Search results for: health care services

Authors: Thanom Kaeniam

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ST-Elevation Myocardial Infarction (STEMI) is a state of sudden death of the heart muscle due to sudden blockage of the artery. STEMI patients are usually in critical condition and with a potential opportunity for sudden death. Therefore, management guidelines for safety in caring and referring STEMI patients are needed. The objective of this developmental research was to assess the effectiveness of using the guidelines for caring and referring STEMI patients at the Accident and Emergency Department of Songkhla Hospital. The subjects of the study were 22 nurses in the emergency room, and doctors on duty in the accident and emergency room selected using purposive sampling with inclusion criteria. The research instruments were the guidelines for caring and referring STEMI patients, and record forms for the effectiveness of using the guidelines for caring and referring STEMI patients (a general record form for STEMI patients, a record form for SK administering, a referring record form for PCI, and a record form for dead patient in the accident and emergency room and during referring). The instruments were tested for content validity by three experts, and the reliability was tested using Kuder-Richardson 20 (KR20). The descriptive statistic employed was the percentage. The outcomes of using the guidelines for caring and referring ST Elevation Myocardial Infarction (STEMI) Patients at the Accident and Emergency Department revealed that before using the guidelines in 2009, 2010, and 2011, there were 84, 73, and 138 STEMI patients receiving services at the accident and emergency room, of which, only 9, 32, and 48 patients were referred for PCI/SK medications, or 10.74; 43.84; and 34.78 percent, and the death rates were 10.71; 10.95; and 11.59 percent, respectively. However, after the use of the guidelines in 2012, 2013, and 2014, there were 97, 77, and 57 patients, of which, the increases to 77, 72, and 55 patients were referred for PCI /SK medications or 79.37; 93.51; and 96.49 percent, and the death rates were reduced to 10.30; 6.49; and 1.76 percent, respectively. The results of the study revealed that the use of the guidelines for caring and referring STEMI patients at the Accident and Emergency Department increased the effectiveness and quality of nursing, especially in terms of SK medication, caring and referring patients for PCI to reduce the death rate.

Keywords: outcomes, guidelines for caring, referring, myocardial infarction, STEMI

Procedia PDF Downloads 398

Authors: Ahmed Atwa, Ashraf Hafez, Mohamed Abdelhameed, Adel Nabeeh, Mohamed Dawaba, Tamer Helmy

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Introduction and Objective: Tumour staging and grading do not usually reflect the future behavior of Wilms' tumor (WT) regarding mortality. Therefore, in this study, P53, Ki67 and cyclin A immunohistochemistry were used in a trial to predict WT cancer-specific survival (CSS). Methods: In this nonconcurrent cohort study, patients' archived data, including age at presentation, gender, history, clinical examination and radiological investigations, were retrieved then the patients were reviewed at the outpatient clinic of a tertiary care center by history-taking, clinical examination and radiological investigations to detect the oncological outcome. Cases that received preoperative chemotherapy or died due to causes other than WT were excluded. Formalin-fixed, paraffin-embedded specimens obtained from the previously preserved blocks at the pathology laboratory were taken on positively charged slides for IHC with p53, Ki67 and cyclin A. All specimens were examined by an experienced histopathologist devoted to the urological practice and blinded to the patient's clinical findings. P53 and cyclin A staining were scored as 0 (no nuclear staining),1 (<10% nuclear staining), 2 (10-50% nuclear staining) and 3 (>50% nuclear staining). Ki67 proliferation index (PI) was graded as low, borderline and high. Results: Of the 75 cases, 40 (53.3%) were males and 35 (46.7%) were females, and the median age was 36 months (2-216). With a mean follow-up of 78.6±31 months, cancer-specific mortality (CSM) occurred in 15 (20%) and 11 (14.7%) patients, respectively. Kaplan-Meier curve was used for survival analysis, and groups were compared using the Log-rank test. Multivariate logistic regression and Cox regression were not used because only one variable (cyclin A) had shown statistical significance (P=.02), whereas the other significant factor (residual tumor) had few cases. Conclusions: Cyclin A IHC should be considered as a marker for the prediction of WT CSS. Prospective studies with a larger sample size are needed.

Keywords: wilms’ tumour, nephroblastoma, urology, survival

Procedia PDF Downloads 69

Authors: Rekha S., S. J. Nalini, S. Bhuvana, S. Kanmani, Vidhya Venugopal

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Introduction: Pregnant women's occupational heat exposure has been linked to foetal abnormalities and pregnancy complications. The presence of heat in the workplace is expected to lead to Adverse Pregnancy Outcomes (APO), especially in tropical countries where temperatures are rising and workplace cooling interventions are minimal. For effective interventions, in-depth understanding and evidence about occupational heat stress and APO are required. Methodology: Approximately 800 pregnant women in and around Chennai who were employed in jobs requiring moderate to hard labour participated in the cohort research. During the study period (2014-2019), environmental heat exposures were measured using a Questemp WBGT monitor, and heat strain markers, such as Core Body Temperature (CBT) and Urine Specific Gravity (USG), were evaluated using an Infrared Thermometer and a refractometer, respectively. Using a valid HOTHAPS questionnaire, self-reported health symptoms were collected. In addition, a postpartum follow-up with the mothers was done to collect APO-related data. Major findings of the study: Approximately 47.3% of pregnant workers have workplace WBGTs over the safe manual work threshold value for moderate/heavy employment (Average WBGT of 26.6°C±1.0°C). About 12.5% of the workers had CBT levels above the usual range, and 24.8% had USG levels above 1.020, both of which suggested mild dehydration. Miscarriages (3%), stillbirths/preterm births (3.5%), and low birth weights (8.8%) were the most common unfavorable outcomes among pregnant employees. In addition, WBGT exposures above TLVs during all trimesters were associated with a 2.3-fold increased risk of adverse fetal/maternal outcomes (95% CI: 1.4-3.8), after adjusting for potential confounding variables including age, education, socioeconomic status, abortion history, stillbirth, preterm, LBW, and BMI. The study determined that WBGTs in the workplace had direct short- and long-term effects on the health of both the mother and the foetus. Despite the study's limited scope, the findings provided valuable insights and highlighted the need for future comprehensive cohort studies and extensive data in order to establish effective policies to protect vulnerable pregnant women from the dangers of heat stress and to promote reproductive health.

Keywords: adverse outcome, heat stress, interventions, physiological strain, pregnant women

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Authors: Kunal K. S., Shwetashri K. R., Keerthan G., Ajinkya R.

