could effectively suppress the effects of MUI. In addition, two-code keying (TCK) scheme can applied in the proposed SAC FO-CDMA network and enhance the whole network performance. According to the consideration of system flexibility, simple optical encoders/decoders (codecs) using fiber Bragg gratings (FBGs) were also developed. First, we constructed a diagram of the SAC FO-CDMA network, including (N/2-1) optical transmitters, (N/2-1) optical receivers, and one N×N star coupler for broadcasting transmitted optical signals to arrive at the input port of each optical receiver. Note that the parameter N for the PMS code was the code length. In addition, the proposed SAC network was using superluminescent diodes (SLDs) as light sources, which then can save a lot of system cost compared with the other FO-CDMA methods. For the design of each optical transmitter, it is composed of an SLD, one optical switch, and two optical encoders according to assigned PMS codewords. On the other hand, each optical receivers includes a 1 × 2 splitter, two optical decoders, and one balanced photodiode for mitigating the effect of MUI. In order to simplify the next analysis, the some assumptions were used. First, the unipolarized SLD has flat power spectral density (PSD). Second, the received optical power at the input port of each optical receiver is the same. Third, all photodiodes in the proposed network have the same electrical properties. Fourth, transmitting '1' and '0' has an equal probability. Subsequently, by taking the factors of phase‐induced intensity noise (PIIN) and thermal noise, the corresponding performance was displayed and compared with the performance of the previous SAC FO-CDMA networks. From the numerical result, it shows that the proposed network improved about 25% performance than that using other codes at BER=10-9. This is because the effect of PIIN was effectively mitigated and the received power was enhanced by two times. As a result, the SAC FO-CDMA network using PMS codes has an opportunity to apply in applications of the next-generation optical network.

Keywords: spectral amplitude coding, SAC, fiber-optic code-division multiple-access, FO-CDMA, partial M-sequence, PMS code, fiber Bragg grating, FBG

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Authors: Esther M. Folarin, Evans Osabuohien, Ademola Onabote

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Agriculture constitutes an important part of development and poverty mitigation in lower-middle-income countries, like Nigeria. The level of agricultural productivity in the Nigerian economy in line with the level of demand necessary to meet the desired expectation of the Nigerian populace is threatening to meeting the standard of the United Nations (UN) Sustainable Development Goals (SDGs); This includes the SDG-2 (achieve food security through agricultural productivity). The overall objective of the study is to reveal the performance of the interaction variable in the model among other factors that help in the achievement of greater Nigerian agricultural productivity. The study makes use of Wave 4 (2018/2019) of the Living Standard Measurement Studies, Integrated Survey on Agriculture (LSMS-ISA). Qualitative analysis of the information was also used to provide complimentary answers to the quantitative analysis done in the study. The study employed human capital theory and Grossman’s theory of health Demand in explaining the relationships that exist between the variables within the model of the study. The study engages the Instrumental Variable Regression technique in achieving the broad objectives among other techniques for the other specific objectives. The estimation results show that there exists a positive relationship between female healthcare and the level of female agricultural productivity in Nigeria. In conclusion, the study emphasises the need for more provision and empowerment for greater female access to healthcare and educational attainment levels that aids higher female agricultural productivity and consequently an improvement in the total agricultural productivity of the Nigerian economy.

Keywords: agricultural productivity, education, female, healthcare, investment

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Authors: Karin Schoenpflug, Christine M. Klapeer

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In a large study for the Vienna City Council’s Antidiscrimination unit (WASt) an interdisciplinary team (in the fields of economics, sociology and political science) working with urban economics, critical citizenship studies, the sociology of work & inequality and urban political/human geography conducted an online survey asking LGBTIs (lesbians, gays, bisexuals, transgender and intersex people) in Vienna detailed questions on their quality-of-life, happiness and well-being. 3.161 persons responded and provided us with a rich data set concerning: 1) Labor market structures, discrimination, working conditions and employment practices (economic citizenship); 2) access to health care, welfare, education and safety in public spaces (social citizenship); 3) political participation as well as access to legal institutions (political citizenship). All those fields are important dimensions in regards to “full” citizenship and the well-being of the LGBTI population, but are also constitutive for the inclusion of sexual and gender minorities into the city population(s) of Vienna. Our data also allows us to map the sexual geography of Vienna as LGBTI communities are more likely to live in certain districts; some places are considered safe(r) and “friendlier”. In this way our work helps to fill a research gap connecting (urban) spaces and sexuality, and it produces new data and insights on the quality-of-life of this subpopulation. Our findings allow for urban (policy) planning and limiting violence and discrimination and improving the collective wellbeing and social cohesion.

