Search results for: early childhood care and development (ECCD)

Authors: Eliza Torrigue, Efrelyn Iellamo

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Maternal death is one of the rising health issues in the Philippines. It is alarming to know that in every hour of each day, a mother gives birth to a child who may not live to see the next day. Statistics shows that intrapartum period and third stage of labor are the very crucial periods for the expectant mother, as well as the first six hours of life for the newborn. To address the issue, The Essential Intrapartum Newborn Care (EINC) was developed. Through this, Obstetric Delivery Room (OB-DR) Nurses shall be updated with the evidence-based maternal and newborn care to ensure patient safety, thus, reducing maternal and child mortality. This study aims to describe the compliance of hospitals, especially of OB-DR nurses, to the EINC Protocols. The researcher aims to link the profile variables of the respondents in terms of age, length of service and formal training to their compliance on the EINC Protocols. The outcome of the study is geared towards the development of appropriate training program for OB-DR Nurses assigned in the delivery room of the hospitals based on the study’s results to sustain the EINC standards. A descriptive correlational method was used. The sample consists of 75 Obstetric Delivery Room (OB-DR) Nurses from three government hospitals in the City of Manila namely, Ospital ng Maynila Medical Center, Tondo Medical Center, and Gat Andres Bonifacio Memorial Medical Center. Data were collected using an evaluative checklist. Ranking, weighted mean, Chi-square and Pearson’s R were used to analyze data. The level of compliance to the EINC Protocols by the respondents was evaluated with an overall mean score of 4.768 implying that OB-DR Nurses have a high regard in complying with the step by step procedure of the EINC. Furthermore, data shows that formal training on EINC have a significant relationship with OB-DR Nurses’ level of compliance during cord care, AMTSL, and immediate newborn care until the first ninety minutes to six hours of life. However, the respondents’ age and length of service do not have a significant relationship with the compliance of OB-DR Nurses on EINC Protocols. In the pursuit of decreasing the maternal mortality in the Philippines, EINC Protocols have been widely implemented in the country especially in the government hospitals where most of the deliveries happen. In this study, it was found out that OB-DR Nurses adhere and are highly compliant to the standards in order to assure that optimum level of care is delivered to the mother and newborn. Formal training on EINC, on the other hand, create the most impact on the compliance of nurses. It is therefore recommended that there must be a structured enhancement training program to plan, implement and evaluate the EINC protocols in these government hospitals.

Keywords: compliance, intrapartum, newborn care, nurses

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Authors: Tejasvi Parupudi, Mochen Li, Lakshya Mittal, Ignacio G. Camarillo, Raji Sundararajan

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With breast cancer becoming a global pandemic, it is very important to assess a woman’s risk profile accurately in a timely manner. Providing an estimate of the risk of developing breast cancer to a woman gives her an opportunity to consider options to decrease this risk. Women at low risk may be suggested yearly screenings whereas women with a high risk of developing breast cancer would be candidates for aggressive surveillance. Fortunately, there is a set of risk factors that are used to predict the probability of a woman being diagnosed with breast cancer in the future. Studying risk factors and understanding how they correlate to cancer is important for early diagnosis, prevention and reducing mortality rates. The effect of crucial risk factors among black and white women was compared in this study. The various risk factors analyzed include breast density, age, cancer in a first-degree relative, menopausal status, body mass index (BMI) and prior breast cancer diagnosis, etc. Breast density, age at first full-term birth and BMI were utilized in this study as important risk factors for the comparison of incidence rates between women of black and white races in the USA. Understanding the differences could lead to the development of solutions to reduce disparity in mortality rates among black women by improving overall access to care.

Keywords: big data, breast cancer, risk factors, incidence rates, mortality, race

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Authors: Aleema Rahman

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Introduction: This study aims to estimate the prevalence of long-term otitis media with effusion (OME) and hearing loss in a prospective longitudinal cohort studyand to study the relationship between the condition and educational and psychosocial outcomes. Methods: Analysis of data from the Avon Longitudinal Study of Parents and Children (ALSPAC) will be undertaken. ALSPAC is a longitudinal birth cohort study carried out in the UK, which has collected detailed measures of hearing on ~7000 children from the age of seven. A descriptive analysis of the data will be undertaken to estimate the prevalence of OME and hearing loss (defined as having average hearing levels > 20dB and type B tympanogram) at 7, 9, 11, and 15 years as well as that of long-term OME and hearing loss. Logistic and linear regression analyses will be conducted to examine associations between long-term OME and hearing loss and educational outcomes (grades obtained from standardised national attainment tests) and psychosocial outcomes such as anxiety, social fears, and depression at ages 10-11 and 15-16 years. Results: Results will be presented in terms of the prevalence of OME and hearing loss in the population at each age. The prevalence of long-term OME and hearing loss, defined as having OME and hearing loss at two or more time points, will also be reported. Furthermore, any associations between long-term OME and hearing loss and the educational and psychosocial outcomes will be presented. Analyses will take into account demographic factors such as sex and social deprivation and relevant confounders, including socioeconomic status, ethnicity, and IQ. Discussion: Findings from this study will provide new epidemiological information on the prevalence of long-term OME and hearing loss. The research will provide new knowledge on the impact of OME for the small group of children who do not grow out of condition by age 7 but continue to have hearing loss and need clinical care through later childhood. The study could have clinical implications and may influence service delivery for this group of children.

