Search results for: health system reconstruction
Commenced in January 2007
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Edition: International
Paper Count: 24807

Search results for: health system reconstruction

14127 The Early Discovery and Confirmation of the Indus Valley Civilization

Authors: Muhammad Ishaqa, Quanchao Zhanga, Qian Wangb

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The Indus Valley Civilization is predominantly found in the northeast of Afghanistan, Pakistan, and the northwest of India and is considered one of the four ancient civilizations of the Old World, as well as the first urban civilization in South Asia. In 1920, John Marshall and other archaeologists established the existence of this civilization. Over the course of a century, India and Pakistan have made significant advancements in their joint archaeological investigation and excavation, contributing to the study of the Indus Valley Civilization. Given the importance of early discovery and confirmation of this civilization, our research focuses on the academic history of its archaeology by gathering published research material. Our research begins by collecting research data associated with the Indus Valley Civilization and documenting the process of archaeological investigations and excavations from the 19th century until the present day. We also summarize the archaeological works conducted during different periods. Furthermore, we present the primary academic views on the Indus Civilization from the 19th century until the present, explaining their developmental process and highlighting recent research. This forms a foundation for further study. We discovered that the archaeological research of the Indus Civilization is significantly influenced by Western archaeology and has yet to establish an independent, local research system. We delve into the three primary sites of the Indus Valley Civilization - Harappa, Mohenjo-Daro, and Chanhudaro - discussing their history and archaeological excavation records. Our findings indicate that the Indus Civilization is solely dependent on archaeology, distinguishing it from the Sumerian Civilization and verifying that it originates from the Bronze Age of the Indus Valley. Lastly, we examine the primary academic issues associated with the Indus Civilization in greater depth. These issues include climate environment, political system, primitive religion, and academic contribution.

Keywords: Indus Valley civilization, archaeology, Harappa, Mohenjo-Daro

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14126 On the Monitoring of Structures and Soils by Tromograph

Authors: Magarò Floriana, Zinno Raffaele

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Since 2009, with the coming into force of the January 14, 2008 Ministerial Decree "New technical standards for construction", and the explanatory ministerial circular N°.617 of February 2, 2009, the question of seismic hazard and the design of seismic-resistant structures in Italy has acquired increasing importance. One of the most discussed aspects in recent Italian and international scientific literature concerns the dynamic interaction between land and structure, and the effects which dynamic coupling may have on individual buildings. In effect, from systems dynamics, it is well known that resonance can have catastrophic effects on a stimulated system, leading to a response that is not compatible with the previsions in the design phase. The method used in this study to estimate the frequency of oscillation of the structure is as follows: the analysis of HVSR (Horizontal to Vertical Spectral Ratio) relations. This allows for evaluation of very simple oscillation frequencies for land and structures. The tool used for data acquisition is an experimental digital tromograph. This is an engineered development of the experimental Languamply RE 4500 tromograph, equipped with an engineered amplification circuit and improved electronically using extremely small electronic components (size of each individual amplifier 16 x 26 mm). This tromograph is a modular system, completely "free" and "open", designed to interface Windows, Linux, OSX and Android with the outside world. It an amplifier designed to carry out microtremor measurements, yet which will also be useful for seismological and seismic measurements in general. The development of single amplifiers of small dimension allows for a very clean signal since being able to position it a few centimetres from the geophone eliminates cable “antenna” phenomena, which is a necessary characteristic in seeking to have signals which are clean at the very low voltages to be measured.

Keywords: microtremor, HVSR, tromograph, structural engineering

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14125 Security Issues on Smart Grid and Blockchain-Based Secure Smart Energy Management Systems

Authors: Surah Aldakhl, Dafer Alali, Mohamed Zohdy

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The next generation of electricity grid infrastructure, known as the "smart grid," integrates smart ICT (information and communication technology) into existing grids in order to alleviate the drawbacks of existing one-way grid systems. Future power systems' efficiency and dependability are anticipated to significantly increase thanks to the Smart Grid, especially given the desire for renewable energy sources. The security of the Smart Grid's cyber infrastructure is a growing concern, though, as a result of the interconnection of significant power plants through communication networks. Since cyber-attacks can destroy energy data, beginning with personal information leaking from grid members, they can result in serious incidents like huge outages and the destruction of power network infrastructure. We shall thus propose a secure smart energy management system based on the Blockchain as a remedy for this problem. The power transmission and distribution system may undergo a transformation as a result of the inclusion of optical fiber sensors and blockchain technology in smart grids. While optical fiber sensors allow real-time monitoring and management of electrical energy flow, Blockchain offers a secure platform to safeguard the smart grid against cyberattacks and unauthorized access. Additionally, this integration makes it possible to see how energy is produced, distributed, and used in real time, increasing transparency. This strategy has advantages in terms of improved security, efficiency, dependability, and flexibility in energy management. An in-depth analysis of the advantages and drawbacks of combining blockchain technology with optical fiber is provided in this paper.

Keywords: smart grids, blockchain, fiber optic sensor, security

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14124 The Quality of Life of Transtibial Amputees: The Prosthetists Role

Authors: Riyona Chetty, Raisuyah Bhagwan, Nalini Govender

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Background: During rehabilitation, the prosthetist establishes prosthetic and/or orthotic realistic goals and programmes as well as clinical outcome measures. They are well-positioned to improve the amputee’s physical and psychosocial well-being. Objective: This study aims to explore the ways in which the prosthetist may be able to improve the holistic well-being of the amputee. Methods: Data was collected using a focus group discussion with 16 prosthetists at a medical facility in KwaZulu-Natal, South Africa. Results: The findings indicate that amputees are encouraged to consider physical activities to improve their health. However, a major challenge experienced by the prosthetists was their lack of adequate psychosocial expertise, which affected their ability to offer emotional support. Additional factors such as language barriers, rotational systems, and unrealistic expectations further obstructed optimal service delivery. Conclusion: The prosthetists are adequately skilled in manufacturing the ideal prosthesis and encouraging physical exercise to promote the amputee’s physical health. However, their lack of psychosocial training limits them in providing emotional support during rehabilitation. It is recommended that prosthetists are provided with professional training to provide emotional support as part of holistic healthcare. Clinical relevance: The intention of this study was to provide pertinent recommendations for prosthetists, enabling them to provide holistic quality care to their patients.