Keywords: urban sexual geographies, LGBTI, socio-economic status, Vienna, sitizenship status

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Authors: W. Pungchompoo, A. Richardson, L. Brindle

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Background: The developing of a culturally acceptable end of life survey (the VOICES-ESRD/Thai questionnaire) is an essential instrument for evaluation health services provision of older persons with ESRD in Thailand. The focus of the questionnaire was on symptoms, symptom control and the health care needs of older people with ESRD who are managed without dialysis. Objective: The objective of this study was to develop and adapt VOICES to make it suitable for use in a population survey in Thailand. Methods: The mixed methods exploratory sequential design was focussed on modifying an instrument. Data collection: A cognitive interviewing technique was implemented, using two cycles of data collection with a sample of 10 bereaved carers and a prototype of the Thai VOICES questionnaire. Qualitative study was used to modify the developing a culturally acceptable end of life survey (the VOICES-ESRD/Thai questionnaire). Data analysis: The data were analysed by using content analysis. Results: The revisions to the prototype questionnaire were made. The results were used to adapt the VOICES questionnaire for use in a population-based survey with older ESRD patients in Thailand. Conclusions: A culturally specific questionnaire was generated during this second phase and issues with questionnaire design were rectified.

Keywords: VOICES-ESRD/Thai questionnaire, cognitive interviewing, end of life survey, health services provision, older persons with ESRD

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Authors: Kevin Yeo, Christine Hall, Babinchak Tim

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BAT® [Botulism Antitoxin Heptavalent (A,B,C,D,E,F,G)-(Equine)] anti-toxin is a mixture of equine immune globulin fragments indicated for the treatment of symptomatic botulism in adult and pediatric patients. The effectiveness of BAT anti-toxin is based on efficacy studies conducted in animal models. A general explanation of the pivotal animal studies, post market surveillance and outcomes of an observational patient registry for patients treated with BAT product distributed in the USA is briefly discussed. Overall it took 20 animal studies for two well-designed and appropriately powered pivotal efficacy studies – one in which the effectiveness of BAT was assessed against all 7 serotypes in the guinea pig, and the other where efficacy is confirmed in the Rhesus macaque using Serotype A. Clinical Experience for BAT to date involves approximately 600 adult and pediatric patients with suspected botulism. In pre-licensure, patient data was recorded under the US CDC expanded access program (259 adult and pediatric patients between 10 days to 88 years of age). In post licensure, greater than 350 patients to date have received BAT and been followed up by enhanced expanded access program. The analysis of the post market surveillance data provided a unique opportunity to demonstrate clinical benefit in the field study required by the animal rule. While the animal rule is applied because human efficacy studies are not ethical or feasible, a post-marketing requirement is to conduct a study to evaluate safety and clinical benefit when circumstances arise and demonstrate the favourable benefit-risk profile that supported licensure.

Keywords: botulism, threat, clinical benefit, observational patient registry

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Authors: Grace Modupe Adebo, Ayodeji Oluwamuyiwa Adedapo

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Women are key actors in ensuring food security in terms of food availability, food access, and food utilization in the developing economy, however, they suffer mostly during violent conflicts due to their feminist nature of rearing and caring for their children and relatives. The study was embarked upon to access the effects of violent conflicts posed by Boko Haram insurgency on women and food security in the Northeast of Nigeria. The study made use of secondary data. A time series data collected over a 22 years period were used. The data collected were subjected to descriptive statistics and t-test analysis. The findings of the study established a significant difference in food production (availability) before and after the Boko Haram insurgency at the 1% level of significance. The high level of Internally Displaced Person (IDP) with a high proportion of women depicts a very low level of food accessibility as the men and women has fled and uninhabited their place of abode for over a period of four to five years, thus diminishing their economic power, and the means of acquiring food which invariably endanger food stability and utilization. The study confirmed the abduction and changing roles of women as cooks, porters, spies, partners, and sex slaves to Boko Haram troop members, thus affecting their livelihoods and food security. The study recommends hands-on interventions by the governmental, non-governmental and international agencies to terminate the activities of Boko Haram in the area and restore the food production for enhanced food security.

