Search results for: qualitative criteria

Authors: I. Wayan Wiwin

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Poverty is one of the big problems faced by big cities in the world. Urbanization one cause, many rural communities trying to earn a living to the city in the hope that they can improve the level of economy, but not equipped with adequate skills so that it becomes an urban demographic problem. Denpasar as the capital of the province of Bali one of them, in the city area of Denpasar there are many slum dwellings inhabited by the poor, whereas Bali is known as one of the best tourist destinations in the world. This condition is very inversely proportional to the progress of tourism in Bali. For that it is necessary to attempt to overcome poverty in the city of Denpasar, one with the development of city tours in the form of charity walking tours, where tourists are invited to take a walk to see directly the state of the poor in the city of Denpasar and provide assistance to them in the form of home assistance, educational scholarships, health assistance, as well as skill and business capital assistance. This research is explorative-qualitative, that is exploring the potential of charity walking tour to overcome poverty in Denpasar City, which is written qualitatively. In the end based on potential data and information, then analyzed into a decision whether it is possible to develop. Therefore, this study only requires respondents or informants who are able to provide answers or qualitative information about matters related to the potential development of charity walking tour. Thus, informants in this study are tourism stakeholders, such as Municipal government officials, businessmen, community leaders and tourism actors, who are considered to be providing information relating to the development of urban tourism.

Keywords: tourism, city tours, charity walking tours, poverty

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Authors: Mustafa M. Donma, Erkut Karasu, Burcu Ozdilek, Burhan Turgut, Birol Topcu, Burcin Nalbantoglu, Orkide Donma

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The mechanisms underlying the association between obesity and asthma may be related to a decreased immunological tolerance induced by a defective function of regulatory T cells (Tregs). The aim of this study is to establish the potential link between these diseases and CD4+, CD25+ FoxP3+ Tregs as well as T helper cells (Ths) in children. This is a prospective case control study. Obese (n:40), asthmatic (n:40), asthmatic obese (n:40), and healthy children (n:40), who don't have any acute or chronic diseases, were included in this study. Obese children were evaluated according to WHO criteria. Asthmatic patients were chosen based on GINA criteria. Parents were asked to fill up the questionnaire. Informed consent forms were taken. Blood samples were marked with CD4+, CD25+ and FoxP3+ in order to determine Tregs and Ths by flow cytometric method. Statistical analyses were performed. p≤0.05 was chosen as meaningful threshold. Tregs exhibiting anti-inflammatory nature were significantly lower in obese (0,16%; p≤0,001), asthmatic (0,25%; p≤0,01) and asthmatic obese (0,29%; p≤0,05) groups than the control group (0,38%). Ths were counted higher in asthma group than the control (p≤0,01) and obese (p≤0,001)) groups. T cell immunity plays important roles in obesity and asthma pathogeneses. Decreased numbers of Tregs found in obese, asthmatic and asthmatic obese children may help to elucidate some questions in pathophysiology of these diseases. For HOMA-IR levels, any significant difference was not noted between control and obese groups, but statistically higher values were found for obese asthmatics. The values obtained in all groups were found to be below the critical cut off points. This finding has made the statistically significant difference observed between Tregs of obese, asthmatic, obese asthmatic, and control groups much more valuable. These findings will be useful in diagnosis and treatment of these disorders and future studies are needed. The production and propagation of Tregs may be promising in alternative asthma and obesity treatments.

Keywords: asthma, flow cytometry, pediatric obesity, T cells

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Authors: G. Salavwa, P. Erhijakpor Jr., H. Ukwu

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This study will explore child labour issues in Nigeria because it is capable of affecting the physical and general well-being of children who perform hazardous work. This feat will be achieved through qualitative research methodology. Data collection shall be elicited by oral interviews and documental content analysis to delve on the application of the Convention on the Rights of the Child (CRC), International Labour Organization ILO and Geneva Convention relating to child labour practices in Nigeria. This will include the relevance of present domestic laws relating to child labour as implemented in Nigeria, together with factors that contribute to the practice of child labour in the country. The oral interview data analysis will be performed by breaking the interview data into significant statements and themes. This shall be done by comparing and determining the commonalities that are prevalent in the participants’ views regarding child labour menace in Nigeria. Presumably, findings from this study shall unveil that a poor educational policy, a widespread poverty level which is mostly prevalent amongst families in the rural areas of the country, a lack of employment for adults, have led to the ineffectiveness of the local child labour laws in Nigeria. These has in turn culminated into a somewhat non-implementation of the international laws of the CRC, ILO and Geneva Declaration on child labour to which the Nigerian government is a signatory. Based on the finding, this study will calls on the government of Nigeria to extend its free educational policy from the elementary, secondary to tertiary educations. The government also has to ensure that offenders of children’s rights should face a severe punishment.

