Search results for: public health sector
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 14673

Search results for: public health sector

6903 Sexual Behaviours among Iranian Men and Women Aged 15 to 49 Years in Metropolitan Tehran, Iran: A Cross-Sectional Study

Authors: Mahnaz Motamedi, Mohammad Shahbazi, Shahrzad Rahimi-Naghani, Mehrdad Salehi

Abstract:

Introduction and Aim: This study assessed sexual behaviours among men and women aged 15 to 49 years in Tehran. Material and Methods: This was a cross-sectional study conducted on 755 men and women aged 15 to 49 years who were residents of Tehran. To select the participants, a multistage, cluster, random sampling method was used and included different regions of Tehran. The data were collected using the WHO-endorsed Questionnaire of Sexual and Reproductive Health. Descriptive, bivariate, and multivariate analyses were conducted using SPSS version 20. Sexual and reproductive health (SRH) behaviours was a scale variable that was constructed from items of six sections: sexual experiences, characteristics of the first sexual partner, characteristics of the first intercourse, next sexual contact and the consequences of the first sexual contact, homosexual experiences and the causes of sexual abstinence. Results: The mean age at the time of sexual intercourse with penetration (vaginal, anal) was 19.88 in men and 21.82 in women. Multivariate analysis using linear regression showed that by controlling for other variables, gender had a significant relationship with having sexual experience, mean age of first sexual intercourse, and being multi-partner. Thus, women with sexual experience were 0.158 units less than men. The mean age of first intercourse in women was 1.57 units higher than men and being a multi-partner in women was 0.247 less than men (P < 0.001). Sexual experience in very religious and relatively religious individuals was 0.332 and 0.218 units less than those for whom religion did not matter (P < 0.001). 25.6% of men and 40.7% of women who did not have sexual experience at the time of the study stated that their reason for abstinence was their unwillingness to have sex (P < 0.05). 35.9% of men and 16.5% of women stated that the reason for abstinence was not providing a suitable opportunity (P < 0.001). 4.7% of men and 1.7% of women had sexual attraction to the same sex. The difference between men and women was significant (P < 0.001). Conclusion: Sexual relation is also present in singles and younger groups and is not limited to married or final marriage candidates. Therefore, more evaluation should be done in national research and interventions for sexual and reproductive health services should be done at the macro level of policy making.

Keywords: sexual behaviours, Iranian men and women, Iran, cross-sectional study

Procedia PDF Downloads 142
6902 The Power of a Vulnerable State: The Rights Revolution and the Emergence of Human Resources Management Departments

Authors: Soheila Ghanbari

Abstract:

After the Civil Rights Act of 1964 was enacted, federal policy transformed employment rights. Equal employment opportunity law, legislation for occupational safety and health, and regulations for fringe benefits were established to ensure that employees have rights to equal protection, health and safety, and the benefits guaranteed by employers. In research analyzing data from 279 organizations over time, it was discovered that legal changes prompted organizations to establish personnel, antidiscrimination, safety, and benefits departments to ensure compliance. However, as the process of institutionalization advanced, middle managers began to separate these fresh offices from policy and rationalize them solely in economic terms as a component of the new human resources management model. This common occurrence is seen in the United States, where the Constitution represents government control of business as unlawful. It could potentially clarify the extended lack of a state theory in organizational analysis and shed light on a puzzle pointed out by state theorists: the federal state is weak in terms of administration but strong in terms of norms.

Keywords: management, state, human, resources, employment

Procedia PDF Downloads 23
6901 Continuance Intention to Use E-administration Information Portal by Non-teaching Staff in Selected Universities, Southwest, Nigeria

Authors: Adebayo Muritala Adegbore

Abstract:

The e-administration is increasingly being recognized as an important phenomenon in this 21st century and its place in society both at the public and private levels cannot be downplayed. Of close attention is how these platforms are adopted and used in academia due to academia’s role in shaping the overall development of the society, particularly the administrative activities of the non-teaching staff in universities since much has not been done to find out the continuance intention to use e-administration information portal by non-teaching staff in universities. This study, therefore, investigates the continuance intention to use e-administration of information portals of senior non-teaching staff in selected universities in southwest Nigeria. The study’s design was a correlational survey using simple random sampling to select three hundred and fifty-two (352) senior non-teaching staff in the selected universities. A standardized questionnaire was used for data capturing while data were analyzed using the descriptive statistics of frequency counts, percentages, means, and standard deviation for the research questions and the Pearson Product Moment Correlation was used for the hypothesis. Findings revealed that the continuance intention of senior non-teaching staff to use e-administration information portal is positive (x = 3.13), the university portal is one of the most utilized e-administration tools (83.4%), while there was an inversely significant relationship between continuance intention to use and use of e-administration information portal (r = -.254; p< 0.05; N = 320).

Keywords: e-administration, e-portal, non-teaching staff, information systems, continuance intention, use of e-administration portals

Procedia PDF Downloads 174
6900 Influence and Depiction of Power in an Urban Space

Authors: Kalpeshkumar Patel, Nikita Manvi

Abstract:

The paper is an attempt to understand the influence and depiction of power in an urban space by throwing light across a few examples across the architectural timeline. Power has been the medium through which ideologies function, as witnessed across the timeline. The center to understand this ideology is to apprehend how power is formed, captured, owned, traded, and distorted. Every urban space has power embedded in it, either for the people who are imposing it or for the public who are receiving it. The most fundamental question in the issue of power is who – who will judge, whose tastes will matter and whose interests are being served. Power is expressed and reinforced by regular means, a boundary and gates, a parade route, a dominant landmark, play of shape or scale in elevation, ceremonial axis, boulevards and avenues, the vista, bilateral symmetry, or regular order. Even if people accept the psychological efficacy of these forms, the way they perceive them may vary depending on the subject. They are cold devices of power used to make some people submit to others. Yet it is also true that these symbolic forms are attractive because they speak to the deep emotions of people. They do indeed give us a sense of security, stability and continuity, awe and pride. The Urban Space for mass assembly is an idea that continues to seduce dictators and democracies. It is a tradition as old as an agora and as manipulative as Baroque Rome.