Keywords: educational attainment, hearing loss, otitis media with effusion, psychosocial development

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Authors: Maryam Ghareh Chaei, Masuzyo Chilwesa, Ali Akbarnezhad, Arnaud Castel, Redmond Lloyd, Stephen Foster

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Cement hydration is an exothermic chemical reaction generally leading to a rise in concrete’s temperature. This internal heating of concrete may, in turn, lead to a temperature difference between the hotter interior and the cooler exterior of concrete and thus differential thermal stresses in early ages which could be particularly significant in mass concrete. Such differential thermal stresses result in early age thermal cracking of concrete when exceeding the concrete’s tensile strength. The extent of temperature rise and thus early age differential thermal stresses is generally a function of hydration heat intensity, thermal properties of concrete and size of the concrete element. Both hydration heat intensity and thermal properties of concrete may vary considerably with variations in the type cementitious materials and other constituents. With this in mind, partial replacement of cement with supplementary cementitious materials including fly ash and ground granulated blast furnace slag has been investigated widely as an effective strategy to moderate the heat generation rate and thus reduce the risk of early age thermal cracking of concrete. However, there is currently a lack of adequate literature on effect of partial replacement of cement with fly ash and/or ground granulated blast furnace slag on the thermal properties of concrete. This paper presents the results of an experimental conducted to evaluate the effect of addition of varying percentages of fly ash (up to 60%) and ground granulated blast furnace slag (up to 50%) on the heat capacity and thermal conductivity of early age cement paste. The water to cementitious materials ratio is kept 0.45 for all the paste samples. The results of the experimental studies were used in a numerical analysis performed using Comsol Multiphysics to highlight the effects of variations in the thermal properties of concrete, due to variations in the type of aggregate and content of supplemenraty cementitious materials, on the risk of early age cracking of a concrete raft.

Keywords: thermal diffusivity, early age thermal cracking, concrete, supplementary cementitious materials

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Authors: Thumesha Jayatilake

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As platform work continues to proliferate, algorithmic management, which takes care of its operational role, poses complex challenges, including job satisfaction, worker involvement, ethical decision-making, and worker well-being. This conceptual paper scrutinizes how algorithmic management influences virtue development among platform workers, with an emphasis on the effects of role conflict and role ambiguity. Using an interdisciplinary approach, the research elucidates the complex relationship between algorithmic management systems and the ethical dimensions of work. The study also incorporates the interplay of human interaction and short-term task orientation, thus broadening the understanding of the impacts of algorithmic management on virtue development. The findings have significant implications for policymakers, academics, and industry practitioners, illuminating the ethical complexities presented by the use of algorithms in modern employment settings.

Keywords: algorithmic management, ethics, platform work, virtue

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Authors: Ya-Ping Chang

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Starting from the early stages of pregnancy, parents begin to form hopes and dreams about the future of their child. They will think about the appearance and personality of their child and may even develop many expectations. The patient in this study experienced a successful pregnancy following multiple attempts at artificial insemination. However, due to arrested embryonic development, and based on the physician’s evaluation, a caesarean section was performed at week 25. However, the baby suffered from infections and subsequently died from multiple organ failures. This study collected and analyzed objective and subjective data through observation, interviews, recording, and interactions with the patient. The following nursing issues of the patient were identified: anxiety, anticipatory grief, and adjustment disorder. The psychology of caring as proposed in Watson’s theory was applied to address these nursing issues. Comprehensive and continuous care was provided to the patient on the basis of mutual trust and individual nursing guidelines in order to alleviate the patient’s anxiety, help her to cope with grief, and prepare her for the eventual death of her child. The author helped the patient to say goodbye to her child and accept the child’s death calmly, such that she had no regrets about the experience. This nursing experience may serve as a reference to nurses managing similar cases in the future.

Keywords: dying baby, mother, grief, Watson’s theory

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Authors: Debasis Sarkar

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Development of a Smart City would depend upon the development of its infrastructure in a smart way. Primarily based on the ideology of the fourth industrial revolution a Smart City project should have Smart governance, smart health care, smart building, smart transportation, smart mobility, smart energy, smart technology and smart citizen. Considering the Indian scenario of current state of cities in India, it has become very essential to decide the specific parameters which would govern the development of a Smart City project. It has been observed that there are significant parameters beyond Information and Communication Technology (ICT), which govern the development of a Smart City project. This paper is an attempt to identify the Critical Success Factors (CSF) which are significantly responsible for the development of a Smart City project in Western India. Responses to questionnaire survey were analyzed on basis of Likert scale. They were further critically evaluated with help of Factor Comparison Method (FCM) and Analytical Hierarchy Process (AHP). The project authorities need to incorporate Building Information Modeling (BIM) to make the smart city project more collaborative. To make the project more sustainable, use of flyash in the concrete used, reduced usage of cement and steel, use of alternate fuels like biodiesel is recommended.

Keywords: analytical hierarchical process, building information modeling, critical success factors, factor comparison method

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Authors: Zhang Bian, Zhao Jijun

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The urban layout of Xi’an city (the capital Chang’an in the Tang dynasty) was shaped by feudal etiquette, but this dominant factor was replaced by modern city planning during the period of the Republic of China. This makes Xi’an a representative case to explore the transformation process of Chinese cities in the early 20^th century. By analyzing the contrast and connection between the historical texts of city planning and the realistic construction activities recorded by the maps and images, this paper reviews the transformation process of the urban space of Xi’an in the early 20^th century and divides it into four phases according to important events that significantly impacted planning and construction activities. Based on this, the entire transformation of Xi’an’s city planning and practices can be characterized by three aspects: 1) the dominant force of the city plan and construction changed with the establishment of modern city administrations; 2) the layout of the city was continuously broadened to meet the demand of modern economy and city life; and, 3) the ritual space was transformed into practical space for commercial and recreational activities.