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Background: Normal pressure hydrocephalus is a condition caused by abnormal accumulation of cerebrospinal fluid (CSF) within the brain resulting in enlarged cerebral ventricles due to a disruption of CSF formation, absorption, or flow. Over the course of time, ventriculoperitoneal shunt under general anesthesia has become a standard of care. Yet only a finite number of centers have started the inclusion of regional anesthesia techniques for the such patient cohort. Stem Case: We report a case of a 75-year-old male with underlying aortic sclerosis and cardiomyopathy who presented with complaints of confusion, forgetfulness, and difficulty in walking. Neuro-imaging studies revealed disproportionally enlarged subarachnoid space hydrocephalus (DESH). The baseline blood pressure was 116/67 mmHg with a heart rate of 106 beats/min and SpO2 of 96% on room air. The patient underwent smooth induction followed by sonographically guided superficial cervical plexus block and transverse abdominis plane block. Intraoperative pain indices were monitored with Analgesia nociceptive index monitor (ANI, MdolorisTM) and surgical plethysmographic index (SPI, GE Healthcare, Helsinki, FinlandTM). These remained stable during the application of the block and the entire surgical duration. No significant hemodynamic response was observed during the tunneling of the skin by the surgeon. The patient underwent a smooth recovery and emergence. Conclusion: Our decision to incorporate peripheral nerve blockade in conjunction with general anesthesia resulted in opioid-sparing anesthesia and decreased post-operative analgesic requirement by the patient. This blockade was successful in suppressing intraoperative stress responses. Our patient recovered adequately and underwent an uncomplicated post-operative stay.

Keywords: desh, NPH, VP shunt, cervical plexus block, transversus abdominis plane block

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Authors: Nuo Xu, Sijing Chen

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Background: Childbirth is considered a critical traumatic event throughout our lives, positively or negatively impacting the mother's physiology, psychology, and even the whole family. Adverse birth experiences, such as labor pain, anxiety, and fear can negatively impact the mother. Studies had shown that the immersive nature of VR can distract attention from pain and increase focus on interventions for pain relief. However, the existing studies that applied VR to maternal delivery were still in their infancy and showed disparate results, and the small sample size is not representative, so this review analyzed the effects of VR in labor, such as on maternal pain and anxiety, with a view to providing a basis for future applications. Search strategy: We searched Pubmed, Embase, Web of Science, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wan-Fang database from the building to November 17, 2021. Selection Criteria: Randomized controlled trials (RCTs) that intervened the pregnant women aged 18-35 years with gestational >34 weeks and without complications with VR technology were contained within this review. Data Collection and Analysis: Two researchers completed the study selection, data extraction, and assessment of study quality. For quantitative data we used MD or SMD, and RR (risk ratio) for qualitative data. Random-effects model and 95% confidence interval (95% CI) were used. Main Results: 12 studies were included. Using VR could relieve pain during labor (MD=-1.81, 95% CI (-2.04, -1.57), P< 0.00001) and active period (SMD=-0.41, 95% CI (-0.68, -0.14), P= 0.003), reduce anxiety (SMD=-1.39, 95% CI (-1.99, -0.78), P< 0.00001) and improve satisfaction (RR = 1.32; 95% CI (1.10, 1.59); P = 0.003), but the effect on the duration of first (SMD=-1.12, 95% CI (-2.38, 0.13), P=0.08) and second (SMD=-0.22, 95% CI (-0.67, 0.24), P=0.35) stage of labor was not statistically significant. Conclusions: Compared with conventional care, VR technology can relieve labor pain and anxiety and improve satisfaction. However, extensive experimental validation is still needed.

Keywords: virtual reality, delivery, labor pain, anxiety, meta-analysis, systematic review

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Authors: Pradeep Kulshrestha, Maulana Ayoub Ali

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The level of penetration of Islamic banking products and services has recorded a reasonable growth at an exponential rate in many parts of the world. There are many factors which have contributed to this growth including, but not limited to the rapid growth of number of Muslims who are uncomfortable with the conventional ways of banking, interest and higher interest rates scheduled by conventional banks and financial institutions as well as the financial inclusion campaign conducted in many countries. The system is facing legal challenges which open the research fdoor for practitioners and academicians for the sake of finding out solutions to those challenges. This paper tries to investigate the development of the Islamic banking system in the United Kingdom (UK), Saudi Arabia, Malaysia, Iran, Kenya, Nigeria and Uganda in order to understand the modalities which have been employed to run an Islamic banking system in the aforementioned countries. The methodology which has been employed in doing this research paper is Doctrinal, of which legislations, policies and other legal tools have been carefully studied and analysed. Again, papers from academic journals, books and financial reports have been deeply analysed for the purpose of enriching the paper and come up with a tangible results. The paper found that in Asia, Malaysia has created the smoothest legal platform for Islamic banking system to work properly in the country. The United Kingdom has tried harder to smooth the banking system without affecting the conventional banking methods and without favouring the operations of Islamic banks. It also tries harder to make UK as an Islamic banking and finance hub in Europe. The entire banking system in Iran is Islamic, while Nigeria has undergone several legal reforms to suit Islamic banking system in the country. Kenya and Uganda are at a different pace in making Islamic Banking system work alongside the conventional banking system.  

Keywords: shariah, Islamic banking, law, alternative banking

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Authors: Seyyed Farzad Motevalli-Haghi, Javad Rafinejad, Mahboobeh Hosseni, Jamshid Yazdani-Charati, Behzad Parsi

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Background and purpose: Pediculosis is a worldwide public health concern. This descriptive study was performed on primary-school-aged children to determine the prevalence of pediculosis and its risk factors in Mazandaran Province, Iran, on basis of geographic information system (GIS). Materials and methods: A random sampling method was used to select 45237 school-aged children from Sari to Ramsar cities during September 2012 to June 2013. Data were collected from the selected schools by five trained nursing inspectors. A detailed questionnaire was filled for each child prior to hair examination following which examination was carried out to detect head lice as well as eggs/nits. Data were analyzed chi-square test. Finally, the GIS map was obtained in province informational chart. Results: 823 primary-school children (of 45237) were infected with lice in Mazandaran Province. The mean infection prevalence was 1.4% in cities 5.64% in rural area from Sari to Ramsar. There were significant relationships between pediculosis and some factors (P<0.05). GIS map revealed that the contamination was less in west than in east and central regions. Conclusion: Increasing awareness and training of teachers and parents, as well as improving standards of personal health can significantly reduce the prevalence of pediculosis.