Keywords: psychological, social, well-being, amputee, prosthetist

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14123 Selected Ethnomedicinal Plants of Northern Surigao Del Sur: Their Antioxidant Activities in Terms of Total Phenolics, ABTS Radical Cation Decolorization Power, and Ferric Reducing Ability

Authors: Gemma A. Gruyal

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Plants can contain a wide variety of substances with antioxidative properties which are associated to important health benefits. These positive health effects are of great importance at a time when the environment is laden with many toxic substances. Five selected herbal plants namely, Mimosa pudica, Phyllanthus niruri, Ceiba pentandra, Eleusine polydactyla and Trema amboinensis, were chosen for the experiment to investigate their total phenolics content and antioxidant activities using ABTS radical cation decolorization power, and ferric reducing antioxidant power. The total phenolic content of each herbal plants ranges from 0.84 to 42.59 mg gallic acid equivalent/g. The antioxidant activity in the ABTS radical cation decolorization power varies from 0.005 to 0.362 mg trolox equivalent/g and the FRAP ranges from 0.30 to 28.42 mg gallic acid equivalent/g. Among the five medicinal plants, Mimosa pudica has been an excellent performer in terms of the 3 parameters measured; it is followed by Phyllanthus niruri. The five herbal plants do not have equivalent antioxidant power. The relative high values for M. pudica and P. niruri supports the medicinal value of both plants. The total phenolics, ABTS and FRAP correlate strongly with one another.

Keywords: ABTS, FRAP, Leaf extracts, phenol

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14122 Effects and Mechanisms of an Online Short-Term Audio-Based Mindfulness Intervention on Wellbeing in Community Settings and How Stress and Negative Affect Influence the Therapy Effects: Parallel Process Latent Growth Curve Modeling of a Randomized Control

Authors: Man Ying Kang, Joshua Kin Man Nan

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The prolonged pandemic has posed alarming public health challenges to various parts of the world, and face-to-face mental health treatment is largely discounted for the control of virus transmission, online psychological services and self-help mental health kits have become essential. Online self-help mindfulness-based interventions have proved their effects on fostering mental health for different populations over the globe. This paper was to test the effectiveness of an online short-term audio-based mindfulness (SAM) program in enhancing wellbeing, dispositional mindfulness, and reducing stress and negative affect in community settings in China, and to explore possible mechanisms of how dispositional mindfulness, stress, and negative affect influenced the intervention effects on wellbeing. Community-dwelling adults were recruited via online social networking sites (e.g., QQ, WeChat, and Weibo). Participants (n=100) were randomized into the mindfulness group (n=50) and a waitlist control group (n=50). In the mindfulness group, participants were advised to spend 10–20 minutes listening to the audio content, including mindful-form practices (e.g., eating, sitting, walking, or breathing). Then practice daily mindfulness exercises for 3 weeks (a total of 21 sessions), whereas those in the control group received the same intervention after data collection in the mindfulness group. Participants in the mindfulness group needed to fill in the World Health Organization Five Well-Being Index (WHO), Positive and Negative Affect Schedule (PANAS), Perceived Stress Scale (PSS), and Freiburg Mindfulness Inventory (FMI) four times: at baseline (T0) and at 1 (T1), 2 (T2), and 3 (T3) weeks while those in the waitlist control group only needed to fill in the same scales at pre- and post-interventions. Repeated-measure analysis of variance, paired sample t-test, and independent sample t-test was used to analyze the variable outcomes of the two groups. The parallel process latent growth curve modeling analysis was used to explore the longitudinal moderated mediation effects. The dependent variable was WHO slope from T0 to T3, the independent variable was Group (1=SAM, 2=Control), the mediator was FMI slope from T0 to T3, and the moderator was T0NA and T0PSS separately. The different levels of moderator effects on WHO slope was explored, including low T0NA or T0PSS (Mean-SD), medium T0NA or T0PSS (Mean), and high T0NA or T0PSS (Mean+SD). The results found that SAM significantly improved and predicted higher levels of WHO slope and FMI slope, as well as significantly reduced NA and PSS. FMI slope positively predict WHO slope. FMI slope partially mediated the relationship between SAM and WHO slope. Baseline NA and PSS as the moderators were found to be significant between SAM and WHO slope and between SAM and FMI slope, respectively. The conclusion was that SAM was effective in promoting levels of mental wellbeing, positive affect, and dispositional mindfulness as well as reducing negative affect and stress in community settings in China. SAM improved wellbeing faster through the faster enhancement of dispositional mindfulness. Participants with medium-to-high negative affect and stress buffered the therapy effects of SAM on wellbeing improvement speed.

Keywords: mindfulness, negative affect, stress, wellbeing, randomized control trial

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14121 Descriptive Analysis of Community-Based Needs among Asylum Seekers in New England before and after COVID-19

Authors: Viknesh Kasthuri, Victoria Angenent-Mari, Jade Wexler

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The COVID-19 pandemic dramatically altered the landscape of asylum medicine. Brown Human Rights Asylum Clinic (BHRAC) is a medical-student-run asylum clinic that provides pro-bono medical evaluations and forensic affidavits for individuals seeking asylum in New England. After the outbreak of COVID-19 in March 2020, BHRAC experienced numerous changes both in the number of clients requesting services as well as in the resource needs of these clients. Uniquely, BHRAC assesses the needs of clients during their affidavit interview and seeks to address these needs by connecting clients to local community organizations and resources. Data regarding the specific needs of clients range from 2019-present day. Analysis of internal BHRAC’s internal data suggested a small increase in requests for assistance with light and gas (from 5% of total resource requests pre-COVID to 11%), as well as a decrease in requests for mental health services (from 20% of resources pre-COVID to 13% post-COVID). Furthermore, BHRAC witnessed a decline in clinic volume during the second half of 2020. In short, our data suggest that the pandemic affected asylum seekers' access to medico-legal services and the resources they need. Future research with larger sample sizes and in other geographic locations is required to determine the holistic impact of the COVID-19 pandemic on asylum seekers.

Keywords: asylum clinic, asylum medicine, COVID, social determinants of health

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14120 A Quality Improvement Project to Assess the Impact of Orthognathic Surgery on the Quality of Life of Patients: Pre-Operatively versus Post-Operatively

Authors: Fiona Lourenco, William Allen

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Dentofacial deformities are primarily surgically treated via orthognathic surgery. Health-related quality of life is concerned with aspects of quality of life that relate specifically to an individual’s health. Design and Setting: Retrospective analysis of patients who had orthognathic surgery from January 2018 - December 2022 at the trust using the previously validated Orthognathic Quality of Life questionnaire (OQoL). Materials and Methods: 32 Patient questionnaires (which included pre-operative and post-operative separate sections) were obtained via telephone survey. The data was analysed using the two-tailed paired t-test and Wilcoxon signed-rank test. Results: The change in perception post-surgery was highly significant (both tests resulted in p<0.001 for overall analysis as well as for each domain). Overall, a 74% improvement in QoL was seen following orthognathic surgery. Reports of improvement in each domain were as follows: 71% in the social aspect of the deformity domain, 76% in facial aesthetics, 60% in function, and 57% improvement in awareness of facial deformity. Conclusion: The assessment of QoL is becoming progressively imperative in clinical research. The above data shows that orthognathic surgery has a significant improvement in the QoL of patients post-operatively. The results demonstrate improvement in all domains, with perceptions in facial aesthetics seeing the highest change post-operatively.