Keywords: Boko Haram insurgency, food accessibility, food production, food utilization, women’s livelihoods

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Authors: Rebecca Zahra, Joseph G. Vella, Ernest Cachia

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The notion of cloud computing is rapidly gaining ground in the IT industry and is appealing mostly due to making computing more adaptable and expedient whilst diminishing the total cost of ownership. This paper focuses on the software as a service (SaaS) architecture of cloud computing which is used for the outsourcing of databases with their associated business processes. One approach for offering SaaS is basing the system’s architecture on multi-tenancy. Multi-tenancy allows multiple tenants (users) to make use of the same single application instance. Their requests and configurations might then differ according to specific requirements met through tenant customisation through the software. Despite the known advantages, companies still feel uneasy to opt for the multi-tenancy with data security being a principle concern. The fact that multiple tenants, possibly competitors, would have their data located on the same server process and share the same database tables heighten the fear of unauthorised access. Security is a vital aspect which needs to be considered by application developers, database administrators, data owners and end users. This is further complicated in cloud-based multi-tenant system where boundaries must be established between tenants and additional access control models must be in place to prevent unauthorised cross-tenant access to data. Moreover, when altering the database state, the transactions need to strictly adhere to the tenant’s known business processes. This paper focuses on the fact that security in cloud databases should not be considered as an isolated issue. Rather it should be included in the initial phases of the database design and monitored continuously throughout the whole development process. This paper aims to identify a number of the most common security risks and threats specifically in the area of multi-tenant cloud systems. Issues and bottlenecks relating to security risks in cloud databases are surveyed. Some techniques which might be utilised to overcome them are then listed and evaluated. After a description and evaluation of the main security threats, this paper produces a list of software requirements to ensure that proper security policies are implemented by a software development team when designing and implementing a multi-tenant based SaaS. This would then assist the cloud service providers to define, implement, and manage security policies as per tenant customisation requirements whilst assuring security for the customers’ data.

Keywords: cloud computing, data management, multi-tenancy, requirements, security

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Authors: Vidyarini Dwita, Rebecca Fanany

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This study will discuss the growth of the market for smartphone technology in Indonesia. This country, with the world’s fourth largest population, has a reputation as the social media capital of the world, and this reputation is largely justified. The penetration of social media is high in Indonesia which has one of the largest global markets. Most Indonesian users of Facebook, Twitter and other social media platforms access the sites from their mobile phones. Indonesia is expected to continue to be a major market for digital mobile devices, such as smartphone and tablets that can access the internet. The aim of this study to describe the way responses of Indonesian consumers to smartphone advertising using English and Indonesian will impact on their perceptions of the prestige and product image of the advertised items and thus influence consumer intention to purchase the item. Advertising for smartphones and similar products is intense and dynamic and often draws on the social attitudes of Indonesians with respect to linguistic and cultural content and especially appeals to their desire to be part of global mainstream culture. The study uses a qualitative method based on in-depth interviews with 30 participants. Content analysis is employed to analyse the responses of Indonesian consumers to smartphone advertising that uses English and Indonesian text. Its findings indicate that consumers’ impressions of English and Indonesian slogans influence their attitudes toward smartphones, suggesting that linguistic context plays a role in influencing consumer purchases.

Keywords: consumer purchases, marketing communication, product image, smartphone advertising, sociolinguistic