Keywords: city space, the early 20th century, transformation, Xi’an city

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Authors: G. Natuhwera, M. Rabwoni, P. Ellis, A. Merriman

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Aims: Health workers are likely to document patients’ care inaccurately, especially when using new and revised case tools, and this could negatively impact patient care. This study set out to; (1) assess nurses’ and clinicians’ documentation practices when using a new patients’ continuation case sheet (PCCS) and (2) explore nurses’ and clinicians’ experiences regarding documentation of patients’ information in the new PCCS. The purpose of introducing the PCCS was to improve continuity of care for patients attending clinics at which they were unlikely to see the same clinician or nurse consistently. Methods: This was a mixed methods study. The cross-sectional inquiry retrospectively reviewed 100 case notes of active patients on hospice and palliative care program. Data was collected using a structured questionnaire with constructs formulated from the new PCCS under study. The qualitative element was face-to-face audio-recorded, open-ended interviews with a purposive sample of one palliative care clinician, and four palliative care nurse specialists. Thematic analysis was used. Results: Missing patients’ biogeographic information was prevalent at 5-10%. Spiritual and psychosocial issues were not documented in 42.6%, and vital signs in 49.2%. Poorest documentation practices were observed in past medical history part of the PCCS at 40-63%. Four themes emerged from interviews with clinicians and nurses-; (1) what remains unclear and challenges, (2) comparing the past with the present, (3) experiential thoughts, and (4) transition and adapting to change. Conclusions: The PCCS seems to be a comprehensive and simple tool to be used to document patients’ information at subsequent visits. The comprehensiveness and utility of the PCCS does paper to be limited by the failure to train staff in its use prior to introducing. The authors find the PCCS comprehensive and suitable to capture patients’ information and recommend it can be adopted and used in other palliative and hospice care settings, if suitable introductory training accompanies its introduction. Otherwise, the reliability and validity of patients’ information collected by this PCCS can be significantly reduced if some sections therein are unclear to the clinicians/nurses. The study identified clinicians- and nurses-related pitfalls in documentation of patients’ care. Clinicians and nurses need to prioritize accurate and complete documentation of patient care in the PCCS for quality care provision. This study should be extended to other sites using similar tools to ensure representative and generalizable findings.

Keywords: documentation, information case sheet, palliative care, quality improvement

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Authors: Vaikunthan Rajaratnam

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Maintaining continuous professional development among clinicians has been a challenge. Hand surgery is a unique speciality with the coming together of orthopaedics, plastics and trauma surgeons. The requirements for a team-based approach to care with the inclusion of other experts such as occupational, physiotherapist and orthotic and prosthetist provide the impetus for the creation of communities of practice. This study analysed the community of practice in hand surgery that was created through a social networking website for professionals. The main objectives were to discover the usefulness of this community of practice created in the platform of the group function of LinkedIn. The second objective was to determine the usability of this platform for the purposes of continuing professional development among members of this community of practice. The methodology used was one of mixed methods which included a quantitative analysis on the usefulness of the social network website as a community of practice, using the analytics provided by the LinkedIn platform. Further qualitative analysis was performed on the various postings that were generated by the community of practice within the social network website. This was augmented by a respondent driven survey conducted online to assess the usefulness of the platform for continuous professional development. A total of 31 respondents were involved in this study. This study has shown that it is possible to create an engaging and interactive community of practice among hand surgeons using the group function of this professional social networking website LinkedIn. Over three years the group has grown significantly with members from multiple regions and has produced engaging and interactive conversations online. From the results of the respondents’ survey, it can be concluded that there was satisfaction of the functionality and that it was an excellent platform for discussions and collaboration in the community of practice with a 69 % of satisfaction. Case-based discussions were the most useful functions of the community of practice. This platform usability was graded as excellent using the validated usability tool. This study has shown that the social networking site LinkedIn’s group function can be easily used as a community of practice effectively and provides convenience to professionals and has made an impact on their practice and better care for patients. It has also shown that this platform was easy to use and has a high level of usability for the average healthcare professional. This platform provided the improved connectivity among professionals involved in hand surgery care which allowed for the community to grow and with proper support and contribution of relevant material by members allowed for a safe environment for the exchange of knowledge and sharing of experience that is the foundation of a community practice.

Keywords: community of practice, online community, hand surgery, lifelong learning, LinkedIn, social media, continuing professional development

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Authors: F. Slaven, M. Uys, Y. Erasmus

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The South African National Mental Health Education Programme (SANMHEP) was a National Department of Health (NDoH) initiative to strengthen mental health services in South Africa in collaboration with the Foundation for Professional Development (FPD), SANOFI and the various provincial departments of health. The programme was implemented against the backdrop of a number of challenges in the management of mental health in the country related to staff shortages and infrastructure, the intersection of mental health with the growing burden of non-communicable diseases and various forms of violence, and challenges around substance abuse and its relationship with mental health. The Mental Health Care Act (No. 17 of 2002) prescribes that mental health should be integrated into general health services including primary, secondary and tertiary levels to improve access to services and reduce stigma associated with mental illness. In order for the provisions of the Act to become a reality, and for the journey of mental health patients through the system to improve, sufficient and skilled health care providers are critical. SANMHEP specifically targeted Medical Doctors and Professional Nurses working within the facilities that are listed to conduct 72-hour assessments, as well as District Hospitals. The aim of the programme was to improve the clinical diagnosis and management of mental disorders/conditions and the understanding of and compliance with the Mental Health Care Act and related Regulations and Guidelines in the care, treatment and rehabilitation of mental health care users. The course used a blended-learning approach and trained 1 120 health care providers through 36 workshops between February and November 2019. Of those trained, 689 (61.52%) were Professional Nurses, 337 (30.09%) were Medical Doctors, and 91 (8.13%) indicated their occupation as ‘other’ (of these more than half were psychologists). The pre- and post-evaluation of the face-to-face training sessions indicated a marked improvement in knowledge and confidence level scores (both clinical and legislative) in the care, treatment and rehabilitation of mental health care users by participants in all the training sessions. There was a marked improvement in the knowledge and confidence of participants in performing certain mental health activities (on average the ratings increased by 2.72; or 27%) and in managing certain mental health conditions (on average the ratings increased by 2.55; or 25%). The course also required that participants obtain 70% or higher in their formal assessments as part of the online component. The 337 participants who completed and passed the course scored 90% on average. This illustrates that when participants attempted and completed the course, they did very well. To further assess the effect of the course on the knowledge and behaviour of the trained mental health care practitioners a mixed-method outcome evaluation is currently underway consisting of a survey with participants three months after completion, follow-up interviews with participants, and key informant interviews with department of health officials and course facilitators. This will enable a more detailed assessment of the impact of the training on participants' perceived ability to manage and treat mental health patients.