Keywords: urban space, aggrandization, city planning, landscape, supremacy, democratic

Procedia PDF Downloads 110
6899 Pro Grow Business Partnerships: Unlocking the Potential of SMEs Indonesia With Resource Advantage Theory of Competition Approach

Authors: Kesi Widjajanti

Abstract:

To develop the growth of small and medium enterprises (SMEs), it is important to unlock potential resources that can improve their performance. Business Partnerships (BP) are currently an interesting topic of strategy to use to expand markets and maximize financial and marketing performance. However, many business partnerships have not quite a role among small and medium companies in the creative industry in the Batik Craft sector in Indonesia. This study is rooted in the Resource Advantage Theory of Competition ( RAToC), which emphasizes that the advantage of company resources can be sourced from organizational and relational resources. With the basis of this theory, SMEs can optimize the allocation of relational resources and organizational goals, improve operational efficiency, and gain a strategic advantage in the market. Companies that are able to actualize organizational and relational resources better than other market players can be used for the process of increasing their superior performance. This study explores key elements from the RAToC perspective and shows how Business Partnerships have the potential to drive SMEs' growth. By aligning visions, and organizational resources, sharing knowledge and leveraging complementary relational resources, SMEs can increase their competitiveness, enter new markets, and achieve superior performance. The theoretical contribution of RAToC in small companies is due to the role of Pro-Grow Business Partnership strength as an important antecedent for improving SMEs' performance. The benefits (scenarios) of a Business Partnership to grow together are directed at optimizing resources that can create additional value for customers so that they can outperform competitors. Furthermore, managerial implications for SMEs who wish to unlock their resource potential can encourage the role of Pro-Grow Business Partnerships, which have specific characteristics, can absorb experience/knowledge capacity and utilize this knowledge for the development of "together" business ventures.

Keywords: pro grow business partnership, performance, SMEs, resources advantage theory of competition, industry kreatif batik handycraft indonesia

Procedia PDF Downloads 54
6898 Microthermometry of Carbonated Rocks of the Hondita-Lomagorda Formations, the Tiger Cave Sector, Municipality of Yaguara, Colombia

Authors: Camila Lozano-Vivas, Camila Quevedo-Villamil, Ingrid Munoz-Quijano, Diego Loaiza

Abstract:

Colombia's limited oil reserves make the finding of new fields of extraction or the potentiate of the existing ones a more important task to do every day; the exploration projects that allow to have a better knowledge of the oil basins are essential. The upper Magdalena Valley basin - VSM, whose reserves are limited, has been one of the first basins for the exploration and production of hydrocarbons in Colombia. The Hondita and Lomagorda formations were deposited in the Late Cretaceous Middle Albian to the Coniacian and are characterized by being the hydrocarbon-generating rocks in the VSM basin oil system along with the Shale de Bambucá; therefore multiple studies have been made. In the oil industry, geochemical properties are used to understand the origin, migration, accumulation, and alteration of hydrocarbons and, in general, the evolution of the basin containing them. One of the most important parameters to understand this evolution is the formation temperature of the oil system. For this reason, a microthermometric study of fluid inclusions was carried out to recognize formation temperatures and to determine certain basic physicochemical variables, homogenization temperature, pressure, density and salinity of the fluid at the time of entrapment, providing evidence on the history of different events in different geological environments in the evolution of a sedimentary basin. Prior to this study, macroscopic and microscopic petrographic analyses of the samples collected in the field were performed. The results of the mentioned properties of the fluid inclusions in the different samples analyzed have salinities ranging from 20.22% to 26.37% eq. by weight NaCl, similar densities found in the ranges of 1.05 to 1.16 g/cc and an average homogenization temperature at 142.92°C, indicating that, at the time of their entanglement, the rock was in the window of generation of medium hydrocarbons –light with fragile characteristics of the rock that would make it useful to treat them as naturally fractured reservoirs.

Keywords: homogenization temperature, fluid inclusions, microthermometry, salinity

Procedia PDF Downloads 134
6897 Safeguarding Product Quality through Pre-Qualification of Material Manufacturers: A Ship and Offshore Classification Society's Perspective

Authors: Sastry Y. Kandukuri, Isak Andersen

Abstract:

Despite recent advances in the manufacturing sector, quality issues remain a frequent occurrence, and can result in fatal accidents, equipment downtime, and loss of life. Adequate quality is of high importance in high-risk industries such as sea-going vessels and offshore installations in which third party quality assurance and product control play an important essential role in ensuring manufacturing quality of critical components. Classification societies play a vital role in mitigating risk in these industries by making sure that all the stakeholders i.e. manufacturers, builders, and end users are provided with adequate rules and standards that effectively ensures components produced at a high level of quality based on the area of application and risk of its failure. Quality issues have also been linked to the lack of competence or negligence of stakeholders in supply value chain. However, continued actions and regulatory reforms through modernization of rules and requirements has provided additional tools for purchasers and manufacturers to confront these issues. Included among these tools are updated ‘approval of manufacturer class programs’ aimed at developing and implementing a set of standardized manufacturing quality metrics for use by the manufacturer and verified by the classification society. The establishment and collection of manufacturing and testing requirements described in these programs could provide various stakeholders – from industry to vessel owners – with greater insight into the state of quality at a given manufacturing facility, and allow stakeholders to anticipate better and address quality issues while simultaneously reducing unnecessary failures that are costly to the industry. The publication introduces, explains and discusses critical manufacturing and testing requirements set in a leading class society’s approval of manufacturer regime and its rationale and some case studies.

Keywords: classification society, manufacturing, materials processing, materials testing, quality control

Procedia PDF Downloads 335
6896 Lessons from Implementation of a Network-Wide Safety Huddle in Behavioral Health

Authors: Deborah Weidner, Melissa Morgera

Abstract:

The model of care delivery in the Behavioral Health Network (BHN) is integrated across all five regions of Hartford Healthcare and thus spans the entirety of the state of Connecticut, with care provided in seven inpatient settings and over 30 ambulatory outpatient locations. While safety has been a core priority of the BHN in alignment with High Reliability practices, safety initiatives have historically been facilitated locally in each region or within each entity, with interventions implemented locally as opposed to throughout the network. To address this, the BHN introduced a network wide Safety Huddle during 2022. Launched in January, the BHN Safety Huddle brought together internal stakeholders, including medical and administrative leaders, along with executive institute leadership, quality, and risk management. By bringing leaders together and introducing a network-wide safety huddle into the way we work, the benefit has been an increase in awareness of safety events occurring in behavioral health areas as well as increased systemization of countermeasures to prevent future events. One significant discussion topic presented in huddles has pertained to environmental design and patient access to potentially dangerous items, addressing some of the most relevant factors resulting in harm to patients in inpatient and emergency settings for behavioral health patients. The safety huddle has improved visibility of potential environmental safety risks through the generation of over 15 safety alerts cascaded throughout the BHN and also spurred a rapid improvement project focused on standardization of patient belonging searches to reduce patient access to potentially dangerous items on inpatient units. Safety events pertaining to potentially dangerous items decreased by 31% as a result of standardized interventions implemented across the network and as a result of increased awareness. A second positive outcome originating from the BHN Safety Huddle was implementation of a recommendation to increase the emergency Narcan®(naloxone) supply on hand in ambulatory settings of the BHN after incidents involving accidental overdose resulted in higher doses of naloxone administration. By increasing the emergency supply of naloxone on hand in all ambulatory and residential settings, colleagues are better prepared to respond in an emergency situation should a patient experience an overdose while on site. Lastly, discussions in safety huddle spurred a new initiative within the BHN to improve responsiveness to assaultive incidents through a consultation service. This consult service, aligned with one of the network’s improvement priorities to reduce harm events related to assaultive incidents, was borne out of discussion in huddle in which it was identified that additional interventions may be needed in providing clinical care to patients who are experiencing multiple and/ or frequent safety events.