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Authors: Bessy Thuranira

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Buildings, as they are designed and used, may contribute to serious environmental problems because of excessive consumption of energy and other natural resources. Buildings in the informal settlements particularly, due to their unplanned physical structure and design, have significantly contributed the global energy problematic scenario typified by high-level inefficiencies. Energy used in buildings in Africa is estimated to be the highest of the total national electricity consumption. Over the last decade, assessments of energy consumption and efficiency/inefficiency has focused on formal and modern buildings. This study seeks to go off the beaten path, by focusing on energy use in informal settlements. Operationally, it sought to establish the contribution of informal buildings in the overall energy consumption in the city and the country at large. This study was carried out in Mukuru kwa Reuben informal settlement where there is distinct manifestation of different settlement morphologies within a small locality. The research narrowed down to three villages (Mombasa, Kosovo and Railway villages) within the settlement, that were representative of the different slum housing typologies. Due to the unpredictability nature and informality in slums, this study takes a multi-methodology approach. Detailed energy audits and measurements are carried out to predict total building consumption, and document building design and envelope, typology, materials and occupancy levels. Moreover, the study uses semi-structured interviews and to access energy supply, cost, access and consumption patterns. Observations and photographs are also used to shed more light on these parameters. The study reveals the high energy inefficiencies in slum buildings mainly related to sub-standard equipment and appliances, building design and settlement layout, poor access and utilization/consumption patterns of energy. The impacts of this inefficiency are high economic burden to the poor, high levels of pollution, lack of thermal comfort and emissions to the environment. The study highlights a set of urban planning and building design principles that can be used to retrofit slums into more energy efficient settlements. The study explores principles of responsive settlement layouts/plans and appropriate building designs that use the beneficial elements of nature to achieve natural lighting, natural ventilation, and solar control to create thermally comfortable, energy efficient, and environmentally responsive buildings/settlements. As energy efficiency in informal settlements is a relatively less explored area of efficiency, it requires further research and policy recommendations, for which this paper will set a background.

Keywords: energy efficiency, informal settlements, renewable energy, settlement layout

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Authors: Chinyama Lukama, Million Phiri, Namuunda Mutombo

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Background: Improving access and utilization to high-quality sexual and reproductive health (SRH) information and services, including family planning (FP) commodities, is central to the global developmental agenda of sub-Saharan Africa (SSA). Despite the importance of family planning use in enhancing maternal health outcomes and fertility reduction, the prevalence of adolescents and young women using modern contraception is generally low in SSA. Zambia is one of the countries in Southern Africa with a high prevalence of teenage pregnancies and fertility rates. Despite many initiatives that have been implemented to improve access and demand for family planning commodities, utilization of FP, especially among adolescents and young women, has generally been low. The objective of this research agenda was to better understand the determinants of modern contraceptive use in adolescents and young women in Zambia. This analysis produced findings that will be critical for informing the strengthening of sexual and reproductive health policy strategies aimed at bolstering the provision and use of maternal health services in order to further improve maternal health outcomes in the country. Method: The study used the recent data from the Demographic and Health Survey of 2018. A sample of 3,513 adolescents and young women (ADYW) were included in the analysis. Multilevel logistic regression models were employed to examine the association of individual and contextual factors with modern contraceptive use among adolescents and young women. Results: The prevalence of modern contraception among sexually active ADYW in Zambia was 38.1% [95% CI, 35.9, 40.4]. ADYW who had secondary or higher level education [aOR = 2.16, 95% CI=1.35–3.47], those with exposure to listening to the radio or watching television [aOR = 1.26, 95% CI=1.01–1.57], and those who had decision-making power at household level [aOR = 2.18, 95% CI=1.71–2.77] were more likely to use modern contraceptives. Conversely, strong neighborhood desire for large family size among ADYW [aOR = 0.65 95% CI = 0.47–0.88] was associated with less likelihood to use modern contraceptives. Community access to family planning information through community health worker visits increased the likelihood [aOR = 1.48, 95% CI=1.16–1.91] of using modern contraception among ADYW. Conclusion: The study found that both individual and community factors were key in influencing modern contraceptive use among adolescents and young women in Zambia. Therefore, when designing family planning interventions, the Government of Zambia, through its policymakers and sexual reproductive health program implementers at the Ministry of Health, in collaboration with stakeholders, should consider the community context. There should also be deliberate actions to encourage family planning education through the media.

Keywords: adolescents, young women, modern contraception use, fertility, family planning

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Authors: B. B. Siswanto, A. Halimi, K. M. H. J. Tandayu, C. Abdillah, F. Nanda , E. Chandra