Keywords: mental health, public health facilities, South Africa, training

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Authors: Najith Duminda Galmangoda Guruge, Nadeeka Rathnayake, Vinodani Wimalasena, Dinesha Wijesooriya

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Investing in Early Learning can improve children’ interests for education and makes them ready for school. Children in economically disadvantaged communities may have reduced readiness for schools. Health Promotion approach enables communities including disadvantaged to control over their health. Mothers of children under the age five in ‘Alapathwewa’ community (n=40) were selected as the sample with the aim to promote early learning of children to improve their school readiness. Mothers in ‘Morakeewa’ community (n=40) were the control. Interventions were for a period of 2 years and children of these mothers were followed up to school entry. Importance of early learning and possibility of providing quality learning environments for children at a low cost was discussed with mothers in an experimental setting by facilitators. Mothers were enabled to make age-appropriate baby rooms which provide learning opportunities. Collective community playhouses and play areas were developed by mothers to provide opportunities for children to interact and learn with each other. Mothers started discussing with each other and sharing experiences. The progress was monitored by mothers at regular intervals. Data regarding school competencies of children were obtained from school teachers. School teachers measured thirteen competencies of children on a scale of ‘very good, good, moderate and weak’. All children in the experimental group were in ‘very good’ level in two competencies, ‘communicate friendly with others’ and ‘express ideas well’. Children in the experimental group reported a significantly higher achievement of all thirteen competencies (p < .05) than children in control. Providing quality early learning environments for children even in economically disadvantaged settings makes them ready for schools. Through a Health Promotion approach, early learning experiences for children can be provided at a low cost.

Keywords: disadvantaged, early learning, economically, health promotion

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Authors: S. J. Sirima, C. Thirawan, R.Puntharikorn, K. Ungsumalin, J. Kaemwich

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Acinetobacter spp. is a gram negative bacterium causing the high incidence of multi-drug resistance in patients admitted to an intensive care unit. A hundred isolates of Imipenem-resistant Acinetobacter spp. isolated from patients admitted at tertiary health care center, Northeastern region, Ubon Ratchathani, Thailand, were subjected to modified Hodge test and combined disc test in order to evaluate the production of carbapenemases. The results revealed that about 35% of isolates were found to be carbapenemases producers. In addition, multiplex polymerase chain reactions were performed to detect blaOXA-like genes. It showed that 92% of isolates possess blaOXA-51-like and blaOXA-23-like genes. However, blaOXA-58-like gene was detected in only 8 isolates. No detection of blaOXA-24-like gene was observed in all isolates. In conclusion, an ability to produce carbepenemases would be an important mechanism of multi-drug resistance among clinical isolates of Acinetobacter spp. at tertiary health care center, Northeastern region, Ubon Ratchathani, Thailand. Furthermore, it was likely that the class D carbapenemases genes, blaOXA-51-like and blaOXA-23-like, might contribute to imipenem-resistance exhibiting among isolates.

Keywords: Acinetobacter spp., blaOXA-like genes, carbapenemases, tertiary health care center

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Authors: J. Dutton, L. Knight

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Achieving quality and respectful maternal health care is part of the global agenda to improve reproductive health and achieve universal reproductive rights. Barriers to quality of care in South African maternal health facilities exist at both systemic and individual levels. Addition to this, the normalization of gender violence within South Africa has a large impact on people seeking health care as well as those who provide care within health facilities. The hierarchical environment of South Africa’s public health system penalizes both patients and providers who battle to assume any assessable power. This paper explores how systemic and individual level barriers to quality of care affect the midwifery profession within South African maternal health services and create, at times, an environment of enmity rather than care. This paper analyzes and discusses the data collected from in-depth, semi-structured interviews with nurses and midwives at three maternal health facilities in South Africa. This study has taken a holistic approach to understand the realities of nurses and midwives in order to explore the ways in which experience informs their practice and treatment of pregnant women. Through collecting and analyzing narratives, linkages between nurses and midwives day-to-day and historical experiences and disrespectful care have been made. Findings from this study show that barriers to quality of care take form in complex and interrelated ways. The physical structure of the health facility, human resource shortages, and the current model of maternal health care, which often lacks a person-centered approach, is entangled within personal beliefs and attitudes of what it means to be a midwife to create an environment that is often not conducive to a positive birthing experience. This entanglement sits within a society of high rates of violence, inequality, and poverty. Having teased out the nuances of each of these barriers and the multiple ways they reinforce each other, the findings of this paper demonstrate that birth, and the work of a midwife, are situated in a mode of discipline and punishment within this context. For analytical purposes, this paper has broken down the individual barriers to quality care and discusses the current and historical significance before returning to the interrelated forms in which barriers to quality maternal health care manifest. In conclusion this paper questions the role of agency in the ability to subvert systemic barriers to quality care and ideas around shifting attitudes and beliefs of and about midwives. International and local policies and guidelines have a role to play in realizing such shifts, however, as this paper suggests, when policy does not speak to the local context there is the risk of it contributing to frustrations and impeding the path to quality and respectful maternal health care.

Keywords: disrespect and abuse in childbirth, midwifery, South African maternal health care, quality of care

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Authors: Jorn Meyer, Stefan Sturmer

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The assessment of attachment patterns in toddlers and adults has been well researched, and valid diagnostic methods (e.g., Strange Situation Test, Adult Attachment Interview) are applicable. For middle and late childhood, on the other hand, there are only few validated methods available so far. For the Child Attachment Interview (CAI) promising validation studies from English-speaking countries are available, but so far a comprehensive study on the validity of a German sample is lacking. Within the scope of a longitudinal project, the results of the first point of measurement are reported in this study. A German-language version of the CAI was carried out with 111 primary school children (56% female; age: M = 8.34, SD = 0.49). In relation to psychometric quality criteria, parameters on interrater reliability, construct validity and discriminant, and convergent validity are reported. Analyses of the correlations between attachment patterns and internalizing and externalizing behavior problems from parent and teacher reports are presented. The implications for the German-language assessment of attachment in middle and late childhood in research and individual case diagnostics, e.g., in the context of conducting expert evaluation reports for family courts, are discussed.