Keywords: quality, safety, behavioral health, risk management

Procedia PDF Downloads 69
6895 Physico-Chemical and Heavy Metals Analysis of Contaminated Ndawuse River in North Central of Nigeria

Authors: Abimbola Motunrayo Enitan, Ibironke Titilayo Enitan, John Odiyo

Abstract:

The study assessed quality of surface water across Ndawuse River Phase 1, District of the Federal Capital Territory (FCT), Abuja, Nigeria based on physico-chemical variables that are linked to agrochemical and eutrophication, as well as heavy metals concentrations. In total, sixteen surface water samples were obtained from five locations along the river. The results were compared with the standard limits set by both World Health Organization and Federal Environmental Protection Agency for drinking water. The results obtained indicated that BOD5, turbidity, 0.014-3.511 mg Fe/L and 0.078-0.14 mg Cr/L were all above the standard limits. The results further showed that the quality of surface water is being significantly affected by human activities around the Ndawuse River which could pose an adverse health risk to several communities that rely on these receiving water bodies primarily as their source of water. Therefore, there is a need for strict enforcement of environmental laws considering the physico-chemical analysis.

Keywords: Abuja, heavy metals, human exposure risk, Ndawuse River, Nigeria, surface water

Procedia PDF Downloads 240
6894 Access to Higher Education in Nigeria: The University of Calabar Pre-Degree Programme Experience

Authors: Eni I. Eni, James Okon, Ashang J. Ashang

Abstract:

The pre-degree programme of the University of Calabar was introduced to help increase access to tertiary Education in science related courses. This has become necessary due to population increase and public awareness. Its main objective was to provide access to candidates from educationally less developed states (ELDS) and states within its catchment area. To find out if this objective of the programme has been achieved, an impact evaluation of the programme was conducted, from where the aspect of providing access to University Education was reported here. It was reasoned that if this objective of the programme was properly implemented, there should be an evidence of increase in the access to University Education. To achieve the purpose of this study, two research questions were formulated; expost-facto research design and purposive sampling technique were adopted for the study. Data was collected from the Faculty of Science and analyzed using descriptive statistics in terms of frequencies and percentages. The result of data analysis showed that the pre-degree programme of the University of Calabar has provided educational access to Nigerians especially those from educationally less developed states in science related courses. It was therefore recommended that the programme be sustained and further be improved upon to facilitate its continued provision of access to University Education in Nigeria.

Keywords: higher education, pre-degree programme, University of Calabar, educationally less developed states

Procedia PDF Downloads 316
6893 [Keynote Speech]: Bridge Damage Detection Using Frequency Response Function

Authors: Ahmed Noor Al-Qayyim

Abstract:

During the past decades, the bridge structures are considered very important portions of transportation networks, due to the fast urban sprawling. With the failure of bridges that under operating conditions lead to focus on updating the default bridge inspection methodology. The structures health monitoring (SHM) using the vibration response appeared as a promising method to evaluate the condition of structures. The rapid development in the sensors technology and the condition assessment techniques based on the vibration-based damage detection made the SHM an efficient and economical ways to assess the bridges. SHM is set to assess state and expects probable failures of designated bridges. In this paper, a presentation for Frequency Response function method that uses the captured vibration test information of structures to evaluate the structure condition. Furthermore, the main steps of the assessment of bridge using the vibration information are presented. The Frequency Response function method is applied to the experimental data of a full-scale bridge.

Keywords: bridge assessment, health monitoring, damage detection, frequency response function (FRF), signal processing, structure identification

Procedia PDF Downloads 328
6892 The Motivating and Limiting Factors of Learners’ Engagement in an Online Discussion Forum

Authors: K. Durairaj, I. N. Umar

Abstract:

Lately, asynchronous discussion forum is integrated in higher educational institutions as it may increase learning process, learners’ understanding, achievement and knowledge construction. Asynchronous discussion forum is used to complement the traditional, face-to-face learning session in hybrid learning courses. However, studies have proven that students’ engagement in online forum are still unconvincing. Thus, the aim of this study is to investigate the motivating factors and obstacles that affect the learners’ engagement in asynchronous discussion forum. This study is carried out in one of the public higher educational institutions in Malaysia with 18 postgraduate students as samples. The authors have developed a 40-items questionnaire based on literature review. The results indicate several factors that have encouraged or limited students’ engagement in asynchronous discussion forum: (a) the practices or behaviors of peers, or instructors, (b) the needs for the discussions, (c) the learners’ personalities, (d) constraints in continuing the discussion forum, (e) lack of ideas, (f) the level of thoughts, (g) the level of knowledge construction, (h) technical problems, (i) time constraints and (j) misunderstanding. This study suggests some recommendations to increase the students’ engagement in online forums. Finally, based upon the findings, some implications are proposed for further research.

Keywords: asynchronous discussion forum, engagement, factors, motivating, limiting

Procedia PDF Downloads 311
6891 On-Farm Research on Organic Fruits Production in the Eastern Thailand

Authors: Sali Chinsathit, Haruthai Kaenla

Abstract:

Organic agriculture has become a major policy theme for agricultural development in Thailand since October 2005. Organic farming is enlisted as an important national agenda, to promote safe food and national export, and many government authorities have initiated projects and activities centered on organic farming promotion. Currently, Thailand has the market share of about 32 million US$ a year by exporting organic products of rice, vegetables, tea, fruits and a few medicinal herbs. There is high potential in organic crop production as there is the tropical environment promoting crop growth and leader farmer in organic farming. However, organic sector is relatively small (0.2%) comparing with conventional agricultural area, since there are many factors affecting farmers’ adoption and success in organic farming. The objective of this project was to get the organic production technology for at least 3 organic crops. The treatment and method were complied with Thai Organic Standard, and were mainly concerned on increase plant biodiversity and soil improvement by using organic fertilizer and bio-extract from fish, egg, plant and fruits. The bio-logical control, plant-extracts, and cultural practices were used to control insect pests and diseases of 3 crops including mangosteen (Garcinia mangostana L.), longkong (Aglaia dookoo Griff.) and banana (Musa (AA group)). The experiments were carried out at research centers of Department of Agriculture and farmers’ farms in Rayong and Chanthaburi provinces from 2009 to 2013. We found that both locations, plant biodiversity by intercropping mangosteen or longkong with banana and soil improvement with composts and bio-extract from fish could increased yield and farmers’ income by 6,835 US$/ha/year. Farmers got knowledge from these technologies to produce organic crops. The organic products were sold both in domestic and international countries. The organic production technologies were also environmental friendly and could be used as an alternative way for farmers in Thailand.