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Nowadays, modern cardiac biomarkers, such as ST2 and NT-proBNP, have important roles in predicting morbidity and mortality in heart failure patients. Abnormalities of serum electrolytes, sepsis or infection, and deteriorating renal function will worsen the conditions of patients with heart failure. It is intriguing to know whether cardiac biomarkers elevations are affected by laboratory findings in heart failure patients. We recruited 65 patients from the heart failure clinic in NCVC Harapan Kita in 2014-2015. All of them have consented for laboratory examination, including cardiac biomarkers. The findings were recorded in our Research and Development Centre and analyzed using linear regression to find whether there is a relationship between laboratory findings (sodium, potassium, creatinine, and leukocytes) and ST2 or NT-proBNP. From 65 patients, 26.9% of them are female, and 73.1% are male, 69.4% patients classified as NYHA I-II and 31.6% as NYHA III-IV. The mean age is 55.7+11.4 years old; mean sodium level is 136.1+6.5 mmol/l; mean potassium level is 4.7+1.9 mmol/l; mean leukocyte count is 9184.7+3622.4 /ul; mean creatinine level is 1.2+0.5 mg/dl. From linear regression logistics, the relationship between NT-proBNP and sodium level (p<0.001), as well as leukocyte count (p=0.002) are significant, while NT-proBNP and potassium level (p=0.05), as well as creatinine level (p=0.534) are not significant. The relationship between ST2 and sodium level (p=0.501), potassium level (p=0.76), leukocyte level (p=0.897), and creatinine level (p=0.817) are not significant. To conclude, laboratory findings are more sensitive in predicting NT-proBNP elevation than ST2 elevation. Larger studies are needed to prove that NT-proBNP correlation with laboratory findings is more superior than ST2.

Keywords: heart failure, laboratory, NT-proBNP, ST2

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Authors: Raja Ezman Raja Shariff

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Acute kidney injury (AKI) is commonly seen in inpatients, and places a great cost on the NHS and patients. Timely and appropriate management is both nephron sparing and potentially life-saving. Ultrasound scanning (USS) is a well-recognised method for stratifying patients. Subsequently, the NICE AKI guidance has defined groups in whom scanning is recommended within 6 hours of request (pyonephrosis), within 24 hours (obstruction/cause unknown), and in whom routine scanning isn't recommended (cause for AKI identified). The audit looks into whether Stockport NHS Trust USS practice was in line with such recommendations. The audit evaluated 92 patients with AKI who had USS, between 01/01/14 to 30/04/14. Data collection was divided into 2 parts. Firstly, radiology request cards and the online imaging software (PACS) were evaluated. Then, the electronic case notes (ADVANTIS) was evaluated further. Based on request cards, 10% of requests were for pyonephrosis. Only 33% were scanned within 6hours and a further 33% within 24hours. 75% were requested for possible obstructions and unknown cause collectively. Of those due to possible obstruction, 71% of patients were scanned within 24 hours. Of those with unknown cause, 50% were scanned within 24 hours. 15% of requests had a cause declared and so potentially did not require scanning. Evaluation of the patients’ notes suggested further interesting findings. Firstly, potentially 39% of patients had a known cause for AKI, therefore, did not need USS. Subsequently, the cohort of unknown cause and possible obstruction was collectively reduced to 45%. Alarmingly the patient cohort with possible pyonephrosis went up to 16%, suggesting an under-recognition of this life-threatening condition. We plan to highlight these findings within our institution and make changes to encourage more appropriate requesting and timely scanning. Time will tell if we manage to save or increase our costs in this cost-conscious NHS. Patient benefits, though, seem to be guaranteed.

Keywords: AKI, ARF, kidney, renal

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Authors: Alejandra Cardenas, Ona Flores, Fabiola Gretzinger

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Since the 1990s, legal strategies for the promotion and protection of maternal health rights have achieved significant gains. Successful litigation in courts around the world have shown that these rights can be judicially enforceable. Governments and international organizations have acknowledged the importance of a human rights-based approach to maternal mortality and morbidity, and obstetric violence has been recognized as a human rights issue. Despite the progress made, maternal mortality has worsened in some regions of the world, while progress has stagnated elsewhere, and mistreatment in maternal care is reported almost universally. In this context, issues of maternal autonomy and decision-making during pregnancy, labor, and delivery as a critical barrier to access quality maternal health have been largely overlooked. Indeed, despite the principles of autonomy and informed consent in medical interventions being well-established in international and regional norms, how they are applied particularly during childbirth and pregnancy remains underdeveloped. National and global legal standards and decisions related to maternal health were reviewed and analyzed to determine how maternal autonomy and decision-making during pregnancy, labor, and delivery have been protected (or not) by international and national courts. The results of this legal research and analysis lead to the conclusion that a few standards have been set by courts regarding pregnant people’s rights to make choices during pregnancy and birth; however, most undermine the agency of pregnant people. These decisions recognize obstetric violence and gender-based discrimination, but fail to protect pregnant people’s autonomy, privacy, and their right to informed consent. As current human rights standards stand today, maternal health is the only field in medicine and law in which informed consent can be overridden, and patients can be forced to submit to treatments against their will. Unconsented treatment and loss of agency during pregnancy and childbirth can have long-term physical and mental impacts, reduce satisfaction and trust in health systems, and may deter future health-seeking behaviors. This research proposes a path forward that focuses on the pregnant person as an independent agent, relying on the doctrine of self-determination during pregnancy and childbirth, which includes access to the necessary conditions to enable autonomy and choice throughout pregnancy and childbirth as a critical step towards our approaches to reduce maternal mortality, morbidity, and mistreatment, and realize the promise of access to quality maternal health as a human right.

