Search results for: oral health indicators

Authors: Shailender Kumar

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Current health policy pronouncements in India advocate for insurance-based financing mechanism to achieve universal health coverage (UHC), while undermine the role of comprehensive healthcare provision system. UHC is achieved when all people receive the health services they need without suffering financial hardship. This study, using 68th & 71st NSS rounds data, examines their relative and combined strength in achieving the above objective. Health-insurance has been unsuccessful in reducing prevalence and catastrophic effects of out-of-pocket payment and even dismantle the effectiveness of traditional way of health financing system. Healthcare provision is the best way forward to enhance health and well-being of households in condition if India removes existing inadequacies and inequalities in service provision across districts/states and ensure free/low cost medicines/diagnostics to the citizens.

Keywords: health policy, demand-side financing, supply-side financing, incidence of health payment

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Authors: Dernie Taganna Olguera

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Marginal uplands are fragile ecosystems in the tropics that need to be evaluated for sustainable utilization and land degradation mitigation. Thus, this study evaluated the dominant soil degradation processes in selected marginal uplands of Samar Island, Philippines; evaluated the important factors influencing soil degradation in the selected sites and identified the indicators of soil degradation in marginal uplands of the tropical landscape of Samar Island, Philippines. Two (2) sites were selected (Sta. Rita, Samar and Salcedo, Eastern, Samar) representing the western and eastern sides of Samar Island respectively. These marginal uplands represent different agro-climatic zones suitable for the study. Soil erosion is the major soil degradation process in the marginal uplands studied. It resulted in not only considerable soil losses but nutrient losses as well. Soil erosion varied with vegetation cover and site. It was much higher in the sweetpotato, cassava, and gabi crops than under natural vegetation. In addition, soil erosion was higher in Salcedo than in Sta. Rita, which is related to climatic and soil characteristics. Bulk density, porosity, aggregate stability, soil pH, organic matter, and carbon dioxide evolution are good indicators of soil degradation. The dominance of Saccharum spontaneum Linn., Imperata cylindrica Linn, Melastoma malabathricum Linn. and Psidium guajava Linn indicated degraded soil condition. Farmer’s practices particularly clean culture and organic fertilizer application influenced the degree of soil degradation in the marginal uplands of Samar Island, Philippines.

Keywords: soil degradation, soil erosion, marginal uplands, Samar island, Philippines

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Authors: Masoumeh Khailghi Sikaroudi, Mohsen Masoodi, Fazad Shidfar, Meghdad Sedaghat

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Background: The hypertonicity of internal anal sphincter resting pressure is one of the main reasons for chronic anal fissures. The aim of this study is to assess the effect of oral administration of L-arginine on anal fissure symptom improvement by relaxation of the internal anal sphincter. Method: Seventy-six chronic anal fissure patients (age: 18-65 years) took part in this randomized, double-blind, placebo-controlled trial study from February 2019 to October 2020 at Rasoul-e-Akram Hospital, Tehran, Iran. Participants were allocated into treatment (L-arginine) or placebo groups. They took a 1000 mg capsule three times a day for one month and were followed up at the end of the first and third months after receiving the intervention. Clinical symptoms, anal sphincter resting pressure, and quality of life (QoL) were completed at baseline and the end of the study. Result: The analysis of data was shown significant improvement in bleeding, fissure size, and pain within each group; however, this effect was more seen in the arginine group compared to the control group at the end of the study (P-values<0.001). Following that, a significant increase in QoL was seen just in patients who were treated with arginine (P-value=0.006). Also, the comparison of anal pressures to baseline and between groups at the end of the study showed a significant reduction in sphincter pressure in treated patients (P-value<0.001, =0.049; respectively). Conclusion: Oral administration of 3000 mg L-arginine can heal chronic anal fissures by reducing anal internal sphincter pressure with fewer side effects. However, a long-term study with more follow-up is recommended.

Keywords: L-arginine, anal fissure, sphincter pressure, clinical symptoms, quality of life

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Authors: Malik Takreem Ahmad, Pablo Lamata, Rasi Mizori

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Background: In recent years, mobile health apps have grown in popularity as a means for people to track and manage their health. While there is increasing worry that these applications may potentially contribute to the emergence of health anxiety, they can also help to encourage healthy behaviours and provide access to health information. Objective: The objective of this literature review is to look at available mhealth apps and critically evaluate the compromise between reassurance and anxiety. Methodology: A literature review was carried out to analyse the effects of mhealth apps on the creation of health anxiety within the general population. PubMed and SCOPUS were used to search for relevant articles, and abstracts were screened using inclusion criteria of the terms: mhealth apps; e-Health; healthcare apps; cyberchondria; Health anxiety; illness anxiety disorder. A total of 27 studies were included in the review. Results and discussion: The findings suggest a direct relationship between mobile health app use and health anxiety. The impact of mobile health apps on health anxiety may depend on how they are used - individuals receiving a constant stream of health-related information may trigger unnecessary concern about one's health. The need for more regulation and oversight is identified, which can lead to app quality and safety consistency. There are also concerns about data security and privacy and the resulting "digital gap" for individuals without mobiles or internet access. Conclusion: While health apps can be valuable tools for managing and tracking health, individuals need to use them in a balanced and informed way to avoid increased anxiety.

Keywords: mobile health, mhealth apps, cyberchondria, health anxiety

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Authors: Usha Barahmand, Maria Stalias, Abdul Haq, Esther Rotlevi, Ying Xiang

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Misophonia is a condition in which specific repetitive oral, nasal, or other sounds and movements made by humans trigger impulsive aversive reactions of irritation or disgust that instantly become anger. A few measures exist for the assessment of misophonia, but each has some limitations, and evidence for a formal diagnosis is still lacking. The objective of this study was to develop a reliable and valid measure of misophonia for use in the general population. Adopting a purely descriptive approach, this study focused on developing a self-report measure using all triggers and reactions identified in previous studies on misophonia. A measure with two subscales, one assessing the aversive quality of various triggers and the other assessing reactions of individuals, was developed. Data were gathered from a large sample of both men and women ranging in age from 18 to 65 years. Exploratory factor analysis revealed three main triggers: oral/nasal sounds, hand and leg movements, and environmental sounds. Two clusters of reactions also emerged: nonangry attempts to avoid the impact of the aversive stimuli and angry attempts to stop the aversive stimuli. The examination of the psychometric properties of the scale revealed its internal consistency and test-retest reliability to be excellent. The scale was also found to have very good concurrent and convergent validity. Significant annoyance and disgust in response to the triggers were reported by 12% of the sample, although for some specific triggers, rates as high as 31% were also reported. These findings have implications for the delineation of the criteria for identifying misophonia as a clinical condition.