Keywords: dentofacial, oral, facial asymmetry, orthognathic surgery, quality of life

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14119 The Use of Punctuation by Primary School Students Writing Texts Collaboratively: A Franco-Brazilian Comparative Study

Authors: Cristina Felipeto, Catherine Bore, Eduardo Calil

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This work aims to analyze and compare the punctuation marks (PM) in school texts of Brazilian and French students and the comments on these PM made spontaneously by the students during the ongoing text. Assuming textual genetics as an investigative field within a dialogical and enunciative approach, we defined a common methodological design in two 1st year classrooms (7 years old) of the primary school, one classroom in Brazil (Maceio) and the other one in France (Paris). Through a multimodal capture system of writing processes in real time and space (Ramos System), we recorded the collaborative writing proposal in dyads in each of the classrooms. This system preserves the classroom’s ecological characteristics and provides a video recording synchronized with dialogues, gestures and facial expressions of the students, the stroke of the pen’s ink on the sheet of paper and the movement of the teacher and students in the classroom. The multimodal register of the writing process allowed access to the text in progress and the comments made by the students on what was being written. In each proposed text production, teachers organized their students in dyads and requested that they should talk, combine and write a fictional narrative. We selected a Dyad of Brazilian students (BD) and another Dyad of French students (FD) and we have filmed 6 proposals for each of the dyads. The proposals were collected during the 2nd Term of 2013 (Brazil) and 2014 (France). In 6 texts written by the BD there were identified 39 PMs and 825 written words (on average, a PM every 23 words): Of these 39 PMs, 27 were highlighted orally and commented by either student. In the texts written by the FD there were identified 48 PMs and 258 written words (on average, 1 PM every 5 words): Of these 48 PM, 39 were commented by the French students. Unlike what the studies on punctuation acquisition point out, the PM that occurred the most were hyphens (BD) and commas (FD). Despite the significant difference between the types and quantities of PM in the written texts, the recognition of the need for writing PM in the text in progress and the comments have some common characteristics: i) the writing of the PM was not anticipated in relation to the text in progress, then they were added after the end of a sentence or after the finished text itself; ii) the need to add punctuation marks in the text came after one of the students had ‘remembered’ that a particular sign was needed; iii) most of the PM inscribed were not related to their linguistic functions, but the graphic-visual feature of the text; iv) the comments justify or explain the PM, indicating metalinguistic reflections made by the students. Our results indicate how the comments of the BD and FD express the dialogic and subjective nature of knowledge acquisition. Our study suggests that the initial learning of PM depends more on its graphic features and interactional conditions than on its linguistic functions.

Keywords: collaborative writing, erasure, graphic marks, learning, metalinguistic awareness, textual genesis

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14118 Effects of Transit Fare Discount Programs on Passenger Volumes and Transferring Behaviors

Authors: Guan-Ying Chen, Han-Tsung Liou, Shou-Ren Hu

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To address traffic congestion problems and encourage the use of public transportation systems in the Taipei metropolitan area, the Taipei City Government and the New Taipei City Government implemented a monthly ticket policy on April 16, 2018. This policy offers unlimited rides on the Taipei MRT, Taipei City Bus, New Taipei City Bus, Danhai Light Rail, and Public Bike (YouBike) on a monthly basis. Additionally, both city governments replaced the smart card discount policy with a new frequent flyer discount program (referred to as the loyal customer program) on February 1, 2020, introducing a differential pricing policy. Specifically, the more frequently the Taipei MRT system is used, the greater the discounts users receive. To analyze the impact of the Taipei public transport monthly ticket policy and the frequent user discount program on the passenger volume of the Taipei MRT system and the transferring behaviors of MRT users, this study conducts a trip-chain analysis using transaction data from Taipei MRT smart cards between September 2017 and December 2020. To achieve these objectives, the study employs four indicators: 1) number of passengers, 2) average number of rides, 3) average trip distance, and 4) instances of multiple consecutive rides. The study applies the t-test and Mann-Kendall trend test to investigate whether the proposed indicators have changed over time due to the implementation of the discount policy. Furthermore, the study examines the travel behaviors of passengers who use monthly tickets. The empirical results of the study indicate that the implementation of the Taipei public transport monthly ticket policy has led to an increase in the average number of passengers and a reduction in the average trip distance. Moreover, there has been a significant increase in instances of multiple consecutive rides, attributable to the unlimited rides offered by the monthly tickets. The impact of the frequent user discount program on changes in MRT passengers is not as pronounced as that of the Taipei public transportation monthly ticket policy. This is partly due to the fact that the frequent user discount program is only applicable to the Taipei MRT system, and the passenger volume was greatly affected by the COVID-19 pandemic. The findings of this research can serve as a reference for Taipei MRT Corporation in formulating its fare strategy and can also provide guidance for the Taipei and New Taipei City Governments in evaluating differential pricing policies for public transportation systems.

Keywords: frequent user discount program, mass rapid transit, monthly ticket, smart card

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14117 The Association of Anthropometric Measurements, Blood Pressure Measurements, and Lipid Profiles with Mental Health Symptoms in University Students

Authors: Ammaarah Gamieldien

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Depression is a very common and serious mental illness that has a significant impact on both the social and economic aspects of sufferers worldwide. This study aimed to investigate the association between body mass index (BMI), blood pressure, and lipid profiles with mental health symptoms in university students. Secondary objectives included the associations between the variables (BMI, blood pressure, and lipids) with themselves, as they are key factors in cardiometabolic disease. Sixty-three (63) students participated in the study. Thirty-two (32) were assigned to the control group (minimal-mild depressive symptoms), while 31 were assigned to the depressive group (moderate to severe depressive symptoms). Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI) were used to assess depressive scores. Anthropometric measurements such as weight (kg), height (m), waist circumference (WC), and hip circumference were measured. Body mass index (BMI) and ratios such as waist-to-hip ratio (WHR) and waist-to-height ratio (WtHR) were also calculated. Blood pressure was measured using an automated AfriMedics blood pressure machine, while lipids were measured using a CardioChek plus analyzer machine. Statistics were analyzed via the SPSS statistics program. There were no significant associations between anthropometric measurements and depressive scores (p > 0.05). There were no significant correlations between lipid profiles and depression when running a Spearman’s rho correlation (P > 0.05). However, total cholesterol and LDL-C were negatively associated with depression, and triglycerides were positively associated with depression after running a point-biserial correlation (P < 0.05). Overall, there were no significant associations between blood pressure measurements and depression (P > 0.05). However, there was a significant moderate positive correlation between systolic blood pressure and MADRS scores in males (P < 0.05). Depressive scores positively and strongly correlated to how long it takes participants to fall asleep. There were also significant associations with regard to the secondary objectives. This study indicates the importance of determining the prevalence of depression among university students in South Africa. If the prevalence and factors associated with depression are addressed, depressive symptoms in university students may be improved.