Keywords: autonomy in childbirth and pregnancy, choice, informed consent, jurisprudential analysis

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Authors: Juliet Sorensen, Anna Maitland

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Introduction: Characterized by lack of water and sanitation, food insecurity, and low access to hospitals and clinics, informal urban settlements in Lagos, Nigeria have very poor health outcomes. With little education and a general inability to demand basic rights, these communities are often disempowered and isolated from understanding, claiming, or owning their health needs. Utilizing community-based participatory research characterized by interdisciplinary, cross-cultural partnerships, evidence-based assessments, and both primary and secondary source research, a holistic health education and advocacy program was developed in Lagos to address health barriers for targeted communities. This includes a first of its kind guide formulated to teach community-based health educators how to transmit health information to low-literacy Nigerian audiences while supporting behavior change models and social support mechanisms. This paper discusses the interdisciplinary contributions to developing a health education program while also looking at the need for greater beneficiary ownership and implementation of health justice and access. Methods: In March 2016, an interdisciplinary group of medical, legal, and business graduate students and faculty from Northwestern University conduced a Health Needs Assessment (HNA) in Lagos with a partner and a local non-governmental organization. The HNA revealed that members of informal urban communities in Lagos were lacking basic health literacy, but desired to remedy this lacuna. Further, the HNA revealed that even where the government mandates specific services, many vulnerable populations are unable to access these services. The HNA concluded that a program focused on education, advocacy, and organizing around anatomy, maternal and sexual health, infectious disease and malaria, HIV/AIDS, emergency care, and water and sanitation would respond to stated needs while also building capacity in communities to address health barriers. Results: Based on the HNA, including both primary and secondary source research on integrated health education approaches and behavior change models and responsive, adaptive material development, a holistic program was developed for the Lagos partners and first implemented in November 2016. This program trained community-nominated health educators in adult, low-literacy, knowledge exchange approaches, utilizing information identified by communities as a priority. After a second training in March 2017, these educators will teach community-based groups and will support and facilitate behavior change models and peer-support methods around basic issues like hand washing and disease transmission. They will be supported by community paralegals who will help ensure that newly trained community groups can act on education around access, such as receiving free vaccinations, maternal health care, and HIV/AIDS medicines. Materials will continue to be updated as needs and issues arise, with a focus on identifying best practices around health improvements that can be shared across these partner communities. Conclusion: These materials are the first of their kind, and address a void of health information and understanding pervasive in informal-urban Lagos communities. Initial feedback indicates high levels of commitment and interest, as well as investment by communities in these materials, largely because they are responsive, targeted, and build community capacity. This methodology is an important step in dignity-based health justice solutions, albeit in the process of refinement.

Keywords: community health educators, interdisciplinary and cross cultural partnerships, health justice and access, Nigeria

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Authors: Muhammad nor Farhan Sa'At, Xin Y. Lim, Terence Y. C. Tan, Siti Hajar M. Rosli, Syazwani S. Ali, Ami F. Syed Mohamed