Keywords: banana, longkong, mangosteen, organic farming

Procedia PDF Downloads 339
6890 Improving Food Security and Commercial Development through Promotion of High Value Medicinal and Industrial Plants in the Swat Valley of Pakistan

Authors: Hassan Sher

Abstract:

Agriculture has a pivotal role in Pakistan’s economy, accounting for about one-fourth of the GDP and employing almost half the population. However, the competitiveness, productivity, growth, employment potential, export opportunity, and contribution to GDP of the sector is significantly hampered by agriculture marketing laws/regulations at the provincial level that reward rent seeking behavior, promote monopoly power, artificially reduce farmer incomes while inflating prices to consumers, and act as disincentives to investment. Although of more recent vintage than some other provincial agricultural marketing laws, the NWFP Agricultural and Livestock Produce Markets Act, 2007 is a throwback to a colonial paradigm, where restrictions on agricultural produce marketing and Government control of distribution channels is the norm. The Swat Valley (in which we include its tributary valleys) is an area of Pakistan in which there is poverty is both extreme and pervasive. For many, a significant portion of the family’s income comes from selling plants that are used as herbs, medicines, and perfumes. Earlier studies have shown that the benefit they derive from this work is less than they might because of: Lack of knowledge concerning which plants and which plant parts are valuable, Lack of knowledge concerning optimal preservation and storage of material, illiteracy. Another concern that much of the plant material sold from the valley is collected in the wild, without an appreciation of the negative impact continued collecting has on wild populations. We propose: Creating colored cards to help inhabitants recognize the 25 most valuable plants in their area; Developing and sharing protocols for growing the 25 most valuable plants in a home garden; Developing and sharing efficient mechanisms for drying plants so they do not lose value; Encouraging increased literacy by incorporating numbers and a few words in the handouts.

Keywords: food security, medicinal plants, industrial plants, economic development

Procedia PDF Downloads 310
6889 Experimental Study of Reflective Roof as a Passive Cooling Method in Homes Under the Paradigm of Appropriate Technology

Authors: Javier Ascanio Villabona, Brayan Eduardo Tarazona Romero, Camilo Leonardo Sandoval Rodriguez, Arly Dario Rincon, Omar Lengerke Perez

Abstract:

Efficient energy consumption in the housing sector in relation to refrigeration is a concern in the construction and rehabilitation of houses in tropical areas. Thermal comfort is aggravated by heat gain on the roof surface by heat gains. Thus, in the group of passive cooling techniques, one of the practices and technologies in solar control that provide improvements in comfortable conditions are thermal insulation or geometric changes of the roofs. On the other hand, methods with reflection and radiation are the methods used to decrease heat gain by facilitating the removal of excess heat inside a building to maintain a comfortable environment. Since the potential of these techniques varies in different climatic zones, their application in different zones should be examined. This research is based on the experimental study of a prototype of a roof radiator as a method of passive cooling in homes, which was developed through an experimental research methodology making measurements in a prototype built by means of the paradigm of appropriate technology, with the aim of establishing an initial behavior of the internal temperature resulting from the climate of the external environment. As a starting point, a selection matrix was made to identify the typologies of passive cooling systems to model the system and its subsequent implementation, establishing its constructive characteristics. Step followed by the measurement of the climatic variables (outside the prototype) and microclimatic variables (inside the prototype) to obtain a database to be analyzed. As a final result, the decrease in temperature that occurs inside the chamber with respect to the outside temperature was evidenced. likewise, a linearity in its behavior in relation to the variations of the climatic variables.

Keywords: appropriate technology, enveloping, energy efficiency, passive cooling

Procedia PDF Downloads 78
6888 Alcohol and Soda Consumption of University Students in Manila

Authors: Alexi Colleen F. Lim, Inna Felicia I. Agoncillo, Quenniejoy T. Dizon, Jennifer Joyce T. Eti, Carlota Aileen H. Monares, Neil Roy B. Rosales, Joshua F. Santillan, Alyssa Francesca D. S. Tanchuling, Josefina A. Tuazon, Mary Joan Therese C. Valera-Kourdache

Abstract:

Majority of leading causes of mortality in the Philippines are NCDs, which are preventable through control of known risk factors such as smoking, obesity, physical inactivity, and alcohol. Sugar-sweetened beverages such as soda and energy drinks also contribute to NCD risk and are of concern particularly for youth. This study provides baseline data on beverage consumption of university students in Manila with the focus on alcohol and soda. It further aims to identify factors affecting consumption. Specific objectives include: (1) to describe beverage consumption practices of university students in Manila; and (2) to determine factors promoting excessive consumption of alcohol and soda including demographic characteristics, attitude, interpersonal and environmental variables. Methods: The study employed correlational design with randomly selected students from two universities in Manila. Students 18 years or older who agreed to participate were included after obtaining ethical clearance. The study had two instruments: (1) World Health Organization’s Alcohol Use Disorders Identification Test (AUDIT) was used with permission, to determine excessive alcohol consumption; and (2) a questionnaire to obtain information regarding soda and energy drink consumption. Results: Out of 400 students surveyed, 70% were female and 78.75% were 18-20 years old (mean=19.79; SD=3.76). Among them, 51.50% consumed alcohol, with 30.10% excessive drinkers. Soda consumption is 91.50% with 37.70% excessive consumers. For energy drinks, 36.75% consume this and only 4.76% drink excessively. Using logistic regression, students who were more likely to be excessive alcohol drinkers belonged to non-health courses (OR=2.21) and purchased alcohol from bars (OR=7.84). Less likely to drink excessively are students who do not drink due to stress (OR=0.05) and drink when it is accessible (OR=0.02). Excessive soda consumption was less likely for female students (OR=0.28), those who drink when it is accessible (OR=0.14), do not drink soda during stressful situations (OR=0.19), and do not use soda as hangover treatment (OR=0.15). Conclusion: Excessive alcohol consumption was greater among students in Manila (30.10%) than in US (20%). Drinking alcohol with friends was not related to excessive consumption but availability in bars was. It is expected that health sciences students are less likely to engage in excessive alcohol as they are more aware of its ill effects. Prevalence of soda consumption in Manila (91.50%) is markedly higher compared to 24.5% in the US. These findings can inform schools in developing appropriate health education interventions and policies. For greater understanding of these behaviors and factors, further studies are recommended to explore knowledge and other factors that may promote excessive consumption.