Keywords: adults, factor analysis, misophonia, psychometric properties, scale

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Authors: Sujata Upgupta, Prasoon Kumar Singh

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The expansion of large scale coal mining into forest areas is a potential hazard for the local biodiversity and wildlife. The objective of this study is to provide a picture of the threat that coal mining poses to the forests of the East Bokaro landscape. The vulnerable forest areas at risk have been assessed and the priority areas for conservation have been presented. The forested areas at risk in the current scenario have been assessed and compared with the past conditions using classification and buffer based overlay approach. Forest vulnerability has been assessed using an analytical framework based on systematic indicators and composite vulnerability index values. The results indicate that more than 4 km² of forests have been lost from 1973 to 2016. Large patches of forests have been diverted for coal mining projects. Forests in the northern part of the coal field within 1-3 km radius around the coal mines are at immediate risk. The original contiguous forests have been converted into fragmented and degraded forest patches. Most of the collieries are located within or very close to the forests thus threatening the biodiversity and hydrology of the surrounding regions. Based on the vulnerability values estimated, it was concluded that more than 90% of the forested grids in East Bokaro are highly vulnerable to mining. The forests in the sub-districts of Bermo and Chandrapura have been identified as the most vulnerable to coal mining activities. This case study would add to the capacity of the forest managers and mine managers to address the risk and vulnerability of forests at a small landscape level in order to achieve sustainable development.

Keywords: forest, coal mining, indicators, vulnerability

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Authors: Xing Wang, Lin Feng, Xuan Zou, Hongchen liu

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Immediate Implantation after tooth extraction is considered to be the ideal way to retain the alveolar bone, but some scholars believe the aesthetic effect in the Early Implantation case are more reliable. In this study, 89 patients were added to this retrospective study up to 5 years. Assessment indicators was including the survival of the implant (peri-implant infection, implant loosening, shedding, crowns and occlusal), aesthetics (color and fullness gums, papilla height, probing depth, X-ray alveolar crest height, the patient's own aesthetic satisfaction, doctors aesthetics score), repair defects around the implant (peri-implant bone changes in height and thickness, whether the use of autologous bone graft, whether to use absorption/repair manual nonabsorbable material), treatment time, cost and the use of antibiotics.The results demonstrated that there is no significant difference in long-term success rate of immediate implantation, early implantation and delayed implantation (p> 0.05). But the results indicated immediate implantation group could get get better aesthetic results after two years (p< 0.05), but may increase the risk of complications and failures (p< 0.05). High-risk indicators include gingival recession, labial bone wall damage, thin gingival biotypes, planting position and occlusal restoration bad and so on. No matter which type of implanting methods was selected, the extraction methods and bone defect amplification techniques are observed as a significant factors on aesthetic effect (p< 0.05).

Keywords: immediate implantation, long-term effects, aesthetics area, dental implants

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Authors: Djeddi Khaled, Houssou Hind, Miloudi Abdellatif, Rabah Siham

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In the field of veterinary medicine, there is a growing application of artificial intelligence (AI) for diagnosing bovine mastitis, a prevalent inflammatory disease in dairy cattle. AI technologies, such as automated milking systems, have streamlined the assessment of key metrics crucial for managing cow health during milking and identifying prevalent diseases, including mastitis. These automated milking systems empower farmers to implement automatic mastitis detection by analyzing indicators like milk yield, electrical conductivity, fat, protein, lactose, blood content in the milk, and milk flow rate. Furthermore, reports highlight the integration of somatic cell count (SCC), thermal infrared thermography, and diverse systems utilizing statistical models and machine learning techniques, including artificial neural networks, to enhance the overall efficiency and accuracy of mastitis detection. According to a review of 15 publications, machine learning technology can predict the risk and detect mastitis in cattle with an accuracy ranging from 87.62% to 98.10% and sensitivity and specificity ranging from 84.62% to 99.4% and 81.25% to 98.8%, respectively. Additionally, machine learning algorithms and microarray meta-analysis are utilized to identify mastitis genes in dairy cattle, providing insights into the underlying functional modules of mastitis disease. Moreover, AI applications can assist in developing predictive models that anticipate the likelihood of mastitis outbreaks based on factors such as environmental conditions, herd management practices, and animal health history. This proactive approach supports farmers in implementing preventive measures and optimizing herd health. By harnessing the power of artificial intelligence, the diagnosis of bovine mastitis can be significantly improved, enabling more effective management strategies and ultimately enhancing the health and productivity of dairy cattle. The integration of artificial intelligence presents valuable opportunities for the precise and early detection of mastitis, providing substantial benefits to the dairy industry.

Keywords: artificial insemination, automatic milking system, cattle, machine learning, mastitis

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Authors: Nadia Fatima Zahra Malki

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Quality is one of the most important modern management patterns that organizations seek to achieve in all areas and sectors in order to meet the needs and desires of customers and to remain and continuity, as they constitute a competitive advantage for the organization. and among the most prominent organizations that must be available on the quality factor are health organizations as they relate to the most valuable component of production. It is a person, and his health, and any error in it threatens his life and may lead to death, so she must provide health services of high quality to achieve the highest degree of satisfaction for the patient. This research aims to study the quality of health services and the extent of their impact on patient satisfaction, and this is through an applied study that relied on measuring the level of quality of health services in the university hospital center of Algeria and the extent of their impact on patient satisfaction according to the dimensions of the quality of health services, and we reached a conclusion that the determinants of the quality of health services It affects patient satisfaction, which necessitates developing health services according to patients' requirements and improving their quality to obtain patient satisfaction.