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INTRODUCTION: Hemp (Cannabis sativa subsp. sativa), commonly used for industrial purposes, differs from marijuana by containing lower levels of delta-9-tetrahydronannabidiol- the principal psychoactive constituent in cannabis. Due to its non-psychoactive nature, there has been growing interest in hemp’s therapeutic potential, which has been investigated through pre-clinical and clinical study modalities. OBJECTIVE: To provide an overview of the current landscape of hemp research, through recent scientific findings specific to the pharmacological effects of the medicinal hemp plant and its derived compounds. METHODS: This review was conducted through a systematic search strategy according to the preferred reporting items for systematic review and meta-analysis-ScR (PRISMA-ScR) checklist on electronic databases including MEDLINE, OVID (OVFT, APC Journal Club, EBM Reviews), Cochrane Library Central and Clinicaltrials.gov. RESULTS: From 65 primary articles reviewed, there were 47 pre-clinical studies related to medicinal hemp. Interestingly, the hemp derivatives showed several potential activities such as anti-oxidative, anti-hypertensive, anti-inflammatory, anti-diabetic, anti-neuroinflammatory, anti-arthritic, anti-acne, and anti-microbial activities. Renal protective effects and estrogenic properties were also exhibited in vitro. CONCLUSION: Medicinal hemp possesses various pharmacological effects tested in vitro and in vivo. Information provided in this review could be used as tool to strengthen the study design of future clinical trial research.

Keywords: Preclinical, Herbal Medicine, Hemp, Cannabis

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Authors: Mesfin Nigussie Ibido

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The study is designed to explore the effects of land certification in securing women’s land rights of two rural villages in Robe district at Arsi Zone of Oromia regional state. The land is very critical assets for human life survival and the backbone for rural women livelihood. Equal access and control power to the land have given a chance for rural women to participate in different economic activities and improve their bargaining ability for decision making on their rights. Unfortunately, women were discriminated and marginalized from access and control of land for centuries through customary practices. However, in many countries, legal reform is used as a powerful tool for eliminating discriminatory provisions in property rights. Among other equity and efficiency concerns, the land certification program in Ethiopia attempts to address gender bias concerns of the current land-tenure system. The existed rural land policy was recognizing a women land rights and benefited by strengthened wives awareness of their land rights and contribute to the strong involvement of wives in decision making. However, harmful practices and policy implementation problems still against women do not fully exercise a provision of land rights in a different area of the country. Thus, this study is carried out to examine the effect of land certification in securing women’s land rights by eliminating the discriminatory nature of cultural abuses of study areas. Probability and non-probability sampling types were used, and the sample size was determined by using the sampling distribution of the proportion method. Systematic random sampling method was applied by taking the nth element of the sample frame. Both quantitative and qualitative research methods were applied, and survey respondents of 192 households were conducted and administering questionnaires in the quantitative method. The qualitative method was applied by interviews with focus group discussions with rural women, case stories, Village, and relevant district offices. Triangulation method was applied in data collection, data presentation and in the analysis of findings. Study finding revealed that the existence of land certification is affected by rural women positively by advancing their land rights, but still, some women are challenged by unsolved problems in the study areas. The study forwards recommendation on the existed problems or gaps to ensure women’s equal access to and control over land in the study areas.

Keywords: decision making, effects, land certification, land right, tenure security

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Authors: Ridha Abdulla Al Hammam

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Purpose: to measure the extent of perceived structural empowerment and work commitment the intensive care unit in SMC have in their work place. Background: nurses’ access to power structures (information, recourses, opportunity, and support) directly influences their productivity, retention, and job satisfaction. Exploring nurses’ level and sources of work commitment (affective, normative, and continuance) is very essential to guide nursing leaders making decisions to improve work environment to facilitate effective nursing care. Both concepts (Structural Empowerment and Work Commitment) were never investigated in our critical care unit. Methods: a sample of 50 nurses attained from the Intensive Care Unit (Adult). Conditions for Workplace Effectiveness Questionnaire and Three-Component Model Employee Commitment Survey were used to measure the two concepts respectively. The study is quantitative, descriptive, and correlational in design. Results: the participants reported moderate structural empowerment provided by their work place (M=15 out of 20). The sample perceived high access to opportunity mainly through gaining more skills (M=4.45 out of 5) where the rest power structures were perceived with moderate accessibility. The participants’ affective commitment (M=5.6 out of 7) to work in the ICU overweighed their normative and continuance commitment (M=5.1, M=4.9 out of 7) implying a stronger emotional connection with their unit. Strong positive and significant correlations were observed between the participants’ structural empowerment scores and all work commitment sources. Conclusion: these results provided an insight on aspects of work environment that need to be fostered and improved in our intensive care unit which have a direct linkage to nurses’ work commitment and potentially to their quality of care they provide.

Keywords: structural empowerment, commitment, intensive care, nurses

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