Keywords: pediculosis capitis, primary school children, epidemiology, geographic information system (GIS), Mazandaran, Iran

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Authors: Dipti Chand, Riya Saboo

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OBJECTIVES: Early and correct diagnosis may present a significant clinical challenge in diagnosis of patients presenting to Emergency Department with Acute Dyspnoea. The common cause of acute dyspnoea and respiratory distress in Emergency Department are Decompensated Heart Failure (HF), Chronic Obstructive Pulmonary Disease (COPD), Asthma, Pneumonia, Acute Respiratory Distress Syndrome (ARDS), Pulmonary Embolism (PE), and other causes like anaemia. The aim of the study was to measure NT-pro Brain Natriuretic Peptide (BNP) and exhaled End-Tidal Carbon dioxide (ETCO2) in patients presenting with dyspnoea. MATERIAL AND METHODS: This prospective, cross-sectional and observational study was performed at the Government Medical College and Hospital, Nagpur, between October 2019 and October 2021 in patients admitted to the Medicine Intensive Care Unit. Three groups of patients were compared: (1) HFrelated acute dyspnoea group (n = 52), (2) pulmonary (COPD/PE)-related acute dyspnoea group (n = 31) and (3) sepsis with ARDS-related dyspnoea group (n = 13). All patients underwent initial clinical examination with a recording of initial vital parameters along with on-admission ETCO2 measurement, NT-proBNP testing, arterial blood gas analysis, lung ultrasound examination, 2D echocardiography, chest X-rays, and other relevant diagnostic laboratory testing. RESULTS: 96 patients were included in the study. Median NT-proBNP was found to be high for the Heart Failure group (11,480 pg/ml), followed by the sepsis group (780 pg/ml), and pulmonary group had an Nt ProBNP of 231 pg/ml. The mean ETCO2 value was maximum in the pulmonary group (48.610 mmHg) followed by Heart Failure (31.51 mmHg) and the sepsis group (19.46 mmHg). The results were found to be statistically significant (P < 0.05). CONCLUSION: NT-proBNP has high diagnostic accuracy in differentiating acute HF-related dyspnoea from pulmonary (COPD and ARDS)-related acute dyspnoea. The higher levels of ETCO2 help in diagnosing patients with COPD.

Keywords: NT PRO BNP, ETCO2, dyspnoea, lung USG

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Authors: Tebikew Yeneabat, Tefera Belachew, Muluneh Haile

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Background: Exclusive breast-feeding (EBF) is the practice of feeding only breast milk (including expressed breast milk) during the first six months and no other liquids and solid foods except medications. The time to cessation of exclusive breast-feeding, however, is different in different countries depending on different factors. Studies showed the risk of diarrhea morbidity and mortality is higher among none exclusive breast-feeding infants, common during starting other foods. However, there is no study that evaluated the time to cessation of exclusive breast-feeding in the study area. The aim of this study was to show time to cessation of EBF and its predictors among mothers of index infants less than twelve months old. Methods: We conducted a community-based cross-sectional study from February 13 to March 3, 2012 using both quantitative and qualitative methods. This study included a total of 592 mothers of index infant using multi-stage sampling method. Data were collected by using interviewer administered structured questionnaire. Bivariate and multivariate Cox regression analyses were performed. Results: Cessation of exclusive breast-feeding occurred in 392 (69.63%) cases. Among these, 224 (57.1%) happened before six months, while 145 (37.0%) and 23 (5.9%) occurred at six months and after six months of age of the index infant respectively. The median time for infants to stay on exclusive breast-feeding was 6.36 months in rural and 5.13 months in urban, and this difference was statistically significant on a Log rank (Cox-mantel) test. Maternal and paternal occupation, place of residence, postnatal counseling on exclusive breast-feeding, mode of delivery, and birth order of the index infant were significant predictors of cessation of exclusive breast-feeding. Conclusion: Providing postnatal care counseling on EBF, routine follow-up and support of those mothers having infants stressing for working mothers can bring about implementation of national strategy on infant and young child feeding.

Keywords: exclusive breastfeeding, cessation, median duration, Ankesha Guagusa Woreda

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Authors: Jiashu Shen

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Objectives: Spirometry is a basic reference for health evaluation which is widely used in clinical. Previous reference of spirometry is not applicable because of drastic changes of social and natural circumstance in China. A new reference values for the spirometry of the Chinese population is extremely needed. Method: Spirometric reference value was established using the statistical modeling method Generalized Additive Models for Location, Scale and Shape for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and maximal mid-expiratory flow (MMEF). Results: Data from 236,606 healthy non-smokers aged 4–90 years was collected from the MJ Health Check database. Spirometry equations for FEV1, FVC, MMEF, and FEV1/FVC were established, including the predicted values and lower limits of normal (LLNs) by sex. The predictive equations that were developed for the spirometric results elaborated the relationship between spirometry and age, and they eliminated the effects of height as a variable. Most previous predictive equations for Chinese spirometry were significantly overestimated (to be exact, with mean differences of 22.21% in FEV1 and 31.39% in FVC for males, along with differences of 26.93% in FEV1 and 35.76% in FVC for females) or underestimated (with mean differences of -5.81% in MMEF and -14.56% in FEV1/FVC for males, along with a difference of -14.54% in FEV1/FVC for females) the results of lung function measurements as found in this study. Through cross-validation, our equations were established as having good fit, and the means of the measured value and the estimated value were compared, with good results. Conclusions: Our study updates the spirometric reference equations for Chinese people of all ages and provides comprehensive values for both physical examination and clinical diagnosis.

Keywords: Chinese, GAMLSS model, reference values, spirometry

Procedia PDF Downloads 138

Authors: Saeed M. Alshahrani

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This research integrated blockchain technology to reform medical records management in healthcare informatics. It was aimed at resolving the limitations of centralized systems by establishing a secure, decentralized, and user-centric platform. The system was architected with a sophisticated three-tiered structure, integrating advanced cryptographic methodologies, consensus algorithms, and the Fast Healthcare Interoperability Resources (HL7 FHIR) standard to ensure data security, transaction validity, and semantic interoperability. The research has profound implications for healthcare delivery, patient care, legal compliance, operational efficiency, and academic advancements in blockchain technology and healthcare IT sectors. The methodology adapted in this research comprises of Preliminary Feasibility Study, Literature Review, Design and Development, Cryptographic Algorithm Integration, Modeling the data and testing the system. The research employed a permissioned blockchain with a Practical Byzantine Fault Tolerance (PBFT) consensus algorithm and Ethereum-based smart contracts. It integrated advanced cryptographic algorithms, role-based access control, multi-factor authentication, and RESTful APIs to ensure security, regulate access, authenticate user identities, and facilitate seamless data exchange between the blockchain and legacy healthcare systems. The research contributed to the development of a secure, interoperable, and decentralized system for managing medical records, addressing the limitations of the centralized systems that were in place. Future work will delve into optimizing the system further, exploring additional blockchain use cases in healthcare, and expanding the adoption of the system globally, contributing to the evolution of global healthcare practices and policies.