Keywords: depression, blood pressure, body mass index, lipid profiles, mental health symptoms

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14116 Evaluating the Benefits of Intelligent Acoustic Technology in Classrooms: A Case Study

Authors: Megan Burfoot, Ali GhaffarianHoseini, Nicola Naismith, Amirhosein GhaffarianHoseini

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Intelligent Acoustic Technology (IAT) is a novel architectural device used in buildings to automatically vary the acoustic conditions of space. IAT is realized by integrating two components: Variable Acoustic Technology (VAT) and an intelligent system. The VAT passively alters the RT by changing the total sound absorption in a room. In doing so, the Reverberation Time (RT) is changed and thus, the sound strength and clarity are altered. The intelligent system detects sound waves in real-time to identify the aural situation, and the RT is adjusted accordingly based on pre-programmed algorithms. IAT - the synthesis of these two components - can dramatically improve acoustic comfort, as the acoustic condition is automatically optimized for any detected aural situation. This paper presents an evaluation of the improvements of acoustic comfort in an existing tertiary classroom located at Auckland University of Technology in New Zealand. This is a pilot case study, the first of its’ kind attempting to quantify the benefits of IAT. Naturally, the potential acoustic improvements from IAT can be actualized by only installing the VAT component of IAT and by manually adjusting it rather than utilizing an intelligent system. Such a simplified methodology is adopted for this case study to understand the potential significance of IAT without adopting a time and cost-intensive strategy. For this study, the VAT is built by overlaying reflective, rotating louvers over sound absorption panels. RT's are measured according to international standards before and after installing VAT in the classroom. The louvers are manually rotated in increments by the experimenter and further RT measurements are recorded. The results are compared with recommended guidelines and reference values from national standards for spaces intended for speech and communication. The results obtained from the measurements are used to quantify the potential improvements in classroom acoustic comfort, where IAT to be used. This evaluation reveals the current existence of poor acoustic conditions in the classroom caused by high RT's. The poor acoustics are also largely attributed to the classrooms’ inability to vary acoustic parameters for changing aural situations. The classroom experiences one static acoustic state, neglecting to recognize the nature of classrooms as flexible, dynamic spaces. Evidently, when using VAT the classroom is prescribed with a wide range of RTs it can achieve. Namely, acoustic requirements for varying teaching approaches are satisfied, and acoustic comfort is improved. By quantifying the benefits of using VAT, it can confidently suggest these same benefits are achieved with IAT. Nevertheless, it is encouraged that future studies continue this line of research toward the eventual development of IAT and its’ acceptance into mainstream architecture.

Keywords: acoustic comfort, classroom acoustics, intelligent acoustics, variable acoustics

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14115 Household Food Insecurity, Maternal Mental Health and Self-Efficacy

Authors: Nahid Salarkia, Nasrin Omidvar, Erfan Ghassemi, Vahideh Arab-Salari, Tirang Reza Neyestani

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Background: Household food insecurity has an adverse impact on the maternal mental health. This study was carried out to assess the relationship between household food insecurity, maternal depression and mother’s self-efficacy in Varamin, Iran, in 2014. Methods: In this cross-sectional study 423 mothers with children under 2 years old, with mean age 28.1±5.2 year; weight 66.3±13.4 kg; height 160.3± 5.7 cm and BMI 25.7±4.8 kg/m2 were selected by a multistage random sampling scheme. The instruments were: Beck Depression Inventory (BDI-III) and mother’s self-efficacy questionnaire. Data was analyzed using χ2 test, ANOVA and Pearson correlation. Results: Mildly, moderately and severely food insecure households were 39.5, 9.7 and 3.1%, respectively. Mild, moderate and sever depression was: 18.7, 13.9 and 5.7%. Mean score of depression in moderate and severe food insecure (8.6±5.3) was more than mild food insecure (4.8±4.7) and food secure (3.1±3.6) mothers. Frequency of very good, good and low mother’s self-efficacy were 62.8, 36.5, and 0.7%, respectively. Very good mother’s self-efficacy in food secure mothers (33.4%) was more than mild (25.4%) and moderate-sever food insecure groups (4%). There was a negative significant association between household food insecurity and mother’s self-efficacy (r= -0.297, p<0.01), and between mother’s depression and self-efficacy (r= -0.309, p=0.001). Conclusion: Empowerment of mothers with educational programs and social support can decrease mothers’ depression and increase self-efficacy that lead to improve maternal practices in food insecure households.

Keywords: Household food insecurity, Iran, mothers, physiological characteristics, self-efficacy

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14114 Heat Stress a Risk Factor for Poor Maternal Health- Evidence from South India

Authors: Vidhya Venugopal, Rekha S.

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Introduction: Climate change and the growing frequency of higher average temperatures and heat waves have detrimental health effects, especially for certain vulnerable groups with limited socioeconomic status (SES) or physiological capacity to adapt to or endure high temperatures. Little research has been conducted on the effects of heat stress on pregnant women and fetuses in tropical regions such as India. Very high ambient temperatures may worsen Adverse Pregnancy Outcomes (APOs) and are a major worry in the scenario of climate change. The relationship between rising temperatures and APO must be better understood in order to design more effective interventions. Methodology: We conducted an observational cohort study involving 865 pregnant women in various districts of Tamil Nadu districts between 2014 and 2021. Physiological Heat Strain Indicators (HSI) such as morning and evening Core Body Temperature (CBT) and Urine Specific Gravity (USG) were monitored using an infrared thermometer and refractometer, respectively. A validated, modified version of the HOTHAPS questionnaire was utilised to collect self-reported health symptoms. A follow-up was undertaken with the mothers to collect information regarding birth outcomes and APOs, such as spontaneous abortions, stillbirths, Preterm Birth (PTB), birth abnormalities, and Low Birth Weight (LBW). Major findings of the study: According to the findings of our study, ambient temperatures (mean WBGT°C) were substantially higher (>28°C) for approximately 46% of women performing moderate daily life activities. 82% versus 43% of these women experienced dehydration and heat-related complaints. 34% of women had USG >1.020, which is symptomatic of dehydration. APOs, which include spontaneous abortions, were prevalent at 2.2%, stillbirth/preterm birth/birth abnormalities were prevalent at 2.2%, and low birth weight was prevalent at 16.3%. With exposures to WBGT>28°C, the incidence of miscarriage or unexpected abortion rose by approximately 2.7 times (95% CI: 1.1-6.9). In addition, higher WBGT exposures were associated with a 1.4-fold increased risk of unfavorable birth outcomes (95% Confidence Interval [CI]: 1.02-1.09). The risk of spontaneous abortions was 2.8 times higher among women who conceived during the hotter months (February – September) compared to those women who conceived in the cooler months (October – January) (95% CI: 1.04-7.4). Positive relationships between ambient heat and APOs found in this study necessitate further exploration into the underlying factors for extensive cohort studies to generate information to enable the formulation of policies that can effectively protect these women against excessive heat stress for enhanced maternal and fetal health.