Keywords: health service, health quality, quality determinants, patient satisfaction

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Authors: Seyed Salahedin Naghshbandi, Zahra Bozorgzadeh, Leila Zakizadeh, Siavash Hamidzadeh

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From the sport economy experts point of view, the existence of competitive balance among sport leagues and its numerous effects on league is an important and undeniable issue. In general, sport events fans are so eager to unpredictable results of competition in order to reach the top of excitement and necessary motivation for following competitions. The purpose of this research is to consider and compare the competitive balance among five provisional European football leagues (Spain, England, Italy, France and Germany) during 1966 - 2015 seasons. Research data are secondary and obtained from Premier League final tables of selected countries in 1966 - 2015 seasons. For analyzing data, C5 and C5ICB indicators used. whatever these indicators be less, more balance establishes in the league and vice-versa. The result showed that Le champion of France reached from 1,259 to 1,395; Italy Serie-A league from 1,316 to 1,432; England premier league from 1, 342 to 1,455; Germany Bundesliga from 1,238 to 1,465 and Spain La liga from 1,295 to 1,495. So by comparing C5ICB charts during 1966 - 2015 seasons, La liga of Spain moved more toward imbalance and enjoyed less balance with other European Leagues. Also, La champion of France during the mentioned season, enjoyed less imbalance and preserved its relative balance with monotonous process. It seems that football in France has been followed as stable during 1966 to 2015, and prediction of results was more difficult and competitions were so attractive for spectators, but in Italy, England, Germany, and Spain there were less balance, respectively.

Keywords: competitive balance, professional football league, competition, C5ICB

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Authors: K. Y. S. Putri, Heri Fathurahman, Yuki Surisita, Widi Sagita, Kiki Dwi Arviani

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Society needs the assistance of academics in understanding and being skilled in health communication literacy. Information technology runs very fast while health communication literacy skills in getting health communication information during the pandemic are not as fast as the development of information technology. The research question is whether there is an influence of health communication on information technology in health information during the pandemic in Indonesia. The purpose of the study is to find out the influence of health communication on information technology in health information during the pandemic in Indonesia. The concepts of health communication literacy and information technology are used this study. Previous research is in support of this study. Quantitative research methods by disseminating questionnaires in this study. The validity and reliability test of this study is positive, so it can proceed to the next statistical analysis. Descriptive results of variable health communication literacy are of positive value in all dimensions. All dimensions of information technology are of positive value. Statistical tests of the influence of health communication literacy on information technology are of great value. Discussion of both variables in the influence of health communication literacy and high-value information technology because health communication literacy has a high effect in information technology. Respondents to this study have high information technology skills. So that health communication literacy in obtaining health information during the 2019-2022 pandemic is needed. Research advice is that academics are still very much needed by the community in the development of society during the pandemic.

Keywords: health information, health information needs, literacy health communication, information technology

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Authors: Shima Dehghan

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Aim: imbalance between antioxidant defensive system and increasing production of free radicals caused oxidative stress that can be rolled in cellular damage and occurring some of diseases such as diabetes. The aim of current study was to investigate the effect of eight weeks aerobic training on peroxidant and antioxidants indicators in women with type2 diabetes. Methodology: thirty two inactive women with type 2 diabetes were randomly assigned into four groups: 1. control, 2. Aerobic training, 3. Purslane seed and 4. Aerobic training + Purslane seed groups. Subjects were asked to accomplish eight weeks aerobic training (50 min aerobic exercise, 3 days/week, for to achieve 65-75% maximum of heart rate). Also, subjects in certain groups received purslane seeds for eight weeks. Blood samples were obtained in two sets (one session and after 8 weeks). Data was analyzed using one way ANOVA. A significant difference was accepted at p < 0/05 level. Results: After eight weeks of aerobic training with purslane seeds supplementation, malon dyaldehyde (MDA) concentration in training group were significantly decreased (p < 0/000), but A difference significant was not found in control group. Superoxide dismutase (SOD) and catalase (CAT) concentrations in training group were significantly increased (p < 0/000), while difference significant wasnot found in control group. Conclusion: The finding of the current study indicates that disciplined aerobic training with purslane seeds supplementation can be caused improvement in peroxidant/antioxidant balance in women with type2 diabetes.

Keywords: aerobic training, purslane seed, peroxidant/antioxidant balance, diabetes2

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Authors: Milena Lakicevic

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The paper deals with the problem of optimizing management options for urban parks within different scenarios of nature protection and tourism importance. The procedure is demonstrated on a case study example of urban parks in Novi Sad (Serbia). Six management strategies for the selected area have been processed by the decision support method PROMETHEE. Two criteria used for the evaluation were nature protection and tourism and each of them has been divided into a set of indicators: for nature protection those were biodiversity and preservation of original landscape, while for tourism those were recreation potential, aesthetic values, accessibility and culture features. It was pre-assumed that each indicator in a set is equally important to a corresponding criterion. This way, the research was focused on a sensitivity analysis of criteria weights. In other words, weights of indicators were fixed and weights of criteria altered along the entire scale (from the value of 0 to the value of 1), and the assessment has been performed in two-dimensional surrounding. As a result, one could conclude which management strategy would be the most appropriate along with changing of criteria importance. The final ranking of management alternatives was followed up by investigating the mean PROMETHEE Φ values for all options considered and when altering the importance of nature protection/tourism. This type of analysis enabled detecting an alternative with a solid performance along the entire scale, i.e., regardlessly of criteria importance. That management strategy can be seen as a compromise solution when the weight of criteria is not defined. As a conclusion, it can be said that, in some cases, instead of having criteria importance fixed it is important to test the outputs depending on the different schemes of criteria weighting. The research demonstrates the state of the final decision when the decision maker can estimate criteria importance, but also in cases when the importance of criteria is not established or known.

Keywords: criteria weights, PROMETHEE, sensitivity analysis, urban parks

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Authors: Namrata Mishra

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Health of a person plays a vital role in the collective health of his community and hence the well-being of the society as a whole. But, in today’s fast paced technology driven world, health issues are increasingly being associated with human behaviors – their lifestyle. Social networks have tremendous impact on the health behavior of individuals. Many researchers have used social network analysis to understand human behavior that implicates their social and economic environments. It would be interesting to use a similar analysis to understand human behaviors that have health implications. This paper focuses on concepts of those behavioural analyses that have health implications using social networks analysis and provides possible algorithmic approaches. The results of these approaches can be used by the governing authorities for rolling out health plans, benefits and take preventive measures, while the pharmaceutical companies can target specific markets, helping health insurance companies to better model their insurance plans.