Keywords: attachment, attachment assessment, developmental psychology, longitudinal study

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Authors: K. C. Surekha

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The natural habitat forms the setting for every urban development. The tangible and intangible characteristics of the site contributed to the sustenance of various urban dimensions of early civilizations. However, as the towns were continuously evolving and developing, the attitude towards the natural habitat changed. The after effects of this self-centered attitude resulted in various natural and manmade catastrophes. At the same time the social habitat, cities and new towns were increasingly over-populated; and will become even more numerous and crowded in the future. The coexistence of natural and urban components is necessary for a sustainable future and preserving the region’s unique features. Therefore, there is an urgent need to rethink actively on alternative development paradigms to achieve sustenance of all living forms on the planet in a more sustainable way. The main aim of this paper is to understand bioregionalism as an alternative development paradigm, its theory, concepts as well as the key aspects of bioregional planning. The paper will try to understand the concept of bioregionalism theoretically and take case studies. The critical interpretation of theory and analysis of case studies will be used to form a set of design parameters which can be physically implemented from an urban design and planning standpoint.

Keywords: bioregion, bioregionalism, holistic, sustainable

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Authors: Sumattana Glangkarn, Vorapoj Promasatayaprot

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Background: Proportion of population ageing in Thailand has been increased rapidly in the past decades according to living longer and the fertility rates have decreased. The most important challenge related to this situation is to consider how to improve quality and years of healthy of life. This study aimed to implement the older persons’ long term care (LTC) system for elderly care by family and community. Method: The Consolidated Framework for Implementation Research (CFIR) was employed for guiding and evaluating an implementation process in ageing care. The CFIR composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Results: most elderly participants were couples, educating primary school and living with children and grandchildren. More than half of them had chronic diseases such as diabetes mellitus and hypertension. Factor analysis revealed factors related to health care of older participants which consisted of exercise, diet, accidental prevention, relaxation, self-care capacity, joyfulness, family relationship, and personal hygiene. A pre-implementation phase showed intervention characteristics included facilities and services of the LTC policy from the Ministry of Public Health. The complexities of the LTC and relative advantages were explained. Community leaders, public health volunteers, care givers and health professionals had participated in the LTC activities. Outer and inner settings consisted of context of community, culture, and readiness. Characteristics of the individuals related to knowledge, self-efficacy, perceptions, and believes. The process consisted of planning, acting, observing, and reflecting. The implementation outcomes and service outcomes had been evaluated during-implementation phase. Conclusion: the participation of caregivers, community leaders, public health volunteers, and health professionals had supported the LTC services. Thus, family and community care could improve quality of life of the ageing.

Keywords: ageing, CFIR, long term care, implementation

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Authors: Giovanni Gonzalez Araujo, Michael Kyrilov, Angelo Kyrilov

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STEAMplug is a web-based innovative educational platform which makes teaching easier and learning more effective. It requires no setup, eliminating the barriers to entry, allowing students to focus on their learning throughreal-world development environments. The student-centric tools enable easy collaboration between peers and teachers. Analyzing user interactions with the system enables us to predict student performance and identify at-risk students, allowing early instructor intervention.

Keywords: plagiarism detection, identifying at-Risk Students, education technology, e-learning system, collaborative development, learning and teaching with technology

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Authors: Yongjun Kim

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Since the agreement on the historicity of historical Buddha in eastern India, the beginning, heyday and decline of Buddhism in Early India have been discussed in urbanization, commercialism and state formation context, in short, Weberian socio-politico frame. Recent Scholarship, notably in archaeology and anthropology, has proposed ‘re-materialization of Buddhism in Early India’ based on what Buddhist had actually done rather than what they should do according to canonical teachings or philosophies. But its historical narrations still remain with a domain of socio-politico meta-narrative which tends to unjustifiably dismiss the naturally existing heterogeneity and often chaotic dynamic of diverse agencies, landscape perceptions, localized traditions, etc. An author will argue the multiplicity of theoretical standpoints for the reconstruction on the Buddhism in Early India. For this, at first, the diverse agencies, localized traditions, landscape patterns of Buddhist communities and monasteries in Trans-Himalayan regions; focusing Zanskar Valley and Spiti Valley in India will be illustrated based on an author’s field work. And then an author will discuss this anthropological landscape analysis is better appropriated with textual and archaeological evidences on the tension between urban monastic and forest Buddhism, the phenomena of sacred landscape, cemetery, garden, natural cave along with socio-economic landscape, the demographic heterogeneity in Early India. Finally, it will be attempted to compare between anthropological landscape of present Trans-Himalayan and archaeological one of ancient Western India. The study of Buddhism in Early India has hardly been discussed through multivalent theoretical archaeology and anthropology of religion, thus traditional and recent scholarship have produced historical meta-narrative though heterogeneous among them. The multidisciplinary approaches of textual critics, archaeology and anthropology will surely help to deconstruct the grand and all-encompassing historical description on Buddhism in Early India and then to reconstruct the localized, behavioral and multivalent narratives. This paper expects to highlight the importance of lesser-studied Buddhist archaeological sites and the dynamic views on religious landscape in Early India with a help of critical anthropology of religion.