Keywords: healthcare informatics, blockchain, medical records management, decentralized architecture, data security, cryptographic algorithms

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Authors: Barun K. De

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Acquired immunodeficiency syndrome (AIDS) is caused by two types of human immunodeficiency viruses, collectively designated HIV. HIV infection is spreading globally particularly in developing countries. Before an individual is diagnosed with HIV, the disease goes through different phases. First there is an acute early phase that is followed by an established or chronic phase. Subsequently, there is a latency period after which the individual becomes immunodeficient. It is in the acute phase that an individual is highly infectious due to a high viral load. Presently, HIV diagnosis involves use of tests that do not detect the acute phase infection during which both the viral RNA and p24 antigen are expressed. Instead, these less sensitive tests detect antibodies to viral antigens which are typically sero-converted later in the disease process following acute infection. These antibodies are detected in both asymptomatic HIV-infected individuals as well as AIDS patients. Studies indicate that early diagnosis and treatment of HIV infection can reduce medical costs, improve survival, and reduce spreading of infection to new uninfected partners. Newer 4th generation combination antigen/antibody tests are highly sensitive and specific for detection of acute and established HIV infection (HIV1 and HIV2) enabling immediate linkage to care. The CDC (Center of Disease Control, USA) recently recommended an algorithm involving three different tests to screen and diagnose acute and established infections of HIV-1 and HIV-2 in a general population. Initially a 4th generation combo test detects a viral antigen p24 and specific antibodies against HIV -1 and HIV-2 envelope proteins. If the test is positive it is followed by a second test known as a differentiation assay which detects antibodies against specific HIV-1 and HIV-2 envelope proteins confirming established infection of HIV-1 or HIV-2. However if it is negative then another test is performed that measures viral load confirming an acute HIV-1 infection. Screening results of a Phoenix area population detected 0.3% new HIV infections among which 32.4% were acute cases. Studies in the U.S. indicate that this algorithm effectively reduces HIV infection through immediate treatment and education following diagnosis.

Keywords: new algorithm, HIV, diagnosis, infection

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Authors: Vivek Anand, Rainer Naegele

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Industry 4.0 envisages 'smart' manufacturing and services, taking the automation of the 3rd Industrial Revolution to the autonomy of the 4th Industrial Revolution. Powered by innovations in technology and business models, this disruptive transformation is revitalising industry by integrating silos across and beyond value chains. Motivated by the challenges faced by SMEs and Startups in understanding and adopting Industry 4.0, this paper aims to analyse the concept of Growth Poles and evaluate the possibility of its application to Innovation Clusters that strive to propel Industry 4.0 adoption and capacity building. The proposed paper applies qualitative research methodologies including focus groups and survey questionnaires to identify the various factors that affect formation and development of Innovation Clusters. Employing content analysis, the interaction between SMEs and other ecosystem players in such clusters is studied. A strong collaborative culture is a key driver of digital transformation and technology adoption across sectors, value chains and supply chains; and will position these cluster-based growth poles at the forefront of industrial renaissance. Motivated by this argument, and based on the results of the qualitative research, a roadmap will be proposed to position Innovation Clusters as Growth Poles and effective ecosystems to support Industry 4.0 adoption in a region in the medium to long term. This paper will contribute to the current understanding of the role of Innovation Clusters in capacity building. Relevant management and policy implications stem from the analysis. Furthermore, the findings will be helpful for academicians and policymakers alike, who can leverage an ‘innovation cluster policy’ to enable Industry 4.0 Growth Poles in their regions.

Keywords: digital transformation, fourth industrial revolution, growth poles, industry 4.0, innovation clusters, innovation policy, SMEs and startups

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Authors: Sinead Creedon, Anna Trace

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Nurses were the most exposed of all frontline healthcare workers during the COVID-19 pandemic. Mainly female nurses working in the acute hospital sector formed the frontline defence in the Irish health service. They faced it with resilience and courage despite exposure to risk of burnout and threats to their mental health and wellbeing. Gaining an understanding of the nurses’ journey in adapting to this harsh climate could inform positive psychology interventions and / or support staff such as senior hospital managers in an adverse work situation. Furthermore, it would strengthen our insight and theoretical understanding on the use of positive psychology interventions in adverse work conditions. An interpretative phenomenological analysis was carried out to gain insight into how nurses adapted to the changing work environment during the pandemic. Online semi-structured interviews were done with six experienced female nurses who were all redeployed to the frontline from their own roles. The three themes representing the nurses’ journey were the Protection of Sacrificial Self, The Fortifying Effect of Us, and Critical Turning Points & Growth. Nurses revitalised themselves by creating a sense of ‘us’ to help them face a harsh climate against others, which enabled additional critical turning points. This study further enriches our understanding of personal growth and trauma in adverse work conditions by including an exploration of what sacrificial commitment adds to our understanding of physical and moral courage.

Keywords: COVID-19, nurses, positive psychology, resilience, sacrificial commitment, supports

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Authors: Rehan Mohammad

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Background: Improved Water, Sanitation and Hygiene (WASH) practices in schools ensure children’s health, well-being and cognitive performance. In India under various WASH interventions in schools, teachers, and other staff make every possible effort to educate children about personal hygiene, sanitation practices and harms of open defecation. However, once children get back to their families, they see other practicing inappropriate WASH behaviors, and they consequently start following them. This show disconnect between school behavior and family behavior, which needs to be bridged to achieve desired WASH outcomes. Aims and Objectives: The aim of this study is to assess the factors causing disconnect of WASH-related behaviors between school and the family of children. It also suggests behavior change interventions to bridge the gap. Methodology: The present study has chosen a mixed- method approach. Both quantitative and qualitative methods of data collection have been used in the present study. The purposive sampling for data collection has been chosen. The data have been collected from 20% children in each age group of 04-08 years and 09-12 years spread over three primary schools and 20% of households to which they belong to which is spread over three slum communities in south district of Delhi. Results: The present study shows that despite of several behavior change interventions at school level, children still practice inappropriate WASH behaviors due to disconnect between school and family behaviors. These behaviors show variation from one age group to another. The inappropriate WASH behaviors being practiced by children include open defecation, wrong disposal of garbage, not keeping personal hygiene, not practicing hand washing practices during critical junctures and not washing fruits and vegetables before eating. The present study has highlighted that 80% of children in the age group of 04-08 years still practice inappropriate WASH behaviors when they go back to their families after school whereas, this percentage has reduced to 40% in case of children in the age group 09-12 years. Present study uncovers association between school and family teaching which creates a huge gap between WASH-related behavioral practices. The study has established that children learn and de-learn the WASH behaviors due to the evident disconnect between behavior change interventions at schools and household level. The study has also made it clear that children understand the significance of appropriate WASH practices but owing to the disconnect the behaviors remain unsettled. The study proposes several behavior change interventions to sync the behaviors of children at school and family level to ensure children’s health, well-being and cognitive performance.