Keywords: heat exposures, community, pregnant women, physiological strain, adverse outcome, interventions

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14113 Competing Interactions, and Magnetization Dynamics in Doped Rare-Earth Manganites Nanostructural System

Authors: Wiqar Hussain Shah

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The Structural, magnetic and transport behavior of La1-xCaxMnO3+ (x=0.48, 0.50, 0.52 and 0.55 and =0.015) compositions close to charge ordering, was studied through XRD, resistivity, DC magnetization and AC susceptibility measurements. With time and thermal cycling (T<300 K) there is an irreversible transformation of the low-temperature phase from a partially ferromagnetic and metallic to one that is less ferromagnetic and highly resistive. For instance, an increase of resistivity can be observed by thermal cycling, where no effect is obtained for lower Ca concentration. The time changes in the magnetization are logarithmic in general and activation energies are consistent with those expected for electron transfer between Mn ions. The data suggest that oxygen non-stoichiometry results in mechanical strains in this two-phase system, leading to the development of irreversible metastable states, which relax towards the more stable charge-ordered and antiferromagnetic microdomains at the nano-meter size. This behavior is interpreted in terms of strains induced charge localization at the interface between FM/AFM domains in the antiferromagnetic matrix. Charge, orbital ordering and phase separation play a prominent role in the appearance of such properties, since they can be modified in a spectacular manner by external factor, making the different physical properties metastable. Here we describe two factors that deeply modify those properties, viz. the doping concentration and the thermal cycling. The metastable state is recovered by the high temperature annealing. We also measure the magnetic relaxation in the metastable state and also the revival of the metastable state (in a relaxed sample) due to high temperature (800 ) thermal treatment.

Keywords: Rare-earth maganites, nano-structural materials, doping effects on electrical, magnetic properties, competing interactions

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14112 International Students into the Irish Higher Education System: Supporting the Transition

Authors: Tom Farrelly, Yvonne Kavanagh, Tony Murphy

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The sharp rise in international students into Ireland has provided colleges with a number of opportunities but also a number of challenges, both at an institutional and individual lecturer level and of course for the incoming student. Previously, Ireland’s population, particularly its higher education student population was largely homogenous, largely drawn from its own shores and thus reflecting the ethnic, cultural and religious demographics of the day. However, over the twenty years Ireland witnessed considerable economic growth, downturn and subsequent growth all of which has resulted in an Ireland that has changed both culturally and demographically. Propelled by Ireland’s economic success up to the late 2000s, one of the defining features of this change was an unprecedented rise in the number of migrants, both academic and economic. In 2013, Ireland’s National Forum for the Enhancement for Teaching and Learning in Higher Education (hereafter the National Forum) invited proposals for inter-institutional collaborative projects aimed at different student groups’ transitioning in or out of higher education. Clearly, both as a country and a higher education sector we want incoming students to have a productive and enjoyable time in Ireland. One of the ways that will help the sector help the students make a successful transition is by developing strategies and polices that are well informed and student driven. This abstract outlines the research undertaken by the five colleges Institutes of Technology: Carlow; Cork; Tralee & Waterford and University College Cork) in Ireland that constitute the Southern cluster aimed at helping international students transition into the Irish higher education system. The aim of the southern clusters’ project was to develop a series of online learning units that can be accessed by prospective incoming international students prior to coming to Ireland and by Irish based lecturing staff. However, in order to make the units as relevant and informed as possible there was a strong research element to the project. As part of the southern cluster’s research strategy a large-scale online survey using SurveyMonkey was undertaken across the five colleges drawn from their respective international student communities. In total, there were 573 responses from students coming from over twenty different countries. The results from the survey have provided some interesting insights into the way that international students interact with and understand the Irish higher education system. The research and results will act as a model for consistent practice applicable across institutional clusters, thereby allowing institutions to minimise costs and focus on the unique aspects of transitioning international students into their institution.

Keywords: digital, international, support, transitions

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14111 Quantification of Peptides (linusorbs) in Gluten-free Flaxseed Fortified Bakery Products

Authors: Youn Young Shim, Ji Hye Kim, Jae Youl Cho, Martin JT Reaney

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Flaxseed (Linumusitatissimum L.) is gaining popularity in the food industry as a superfood due to its health-promoting properties. Linusorbs (LOs, a.k.a. Cyclolinopeptide) are bioactive compounds present in flaxseed exhibiting potential health effects. The study focused on the effects of processing and storage on the stability of flaxseed-derived LOs added to various bakery products. The flaxseed meal fortified gluten-free (GF) bakery bread was prepared, and the changes of LOs during the bread-making process (meal, fortified flour, dough, and bread) and storage (0, 1, 2, and 4 weeks) at different temperatures (−18 °C, 4 °C, and 22−23 °C) were analyzed by high-performance liquid chromatography-diode array detection. The total oxidative LOs and LO1OB2 were almost kept stable in flaxseed meals at storage temperatures of 22−23 °C, −18 °C, and 4 °C for up to four weeks. Processing steps during GF-bread production resulted in the oxidation of LOs. Interestingly, no LOs were detected in the dough sample; however, LOs appeared when the dough was stored at −18 °C for one week, suggesting that freezing destroyed the sticky structure of the dough and resulted in the release of LOs. The final product, flaxseed meal fortified bread, could be stored for up to four weeks at −18 °C and 4 °C, and for one week at 22−23 °C. All these results suggested that LOs may change during processing and storage and that flaxseed flour-fortified bread should be stored at low temperatures to preserve effective LOs components.

Keywords: linum usitatissimum L., flaxseed, linusorb, stability, gluten-free, peptides, cyclolinopeptide

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14110 Development of a Nursing Care Program Based on Anthroposophic External Therapy for the Pediatric Hospital in Brazil and Germany

Authors: Karina Peron, Ricardo Ghelman, Monica Taminato, Katia R. Oliveira, Debora C. A. Rodrigues, Juliana R. C. Mumme, Olga K. M. Sunakozaua, Georg Seifert, Vicente O. Filho

Abstract:

The nurse is the most available health professional for the interventions of support in the integrative approach in hospital environment, therefore a professional group key to changes in the model of care. The central components in the performance of anthroposophic nursing procedures are direct physical contact, promotion of proper rhythm, thermal regulation and the construction of a calm and empathic atmosphere, safe for patients and their caregivers. The procedures of anthroposophic external therapies (AET), basically composed of the application of compresses and the use of natural products, provide an opportunity to intensify the therapeutic results through an innovative, complementary and integrative model in the university hospital. The objective of this work is to report the implementation of a program of nursing techniques (AET) through a partnership between the Pediatric Oncology Sector of the Department of Pediatrics of the Faculty of Medicine of the University of Sao Paulo and Charite University of Berlin, with lecturers from Berlin's Integrative Hospital Havelhöhe and Witten-Herdecke Integrative Hospital, both in Germany. Intensive training activities of the Hospital's nursing staff and a survey on AET needs were developed based on the most prevalent complaints in pediatric oncology patients in the three environments of the Hospital of Pediatric Oncology: Bone Marrow Transplantation Unit, Intensive Care Unit and Division of Internal Patients. We obtained the approval of the clinical protocol of external anthroposophic therapies for nursing care by the Ethics Committee and the Academic Council of the Hospital. With this project, we highlight the key AET needs that will be part of the standard program of pediatric oncology care with appropriate scientific support. The results of the prevalent symptoms were: vomiting, nausea, pain, difficulty in starting sleep, constipation, cold extremities, mood disorder and psychomotor agitation. This project was the pioneer within the Integrative Pediatrics Program, as an innovative concept of Medicine and Integrative Health presented at scientific meetings.