Keywords: alcohol consumption, beverage consumption, energy drinks consumption, soda consumption, university students

Procedia PDF Downloads 259
6887 Indicators and Sustainability Dimensions of the Mediterranean Diet

Authors: Joana Margarida Bôto, Belmira Neto, Vera Miguéis, Manuela Meireles, Ada Rocha

Abstract:

The Mediterranean diet has been recognized as a sustainable model of living with benefits for the environment and human health. However, a complete assessment of its sustainability, encompassing all dimensions and aspects, to our best knowledge, has not yet been realized. This systematic literature review aimed to fill this gap by identifying and describing the indicators used to assess the sustainability of the Mediterranean diet, looking at several dimensions, and presenting the results from their application. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines methodology was used, and searches were conducted in PubMed, Scopus, Web of Science, and GreenFile. There were identified thirty-two articles evaluating the sustainability of the Mediterranean diet. The environmental impact was quantified in twenty-five of these studies, the nutritional quality was evaluated in seven studies, and the daily cost of the diet was assessed in twelve studies. A total of thirty-three indicators were identified and separated by four dimensions of sustainability, specifically, the environmental dimension (ten indicators, namely carbon, water, and ecological footprint), the nutritional dimension (eight indicators, namely Health score and Nutrient Rich Food Index), the economic dimension (one indicator, the dietary cost), the sociocultural dimension (six indicators – with no results). Only eight of the studies used combined indicators. The Mediterranean diet was considered in all articles as a sustainable dietary pattern with a lower impact than Western diets. The carbon footprint ranged between 0.9 and 6.88 kg CO₂/d per capita, the water footprint between 600 and 5280 m³/d per capita, and the ecological footprint between 2.8 and 53.42 m²/d per capita. The nutritional quality was high, obtaining 122 points using the Health score and 12.95 to 90.6 points using the Nutrient Rich Food Index. The cost of the Mediterranean diet did not significantly differ from other diets and varied between 3.33 and 14.42€/d per capita. A diverse approach to evaluating the sustainability of the Mediterranean diet was found.

Keywords: Mediterranean diet, sustainability, environmental indicators, nutritional indicators

Procedia PDF Downloads 76
6886 Attention Based Fully Convolutional Neural Network for Simultaneous Detection and Segmentation of Optic Disc in Retinal Fundus Images

Authors: Sandip Sadhukhan, Arpita Sarkar, Debprasad Sinha, Goutam Kumar Ghorai, Gautam Sarkar, Ashis K. Dhara

Abstract:

Accurate segmentation of the optic disc is very important for computer-aided diagnosis of several ocular diseases such as glaucoma, diabetic retinopathy, and hypertensive retinopathy. The paper presents an accurate and fast optic disc detection and segmentation method using an attention based fully convolutional network. The network is trained from scratch using the fundus images of extended MESSIDOR database and the trained model is used for segmentation of optic disc. The false positives are removed based on morphological operation and shape features. The result is evaluated using three-fold cross-validation on six public fundus image databases such as DIARETDB0, DIARETDB1, DRIVE, AV-INSPIRE, CHASE DB1 and MESSIDOR. The attention based fully convolutional network is robust and effective for detection and segmentation of optic disc in the images affected by diabetic retinopathy and it outperforms existing techniques.

Keywords: attention-based fully convolutional network, optic disc detection and segmentation, retinal fundus image, screening of ocular diseases

Procedia PDF Downloads 120
6885 Speciation and Bioavailability of Heavy Metals in Greenhouse Soils

Authors: Bulent Topcuoglu

Abstract:

Repeated amendments of organic matter and intensive use of fertilizers, metal-enriched chemicals and biocides may cause soil and environmental pollution in greenhouses. Specially, the impact of heavy metal pollution of soils on food metal content and underground water quality has become a public concern. Due to potential toxicity of heavy metals to human life and environment, determining the chemical form of heavy metals in greenhouse soils is an important approach of chemical characterization and can provide useful information on its mobility and bioavailability. A sequential extraction procedure was used to estimate the availability of heavy metals (Zn, Cd, Ni, Pb and Cr) in greenhouse soils of Antalya Aksu. Zn was predominantly associated with Fe-Mn oxide fraction, major portion of Cd associated with carbonate and organic matter fraction, a major portion of (>65 %) Ni and Cr were largely associated with Fe-Mn oxide and residual fractions and Pb was largely associated with organic matter and Fe-Mn oxide fractions. Results of the present study suggest that the mobility and bioavailability of metals probably increase in the following order: Cr < Pb < Ni < Cd < Zn. Among the elements studied, Zn and Cd appeared to be the most readily soluble and potentially bioavailable metals and these metals may carry a potential risk for metal transfer in food chain and contamination to ground water.

Keywords: metal speciation, metal mobility, greenhouse soils, biosystems engineering

Procedia PDF Downloads 390
6884 Associated Problems with the Open Dump Site and Its Possible Solutions

Authors: Pangkaj Kumar Mahanta, Md. Rafizul Islam

Abstract:

The rapid growth of the population causes a substantial amount of increase in household waste all over the world. Waste management is becoming one of the most challenging phenomena in the present day. The most environmentally friendly final disposal process of waste is sanitary landfilling, which is practiced in most developing countries. However, in Southeast Asia, most of the final disposal point is an open dump site. Due to the ignominy of proper management of waste and monitoring, the surrounding environment gets polluted more by the open dump site in comparison with a sanitary landfill. Khulna is 3rd largest metropolitan city in Bangladesh, having a population of around 1.5 million and producing approximately 450 tons per day of Municipal Solid Waste. The Municipal solid waste of Khulna city is disposed of in Rajbandh open dump site. The surrounding air is being polluted by the gas produced in the open dump site. Also, the open dump site produces leachate, which contains various heavy metals like Cadmium (Cd), Chromium (Cr), Lead (Pb), Manganese (Mn), Mercury (Hg), Strontium (Sr), etc. Leachate pollutes the soil as well as the groundwater of the open dump site and also the surrounding area through seepage. Moreover, during the rainy season, the surface water is polluted by leachate runoff. Also, the plastic waste flowing out from the open dump site through various drivers pollutes the nearby environment. The health risk assessment associated with heavy metals was carried out by computing the chronic daily intake (CDI), hazard quotient (HQ), and hazard index (HI) via different exposure pathways following the USEPA guidelines. For ecological risk, potential contamination index (Cp), Contamination factor (CF), contamination load index (PLI), numerical integrated contamination factor (NICF), enrichment factor (EF), ecological risk index (ER), and potential ecological risk index (PERI) were computed. The health risk and ecological risk assessment results reveal that some heavy metals possess strong health and ecological risk. In addition, the child faces higher harmful health risks from several heavy metals than the adult for all the exposure pathways and media. The conversion of an open dump site into a sanitary landfill and a proper management system can reduce the problems associated with an open dump site. In the sanitary landfill, the produced gas will be managed properly to save the surrounding atmosphere from being polluted. The seepage of leachate can be minimized by installing a compacted clay layer (CCL) as a baseline and leachate collection in a sanitary landfill to save the underlying soil layer and surrounding water bodies from leachate. Another important component of a sanitary landfill is the conversion of plastic waste to energy will minimize the plastic pollution in the landfill area and also the surrounding soil and water bodies. Also, in the sanitary landfill, the bio-waste can be used to make compost to reduce the volume of bio-waste and proper utilization of the landfill area.