Keywords: analogy by living traditions, Buddhism in Early India, landscape analysis, meta-narrative

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Authors: Budsarin Padwang, Darunee Jongudomkarn, Thawan Nieamsup, Autchareeya Patumwan, Rutja Phuphaibul

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In Northern Thailand, a pilot study by the qualitative data, on caring for family members with chronic illness/bedridden based on in-depth interviews of the 12 elderly caregivers in family was carried out during November to December 2017. There are four families that living with three generations in the family. This report is part of a larger study of 'The intergenerational contract of the family in long-term care for older members' to understand the situation and context related to the research questions. Content analysis was obtained and the results revealed as followings. 1) No choice and no freedom: most caregivers were asked by their family members to do the care giving roles because of various appropriate reasons and they could not refuse and felt like having no freedom. 2) ‘Katanyu’ to the parents: The Thai ideology of making merit by taking care of parents was beliefs to do the best in their caregiver roles. 3) The family commitments: The issues of family caring and relationships were the key value of keeping family members to take care of older members with chronic illness/bedridden. The preliminary findings can be beneficial for other regions and will lead to in-depth explore to answer the research questions of the larger study in the future.

Keywords: intergenerational contract, long term care, older members, generational family

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Authors: Selina Schwaabe

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Community pharmacies deliver high-quality health care and are responsible for medication safety. During the pandemic, accessibility to the nearest pharmacy became more essential to get vaccinated against Covid-19 and to get medical aid. The government's goal is to ensure nationwide, reachable, and affordable medical health care services by pharmacies. Therefore, the density of community pharmacies matters. Overall, the density of community pharmacies is fluctuating, with slightly decreasing tendencies in some countries. So far, the literature has shown that changes in the system affect prices and density. However, a European overview of the development of the density of community pharmacies and its triggers is still missing. This research is essential to counteract against decreasing density consulting in a lack of professional health care through pharmacies. The analysis focuses on liberal versus regulated market structures, mail-order prescription drug regulation, and third-party ownership consequences. In a panel analysis, the relative influence of the measures is examined across 27 European countries over the last 21 years. In addition, the paper examines seven selected countries in depth, selected for the substantial variance in their pharmacy system: Germany, Austria, Portugal, Denmark, Sweden, Finland and Poland. Overall, the results show that regulated pharmacy markets have over 10.75 pharmacies/100.000 inhabitants more than liberal markets. Further, mail-order prescription drugs decrease the density by -17.98 pharmacies/100.000 inhabitants. Countries allowing third-party ownership have 7.67 pharmacies/100.000 inhabitants more. The results are statistically significant at a 0.001 level. The output of this analysis recommends regulated pharmacy markets, with a ban on mail-order prescription drugs allowing third-party ownership to support nationwide medical health care through community pharmacies.

Keywords: community pharmacy, market conditions, pharmacy, pharmacy market, pharmacy lobby, prescription, e-prescription, ownership structures

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Authors: M. Nili, S. Tavasoli, A. R. Yazdandoost

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In this paper, an experimental investigation on the effect of Isfahan Ground Granulate Blast Furnace Slag (GGBS) on the compressive strength development of self-consolidating concrete (SCC) and normal concrete (NC) was performed. For this purpose, Portland cement type I was replaced with GGBS in various Portions. For NC and SCC Mixes, 10*10*10 cubic cm specimens were tested in 7, 28 and 91 days. It must be stated that in this research water to cement ratio was 0.44, cement used in cubic meter was 418 Kg/m³ and Superplasticizer (SP) Type III used in SCC based on Poly-Carboxylic acid. The results of experiments have shown that increasing GGBS Percentages in both types of concrete reduce Compressive strength in early ages.

Keywords: compressive strength, GGBS, normal concrete, self-consolidating concrete

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Authors: Innocent Atuhe, Babra Nalwadda, Grace Mulyowa Kitunzi, Annabella Haninka Ejiri

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Background: Atopic Dermatitis (AD) is one of the most prevalent and growing chronic inflammatory skin diseases in African prisons. AD care is limited in African due to lack of information about the disease amongst primary care workers, limited access to dermatologists, lack of proper training of healthcare workers, and shortage of appropriate treatments. We designed and implemented the Prisons Telederma project based on the recommendations of the International Society of Atopic Dermatitis. Our overall goal was to increase access to dermatologist-led care for prisoners with AD through teledermatology in Uganda. We aimed to; i) to increase awareness and understanding of teledermatology among prison health workers; and ii) to improve treatment outcomes of prisoners with atopic dermatitis through increased access to and utilization of consultant dermatologists through teledermatology in Uganda prisons: Approach: We used Store-and-forward Teledermatology (SAF-TD) to increase access to dermatologist-led care for prisoners and prisons staff with AD. We conducted a five days training for prison health workers using an adapted WHO training guide on recognizing neglected tropical diseases through changes on the skin together with an adapted American Academy of Dermatology (AAD) Childhood AD Basic Dermatology Curriculum designed to help trainees develop a clinical approach to the evaluation and initial management of patients with AD. This training was followed by blended e-learning, webinars facilitated by consultant Dermatologists with local knowledge of medication and local practices, apps adjusted for pigmented skin, WhatsApp group discussions, and sharing pigmented skin AD pictures and treatment via zoom meetings. We hired a team of Ugandan Senior Consultant dermatologists to draft an iconographic atlas of the main dermatoses in pigmented African skin and shared this atlas with prison health staff for use as a job aid. We had planned to use MySkinSelfie mobile phone application to take and share skin pictures of prisoners with AD with Consultant Dermatologists, who would review the pictures and prescribe appropriate treatment. Unfortunately, the National Health Service withdrew the app from the market due to technical issues. We monitored and evaluated treatment outcomes using the Patient Oriented Eczema Measure (POEM) tool. We held four advocacy meetings to persuade relevant stakeholders to increase supplies and availability of first-line AD treatments such as emollients in prison health facilities. Results: Draft iconographic atlas of the main dermatoses in pigmented African skin Increased proportion of prison health staff with adequate knowledge of AD and teledermatology from 20% to 80% Increased proportion of prisoners with AD reporting improvement in disease severity (POEM scores) from 25% to 35% in one year. Increased proportion of prisoners with AD seen by consultant dermatologist through teledermatology from 0% to 20% in one year. Increased the availability of AD recommended treatments in prisons health facilities from 5% to 10% in one year