Keywords: integrative health care, integrative nursing, pediatric nursing, pediatric oncology

Procedia PDF Downloads 251
14109 Design Criteria for Achieving Acceptable Indoor Radon Concentration

Authors: T. Valdbjørn Rasmussen

Abstract:

Design criteria for achieving an acceptable indoor radon concentration are presented in this paper. The paper suggests three design criteria. These criteria have to be considered at the early stage of the building design phase to meet the latest recommendations from the World Health Organization in most countries. The three design criteria are; first, establishing a radon barrier facing the ground; second, lowering the air pressure in the lower zone of the slab on ground facing downwards; third, diluting the indoor air with outdoor air. The first two criteria can prevent radon from infiltrating from the ground, and the third criteria can dilute the indoor air. By combining these three criteria, the indoor radon concentration can be lowered achieving an acceptable level. In addition, a cheap and reliable method for measuring the radon concentration in the indoor air is described. The provision on radon in the Danish Building Regulations complies with the latest recommendations from the World Health Organization. Radon can cause lung cancer and it is not known whether there is a lower limit for when it is not harmful to human beings. Therefore, it is important to reduce the radon concentration as much as possible in buildings. Airtightness is an important factor when dealing with buildings. It is important to avoid air leakages in the building envelope both facing the atmosphere, e.g. in compliance with energy requirements, but also facing the ground, to meet the requirements to ensure and control the indoor environment. Infiltration of air from the ground underneath a building is the main providing source of radon to the indoor air.

Keywords: radon, natural radiation, barrier, pressure lowering, ventilation

Procedia PDF Downloads 338
14108 Uptake of Copper by Dead Biomass of Burkholderia cenocepacia Isolated from a Metal Mine in Pará, Brazil

Authors: Ingrid R. Avanzi, Marcela dos P. G. Baltazar, Louise H. Gracioso, Luciana J. Gimenes, Bruno Karolski, Elen A. Perpetuo, Claudio Auguto Oller do Nascimento

Abstract:

In this study was developed a natural process using a biological system for the uptake of Copper and possible removal of copper from wastewater by dead biomass of the strain Burkholderia cenocepacia. Dead and live biomass of Burkholderia cenocepacia was used to analyze the equilibrium and kinetics of copper biosorption by this strain in function of the pH. Living biomass exhibited the highest biosorption capacity of copper, 50 mg g−1, which was achieved within 5 hours of contact, at pH 7.0, temperature of 30°C, and agitation speed of 150 rpm. The dead biomass of Burkholderia cenocepacia may be considered an efficiently bioprocess, being fast and low-cost to production of copper and also a probably nano-adsorbent of this metal ion in wastewater in bioremediation process. In this study was developed a natural process using a biological system for the uptake of Copper and possible removal of copper from wastewater by dead biomass of the strain Burkholderia cenocepacia. Dead and live biomass of Burkholderia cenocepacia was used to analyze the equilibrium and kinetics of copper biosorption by this strain in function of the pH. Living biomass exhibited the highest biosorption capacity of copper, 50 mg g−1, which was achieved within 5 hours of contact, at pH 7.0, temperature of 30°C, and agitation speed of 150 rpm. The dead biomass of Burkholderia cenocepacia may be considered an efficiently bioprocess, being fast and low-cost to production of copper and also a probably nano-adsorbent of this metal ion in wastewater in bioremediation process.

Keywords: biosorption, dead biomass, biotechnology, copper recovery

Procedia PDF Downloads 327
14107 Feasibility Study on the Use of HEMS for Thermal Comfort and Energy Saving in Japanese Residential Buildings

Authors: K. C. Rajan, H. B. Rijal, Kazui Yoshida, Masanori Shukuya

Abstract:

The electricity consumption in the Japanese household sector has increased with higher rate than that of other sectors. This may be because of aging and information oriented society that requires more electrical appliances to make the life better and easier, under this circumstances, energy saving is one of the essential necessity in Japanese society. To understand the way of energy use and demand response of the residential occupants, it is important to understand the structure of energy used. Home Energy Management System (HEMS) may be used for understanding the pattern and the structure of energy used. HEMS is a visualization system of the energy usage by connecting the electrical equipment in the home and thereby automatically control the energy use in each device, so that the energy saving is achieved. Therefore, the HEMS can provide with the easiest way to understand the structure of energy use. The HEMS has entered the mainstream of the Japanese market. The objective of this study is to understand the pattern of energy saving and cost saving in different regions including Japan during HEMS use. To observe thermal comfort level of HEMS managed residential buildings in Japan, the field survey was made and altogether, 1534 votes from 37 occupants related to thermal comfort, occupants’ behaviors and clothing insulation were collected and analyzed. According to the result obtained, approximately 17.9% energy saving and 8.9% cost saving is possible if HEMS is applied effectively. We found the thermal sensation and overall comfort level of the occupants is high in the studied buildings. The occupants residing in those HEMS buildings are satisfied with the thermal environment and they have accepted it. Our study concluded that the significant reduction in Japanese residential energy use can be achieved by the proper utilization of the HEMS. Better thermal comfort is also possible with the use of HEMS if energy use is managed in a rationally effective manner.

Keywords: energy reduction, thermal comfort, HEMS utility, thermal environment

Procedia PDF Downloads 265
14106 A Causal Model for Environmental Design of Residential Community for Elderly Well-Being in Thailand

Authors: Porntip Ruengtam

Abstract:

This article is an extension of previous research presenting the relevant factors related to environmental perceptions, residential community, and the design of a healing environment, which have effects on the well-being and requirements of Thai elderly. Research methodology began with observations and interviews in three case studies in terms of the management processes and environment design of similar existing projects in Thailand. The interview results were taken to summarize with related theories and literature. A questionnaire survey was designed for data collection to confirm the factors of requirements in a residential community intended for the Thai elderly. A structural equation model (SEM) was formulated to explain the cause-effect factors for the requirements of a residential community for Thai elderly. The research revealed that the requirements of a residential community for Thai elderly were classified into three groups when utilizing a technique for exploratory factor analysis. The factors were comprised of (1) requirements for general facilities and activities, (2) requirements for facilities related to health and security, and (3) requirements for facilities related to physical exercise in the residential community. The results from the SEM showed the background of elderly people had a direct effect on their requirements for a residential community from various aspects. The results should lead to the formulation of policies for design and management of residential communities for the elderly in order to enhance quality of life as well as both the physical and mental health of the Thai elderly.