Keywords: ecological risk, health risk, open dump site, sanitary landfill

Procedia PDF Downloads 179
6883 Traffic Congestion Analysis and Modeling for Urban Roads of Srinagar City

Authors: Adinarayana Badveeti, Mohammad Shafi Mir

Abstract:

In Srinagar City, in India, traffic congestion is a condition on transport networks that occurs as use increases and is characterized by slower speeds, longer trip times, and increased vehicular queuing. Traffic congestion is conventionally measured using indicators such as roadway level-of-service, the Travel Time Index and their variants. Several measures have been taken in order to counteract congestion like road pricing, car pooling, improved traffic management, etc. While new road construction can temporarily relieve congestion in the longer term, it simply encourages further growth in car traffic through increased travel and a switch away from public transport. The full paper report, on which this abstract is based, aims to provide policymakers and technical staff with the real-time data, conceptual framework and guidance on some of the engineering tools necessary to manage congestion in such a way as to reduce its overall impact on individuals, families, communities, and societies dynamic, affordable, liveable and attractive urban regions will never be free of congestion. Road transport policies, however, should seek to manage congestion on a cost-effective basis with the aim of reducing the burden that excessive congestion imposes upon travellers and urban dwellers throughout the urban road network.

Keywords: traffic congestion, modeling, traffic management, travel time index

Procedia PDF Downloads 294
6882 Molecular Identification and Genotyping of Human Brucella Strains Isolated in Kuwait

Authors: Abu Salim Mustafa

Abstract:

Brucellosis is a zoonotic disease endemic in Kuwait. Human brucellosis can be caused by several Brucella species with Brucella melitensis causing the most severe and Brucella abortus the least severe disease. Furthermore, relapses are common after successful chemotherapy of patients. The classical biochemical methods of culture and serology for identification of Brucellae provide information about the species and serotypes only. However, to differentiate between relapse and reinfection/epidemiological investigations, the identification of genotypes using molecular methods is essential. In this study, four molecular methods [16S rRNA gene sequencing, real-time PCR, enterobacterial repetitive intergenic consensus (ERIC)-PCR and multilocus variable-number tandem-repeat analysis (MLVA)-16] were evaluated for the identification and typing of 75 strains of Brucella isolated in Kuwait. The 16S rRNA gene sequencing suggested that all the strains were B. melitensis and real-time PCR confirmed their species identity as B. melitensis. The ERIC-PCR band profiles produced a dendrogram of 75 branches suggesting each strain to be of a unique type. The cluster classification, based on ~ 80% similarity, divided all the ERIC genotypes into two clusters, A and B. Cluster A consisted of 9 ERIC genotypes (A1-A9) corresponding to 9 individual strains. Cluster B comprised of 13 ERIC genotypes (B1-B13) with B5 forming the largest cluster of 51 strains. MLVA-16 identified all isolates as B. melitensis and divided them into 71 MLVA-types. The cluster analysis of MLVA-16-types suggested that most of the strains in Kuwait originated from the East Mediterranean Region, a few from the African group and one new genotype closely matched with the West Mediterranean region. In conclusion, this work demonstrates that B. melitensis, the most pathogenic species of Brucella, is prevalent in Kuwait. Furthermore, MLVA-16 is the best molecular method, which can identify the Brucella species and genotypes as well as determine their origin in the global context. Supported by Kuwait University Research Sector grants MI04/15 and SRUL02/13.

Keywords: Brucella, ERIC-PCR, MLVA-16, RT-PCR, 16S rRNA gene sequencing

Procedia PDF Downloads 366
6881 Assessment of Naturally Occurring Radionuclides of the Surface Water in Vaal River, South Africa

Authors: Kgantsi B. T., Ochwelwang A. R., Mathuthu M., Jegede O. A.

Abstract:

Anthropogenic activities near water bodies contribute to poor water quality, which degrades the condition of the biota and elevates the risk to human health. The Vaal River is essential in supplying Gauteng and neighboring regions of South Africa with portable water for a variety of consumers and industries. Consequently, it is necessary to monitor and assess the radioactive risk in relation to the river's water quality. This study used an inductive coupled plasma mass spectrometer (ICPMS) to analyze the radionuclide activity concentration in the Vaal River, South Africa. Along with thorium and potassium, the total uranium concentration was calculated using the isotopic content of uranium. The elemental concentration of ²³⁸U, ²³⁵U, ²³⁴U, ²³²Th, and 40K were translated into activity concentrations. To assess the water safety for all users and consumers, all values were compared to world average activity concentrations 35, 30, and 400 Bqkg⁻¹ for ²³⁸U, ²³⁴Th, and ⁴⁰K, respectively, according to the UNSCEAR report. The results will serve as a database for further monitoring and evaluation of the radionuclide from the river, taking cognisance of potential health hazards.

Keywords: Val Rivers, ICPMS, uranium, risks

Procedia PDF Downloads 149
6880 Predicting the Lack of GDP Growth: A Logit Model for 40 Advanced and Developing Countries

Authors: Hamidou Diallo, Marianne Guille

Abstract:

This paper identifies leading triggers of deficient episodes in terms of GDP growth based on a sample of countries at different stages of development over 1994-2017. Using logit models, we build early warning systems (EWS), and our results show important differences between developing countries (DCs) and advanced economies (AEs). For AEs, the main predictors of the probability of entering in a GDP growth deficient episode are the deterioration of external imbalances and the vulnerability of fiscal position while DCs face different challenges that need to be considered. The key indicators for them are first, the low ability to pay their debts, and second, their belonging or not to a common currency area. We also build homogeneous pools of countries inside AEs and DCs. The evolution of the proportion of AE countries in the riskiest pool is marked first, by three distinct peaks just after the high-tech bubble burst, the global financial crisis, and the European sovereign debt crisis, and second by a very low minimum level in 2006 and 2007. In contrast, the situation of DCs is characterized first by the relative stability of this proportion and then by an upward trend from 2006, that can be explained by a more unfavorable socio-political environment leading to shortcomings in the fiscal consolidation.