Keywords: behavioral interventions, child health, family behavior, school behavior, WASH

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Authors: Ntandazo Dlatu, Benjamin Longo-Mbenza, Andre Renzaho, Ruffin Appalata, Yolande Yvonne Valeria Matoumona Mavoungou, Mbenza Ben Longo, Kenneth Ekoru, Blaise Makoso, Gedeon Longo Longo

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Background: The gap between complexities related to the integration of Tuberculosis /HIV control and evidence-based knowledge motivated the initiation of the study. Therefore, the objective of this study was to explore correlations between national TB management guidelines, multiple deprivation indexes, quantiles, components and levels of Tuberculosis control programme using mathematical modeling in rural O.R. Tambo District Health Facilities, South Africa. Methods: The study design used mixed secondary data analysis and cross-sectional analysis between 2009 and 2013 across O.R Tambo District, Eastern Cape, South Africa using univariate/ bivariate analysis, linear multiple regression models, and multivariate discriminant analysis. Health inequalities indicators and component of an impediment to the tuberculosis control programme were evaluated. Results: In total, 62 400 records for TB notification were analyzed for the period 2009-2013. There was a significant but negative between Financial Year Expenditure (r= -0.894; P= 0.041) Seropositive HIV status(r= -0.979; P= 0.004), Population Density (r = -0.881; P= 0.048) and the number of TB defaulter in all TB cases. It was shown unsuccessful control of TB management program through correlations between numbers of new PTB smear positive, TB defaulter new smear-positive, TB failure all TB, Pulmonary Tuberculosis case finding index and deprivation-concentration-dispersion index. It was shown successful TB program control through significant and negative associations between declining numbers of death in co-infection of HIV and TB, TB deaths all TB and SMIAD gradient/ deprivation-concentration-dispersion index. The multivariate linear model was summarized by unadjusted r of 96%, adjusted R2 of 95 %, Standard Error of estimate of 0.110, R2 changed of 0.959 and significance for variance change for P=0.004 to explain the prediction of TB defaulter in all TB with equation y= 8.558-0.979 x number of HIV seropositive. After adjusting for confounding factors (PTB case finding the index, TB defaulter new smear-positive, TB death in all TB, TB defaulter all TB, and TB failure in all TB). The HIV and TB death, as well as new PTB smear positive, were identified as the most important, significant, and independent indicator to discriminate most deprived deprivation index far from other deprivation quintiles 2-5 using discriminant analysis. Conclusion: Elimination of poverty such as overcrowding, lack of sanitation and environment of highest burden of HIV might end the TB threat in O.R Tambo District, Eastern Cape, South Africa. Furthermore, ongoing adequate budget comprehensive, holistic and collaborative initiative towards Sustainable Developmental Goals (SDGs) is necessary for complete elimination of TB in poor O.R Tambo District.

Keywords: tuberculosis, HIV/AIDS, success, failure, control program, health inequalities, South Africa

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Authors: Molly Gerrish

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This work explores the physical, emotional, social, and cognitive risks and benefits related to nature-based teaching and highlights the importance of promoting a sustainable workforce within early childhood programs. Assessing and managing risks can help programs reimagine their approach to teaching, learning, recruitment, family connectivity, and staff motivation. The importance of staff sustainability and motivation/engagement related to social justice and the environment will be discussed. We will explore ways to manage fears and limitations faced by early childhood programs regarding nature experiences and risky play in a variety of locations using a lens of place-based learning. We will also examine the alignment of sustainability and social-emotional development, mental health supports, social awareness, and risk assessment. The work will discuss the varied perceptions of risk in diverse areas and the impact on the early childhood workforce. Motivational theory and compassion resiliency are hallmarks of both recruiting and retaining high-quality early childhood educators; the work will discuss how to balance programmatic constraints and healthy motivation for students and teachers while empowering individuals to advocate for their mental health and well-being. Finally, the work will highlight the positive impact of nature-based teaching practices and the overall benefit to young children and their educators.

Keywords: child’s rights, inclusion, nature-based education, risk assessment

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Authors: Thabiso Sthembiso Msomi

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SMEs are the main engine of growth in most developing economies. One of the main factors that hinder the development of SME is access to finance. In this study, we explored the factors that hinder the growth and survival of SMEs in South Africa. The capital structure theory formed the theoretical underpinning for the study. The quantitative research design was adopted and data was collected from retail, construction, manufacturing and agriculture sectors of SMEs within the KwaZulu-Natal province of South Africa. The modified version of the Cochran formula was used to determine the sample size as 321 SMEs and analysed using the five-point Likert scale. The purposive sampling technique was used to select owners of SME. Statistical Package for the Social Sciences (SPSS) was used for the data analysis through Exploratory Factor Analysis (EFA) to determine the factor structures of items employed to measure each of the constructs in this study. Then, the Cronbach’s alpha test was conducted to determine the reliability of each construct. Kaiser-Meyer-Olkin (KMO) was used to determine the adequacy of the sample size. Linear regression was done to determine the effect of the independent variables on the dependent variable. The findings suggest that the main constraints facing South African SMEs were the lack of experienced management. Furthermore, the SMEs would fail to raise customer awareness of their products and services, which in turn affects their market access and monthly turnover. The study recommends that SMEs keep up-to-date records of business transactions to enable the business to keep track of its operations. The study recommends that South African banks adopt an SME accounting and bookkeeping program. The finding of this study benefits policymakers in both the private and public sectors.

Keywords: small businesses, access to finances, COVID-19, SMEs survival

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Authors: Junbeom Lee, Jaehyuck Cho, Wookyeong Jeong, Jonghan Won, Jungmin Hwang, Youngseok Song, Taikyeong Jeong

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This paper investigates and analyzes meta-learning technologies that use multiple-cameras to monitor and check abnormal behavior in people in real-time in the area of healthcare fields. Advances in artificial intelligence and computer vision technologies have confirmed that cameras can be useful for individual health monitoring and abnormal behavior detection. Through this, it is possible to establish a system that can respond early by automatically detecting abnormal behavior of the elderly, such as patients and the elderly. In this paper, we use a technique called meta-learning to analyze image data collected from cameras and develop a commercial product to determine abnormal behavior. Meta-learning applies machine learning algorithms to help systems learn and adapt quickly to new real data. Through this, the accuracy and reliability of the abnormal behavior discrimination system can be improved. In addition, this study proposes a meta-learning-based abnormal behavior detection system that includes steps such as data collection and preprocessing, feature extraction and selection, and classification model development. Various healthcare scenarios and experiments analyze the performance of the proposed system and demonstrate excellence compared to other existing methods. Through this study, we present the possibility that camera-based meta-learning technology can be useful for monitoring and testing abnormal behavior in the healthcare area.

Keywords: artificial intelligence, abnormal behavior, early detection, health monitoring

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Authors: Prima Gusti Yanti, Fairul Zabadi

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The purpose of the study is to find out relation of moral massage with the authority ang globalization in proverb. Proverb is one of the many forms of cultural identity of the Indonesian/Malay people fulled with moral values. The values contained within those proverbs are beneficial not only to the society, but also to those who held power amidst on this era of globalization. The method being used is qualitative research by using content analysis which is done by describing and uncovering the forms and meanings of proverbs used within Indonesia Minangkabau society. Sources for this study’s data were extracted from a Minangkabau native speaker in the subdistrict of Tanah Abang, Jakarta. Said sources were retrieved through a series of interviews with the Minangkabau native speaker, whose speech is still adorned with idiomatic expressions. The research findings show that there existed 30 proverbs or idiomatic expressions in the Minangkabau language that are often used by its indigenous people. The thirty data contain moral values that are closely interwoven with the matter of power and globalization. Analytical results show that there are fourteen moral values contained within proverbs reflect a firm connection between rule and power in globalization; such as: responsible, brave, togetherness and consensus,tolerance, politeness, thorough and meticulous,honest and keeping promise, ingenious and learning, care, self-correction, be fair, alert, arbitrary, self-awareness. Structurally, proverbs possess an unchangeably formal construction; symbolically, proverbs possess meanings that are clearly decided through ethnographic communicative factors along with situational and cultural contexts. Values contained within proverbs may be used as a guide in social management, be it between fellow men, men between nature, or even men between their Creator. Therefore, the meanings and values contained within the morals of proverbs could also be utilized as a counsel for those who rule and in charge of power in order to stem the tides of globalization that had already spread into sectoral, territorial and educational continuums.