Keywords: elderly, environmental design, residential community, structural equation modeling

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14105 Transformation of the Business Model in an Occupational Health Care Company Embedded in an Emerging Personal Data Ecosystem: A Case Study in Finland

Authors: Tero Huhtala, Minna Pikkarainen, Saila Saraniemi

Abstract:

Information technology has long been used as an enabler of exchange for goods and services. Services are evolving from generic to personalized, and the reverse use of customer data has been discussed in both academia and industry for the past few years. This article presents the results of an empirical case study in the area of preventive health care services. The primary data were gathered in workshops, in which future personal data-based services were conceptualized by analyzing future scenarios from a business perspective. The aim of this study is to understand business model transformation in emerging personal data ecosystems. The work was done as a case study in the context of occupational healthcare. The results have implications to theory and practice, indicating that adopting personal data management principles requires transformation of the business model, which, if successfully managed, may provide access to more resources, potential to offer better value, and additional customer channels. These advantages correlate with the broadening of the business ecosystem. Expanding the scope of this study to include more actors would improve the validity of the research. The results draw from existing literature and are based on findings from a case study and the economic properties of the healthcare industry in Finland.

Keywords: ecosystem, business model, personal data, preventive healthcare

Procedia PDF Downloads 238
14104 Bank, Stock Market Efficiency and Economic Growth: Lessons for ASEAN-5

Authors: Tan Swee Liang

Abstract:

This paper estimates bank and stock market efficiency associations with real per capita GDP growth by examining panel-data across three different regions using Panel-Corrected Standard Errors (PCSE) regression developed by Beck and Katz (1995). Data from five economies in ASEAN (Singapore, Malaysia, Thailand, Philippines, and Indonesia), five economies in Asia (Japan, China, Hong Kong SAR, South Korea, and India) and seven economies in OECD (Australia, Canada, Denmark, Norway, Sweden, United Kingdom U.K., and United States U.S.), between 1990 and 2017 are used. Empirical findings suggest one, for Asia-5 high bank net interest margin means greater bank profitability, hence spurring economic growth. Two, for OECD-7 low bank overhead costs (as a share of total assets) may reflect weak competition and weak investment in providing superior banking services, hence dampening economic growth. Three, stock market turnover ratio has negative association with OECD-7 economic growth, but a positive association with Asia-5, which suggest the relationship between liquidity and growth is ambiguous. Lastly, for ASEAN-5 high bank overhead costs (as a share of total assets) may suggest expenses have not been channelled efficiently to income generating activities. One practical implication of the findings is that policy makers should take necessary measures toward financial liberalisation policies that boost growth through the efficiency channel, so that funds are efficiently allocated through the financial system between financial and real sectors.

Keywords: financial development, banking system, capital markets, economic growth

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14103 Optimization of Interface Radio of Universal Mobile Telecommunication System Network

Authors: O. Mohamed Amine, A. Khireddine

Abstract:

Telecoms operators are always looking to meet their share of the other customers, they try to gain optimum utilization of the deployed equipment and network optimization has become essential. This project consists of optimizing UMTS network, and the study area is an urban area situated in the center of Algiers. It was initially questions to become familiar with the different communication systems (3G) and the optimization technique, its main components, and its fundamental characteristics radios were introduced.

Keywords: UMTS, UTRAN, WCDMA, optimization

Procedia PDF Downloads 364
14102 Activities for Increasing Childhood Vaccination Coverage of the Refugee and Migrant Population, Greece, European Program PHILOS, 2017

Authors: C. Silvestros, K. Mellou, T. Georgakopoulou, A. Koustenis, E. Kokkinou, C. Botsi, A. Terzidis

Abstract:

'PHILOS – Emergency health response to refugee crisis' is a programme of the Greek Ministry of Health, implemented by the Hellenic Center for Disease Control and Prevention (HCDCP) funded by the Asylum, Migration and Integration Fund (AMIF) of EU’s DG Migration and Home Affairs. One of the main objectives of the program is the immunization coverage of the target – population to assure the prevention of vaccine-preventable diseases. The program foresees vaccination needs assessment of children hosted at camps at the mainland and implementation of interventions to cover the vaccination gaps in co-operation with the Ministry of Health. The National Immunization Advisory Committee in Greece recommended that MMR (Measles, Mumps, and Rubella), PCV (Pneumococcal conjugate vaccine) and HEXA (diphtheria, tetanus, pertussis, polio, hepatitis B and Haemophilus influenzae type b) vaccines should be performed in priority. Recording was completed at 24 camps (May - June 2017); 3381 children (0-18 years) were recorded. The median number of children hosted at each camp was 95 (range: 5-553). For 68% of the children, the WHO vaccination booklet was available. 44%, 48.5% and 61% of the children were vaccinated with at least one dose of PCV, HEXA, and MMR, respectively. The proportion of vaccinated children for the three vaccines mentioned above is significantly lower for the remaining doses; PCV (second dose 8%, third dose 1.3%), HEXA (second dose 13%, third dose 2.7%, forth dose 0.1%) and MMR (second dose 23%). None of the 37 (10 from Afghanistan, 3 from Bangladesh, 23 from Pakistan, 1 from Syria) recorded unaccompanied children did not have a WHO vaccination booklet and were considered unvaccinated. There is no differentiation in vaccination coverage among different ethnicities. Massive catch up vaccination was performed at 4 camps, and 671 vaccinations were performed (245 PCV, 307 HEXA, and 119 MMR). Similar interventions are planned for all camps of the country. Recording reveled gaps in vaccination coverage of the population, mainly because of the mobility of the population, the influx of refugees- which is still ongoing- and new births. Mass vaccination campaigns are considered vital in order to increase vaccination coverage, and continuous efforts are needed in order all children living at the camps to have full access to the National Childhood Immunization Program.

Keywords: vaccine preventable, refugee–migrants camps, vaccination coverage, PCV, MMR, HEXA

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14101 Bioavailability of Iron in Some Selected Fiji Foods using In vitro Technique

Authors: Poonam Singh, Surendra Prasad, William Aalbersberg

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Iron the most essential trace element in human nutrition. Its deficiency has serious health consequences and is a major public health threat worldwide. The common deficiencies in Fiji population reported are of Fe, Ca and Zn. It has also been reported that 40% of women in Fiji are iron deficient. Therefore, we have been studying the bioavailability of iron in commonly consumed Fiji foods. To study the bioavailability it is essential to assess the iron contents in raw foods. This paper reports the iron contents and its bioavailability in commonly consumed foods by multicultural population of Fiji. The food samples (rice, breads, wheat flour and breakfast cereals) were analyzed by atomic absorption spectrophotometer for total iron and its bioavailability. The white rice had the lowest total iron 0.10±0.03 mg/100g but had high bioavailability of 160.60±0.03%. The brown rice had 0.20±0.03 mg/100g total iron content but 85.00±0.03% bioavailable. The white and brown breads showed the highest iron bioavailability as 428.30±0.11 and 269.35 ±0.02%, respectively. The Weetabix and the rolled oats had the iron contents 2.89±0.27 and 1.24.±0.03 mg/100g with bioavailability of 14.19±0.04 and 12.10±0.03%, respectively. The most commonly consumed normal wheat flour had 0.65±0.00 mg/100g iron while the whole meal and the Roti flours had 2.35±0.20 and 0.62±0.17 mg/100g iron showing bioavailability of 55.38±0.05, 16.67±0.08 and 12.90±0.00%, respectively. The low bioavailability of iron in certain foods may be due to the presence of phytates/oxalates, processing/storage conditions, cooking method or interaction with other minerals present in the food samples.