Keywords: breadth first search, directed graph, health behaviors, social network analysis

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Authors: Nouf Aljohani

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The research project described in this presentation focuses on designing and evaluating oral tasks related to students’ needs and levels to foster communication and negotiation of meaning for a group of female Saudi university students. The significance of the current research project lies in its contribution to determining the usefulness of synchronous technology-mediated interactive group discussion in improving different speaking strategies through using synchronous technology. Also, it discovers how to optimize learning outcomes, expand evaluation for online learning tasks and engaging students’ experience in evaluating synchronous interactive tools and tasks. The researcher used SpeakApps, a synchronous technology, that allows the students to practice oral interaction outside the classroom. Such a course of action was considered necessary due to low English proficiency among Saudi students. According to the author's knowledge, the main factor that causes poor speaking skills is that students do not have sufficient time to communicate outside English language classes. Further, speaking and listening course contents are not well designed to match the Saudi learning context. The methodology included designing speaking tasks to match the educational setting; a CALL framework for designing and evaluating tasks; participant involvement in evaluating these tasks in each online session; and an investigation of the factors that led to the successful implementation of Task-based Language Teaching (TBLT) and using SpeakApps. The analysis and data were drawn from the technology acceptance model surveys, a group interview, teachers’ and students’ weekly reflections, and discourse analysis of students’ interactions.

Keywords: CALL evaluation, synchronous technology, speaking skill, task-based language teaching

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Authors: Elizaveta S. Prokofyeva, Svetlana V. Maltseva, Roman D. Zaitsev

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Rapidly evolving modern data analysis technologies in healthcare play a large role in understanding the operation of the system and its characteristics. Nowadays, one of the key tasks in urban healthcare is to optimize the resource allocation. Thus, the application of data analysis in medical institutions to solve optimization problems determines the significance of this study. The purpose of this research was to establish the dependence between the indicators of the effectiveness of the medical institution and its resources. Hospital discharges by diagnosis; hospital days of in-patients and in-patient average length of stay were selected as the performance indicators and the demand of the medical facility. The hospital beds by type of care, medical technology (magnetic resonance tomography, gamma cameras, angiographic complexes and lithotripters) and physicians characterized the resource provision of medical institutions for the developed models. The data source for the research was an open database of the statistical service Eurostat. The choice of the source is due to the fact that the databases contain complete and open information necessary for research tasks in the field of public health. In addition, the statistical database has a user-friendly interface that allows you to quickly build analytical reports. The study provides information on 28 European for the period from 2007 to 2016. For all countries included in the study, with the most accurate and complete data for the period under review, predictive models were developed based on historical panel data. An attempt to improve the quality and the interpretation of the models was made by cluster analysis of the investigated set of countries. The main idea was to assess the similarity of the joint behavior of the variables throughout the time period under consideration to identify groups of similar countries and to construct the separate regression models for them. Therefore, the original time series were used as the objects of clustering. The hierarchical agglomerate algorithm k-medoids was used. The sampled objects were used as the centers of the clusters obtained, since determining the centroid when working with time series involves additional difficulties. The number of clusters used the silhouette coefficient. After the cluster analysis it was possible to significantly improve the predictive power of the models: for example, in the one of the clusters, MAPE error was only 0,82%, which makes it possible to conclude that this forecast is highly reliable in the short term. The obtained predicted values of the developed models have a relatively low level of error and can be used to make decisions on the resource provision of the hospital by medical personnel. The research displays the strong dependencies between the demand for the medical services and the modern medical equipment variable, which highlights the importance of the technological component for the successful development of the medical facility. Currently, data analysis has a huge potential, which allows to significantly improving health services. Medical institutions that are the first to introduce these technologies will certainly have a competitive advantage.

Keywords: data analysis, demand modeling, healthcare, medical facilities

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Authors: Mahsa Habibzadeh

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The function is defined as the process of systematic and systematic measurement of the components of how each task is performed and determining their potential for improvement in accordance with the specific standards of each component. Hence, evaluation is the basis for the improvement of organizations' functional excellence and the move towards performance excellence depends on performance improvement planning. Because of the past two decades, the public sector system has undergone dramatic changes. The purpose of such developments is often to overcome the barriers of the bureaucratic system, which impedes the efficient use of limited resources. Implementing widespread changes in the public sector of developed and even developing countries has led the process of developments to be addressed by many researchers. In this regard, the present paper has been carried out with the approach of analyzing the components that affect the performance of the public sector in Iran. To achieve this goal, indicators that affect the performance of the public sector and the factors affecting the improvement of its accountability have been identified. The research method in this research is descriptive and analytical. A statistical population of 120 people consists of managers and employees of the public sector in Iran. The questionnaires were distributed among them and analyzed using SPSS and LISREL software. The obtained results indicate that the results of the research findings show that between responsibilities there is a significant relationship between participation of managers and employees, legality, justice and transparency of specialty and competency, participation in public sector functions. Also, the significant coefficient for the liability variable is 3.31 for justice 2.89 for transparency 1.40 for legality of 2.27 for specialty and competence 2.13 and 5.17 for participation 5.17. Implementing indicators that affect the performance of the public sector can lead to satisfaction of the audience.

Keywords: performance, accountability system, public sector, components

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Authors: Shittu Bisi Agnes

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Ebola virus Diseases outbreak in Nigeria caused a lot of concerns considering the mode of transmission and no known cure discovered. Therefore a lot of safety measures were taken which eventually led to the eradication of the virus in Nigeria. This therefore attempted to determine the various safety measures, how socio-economic characteristic of the people affected adherence to safety measures. And provide reasonable recommendations for total eradication of the virus, future outbreak and general environmental safety Data were collected with the aid of well structured questionnaires and administered 180 randomly selected of the state and oral interview was also utilize. Data collected were analysed using both descriptive tools and inferential statistics vis-a-vis regression analysis. Finding showed that 70.5% was strongly adhere to almost all the measures, 15.2% was fairly advent, 3% was poorly observing the selected measures while 1.3% was in different. 65% of the respondents was strongly aware of the advent of ebola virus diseases, 20% was fairly in awareness, 8.5% was poorly in awareness while 6.55% was in aware of any disease outbreak. Safety measures put forwards were; hand washing, use of hand sanitize-rs, no shaking of hands non-consumption of wildlife games(Bush Meat) and general health and environmental safety measures. It was recommended that policy instrument to increase peoples income will accelerate eradication of diseases as this will enable households to pay for monetary safety measures, health and environmental education, in form of talk shop, workshop, lectures could be organised at the political ward levels, schools, market women, religious bodies functional unions and mass media.