Keywords: continuum, globalization, identity, proverb, rule-power

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Authors: Thampi Rawther, Jack Cecire, Andrew Sutherland

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Introduction: CT facilitates the diagnosis of potentially life-threatening injuries and facilitates early management. There is evidence that reduced CT acquisition time reduces mortality and length of hospital stay. Currently, there are variable recommendations for ideal timing. Indeed, the NHS standard contract for a major trauma service and STAG both recommend immediate access to CT within a maximum time of 60min and appropriate reporting within 60min of the scan. At Coffs Harbour Health Campus (CHHC), a CT radiographer is on site between 8am-11pm. Aim: To investigate the average time to CT at CHHC and assess for any significant relationship between time to CT and injury severity score (ISS) or time of triage. Method: All major trauma calls between Jan 2021-Oct 2021 were audited (N=87). Patients were excluded if they went from ED to the theatre. Time to CT is defined as the time between triage to the timestamp on the first CT image. Median and interquartile range was used as a measure of central tendency as the data was not normally distributed, and Chi-square test was used to determine association. Results: The median time to CT is 51.5min (IQR 40-74). We found no relationship between time to CT and ISS (P=0.18) and time of triage to time to CT (P=0.35). We compared this to other centres such as John Hunter Hospital and Gold Coast Hospital. We found that the median CT acquisition times were 76min (IQR 52-115) and 43min, respectively. Conclusion: This shows an avenue for improvement given 35% of CT’s were >30min. Furthermore, being proactive and aware of time to CT as an important factor to trauma management can be another avenue for improvement. Based on this, we will re-audit in 12-24months to assess if any improvement has been made.

Keywords: imaging, rural surgery, trauma surgery, improvement

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Authors: M. Weller Jones, J. Moffat, J. Taylor, J. Hartland, M. Natarajan

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Background: Uganda’s teenage pregnancy rate remains a significant problem for female and maternal health in the country. Teenage pregnancy is linked to higher rates of maternal and neonatal mortality and morbidity, including preterm labour, obstructed labour, vesicovaginal fistulae, infections, and maternal mental health morbidity. In 2015, the National Strategy to End Child Marriage and Teenage Pregnancy was launched in Uganda. Research is needed so that the interventions in this Strategy can be effectively applied at a local level. This study at Kitovu and Villa Maria Hospitals, two local community hospitals near Masaka, Uganda, aimed to measure change in the local teenage pregnancy rate over the past 5 years; and to explore the awareness and attitudes of teenagers and healthcare professionals towards 1) teenage pregnancy and, 2) the challenges female adolescents still currently face. Method: Teenage delivery rate, type of delivery, incidence of complications in labour and neonatal and maternal outcomes were collected from the labour ward admission books, at both hospitals, for a six month time period in 2011 and 2016. At Kitovu Hospital, qualitative data regarding the experience of, and attitudes towards teenage pregnancy was collected from interviews conducted with 12 maternity staff members and with eight female teenagers, aged 16-19, who were pregnant or post-partum. Results: The proportion of total births to teenage mothers fell from 14% in 2011 to 7% in 2016 (Kitovu), but it remains higher in rural locations (19%, Villa Maria). Beliefs about exacerbating factors included: poor access to contraception; misconceptions that contraception is damaging to women’s health; failing sex education in schools; and poor awareness of national campaigns to reduce teenage pregnancy. Staff felt that the best way to tackle teenage pregnancy was to improve sex education in schools and to sensitise families to these issues. Six of the eight teenagers wanted more frequent sex education and easier, cheap access to contraception. Only one teenager saw positive consequences stating that teenage pregnancy would ‘avoid operations later in life.’ Discussion: Teenage pregnancy is a recognised problem and strategies in the Masaka region should focus on improving sex education in schools and initiating an organisation that educates and supplies free contraception to teenagers.

Keywords: adolescents, attitudes, teenage pregnancy, Uganda

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Authors: Mahmoud T. Alwidyan, Ahmad Alrawashdeh, Alaa O. Oteir

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Background: Emergency medical service (EMS) providers, oftentimes, use the lights and sirens (L&S) of their ambulances to warn road users, navigate through traffic, and expedite transport to save lives of ill and injured patients. Despite the contribution of road users in the effectiveness of reducing transport time of EMS ambulances using L&S, there is a lack of empirical assessments exploring the road user’s attitude and behavior in such situations. This study, therefore, aimed to assess the attitude and behavior of road users in response to EMS ambulances with warning L&S in use. Methods: This was a cross-sectional survey developed and distributed to adult road users in Northern Jordan. The questionnaire included 20 items addressing demographics, attitudes, and behavior toward emergency ambulances. We described the participants’ responses and assessed the association between demographics and attitude statements using logistic regression. Results: A total of 1302 questionnaires were complete and appropriate for analysis. The mean age was 34.2 (SD± 11.4) years, and the majority were males (72.6%). About half of road users (47.9%) in our sample would perform inappropriate action in response to EMS ambulances with L&S in use. The multivariate logistic regression model show that being female (OR, 0.63; 95% CI = 0.48-0.81), more educated (OR, 0.68; 95% CI = 0.53-0.86), or public transport driver (OR, 0.55; 95% CI = 0.34-0.90) is significantly associated with inappropriate response to EMS ambulances. Additionally, a significant proportion of road users may perform inappropriate and lawless driving practices such as crossing red traffic lights or following the passing by EMS ambulances, which would, in turn, increase the risk on ambulances and other road users. Conclusions: A large proportion of road users in Jordan may respond inappropriately to the EMS ambulances, and many engage in risky driving behaviors due perhaps to the lack of procedural knowledge. Policy-related interventions and educational programs are crucially needed to increase public awareness of the traffic law concerning EMS ambulances and to enhance appropriate driving behavior, which, in turn, improves the efficiency of ambulance services.