Keywords: iron, bioavailability, Fiji foods, in vitro technique, human nutrition

Procedia PDF Downloads 515
14100 Smart Technology Work Practices to Minimize Job Pressure

Authors: Babar Rasheed

Abstract:

The organizations are in continuous effort to increase their yield and to retain their associates, employees. Technology is considered an integral part of attaining apposite work practices, work environment, and employee engagement. Unconsciously, these advanced practices like work from home, personalized intra-network are disturbing employee work-life balance which ultimately increases psychological pressure on employees. The smart work practice is to develop business models and organizational practices with enhanced employee engagement, minimum trouncing of organization resources with persistent revenue and positive addition in global societies. Need of smart work practices comes from increasing employee turnover rate, global economic recession, unnecessary job pressure, increasing contingent workforce and advancement in technologies. Current practices are not enough elastic to tackle global changing work environment and organizational competitions. Current practices are causing many reciprocal problems among employee and organization mechanically. There is conscious understanding among business sectors smart work practices that will deal with new century challenges with addressing the concerns of relevant issues. It is aimed in this paper to endorse customized and smart work practice tools along knowledge framework to manage the growing concerns of employee engagement, use of technology, orgaization concerns and challenges for the business. This includes a Smart Management Information System to address necessary concerns of employees and combine with a framework to extract the best possible ways to allocate companies resources and re-align only required efforts to adopt the best possible strategy for controlling potential risks.

Keywords: employees engagement, management information system, psychological pressure, current and future HR practices

Procedia PDF Downloads 173
14099 Time to Second Line Treatment Initiation Among Drug-Resistant Tuberculosis Patients in Nepal

Authors: Shraddha Acharya, Sharad Kumar Sharma, Ratna Bhattarai, Bhagwan Maharjan, Deepak Dahal, Serpahine Kaminsa

Abstract:

Background: Drug-resistant (DR) tuberculosis (TB) continues to be a threat in Nepal, with an estimated 2800 new cases every year. The treatment of DR-TB with second line TB drugs is complex and takes longer time with comparatively lower treatment success rate than drug-susceptible TB. Delay in treatment initiation for DR-TB patients might further result in unfavorable treatment outcomes and increased transmission. This study thus aims to determine median time taken to initiate second-line treatment among Rifampicin Resistant (RR) diagnosed TB patients and to assess the proportion of treatment delays among various type of DR-TB cases. Method: A retrospective cohort study was done using national routine electronic data (DRTB and TB Laboratory Patient Tracking System-DHIS2) on drug resistant tuberculosis patients between January 2020 and December 2022. The time taken for treatment initiation was computed as– days from first diagnosis as RR TB through Xpert MTB/Rif test to enrollment on second-line treatment. The treatment delay (>7 days after diagnosis) was calculated. Results: Among total RR TB cases (N=954) diagnosed via Xpert nationwide, 61.4% were enrolled under shorter-treatment regimen (STR), 33.0% under longer treatment regimen (LTR), 5.1% for Pre-extensively drug resistant TB (Pre-XDR) and 0.4% for Extensively drug resistant TB (XDR) treatment. Among these cases, it was found that the median time from diagnosis to treatment initiation was 6 days (IQR:2-15.8). The median time was 5 days (IQR:2.0-13.3) among STR, 6 days (IQR:3.0-15.0) among LTR, 30 days (IQR:5.5-66.8) among Pre-XDR and 4 days (IQR:2.5-9.0) among XDR TB cases. The overall treatment delay (>7 days after diagnosis) was observed in 42.4% of the patients, among which, cases enrolled under Pre-XDR contributed substantially to treatment delay (72.0%), followed by LTR (43.6%), STR (39.1%) and XDR (33.3%). Conclusion: Timely diagnosis and prompt treatment initiation remain fundamental focus of the National TB program. The findings of the study, however suggest gaps in timeliness of treatment initiation for the drug-resistant TB patients, which could bring adverse treatment outcomes. Moreover, there is an alarming delay in second line treatment initiation for the Pre-XDR TB patients. Therefore, this study generates evidence to identify existing gaps in treatment initiation and highlights need for formulating specific policies and intervention in creating effective linkage between the RR TB diagnosis and enrollment on second line TB treatment with intensified efforts from health providers for follow-ups and expansion of more decentralized, adequate, and accessible diagnostic and treatment services for DR-TB, especially Pre-XDR TB cases, due to the observed long treatment delays.

Keywords: drug-resistant, tuberculosis, treatment initiation, Nepal, treatment delay

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14098 Traditional and Commercially Prepared Medicine: Factors That Affect Preferences among Elderly Adults in Indigenous Community

Authors: Rhaetian Bern D. Azaula

Abstract:

The Philippines' indigenous population, estimated to be 10%-20%, is protected by the Indigenous Peoples Rights Act (IPRA), passed in 1997. However, due to their isolation and limited access to basic services such as health education or needs for health assistance, the law's implementation remains a challenge. As traditional medicine continues to play a significant role in society as the prevention and treatment of some illnesses, it is still customary and widely used to use plants in both traditional and modern ways; however, commercially prepared drugs are progressively advanced as time goes by. Therefore, the purpose of this quantitative study is to investigate the indigenous community at Barangay Magsikap General Nakar, Quezon, and analyze the factors that affect the respondent’s preferences in an indigenous community and reasons for patronizing traditional and commercially prepared medicines and proposes updated health education strategies and instructional materials. Slovin's formula was utilized to reduce the total population representation, followed by stratified sampling for proportional allocation of respondents. The study selects respondents (1) from an Indigenous Community in Barangay Magsikap, General Nakar, Quezon, (2) aged 60 and above, and (3) who are willing to participate. The researcher utilized a checklist-based questionnaire with a Tagalog version, and a Likert Scale was utilized to assess the respondent's choices on selected items. The researcher obtained informed consent from the indigenous community's regional and local office, the chieftain of the tribe, and the respondents, ensuring confidentiality in the collection and retrieval of data. The study revealed that respondents aged 60-69, males with no formal education, are unemployed and have no income source. They prefer traditional medicines due to their affordability, availability, and cultural practices but lack safe preparation, dosages, and contraindications of used medicines. Commercially prepared medications are acknowledged, but respondents are not fully aware of proper administration instructions and dosage labels. Recommendations include disseminating approved herbal medicines and ensuring proper preparation, indications, and contraindications.

Keywords: traditional medicine, commercially prepared medicine, indigenous community, elderly adult

Procedia PDF Downloads 63