Keywords: currency area, early warning system, external imbalances, fiscal vulnerability, GDP growth, public debt

Procedia PDF Downloads 107
6879 Anti-tuberculosis, Resistance Modulatory, Anti-pulmonary Fibrosis and Anti-silicosis Effects of Crinum Asiaticum Bulbs and Its Active Metabolite, Betulin

Authors: Theophilus Asante, Comfort Nyarko, Daniel Antwi

Abstract:

Drug-resistant tuberculosis, together with the associated comorbidities like pulmonary fibrosis and silicosis, has been one of the most serious global public health threats that requires immediate action to curb or mitigate it. This prolongs hospital stays, increases the cost of medication, and increases the death toll recorded annually. Crinum asiaticum bulb (CAE) and betulin (BET) are known for their biological and pharmacological effects. Pharmacological effects reported on CAE include antimicrobial, anti-inflammatory, anti-pyretic, anti-analgesic, and anti-cancer effects. Betulin has exhibited a multitude of powerful pharmacological properties ranging from antitumor, anti-inflammatory, anti-parasitic, anti-microbial, and anti-viral activities. This work sought to investigate the anti-tuberculosis and resistant modulatory effects and also assess their effects on mitigating pulmonary fibrosis and silicosis. In the anti-tuberculosis and resistant modulatory effects, both CAE and BET showed strong antimicrobial activities (31.25 ≤ MIC ≤ 500) µg/ml against the studied microorganisms and also produced significant anti-efflux pump and biofilm inhibitory effects (ρ < 0.0001) as well as exhibiting resistance modulatory and synergistic effects when combined with standard antibiotics. Crinum asiaticum bulbs extract and betulin were shown to possess anti-pulmonary fibrosis effects. There was an increased survival rate in the CAE and BET treatment groups compared to the BLM-induced group. There was a marked decrease in the levels of hydroxyproline and collagen I and III in the CAE and BET treatment groups compared to the BLM-treated group. The treatment groups of CAE and BET significantly downregulated the levels of pro-fibrotic and pro-inflammatory cytokine concentrations such as TGF-β1, MMP9, IL-6, IL-1β and TNF-alpha compared to an increase in the BLM-treated groups. The histological findings of the lungs suggested the curative effects of CAE and BET following BLM-induced pulmonary fibrosis in mice. The study showed improved lung functions with a wide focal area of viable alveolar spaces and few collagen fibers deposition on the lungs of the treatment groups. In the anti-silicosis and pulmonoprotective effects of CAE and BET, the levels of NF-κB, TNF-α, IL-1β, IL-6 and hydroxyproline, collagen types I and III were significantly reduced by CAE and BET (ρ < 0.0001). Both CAE and BET significantly (ρ < 0.0001) inhibited the levels of hydroxyproline, collagen I and III when compared with the negative control group. On BALF biomarkers such as macrophages, lymphocytes, monocytes, and neutrophils, CAE and BET were able to reduce their levels significantly (ρ < 0.0001). The CAE and BET were examined for anti-oxidant activity and shown to raise the levels of catalase (CAT) and superoxide dismutase (SOD) while lowering the level of malondialdehyde (MDA). There was an improvement in lung function when lung tissues were examined histologically. Crinum asiaticum bulbs extract and betulin were discovered to exhibit anti-tubercular and resistance-modulatory properties, as well as the capacity to minimize TB comorbidities such as pulmonary fibrosis and silicosis. In addition, CAE and BET may act as protective mechanisms, facilitating the preservation of the lung's physiological integrity. The outcomes of this study might pave the way for the development of leads for producing single medications for the management of drug-resistant tuberculosis and its accompanying comorbidities.

Keywords: fibrosis, crinum, tuberculosis, antiinflammation, drug resistant

Procedia PDF Downloads 64
6878 Malaria Menace in Pregnancy; Hard to Ignore

Authors: Nautiyal Ruchira, Nautiyal Hemant, Chaudhury Devnanda, Bhargava Surbhi, Chauhan Nidhi

Abstract:

Introduction: South East Asian region contributes 2.5 million cases of malaria each year to the global burden of 300 to 500 million of which 76% is reported from India. Government of India launched a national program almost half a century ago, still malaria remains a major public health challenge. Pregnant women are more susceptible to severe malaria and its fetomaternal complications. Inadequate surveillance and under-reporting underestimates the problem. Aim: Present study aimed to analyze the clinical course and pattern of malaria during pregnancy and to study the feto-maternal outcome. Methodology: This is a prospective observational study carried out at Himalayan Institute of Medical Sciences – a tertiary care center in the sub-Himalayan state of Uttarakhand, Northern India. All the pregnant women with malaria and its complications were recruited in the study during 2009 to 2014 which included referred cases from the state of western Uttar Pradesh. A thorough history and clinical examination were carried out to assess maternal and fetal condition. Relevant investigations including haemogram, platelet count, LFT, RFT, and USG was done. Blood slides and rapid diagnostic tests were done to diagnose the type of malaria.The primary outcomes measured were the type of malaria infection, maternal complications associated with malaria, outcome of pregnancy and effect on the fetus. Results: 67 antenatal cases with malaria infection were studied. 71% patients were diagnosed with plasmodium vivax infection, 25% cases were plasmodium falciparum positive and in 3% cases mixed infection was found. 38(56%) patients were primigravida and 29(43%) were multiparous. Most of the patients had already received some treatment from their local doctors and presented with severe malaria with the complications. Thrombocytopenia was the commonest manifestation seen in 35(52%) patients, jaundice in 28%, severe anemia in 18%, and severe oligohydramnios in 10% and renal failure in 6% cases. Regarding pregnancy outcome there were 44 % preterm deliveries, 22% had IUFD and abortions in 6% cases.20% of newborn were low birth weight and 6% were IUGR. There was only one maternal death which occurred due to ARDS in falciparum malaria. Although Plasmodium vivax was the main parasite considering the severity of clinical presentation, all the patients received intensive care. As most of the patients had received chloroquine therapy hence they were treated with IV artesunate followed by oral artemesinin combination therapy. Other therapies in the form of packed RBC’s and platelet transfusions, dialysis and ventilator support were provided when required. Conclusion: Even in areas with annual parasite index (API) less than 2 like ours, malaria in pregnancy could be an alarming problem. Vivax malaria cannot be considered benign in pregnancy because of high incidence of morbidity. Prompt diagnosis and aggressive treatment can reduce morbidity and mortality significantly. Increased community level research, integrating ANC checkups with the distribution of insecticide-treated nets in areas of high endemicity, imparting education and awareness will strengthen the existing control strategies.