Keywords: EMS ambulances, lights and sirens, road users, attitude and behavior

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Authors: Kayode Ilesanmi Ebenezer Bowale, Dominic Azuh, Busayo Aderounmu, Alfred Ilesanmi

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There has been a debate among scholars and policymakers about the effects of oil exploration and production on industrial development. In Nigeria, there were many reforms resulting in an increase in crude oil production in the recent past. There is a controversy on the importance of oil production in the development of the manufacturing sector in Nigeria. Some scholars claim that oil has been a blessing to the development of the manufacturing sector, while others regard it as a curse. The objective of the study is to determine if empirical analysis supports the presence of Dutch Disease and de-industrialisation in the Nigerian manufacturing sector between 2019- 2022. The study employed data that were sourced from World Development Indicators, Nigeria Bureau of Statistics, and the Central Bank of Nigeria Statistical Bulletin on manufactured exports, manufacturing employment, agricultural employment, and service employment in line with the theory of Dutch Disease using the unit root test to establish their level of stationarity, Engel and Granger cointegration test to check their long-run relationship. Autoregressive. Distributed Lagged bound test was also used. The Vector Error Correction Model will be carried out to determine the speed of adjustment of the manufacturing export and resource movement effect. The results showed that the Nigerian manufacturing industry suffered from both direct and indirect de-industrialisation over the period. The findings also revealed that there was resource movement as labour moved away from the manufacturing sector to both the oil sector and the services sector. The study concluded that there was the presence of Dutch Disease in the manufacturing industry, and the problem of de-industrialisation led to the crowding out of manufacturing output. The study recommends that efforts should be made to diversify the Nigerian economy. Furthermore, a conducive business environment should be provided to encourage more involvement of the private sector in the agriculture and manufacturing sectors of the economy.

Keywords: Dutch disease, resource movement, manufacturing sector performance, Nigeria

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Authors: Ryan Kelvin Ford

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For individuals and organizations, significant potential benefits were assured by sharing the data in a secure, trusted, and standardized environment. Technical trust and standards help each participant to use data space securely to share and access data. Sharing data in a safe environment helps acquire new business opportunities. Data sovereignty, interoperability, and trust were considered key factors to evaluate data spaces. Businesses and policymakers assure a fair data economy by integrating data space in organizations. A collaborative environment was needed to facilitate data sharing among organizations, satisfied with the implementation of different architectures using data spaces such as Eclipse Data Space Components (EDC), International Data Space Association (IDSA), Gaia-X, and Gaia-X Federation Services (GXFS). The last 15 years of application were reviewed and compared based on the architectures and implementations of different data spaces such as IDSA, EDC, Gaia-X and GXFS, EDC framework, IDSA, GXFS, data connector, data space architecture, characteristics of data space connectors, federated data spaces initiatives, data spaces overview, eclipse data space connector, designing data spaces, building data spaces based on technical overview, European future digital ecosystem based on Gaia-Vision and strategy of Gaia-Architecture. Empirical research based on an organized view was conducted. The current discussion elaborates on the systematic review of the impact of data space technology from various perspectives. The systematic review uses multiple databases such as IEEE Explore, Taylor & Francis, Science Direct, and Google Scholar to pursue publications on the impact of Data space from January 2019 to December 2024. The search results showcased a comparative review of 150 articles, out of which 20 were related to the IDSA, Gaia‑X, and EDC architecture and implementation.

Keywords: IDSA, Gaia-X, Gaia-X architecture, EDC, EDC architecture, GXFS architecture, IDSA, data space connector

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Authors: Hema Lattupalli

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Introduction: A bony bridge extends from the lateral mass of the atlas to postero medial margin of vertebral artery groove, termed as a posterior bridge of atlas or posterior ponticulus. The foramen formed by the bridge is called as arcuate foramen or retroarticulare superior. Another bony bridge sometimes extends laterally from lateral mass to posterior root of transverse foramen forming and additional groove for vertebral artery, above and behind foramen transversarium called Lateral bridge or ponticulus lateralis. When both posterior and lateral are present together it is called as Posterolateral ponticuli. Aim and Objectives: The aim of the present study is to detect the presence of such Bridge or Ponticuli called as Lateral, Posterior and Posterolateral reported by earlier investigators in atlas vertebrae. Material and Methods: The study was done on 100 Atlas vertebrae from the Department of Anatomy Narayana Medical College Nellore, and also from SVIMS Tirupati was collected over a period of 2 years. The parameters that were studied include the presence of ponticuli, complete and incomplete and right and left side ponticuli. They were observed for all these parameters and the results were documented and photographed. Results: Ponticuli were observed in 25 (25%) of atlas vertebrae. Posterior ponticuli were found in 16 (16%), Lateral in 01 (01%) and Posterolateral in 08(08%) of the atlas vertebrae. Complete ponticuli were present in 09 (09%) and incomplete ponticuli in 16 (16%) of the atlas vertebrae. Bilateral ponticuli were seen in 10 (10%) and unilateral ponticuli were seen in 15 (15%) of the atlas vertebrae. Right side ponticuli were seen in 04 (04%) and Left side ponticuli in 05 (05%) of the atlas vertebrae respectively. Interpretation and Conclusion: In the present study posterior complete ponticuli were said to be more than the lateral complete ponticuli. The presence of Bilateral Incomplete Posterior ponticuli is higher and also Atlantic ponticuli. The present study is to say that knowledge of normal anatomy and variations in the atlas vertebra is very much essential to the neurosurgeons giving a message that utmost care is needed to perform surgeries related to craniovertebral regions. This is additional information to the Anatomists, Neurosurgeons and Radiologist. This adds an extra page to the literature.

Keywords: atlas vertebra, ponticuli, posterior arch, arcuate foramen

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Authors: Ayelet Siman-Tov, Shlomo Kaniel

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Objectives: The research validates a multivariate model that predicts parental adjustment to coping successfully with an autistic child. The model comprises four elements: parental stress, parental resources, parental adjustment and the child's autism symptoms. Background and aims: The purpose of the current study is the construction and validation of a model for the adjustment of parents and a child with autism. The suggested model is based on theoretical views on stress and links personal resources, stress, perception, parental mental health and quality of marriage and child adjustment with autism. The family stress approach focuses on the family as a system made up of a dynamic interaction between its members, who constitute interdependent parts of the system, and thus, a change in one family member brings about changes in the processes of the entire family system. From this perspective, a rise of new demands in the family and stress in the role of one family member affects the family system as a whole. Materials and methods: 176 parents of children aged between 6 to 16 diagnosed with ASD answered several questionnaires measuring parental stress, personal resources (sense of coherence, locus of control, social support), adjustment (mental health and marriage quality) and the child's autism symptoms. Results: Path analysis showed that a sense of coherence, internal locus of control, social support and quality of marriage increase the ability to cope with the stress of parenting an autistic child. Directions for further research are suggested.

Keywords: stress, adjustment, resources, Autism, parents, coherence

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Authors: Zachary Bolo Awino

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The need to gain and sustain a competitive advantage is overwhelming for businesses, especially now with cut throat competition. Innovation has been suggested as one way of gaining the advantage sustainably. But innovation can only happen within certain enabling environment and cultures. This study had one hypothesis: that there is no relationship between innovation and performance. This research was a cross sectional survey in which variables of interest are not controlled or manipulated. The cross sectional survey design is also appropriate for this study as it improves accuracy in generalizing findings, since it involves detailed study of a unit. Also known as one shot study, this design enhances uniform data collection and comparison across respondents. The population of the study was the 55 publicly quoted corporations in the Nairobi Securities Exchange (NSE) as at October 2013.The number was initially envisaged to be 60 but 5 firms were delisted or suspended during the year, hence leaving 55 firms as the population of study. The rationale for the choice for these firms is because they cut across the key economic sectors in Kenyan economy which include agriculture, commercial and services, manufacturing, finance and investment. This was a census survey and targeted all the firms listed at the Nairobi Securities Exchange as of October 2013. The primary data for the study was collected through the use of a structured questionnaire. A five point type Likert scale ranging from 1 - denoting to a less event to 5 - denoting to a greater extent was used. Respondents were from senior management of NSE. From the analyses, the study established that there was a strong positive relationship between innovation and performance, and organization innovation significantly contributes to employee engagement. Also there was a moderate positive relationship between innovation and performance. The study drew expressions of interrelations between various variables, offered generalization of understanding and meaning of these relationships, thus expanding the frontiers of knowledge both theoretical and practical with respect to innovation and firm performance. Major conclusion in this study was that there is a positive strong relationship between innovation and major measures of firm performance.