Keywords: ebola diseases, pay, safety, outbreak

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Authors: Jacqueline Eleonora Ek, Michael Spiteri, Chris Giordimaina, Pierre Agius

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Background: Malta is known for being a key player as a frontline country with regard to irregular immigration from Africa to Europe. Every year the island experiences an influx of migrants as boat movement across the Mediterranean continues to be a humanitarian challenge. Irregular immigration and applying for asylum is both a lengthy and mentally demanding process. Those doing so are often faced with multiple challenges, which can adversely affect their mental health. Between January and August 2020, Malta disembarked 2 162 people rescued at sea, 463 of them between July & August. Given the small size of the Maltese islands, this regulation places a disproportionately large burden on the country, creating a backlog in the processing of asylum applications resulting in increased time periods of detention. These delays reverberate throughout multiple management pathways resulting in prolonged periods of detention and challenging access to health services. Objectives: To better understand the spatial dimensions of this humanitarian crisis, this study aims to assess disparities in the acute medical management of migrants presenting to the emergency department (ED) with acute mental health presentations as compared to that of local and non-local residents. Method: In this retrospective study, 17795 consecutive ED attendances were reviewed to look for acute mental health presentations. These were further evaluated to assess discrepancies in transportation routes to hospital, nature of presenting complaint, effects of language barriers, use of CT brain, treatment given at ED, availability of psychiatric reviews, and final admission/discharge plans. Results: Of the ED attendances, 92.3% were local residents, and 7.7% were non-locals. Of the non-locals, 13.8% were migrants, and 86.2% were other-non-locals. Acute mental health presentations were seen in 1% of local residents; this increased to 20.6% in migrants. 56.4% of migrants attended with deliberate self-harm; this was lower in local residents, 28.9%. Contrastingly, in local residents, the most common presenting complaint was suicidal thought/ low mood 37.3%, the incidence was similar in migrants at 33.3%. The main differences included 12.8% of migrants presenting with refused oral intake while only 0.6% of local residents presented with the same complaints. 7.7% of migrants presented with a reduced level of consciousness, no local residents presented with this same issue. Physicians documented a language barrier in 74.4% of migrants. 25.6% were noted to be completely uncommunicative. Further investigations included the use of a CT scan in 12% of local residents and in 35.9% of migrants. The most common treatment administered to migrants was supportive fluids 15.4%, the most common in local residents was benzodiazepines 15.1%. Voluntary psychiatric admissions were seen in 33.3% of migrants and 24.7% of locals. Involuntary admissions were seen in 23% of migrants and 13.3% of locals. Conclusion: Results showed multiple disparities in health management. A meeting was held between entities responsible for migrant health in Malta, including the emergency department, primary health care, migrant detention services, and Malta Red Cross. Currently, national quality-improvement initiatives are underway to form new pathways to improve patient-centered care. These include an interpreter unit, centralized handover sheets, and a dedicated migrant health service.

Keywords: emergency department, communication, health, migration

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Authors: Barbara Eschen Danielsen, Morten Niels Baxter, Per Sieverts Nielsen

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Europe is currently in an energy and climate crisis, which requires more sustainable solutions than what has been used to before. Europe uses 40% of its energy in buildings so there has come a significant focus on trying to find and commit to new initiatives to reduce energy consumption in buildings. The European Union has introduced a building standard in 2021 to be upheld by 2030. This new building standard requires a significant reduction of CO2 emissions from both privately and publicly owned buildings. The overall aim is to achieve a zero-emission building stock by 2050. EU is revising the Energy Performance of Buildings Directive (EPBD) as part of the “Fit for 55” package. It was adopted on March 14, 2023. The new directive’s main goal is to renovate the least energy-efficient homes in Europe. There will be a cost for the home owner with a renovation project, but there will also be an improvement in energy efficiency and, therefore, a cost reduction. After the implementation of the EU directive, many homeowners will have to focus their attention on how to make the most effective energy renovations of their homes. The new EU directive will affect almost one million Danish homes (30%), as they do not meet the newly implemented requirements for energy efficiency. The problem for this one mio homeowners is that it is not easy to decide which renovation project they should consider. The houses are build differently and there are many possible solutions. The main focus of this paper is to identify the most impactful solutions and evaluate their impact and evaluating them with a criteria based sustainability indicator framework. The result of the analysis give each homeowner an insight in the various renovation options, including both advantages and disadvantages with the aim of avoiding unnecessary costs and errors while minimizing their CO2 footprint. Given that the new EU directive impacts a significant number of home owners and their homes both in Denmark and the rest of the European Union it is crucial to clarify which renovations have the most environmental impact and most cost effective. We have evaluated the 10 most impactful solutions and evaluated their impact in an indicator framework which includes 9 indicators and covers economic, environmental as well as social factors. We have packaged the result of the analysis in three packages, the most cost effective (short term), the most cost effective (long-term) and the most sustainable. The results of the study secure transparency and thereby provides homeowners with a tool to help their decision-making. The analysis is based on mostly qualitative indicators, but it will be possible to evaluate most of the indicators quantitively in a future study.

Keywords: energy efficiency, building renovation, renovation solutions, building energy performance criteria

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Authors: E. Grochowska-Niedworok, K. Brukało, M. Hadasik, M. Kardas

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Consumption of vegetables by school children and adolescents is essential for their normal growth, development and health, but a significant minority of the world's population consumes the right amount of these products. The aim of the study was to evaluate the preferences and frequency of consumption of vegetables by school children and adolescents. It has been assumed that effectively implemented nutrition education programs should have an impact on increasing the frequency of vegetable consumption among the recipients. The study covered 514 students of five schools in the Opole Voivodeship aged 9 years to 22 years. The research tool was an author's questionnaire, which consisted of closed questions on the frequency of vegetable consumption and the use of 10 ways to treat them. Preferences and frequencies are shown in percentages, while correlations were estimated on the basis of Cramer`s V and gamma coefficients. In each of the examined age groups, the relationship between sex and vegetable consumption (the Cramer`s V coefficient value was 0.06 to 0.38) was determined and the various methods of culinary processing were used (V Craméra was 0.08 to 0.34). For both sexes, the relationship between age and frequency of vegetable consumption was shown (gamma values ranged from ~ 0.00 to 0.39) and different cooking methods (gamma values were 0.01 to 0.22). The most important determinant of nutritional choices is the taste and availability of products. The fact that they have a positive effect on their health is only in third position. As has been shown, obesity prevention programs can not only address nutrition education but also teach about new flavors and increase the availability of healthy foods. In addition, the frequency of vegetable consumption can be a good indicator reflecting the healthy behaviors of children and adolescents.