Keywords: teledermatology, prisoners, reaching, un-reachable

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Authors: Marjan Ghazisaeedi, Azadeh Bashiri

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Background: Attention-Deficit/Hyperactivity Disorder(ADHD), is one of the most common psychiatric disorders in early childhood that in addition to its main symptoms provide significant deficits in the areas of educational, social and individual relationship. Considering the importance of rehabilitation in ADHD patients to control these problems, this study investigated the advantages of computer-based cognitive training in these patients. Methods: This review article has been conducted by searching articles since 2005 in scientific databases and e-Journals and by using keywords including computerized cognitive rehabilitation, computer-based training and ADHD. Results: Since drugs have short term effects and also they have many side effects in the rehabilitation of ADHD patients, using supplementary methods such as computer-based cognitive training is one of the best solutions. This approach has quick feedback and also has no side effects. So, it provides promising results in cognitive rehabilitation of ADHD especially on the working memory and attention. Conclusion: Considering different cognitive dysfunctions in ADHD patients, application of the computerized cognitive training has the potential to improve cognitive functions and consequently social, academic and behavioral performances in patients with this disorder.

Keywords: ADHD, computer-based cognitive training, cognitive functions, rehabilitation

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Authors: Jirapan Khruesarn, Wimwipa Boonklin

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Background: Currently, Thailand has an aging population. In 2017, the elderly population was over 11.14 million. There will be an increase in the number of elderly people, 8.39 million, some people grumble to themselves and have conflicts with their offspring or those close to them. It is a source of stress. Mental health promotion should be given to the elderly in order to cope with these changes. Due to the family characteristics of Thai society, these family members will act as caregivers for the elderly. Therefore, a group-counseling program based on Personnel-Centered Theory for Elderly Caregivers in Mental Health Promotion for Older People in Na Kaeo Municipality, Kau Ka District, Lampang Province, has been developed to compare the elderly care behavior before and after the participation. Methods: This research was study for 20 elderly' caregiver: Those aimed to compare the before and after use of group program for caregiver to promoting for the elderly by the following methods: Step 1 Establish a framework for evaluating elderly care behaviors and develop a group counseling program for promote mental health for elderly on: 1) Body 2) Willpower 3) Social and community management and 4) Organizing learning process. Step 2 Assessing an Elderly Care Behaviors by using "The behavior assessment on caring for the elderly" and assessing the mental health power level of the elderly and follow the counseling program 9 times and compare of the elderly care behaviors before and after joined a group program, and compare of mental health level of caregiver attends a group program. Results: This study is developing a group counseling program to promoting for the resilience quotient in elderly people that the results of the study could be summarized as follows: 1) Before the elderly's caregivers join a group counseling program: Mental health promotion behaviors of the elderly were at the high level of (3.32), and after: were at the high level of (3.44). 2) Before the elderly's caregiver attends a group counseling program: the mental health level of the elderly the mean score was (47.85 percent), and the standard deviation was (0.21 percent) and after. The elderly had a higher score of (51.45 percent) In summary, after the elderly caregivers joined the group, the elderly are higher in all aspects promote mental health for elderly and the statistically significance at the 0.05, It shows that programs are fit for personal and community condition in promoting the mental health of the elderly because this theory has the idea that: Humans have the ability to use their intelligence to solve problems or make decisions effectively, And member of group counseling program have ventured and express grievances that the counselor is a facilitator who focuses on personal development by building relationships among people. In other words, the factors contributing to higher levels of elderly care behaviors is group counseling, that isn't a hypothetical process but focus on building relationships that are based on mutual trust and Unconditional acceptance.

Keywords: group counseling base on person-centered theory, elderly person, resilience quotient: RQ, caregiver

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Authors: Vasoontara Yiengprugsawan, Sam-ang Seubsman

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As Thais live longer, caregivers will become even more important to social and healthcare systems. Commonly reported in many low and middle‐income countries in Asia, formal social welfare services to support caregivers are lacking and informal family support will be required for all levels of care. In 2005, 87,151 open‐university adults were recruited to the Thai Cohort Study, with the majority aged between 25 and 39 years, and residing nationwide. At the 4‐year follow up in 2009 (n=60569) and the 8‐year follow‐up in 2013 (n=42785), prospective cohort participants were asked if they provide care for chronically ill, disabled, or frail family members. Among Thai cohort members reporting between 2009 and 2013, approximately 56% were not caregivers in either year, 24.5% reported providing care in 2009 only, 8.6% in 2013 only, and 10.6% reported providing care at both time points. Caregivers in the cohort reported providing financial support, help with shopping, emotional support, and assist with daily activities. Kessler 6 psychological distress scale, measured in both 2009 and 2013, was used as the primary outcome of a relationship between caregiving status and mental health. Using multivariate logistic regression, our 4‐year longitudinal findings revealed that cohort members who reported providing care at both time points were 1.4 to 1.6 times more likely to report high psychological distress than non‐caregivers, after accounting for potential covariates. With increasing needs for informal care provided by family members, the future health and social welfare system will need to provide adequate support to caregivers (e.g., respite care, clinical support and information for the family, and awareness of mental health among caregivers).

Keywords: family caregivers, psychological distress, prospective cohort, longitudinal study, Thailand

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Authors: Stephen Hernandez, Nikita Sharma

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The Coronavirus disease (COVID-19) emerged as a worldwide pandemic at the beginning of 2020. The pandemic and its impact reached the shores of the United States by the second week of March. Once infections started to grow in numbers, early intervention programs, including those providing home-based services, recognized that to reduce the spread of the virus, many traditional in-person therapeutic interventions were going to be impossible due to social distancing and self-quarantine requirements. Initially, infants, toddlers, and their families were left without any services from their educators and therapists, but within a few weeks of the public health emergency, various states, including New York, approved the use of teletherapy/virtual visits for early intervention service provision. This paper will detail the results of a survey from over 400 E.I. service providers about their experiences utilizing teletherapy to deliver services to children in early intervention programs. The survey questions focused on how did COVID-19 stay-at-home orders impact E.I. services for young children with special needs? Sub-questions included topics such as availability of the parents, the amount of time that babies remained engaged, as well as the perceived success of teletherapy as a viable option to provide service by both parent and professional. The results of this study found that therapists found teletherapy to be a viable manner of providing services and could be very effective on a case by case basis.