Keywords: emperical, innovation, NSE, organizations, performance

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Authors: Khulud Alhussain, Anna Gavine, Stephen Macgillivray, Sushila Chowdhry

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Background: Estimates show that by the year 2030, mental illness will account for more than half of the global economic burden, second to non-communicable diseases. Often, the perinatal period is characterised by psychological ambivalence and a mixed anxiety-depressive condition. Maternal mental disorder is associated with perinatal anxiety and depression and affects breastfeeding behaviors. Studies also indicate that maternal mental health can considerably influence a baby's health in numerous aspects and impact the newborn health due to lack of adequate breastfeeding. However, studies reporting factors associated with breastfeeding behaviors are predominantly quantitative. Therefore, it is not clear what literature is available to understand the factors affecting breastfeeding and perinatal women’s perspectives and experiences. Aim: This review aimed to explore the perceptions and experiences of women with perinatal anxiety and depression, as well as how these experiences influence their breastfeeding behaviours. Methods: A systematic literature review of qualitative studies in line with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). Four electronic databases (CINAHL, PsycINFO, Embase, and Google Scholar) were explored for relevant studies using a search strategy. The search was restricted to studies published in the English language between 2000 and 2022. Findings from the literature were screened using a pre-defined screening criterion and the quality of eligible studies was appraised using the Walsh and Downe (2006) checklist. Findings were extracted and synthesised based on Braun and Clark. The review protocol was registered on PROSPERO (Ref: CRD42022319609). Result: A total of 4947 studies were identified from the four databases. Following duplicate removal and screening 16 studies met the inclusion criteria. The studies included 87 pregnant and 302 post-partum women from 12 countries. The participants were from a variety of economic, regional, and religious backgrounds, mainly from the age of 18 to 45 years old. Three main themes were identified: Barriers to breastfeeding, breastfeeding facilitators, emotional disturbance, and breastfeeding. Seven subthemes emerged from the data: expectation versus reality, uncertainly about maternal competencies, body image and breastfeeding, lack of sufficient breastfeeding support for family and caregivers’ support, influences positive breastfeeding practices, breastfeeding education, and causes of mental strain among breastfeeding women. Breastfeeding duration is affected in women with mental health disorders, irrespective of their desire to breastfeed. Conclusion: There is significant empirical evidence that breastfeeding behaviour and perinatal mental disturbance are linked. However, there is a lack of evidence to apply the findings to Saudi women due to lack of empirical qualitative information. To improve the psychological well-being of mothers, it is crucial to explore and recognise any concerns with their mental, physical, and emotional well-being. Therefore, robust research is needed so that breastfeeding intervention researchers and policymakers can focus on specifically what needs to be done to help mentally distressed perinatal women and their new-born.

Keywords: pregnancy, perinatal period, anxiety, depression, emotional disturbance, breastfeeding

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Authors: Ekemini M. Okon, Reuben C. Okocha, Babatunde T. Adesina, Judith O. Ehigie, Babatunde M. Falana, Boluwape T. Okikiola

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Antimicrobial resistance (AMR) has evolved to become a significant threat to global public health and food safety. The development of AMR in animals has been associated with antimicrobial overuse. In recent years, the number of antimicrobials used in food animals such as fish and poultry has escalated. It, therefore, becomes imperative to understand the patterns of AMR in fish and poultry and map out future directions for better surveillance efforts. This study used the Preferred Reporting Items for Systematic reviews and Meta-Analyses(PRISMA) to assess the trend, patterns, and spatial distribution for AMR research in Egypt, Nigeria, and South Africa. A literature search was conducted through the Scopus and Web of Science databases in which published studies on AMR between 1989 and 2021 were assessed. A total of 172 articles were relevant for this study. The result showed progressive attention on AMR studies in fish and poultry from 2018 to 2021 across the selected countries. The period between 2018 (23 studies) and 2021 (25 studies) showed a significant increase in AMR publications with a peak in 2019 (28 studies). Egypt was the leading exponent of AMR research (43%, n=74) followed by Nigeria (40%, n=69), then South Africa (17%, n=29). AMR studies in fish received relatively little attention across countries. The majority of the AMR studies were on poultry in Egypt (82%, n=61), Nigeria (87%, n=60), and South Africa (83%, n=24). Further, most of the studies were on Escherichia and Salmonella species. Antimicrobials frequently researched were ampicillin, erythromycin, tetracycline, trimethoprim, chloramphenicol, and sulfamethoxazole groups. Multiple drug resistance was prevalent, as demonstrated by antimicrobial resistance patterns. In poultry, Escherichia coli isolates were resistant to cefotaxime, streptomycin, chloramphenicol, enrofloxacin, gentamycin, ciprofloxacin, oxytetracycline, kanamycin, nalidixic acid, tetracycline, trimethoprim/sulphamethoxazole, erythromycin, and ampicillin. Salmonella enterica serovars were resistant to tetracycline, trimethoprim/sulphamethoxazole, cefotaxime, and ampicillin. Staphylococcusaureus showed high-level resistance to streptomycin, kanamycin, erythromycin, cefoxitin, trimethoprim, vancomycin, ampicillin, and tetracycline. Campylobacter isolates were resistant to ceftriaxone, erythromycin, ciprofloxacin, tetracycline, and nalidixic acid at varying degrees. In fish, Enterococcus isolates showed resistance to penicillin, ampicillin, chloramphenicol, vancomycin, and tetracycline but sensitive to ciprofloxacin, erythromycin, and rifampicin. Isolated strains of Vibrio species showed sensitivity to florfenicol and ciprofloxacin, butresistance to trimethoprim/sulphamethoxazole and erythromycin. Isolates of Aeromonas and Pseudomonas species exhibited resistance to ampicillin and amoxicillin. Specifically, Aeromonashydrophila isolates showed sensitivity to cephradine, doxycycline, erythromycin, and florfenicol. However, resistance was also exhibited against augmentinandtetracycline. The findings constitute public and environmental health threats and suggest the need to promote and advance AMR research in other countries, particularly those on the global hotspot for antimicrobial use.

Keywords: antibiotics, antimicrobial resistance, bacteria, environment, public health

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