Keywords: children and adolescents, frequency, welfare rate, vegetables

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Authors: Mohammad Jahangeer Warsi

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This is, perhaps, the first linguistic study of Maithili Urdu, a dialect of Urdu language of Indo-Aryan family, spoken by around four million speakers in Darbhanga, Samastipur, Begusarai, Madhubani, and Muzafarpur districts of Bihar. It has the subject–verb–object (SOV) word order and it lacks script and literature. Needless to say, this work is an attempt to document this dialect so that it should contribute to the field of descriptive linguistics. Besides, it is also spoken by majority of Maithili diaspora community. Maithili Urdu does not have its own script or literature, yet it has maintained an oral history of over many centuries. It has contributed to enriching the Maithili, Hindi and Urdu languages and literature very profoundly. Dialects are the contact languages of particular regions, and they have a deep impact on their cultural heritage. Slowly with time, these dialects begin to take shape of languages. The convergence of a dialect into a language is a symbol and pride of the people who speak it. Although, confined to the five districts of northern Bihar, yet highly popular among the natives, it is the primary mode of communication of the local Muslims. The paper will focus on the structure of expressions about Maithili Urdu that include the structure of words, phrases, clauses, and sentences. There are clear differences in linguistic features of Maithili Urdu vis-à-vis Urdu, Maithili and Hindi. Though being a dialect of Urdu, interestingly, there is only one second person pronoun tu and lack of agentive marker –ne. Although being spoken in the vicinity of Hindi, Urdu and Maithili, it undoubtedly has its own linguistic features, of them, verb conjugation is remarkably unique. Because of the oral tradition of this link language, intonation has become significantly prominent. This paper will discuss the morpho-syntactic pattern of Maithili Urdu and will go through a sample text to authenticate the findings.

Keywords: cultural heritage, morpho-syntactic pattern, Maithili Urdu, verb conjugation

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Authors: Orkide Donma, M. Metin Donma, Burcin Nalbantoglu, Birol Topcu, Feti Tulubas, Murat Aydin, Tuba Gokkus, Ahmet Gurel

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Increasing prevalence of childhood obesity has increased the interest in early and late indicators of gaining weight. Cell blood counts may be indicators of proinflammatory states. The aim was to evaluate associations of hematological parameters, including Hematocrit (HTC), hemoglobin, blood cell counts, and their indices with the degree of obesity in pediatric population. A total of 249; -139 morbidly obese (MO), 82 healthy Normal Weight (NW) and 28 Overweight (OW) children were included into the scope of the study. WHO BMI-for age percentiles were used to form age- and sex-matched groups. Informed consent forms and the Ethics Committee approval were obtained. Anthropometric measurements were performed. Hematological parameters were determined. Statistical analyses were performed using SPSS. The degree for statistical significance was p≤0.05. Significant differences (p=0.000) between waist-to-hip ratios and head-to-neck ratios (hnrs) of MO and NW children were detected. A significant difference between hnrs of OW and MO children (p=0.000) was observed. Red cell Distribution Width (RDW) was higher in OW children than NW group (p=0.030). Such finding couldn’t be detected between MO and NW groups. Increased RDW was prominent in OW children. The decrease in Mean Corpuscular Hemoglobin Concentration (MCHC) values in MO children was sharper than the values in OW children (p=0.006 vs p=0.042) compared to those in NW group. Statistically higher HTC levels were observed between MO-NW (p=0.014), but none between OW-NW. Though the cause-effect relationship between obesity and erythrocyte indices still needs further investigation, alterations in RDW, HTC, MCHC during obesity may be of significance in the early life.

Keywords: anthropometry, children, erythrocytes, obesity

Procedia PDF Downloads 336

Authors: Anne Tetens, Susan Andersen, Lars Ole Bonde, Pia Jeppesen, Katrine Rich Madsen

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Background: The World Health Organization (WHO) has emphasized the critical need for feasible and effective school-based mental health promotion interventions. High-quality music education in school has been suggested to promote well-being, inclusion, and positive relations, which are essential for children’s mental health. This study explores the potential of choir singing as a distinct approach to enhance children’s mental health within the school setting. ‘Everyone Can Sing’ is a class-based mental health promotion intervention for children in grades 0-3 (ages 5-10) in Danish primary school, which integrates choir singing into the students’ normal school schedule twice a week to promote mental health through the increase of school well-being, class coherence and social inclusion. The intervention uses trained choir leaders to lead the lessons in close collaboration with the class teacher, placing a distinct emphasis on well-being and the inclusive aspect of musical expression through body and voice. Aim: The aim of the study is to evaluate the feasibility of the Everyone Can Sing intervention with the specific objective to assess implementation and changes in mental health parameters, including school well-being, class coherence and social inclusion. Methodologies: The study is a feasibility study of a one-year intervention, which started in January 2024 and is being implemented in grades 0-3 (ages 5-10) across three different Danish primary schools. It is designed according to a mixed methods approach, including both quantitative and qualitative methods. Baseline questionnaires were obtained from students, parents and teachers, and follow-up is planned at 12 months. Participant observations of class choir and individual and group interviews with students, teachers, choir leaders, and school management are collected during the intervention period. The study uses the validated ‘Strengths and Difficulties Questionnaire’ for parent- and teacher-reports. The student questionnaire, which assesses school well-being, class coherence, social inclusion and indicators of mental health, was developed and validated for this study. Participant observations and interviews provide in-depth insights into the implementation process and participants’ experiences of the mental health-promoting potential of the intervention. Findings: The study included 41 classes across three schools (N=904) and questionnaire data from students (n=845, = 93%), teachers (n=890, = 98%), and parents (n=608, = 67%) at baseline. Follow-up data will be obtained in January 2025. While collection and analyses of data are still ongoing, preliminary implementation findings based on interviews and observations indicate high levels of engagement and acceptability. At 6 months into the intervention period, the study protocol is on track and suggests that the intervention is well-received. Further findings and analyses will be presented. The final results of the study will be used to decide whether the AKS intervention should proceed to a future, full-size effectiveness trial, return to refinement of the intervention or the evaluation design, or stop. Contributions: This study will provide valuable insights into new approaches to school-based mental health promotion initiatives. If feasible, the vision is to implement the intervention or elements of it in primary schools across all five Danish regions, potentially lowering the mental health burden.

Keywords: child mental health, early childhood, mental health promotion, mixed methods research, school-based intervention.