Keywords: early intervention, teletheraphy, telehealth, COVID-19

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Authors: Vilma Deltuvaitė

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Comparisons of financial development across countries are central to answering many of the questions on factors leading to economic development. For this reason this study analyzes the implications of financial system’s development on country’s economic development. The aim of the article: to analyze the impact of financial system’s development on economic development. The following research methods were used: systemic, logical and comparative analysis of scientific literature, analysis of statistical data, time series model (Autoregressive Distributed Lag (ARDL) Model). The empirical results suggest about positive short and long term effect of stock market development on GDP per capita.

Keywords: banking sector, economic development, financial system’s development, stock market, private bond market

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Authors: Matthew J. B. Wilson

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Disaster Risk Reduction relies heavily on the effective cooperation of both humanitarian and development actors, particularly in the wake of a disaster, implementing lasting recovery measures that better protect communities from disasters to come. This can be seen to fit within a broader discussion around integrating humanitarian and development work stretching back to the 1980s. Over time, a number of key concepts have been put forward, including Linking Relief, Rehabilitation, and Development (LRRD), Early Recovery (ER), ‘Build Back Better’ (BBB), and the most recent ‘Humanitarian-Development-Peace Nexus’ or ‘Triple Nexus’ (HDPN) to define these goals and relationship. While this discussion has evolved greatly over time, from a continuum to a more integrative synergistic relationship, there remains a lack of consensus around how to describe it, and as such, the reality of effectively closing this gap has yet to be seen. The objective of this research was twofold. First, to map these four identified concepts (LRRD, ER, BBB & HDPN) used in the literature since 1995 to understand the overall trends in how this relationship is discussed. Second, map articles reference a combination of these concepts to understand their interrelationship. A scoping review was conducted for each concept identified. Results were gathered from Google Scholar by firstly inputting specific boolean search phrases for each concept as they related specifically to disasters each year since 1995 to identify the total number of articles discussing each concept over time. A second search was then done by pairing concepts together within a boolean search phrase and inputting the results into a matrix to understand how many articles contained references to more than one of the concepts. This latter search was limited to articles published after 2017 to account for the more recent emergence of HDPN. It was found that ER and particularly BBB are referred to much more widely than LRRD and HDPN. ER increased particularly in the mid-2000’s coinciding with the formation of the ER cluster, and BBB, whilst emerging gradually in the mid-2000s due to its usage in the wake of the Boxing Day Tsunami, increased significantly from about 2015 after its prominent inclusion in Sendai Framework. HDPN has only just started to increase in the last 4-5 years. In regards to the relationship between concepts, it was found the vast majority of all concepts identified were referred to in isolation from each other. The strongest relationship was between LRRD and HDPN (8% of articles referring to both), whilst ER-BBB and ER-HDPN both were about 3%, LRRD-ER 2%, and BBB-HDPN 1% and BBB-LRRD 1%. This research identified a fundamental issue around the lack of consensus and even awareness of different approaches referred to within academic literature relating to integrating humanitarian and development work. More research into synthesizing and learning from a range of approaches could work towards better closing this gap.

Keywords: build back better, disaster risk reduction, early recovery, linking relief rehabilitation and development, humanitarian development integration, humanitarian-development (peace) nexus, recovery, triple nexus

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Authors: Giada Feletti, Daniela Tedesco, Paolo Trucco

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The present study aims to develop a dashboard of Key Performance Indicators (KPI) to enhance information and predictive capabilities in Emergency Medical Services (EMS) systems, supporting both operational and strategic decisions of different actors. The employed research methodology consists of the first phase of revision of the technical-scientific literature concerning the indicators currently used for the performance measurement of EMS systems. From this literature analysis, it emerged that current studies focus on two distinct perspectives: the ambulance service, a fundamental component of pre-hospital health treatment, and the patient care in the Emergency Department (ED). The perspective proposed by this study is to consider an integrated view of the ambulance service process and the ED process, both essential to ensure high quality of care and patient safety. Thus, the proposal focuses on the entire healthcare service process and, as such, allows considering the interconnection between the two EMS processes, the pre-hospital and hospital ones, connected by the assignment of the patient to a specific ED. In this way, it is possible to optimize the entire patient management. Therefore, attention is paid to the dependency of decisions that in current EMS management models tend to be neglected or underestimated. In particular, the integration of the two processes enables the evaluation of the advantage of an ED selection decision having visibility on EDs’ saturation status and therefore considering the distance, the available resources and the expected waiting times. Starting from a critical review of the KPIs proposed in the extant literature, the design of the dashboard was carried out: the high number of analyzed KPIs was reduced by eliminating the ones firstly not in line with the aim of the study and then the ones supporting a similar functionality. The KPIs finally selected were tested on a realistic dataset, which draws us to exclude additional indicators due to the unavailability of data required for their computation. The final dashboard, which was discussed and validated by experts in the field, includes a variety of KPIs able to support operational and planning decisions, early warning, and citizens’ awareness of EDs accessibility in real-time. By associating each KPI to the EMS phase it refers to, it was also possible to design a well-balanced dashboard covering both efficiency and effective performance of the entire EMS process. Indeed, just the initial phases related to the interconnection between ambulance service and patient’s care are covered by traditional KPIs compared to the subsequent phases taking place in the hospital ED. This could be taken into consideration for the potential future development of the dashboard. Moreover, the research could proceed by building a multi-layer dashboard composed of the first level with a minimal set of KPIs to measure the basic performance of the EMS system at an aggregate level and further levels with KPIs that can bring additional and more detailed information.

Keywords: dashboard, decision support, emergency medical services, key performance indicators

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