Keywords: severe malaria, pregnancy, plasmodium vivax, plasmodium falciparum

Procedia PDF Downloads 262
6877 Reinvestment of the Urban Context in Historic Cities: The Case Study of El Sheikh Kandil Street, Rosetta, Egypt

Authors: Riham A. Ragheb, Ingy M. Naguib

Abstract:

Conservation and urban investment are a prerequisite to improve the quality of life. Since the historic street is a part of the economic system, it should be able to play an important role in the city development by upgrading all services, public open spaces and reuse of historical buildings and sites. Furthermore, historical conservation enriches the political, economic, social, cultural and functional aspects of the site. Rosetta has been selected as an area of study because it has a unique character due to its possession of a variety of monuments and historical buildings. The aim of this research is to analyze the existing situation of an historic street named El Sheikh Kandil, to be able to identify the potentials and problems. The paper gives a proposal for the redesign and reinvestment of the street and the reuse for the historical buildings to serve the community, users and visitors. Then, it concludes with recommendations to improve quality of life through the rehabilitation of the historical buildings and strengthening of the cultural and historical identity of the street. Rosetta city can benefit from these development proposals by preserving and revitalizing its unique character which leads to tourism development and benefits from the new investments.

Keywords: adaptive reuse, heritage street, historic investment, restoration, urban design

Procedia PDF Downloads 160
6876 Impact of Firm Location and Organizational Structure on Receipt and Effectiveness of Social Assistance

Authors: Nalanda Matia, Julia Zhao, Amber Jaycocks, Divya Sinha

Abstract:

Social assistance programs for businesses are intended to improve their survival and growth in the face of catastrophic events like the COVID-19 pandemic. However, that goal remains unfulfilled when the mostwantingbusinesses fail to participate in such programs. Reasons for non-participation can include lack of information, inability to cope with applications and program compliance, as well as some programs’ non-entitlement status. Some of these factors may be associated with the organizational and locational characteristics of these businesses. This research investigates these organizational and locational factorsthat determine receipt and effectiveness of social assistance among the firms that receive it. of A sample of firms from the universe of 3 rounds of Small Business Administration backed Paycheck Protection Program recipient and similarly profiled non recipient businesses are used to analyze this question. Initial results show firm organizational factors like size and spatial factors like broadband coverage at firm location impact application for and subsequent receipt of assistance for digitally administered programs. Further, Line of business and wage structure of recipients’ impact effectiveness of the assistance dollars.

Keywords: public economics, economics of social assistance, firm organizational structure, survival analysis

Procedia PDF Downloads 149
6875 Quantifying User-Related, System-Related, and Context-Related Patterns of Smartphone Use

Authors: Andrew T. Hendrickson, Liven De Marez, Marijn Martens, Gytha Muller, Tudor Paisa, Koen Ponnet, Catherine Schweizer, Megan Van Meer, Mariek Vanden Abeele

Abstract:

Quantifying and understanding the myriad ways people use their phones and how that impacts their relationships, cognitive abilities, mental health, and well-being is increasingly important in our phone-centric society. However, most studies on the patterns of phone use have focused on theory-driven tests of specific usage hypotheses using self-report questionnaires or analyses of smaller datasets. In this work we present a series of analyses from a large corpus of over 3000 users that combine data-driven and theory-driven analyses to identify reliable smartphone usage patterns and clusters of similar users. Furthermore, we compare the stability of user clusters across user- and system-initiated sessions, as well as during the hypothesized ritualized behavior times directly before and after sleeping. Our results indicate support for some hypothesized usage patterns but present a more complete and nuanced view of how people use smartphones.

Keywords: data mining, experience sampling, smartphone usage, health and well being

Procedia PDF Downloads 143
6874 Long Term Survival after a First Transient Ischemic Attack in England: A Case-Control Study

Authors: Padma Chutoo, Elena Kulinskaya, Ilyas Bakbergenuly, Nicholas Steel, Dmitri Pchejetski

Abstract:

Transient ischaemic attacks (TIAs) are warning signs for future strokes. TIA patients are at increased risk of stroke and cardio-vascular events after a first episode. A majority of studies on TIA focused on the occurrence of these ancillary events after a TIA. Long-term mortality after TIA received only limited attention. We undertook this study to determine the long-term hazards of all-cause mortality following a first episode of a TIA using anonymised electronic health records (EHRs). We used a retrospective case-control study using electronic primary health care records from The Health Improvement Network (THIN) database. Patients born prior to or in year 1960, resident in England, with a first diagnosis of TIA between January 1986 and January 2017 were matched to three controls on age, sex and general medical practice. The primary outcome was all-cause mortality. The hazards of all-cause mortality were estimated using a time-varying Weibull-Cox survival model which included both scale and shape effects and a random frailty effect of GP practice. 20,633 cases and 58,634 controls were included. Cases aged 39 to 60 years at the first TIA event had the highest hazard ratio (HR) of mortality compared to matched controls (HR = 3.04, 95% CI (2.91 - 3.18)). The HRs for cases aged 61-70 years, 71-76 years and 77+ years were 1.98 (1.55 - 2.30), 1.79 (1.20 - 2.07) and 1.52 (1.15 - 1.97) compared to matched controls. Aspirin provided long-term survival benefits to cases. Cases aged 39-60 years on aspirin had HR of 0.93 (0.84 - 1.00), 0.90 (0.82 - 0.98) and 0.88 (0.80 - 0.96) at 5 years, 10 years and 15 years, respectively, compared to cases in the same age group who were not on antiplatelets. Similar beneficial effects of aspirin were observed in other age groups. There were no significant survival benefits with other antiplatelet options. No survival benefits of antiplatelet drugs were observed in controls. Our study highlights the excess long-term risk of death of TIA patients and cautions that TIA should not be treated as a benign condition. The study further recommends aspirin as the better option for secondary prevention for TIA patients compared to clopidogrel recommended by NICE guidelines. Management of risk factors and treatment strategies should be important challenges to reduce the burden of disease.

Keywords: dual antiplatelet therapy (DAPT), General Practice, Multiple Imputation, The Health Improvement Network(THIN), hazard ratio (HR), Weibull-Cox model

Procedia PDF Downloads 129