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Authors: S. N. T. I. Sampath, J. M. S. Jayasinghe, A. P. Attanayake, V. Karunaratne

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Diabetes mellitus is one of the major public health posers throughout the world today that incidence and associated with increasing mortality. Insufficient regulation of the blood glucose level might be serious effects for health and its necessity to identify new therapeutics that have ability to reduce hyperglycaemic condition in the human body. Even though synthetic antidiabetic drugs are more effective to control diabetes mellitus, there are considerable side effects have been reported. Thus, there is an increasing demand for searching new natural products having high antidiabetic activity with lesser side effects. The purposes of the present study were to evaluate different physical parameters and in-vitro and in-vivo antidiabetic potential of the selected combined medicinal plant extracts mixture composed of leaves of Murraya koenigii, cloves of Allium sativum, fruits of Garcinia queasita and seeds of Piper nigrum. The selected plants parts were mixed and ground together and extracted sequentially into the hexane, ethyl acetate and methanol. Solvents were evaporated and they were further dried by freeze-drying to obtain a fine powder of each extract. Various physical parameters such as moisture, total ash, acid insoluble ash and water soluble ash were evaluated using standard test procedures. In-vitro antidiabetic activity of combined plant extracts mixture was screened using enzyme assays such as α-amylase inhibition assay and α-glucosidase inhibition assay. The acute anti-hyperglycaemic activity was performed using oral glucose tolerance test for the streptozotocin induced diabetic Wistar rats to find out in-vivo antidiabetic activity of combined plant extracts mixture and it was assessed through total oral glucose tolerance curve (TAUC) values. The percentage of moisture content, total ash content, acid insoluble ash content and water soluble ash content were ranged of 7.6-17.8, 8.1-11.78, 0.019-0.134 and 6.2-9.2 respectively for the plant extracts and those values were less than standard values except the methanol extract. The hexane and ethyl acetate extracts exhibited highest α-amylase (IC50 = 25.7 ±0.6; 27.1 ±1.2 ppm) and α-glucosidase (IC50 = 22.4 ±0.1; 33.7 ±0.2 ppm) inhibitory activities than methanol extract (IC50 = 360.2 ±0.6; 179.6 ±0.9 ppm) when compared with the acarbose positive control (IC50 = 5.7 ±0.4; 17.1 ±0.6 ppm). The TAUC values for hexane, ethyl acetate, and methanol extracts and glibenclamide (positive control) treated rats were 8.01 ±0.66; 8.05 ±1.07; 8.40±0.50; 5.87 ±0.93 mmol/L.h respectively, whereas in diabetic control rats the TAUC value was 13.22 ±1.07 mmol/L.h. Administration of plant extracts treated rats significantly suppressed (p<0.05) the rise in plasma blood glucose levels compared to control rats but less significant than glibenclamide. The obtained results from in-vivo and in-vitro antidiabetic study showed that the hexane and ethyl acetate extracts of selected combined plant mixture might be considered as a potential source to isolate natural antidiabetic agents and physical parameters of hexane and ethyl acetate extracts will helpful to develop antidiabetic drug with further standardize properties.

Keywords: diabetes mellitus, in-vitro antidiabetic assays, medicinal plants, standardization

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Authors: Mahera Abdulrahman, Satish Chandrasekhar Nair

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Growing demand for human health research in the United Arab Emirates (UAE) has prompted the need to develop a robust research ethics oversight, particularly given the large unskilled-worker immigrant population and the elderly citizens utilizing health services. Examination of the structure, function, practices and outcomes of the human research ethics committees (HREC) was conducted using two survey instruments, reliable and validated. Results indicate that in the absence of a national ethics regulatory body, the individual emirate’s governed 21 HRECs covering health facilities and academic institutions in the UAE. Among the HRECs, 86% followed International Council for Harmonization-Good Clinical Practice guidelines, 57% have been in operation for more than five years, 81% reviewed proposals within eight weeks, 48% reviewed for clinical and scientific merit apart from ethics, and 43% handled more than 50 research proposals per year. However, researcher recognition, funding transparency, adverse event reporting systems were widespread in less than one-third of all HRECs. Surprisingly, intellectual property right was not included as a research output. Research was incorporated into the vision and mission statements of many (62%) organizations and, mechanisms such as research publications, collaborations, and recognitions were employed as key performance indicators to measure research output. In spite, resources to generate research output such as dedicated budget (19%), support staff (19%) and continuous training and mentoring program for medical residents and HREC members were somehow lacking. HREC structure and operations in the UAE are similar to other regions of the world, resources allocation for efficient, quality monitoring, continuous training, and the creation of a clinical research network are needed to strengthen the clinical research enterprise to scale up for the future. It is anticipated that the results of this study will benefit investigators, regulators, pharmaceutical sponsors and the policy makers in the region.

Keywords: institutional review board, ethics committee, human research ethics, United Arab Emirates (UAE)

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Authors: Anna Ghosh, Dominic Shields, Ceri McIntosh, Stephen Crank

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A 29-year-old male was a referral to the maxillofacial unit following a referral from his general dental practitioner via a routine pathway regarding a large periapical lesion on the LR4 with root resorption. The patient was asymptomatic, the LR4 vital and unrestored, and this was an incidental finding at a routine check-up. The patient's past medical history was unremarkable. Examination revealed no extra or intra-oral pathology and non-mobile teeth. No focal neurology was detected. An orthopantogram demonstrated a well-defined unilocular corticated radiolucency associated with the LR4. The root appeared shortened with the radiolucency between the root and a radio-opacity, possibly representing the displacement of the apical tip of the tooth. It was recommended that the referring general practitioner should proceed with orthograde root canal therapy, after which time exploration, enucleation, and retrograde root filling of the LR4 would be carried out by a maxillofacial unit. The patient was reviewed six months later where, due to the COVID-19 pandemic, the patient had been unable to access general dental services for the root canal treatment. He was still entirely asymptomatic. A one-year review was planned in the hope this would allow time for the orthograde root canal therapy to be completed. At this review, the orthograde root canal therapy had still not been completed. Interestingly, a repeat orthopantogram revealed a significant reduction in size with good bony infill and a significant reduction in the size of the lesion. Due to the ongoing delays with primary care dental therapy, the patient was subsequently internally referred to the restorative dentistry department for care. The patient was seen again by oral and maxillo-facial surgery in mid-2022 where he still reports this tooth as asymptomatic with no focal neurology. The patient's history was fully reviewed, and noted that 15 years previously, the patient underwent open reduction and internal fixation of a left angle of mandible fracture. Temporary IMF involving IMF screws and fixation wires were employed to maintain occlusion during plating and subsequently removed post-operatively. It is proposed that the radiolucency was, as a result of the IMF screw placement, penetrating the LR4 root resulting in resorption of the tooth root and development of a radiolucency. This case highlights the importance of careful screw size and physical site location, and placement of IMF screws, as there can be permeant damage to a patient’s dentition.

Keywords: facial trauma, inter-maxillary fixation, mandibular radiolucency, oral and maxillo-facial surgery

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Authors: V. Rekha, Rama Pal

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The study examines the degree and magnitude of wealth-based inequalities in child health and its determinants in India. Despite making strides in economic growth, India has failed to secure a better nutritional status for all the children. The country currently faces the double burden of malnutrition as well as the problems of overweight and obesity. Child malnutrition, obesity, unsafe water, sanitation among others are identified as the risk factors for Non-Communicable Diseases (NCDs). Eliminating malnutrition in all its forms will catalyse improved health and economic outcomes. The assessment of the distributive dimension of child health across various segments of the population is essential for effective policy intervention. The study utilises the fourth round of District Level Health Survey for 2012-13 to analyse the inequalities among children in the age group 0-14 years in Maharashtra, a state in the western region of India with a population of 11.24 crores which constitutes 9.3 percent of the total population of India. The study considers the extent of health inequality by state, districts, sector, age-groups, and gender. The z-scores of four child health outcome variables are computed to assess the nutritional status of pre-school and school children using WHO reference. The descriptive statistics, concentration curves, concentration indices, correlation matrix, logistic regression have been used to analyse the data. The results indicate that magnitude of inequality is higher in Maharashtra and child health inequalities manifest primarily among the weaker sections of society. The concentration curves show that there exists a pro-poor inequality in child malnutrition measured by stunting, wasting, underweight, anaemia and a pro-rich overweight inequality. The inequalities in anaemia are observably lower due to the widespread prevalence. Rural areas exhibit a higher incidence of malnutrition, but greater inequality is observed in the urban areas. Overall, the wealth-based inequalities do not vary significantly between age groups. It appears that there is no gender discrimination at the state level. Further, rural-urban differentials in gender show that boys from the rural area and girls living in the urban region experience higher disparities in health. The relative distribution of undernutrition across districts in Maharashtra reveals that malnutrition is rampant and considerable heterogeneity also exists. A negative correlation is established between malnutrition prevalence and human development indicators. The findings of logistic regression analysis reveal that lower economic status of the household is associated with a higher probability of being malnourished. The study recognises household wealth, education of the parent, child gender, and household size as factors significantly related to malnutrition. The results suggest that among the supply-side variables, child-oriented government programmes might be beneficial in tackling nutrition deficit. In order to bridge the health inequality gap, the government needs to target the schemes better and should expand the coverage of services.

Keywords: child health, inequality, malnutrition, obesity

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Authors: Rui Lança, Elisa Silva, Fátima Farinha, Miguel José Oliveira, Manuel Duarte Pinheiro, Cátia Miguel

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Tourism has a great potential to bring up progress across the Sustainable Development Goals (SDGs). If well managed and monitored, the tourism sector can create quality jobs, reduce poorness and offer incentives for environmental preservation, helping on the transition towards more inclusive and resilient economies. However, without proper safeguards and investments, expansion of the tourism market will increase pressure on biodiversity and the ecosystems on which the livelihoods of local communities depend. Competitivity is a key dimension in tourism, sustainable tourism challenge new dimensions to competitivity, namely environmental, social, institutional and economic achieve a medium and long-term competitivity. It is undoubtedly clear on the tourism sector, the importance of the region sustainability in the current touristic destinations offer. The basis of a tourism region prosperity will depend on /of it. The OBSERVE project intends to be an instrument for monitoring and evaluating the sustainability levels of the Algarve region. Its main objective is to provide environmental, economic, social-cultural and institutional indicators to support the decision-making process for a sustainable growth of the region. The project´s main goal is a digital portal with the most relevant indicators to allow evaluating and communicating the performance of the region in a sustainable growth perspective. This paper presents the OBSERVE project and highlights the potential contribution to a broad perspective of competitivity and its contribution for different stakeholders and the touristic value chain. Limitations and opportunities are also discussed.

Keywords: sustainable tourism, competitivity, OBSERVE project, Algarve region

Procedia PDF Downloads 132

Authors: Teodorica G. Ani

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Economic activity requires an encouraging regulatory environment and effective rules that are transparent and accessible to all. The World Bank has been publishing the annual Doing Business reports since 2004 to investigate the scope and manner of regulations that enhance business activity and those that constrain it. A streamlined business environment supporting the development of competitive small and medium enterprises (SMEs) may expand employment opportunities and improve the living conditions of low income households. Asia has emerged as one of the most attractive markets in the world. Economies in East Asia and the Pacific were among the most active in making it easier for local firms to do business. The study aimed to describe the ease of doing business and its effect to economic growth among selected economies in Asia for the year 2014. The study covered 29 economies in East Asia, Southeast Asia, South Asia and Middle Asia. Ease of doing business is measured by the Doing Business indicators (DBI) of the World Bank. The indicators cover ten aspects of the ease of doing business such as starting a business, dealing with construction permits, getting electricity, registering property, getting credit, protecting investors, paying taxes, trading across borders, enforcing contracts and resolving insolvency. In the study, Gross Domestic Product (GDP) was used as the proxy variable for economic growth. Descriptive research was the research design used. Graphical analysis was used to describe the income and doing business among selected economies. In addition, multiple regression was used to determine the effect of doing business to economic growth. The study presented the income among selected economies. The graph showed China has the highest income while Maldives produces the lowest and that observation were supported by gathered literatures. The study also presented the status of the ten indicators of doing business among selected economies. The graphs showed varying trends on how easy to start a business, deal with construction permits and to register property. Starting a business is easiest in Singapore followed by Hong Kong. The study found out that the variations in ease of doing business is explained by starting a business, dealing with construction permits and registering property. Moreover, an explanation of the regression result implies that a day increase in the average number of days it takes to complete a procedure will decrease the value of GDP in general. The research proposed inputs to policy which may increase the awareness of local government units of different economies on the simplification of the policies of the different components used in measuring doing business.

Keywords: doing business, economic growth, gross domestic product, Asia

Procedia PDF Downloads 362