Keywords: commonalities, tertiary, constitution, qualitative

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Authors: Jeffrey Chase

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Historically the profession of Occupational Therapy was closely tied to the treatment of those suffering from mental illness; more recently, and especially in the U.S., the percentage of OTs identifying as working in the mental health area has declined significantly despite the estimate that by 2020 behavioral health disorders will surpass physical illnesses as the major cause of disability worldwide. In the U.S. less than 10% of OTs identify themselves as working with the mentally ill and/or practicing in mental health settings. Such a decline has implications for both those suffering from mental illness and the profession of Occupational Therapy. One reason cited for the decline of OT in mental health has been the limited research in the discipline addressing mental health practice. Despite significant advances in technology and growth in the field of neuroscience, major institutions and funding sources such as the National Institute of Mental Health (NIMH) have noted that research into the etiology and treatment of mental illness have met with limited success over the past 25 years. One major reason posited by NIMH is that research has been limited by how we classify individuals, that being mostly on what is observable. A new classification system being developed by NIMH, the Research Domain Criteria (RDoc), has the goal to look beyond just descriptors of disorders for common neural, genetic, and physiological characteristics that cut across multiple supposedly separate disorders. The hope is that by classifying individuals along RDoC measures that both reliability and validity will improve resulting in greater advances in the field. As a result of this change NIH and NIMH will prioritize research funding to those projects using the RDoC model. Multiple disciplines across many different setting will be required for RDoC or similar classification systems to be developed. During this shift in research methodology OT has an opportunity to reassert itself into the research and treatment of mental illness, both in developing new ways to more validly classify individuals, and to document the legitimacy of previously ill-defined and validated disorders such as sensory integration.

Keywords: global mental health and neuroscience, research opportunities for ot, greater integration of ot in mental health research, research and funding opportunities, research domain criteria (rdoc)

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Authors: P. W. G. D. P. Samarasekara, S. M. K. S. Seneviratne, D. Munidasa, S. S. Williams

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Sustaining a spinal cord injury (SCI) causes severe disruption of all aspects of a person’s life, resulting in the difficult process of coping with the distressing effects of paralysis affecting their ability to lead a meaningful life. These persons are hospitalized in the acute stage of injury and subsequently for rehabilitation and the treatment of complications. The purpose of this study was to explore coping strategies used by persons with SCI during their rehabilitation period. A qualitative study was conducted among persons with SCI, undergoing rehabilitation at the Rheumatology and Rehabilitation Hospitals, Ragama and Digana Sri Lanka. Twelve participants were selected purposively to represent both males and females, with cervical, thoracic or lumbar levels of injuries due to traumatic and non-traumatic causes as well as from different socioeconomic backgrounds. Informed consent was taken from the participants. In-depth interviews were conducted using an interview guide to collect data. Probes were used to get more information and to encourage participants. Interviews were audio taped and transcribed verbatim. Qualitative content analysis was conducted. Ethical approval for this study was obtained from the Ethics Review Committee, Faculty of Medicine, University of Kelaniya. Five themes were identified in the content analysis: social support, religious beliefs, determination, acceptance and making comparisons. Participants indicated that the support from their family members had been an essential factor in coping, after sustaining an SCI and they expressed the importance of emotional support from family members during their rehabilitation. Many participants had a strong belief towards the God, who had a personal interest in their lives, played an important role in their ability to cope with the injury. They believed that what happens to them in this life results from their actions in previous lives. They expressed that determination was essential as a factor that helps them cope with their injury. They indicated their focus on the positive aspects of the life and accepted the disability. They made comparisons to other persons who were worse off than them to help lift them out of unpleasant experience. Even some of the most severely injured and disabled participants presented evidence of using this coping strategy. Identification of coping strategies used by persons with SCI will help nurses and other health-care professionals in reinforcing the most effective coping strategies among persons with SCI. The findings recommend that engagement coping positively influences psychosocial adaptation.

Keywords: content analysis, coping strategies, rehabilitation, spinal cord injury

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Authors: Hi̇lal Surat

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People who want to get rid of stress and intensive working tempo for a while head for recreation operations in order to get rest and have fun. Therefore, planning recreation operation makes contributions to social, physiological, economic and psychological development of an individual and the community in a way that the needs of people meet regularly and constantly. The rapid increase of world population rate makes necessary of benefit from natural or man-made resources in a multiple way. Dams and reservoirs which are built near urban area with the aim of electrical energy conversion and agricultural irrigation are considered as natural area providing various opportunities such as recreation operations. Dams have a great importance regarding to protection and improvement of water resources and coming into service of community. There should be a priority to protect these water resources, which are essential for nature and living organisms. It should be taken into consideration that these water resources are the most important input in the area and have high nature value to make sustainability of recreation effectiveness. The Deriner reservoir that has been built yet near the province of Artvin with natural and cultural properties is considered as an alternative option for meeting the needs of people for sportive and recreation activities and as a potential for planning of water-based recreation activities. Hence, in this study, activities that meet the expectations of people who get benefit from the area considering to natural, cultural and sportive recreation opportunities will be developed. In the first place, planning criteria for some sportive and water-based recreation operations will be defined in order to use the area for recreation and sportive activities and these criteria will be a base for a macro planning work within the holistic perspective of natural, cultural, and economical structure of the area. After this time, necessities of local people and evaluation of reservoir recreational potential will be determined, end then different socio-economic groups according to their in-come, age groups will be chosen and the questionnaire which has already prepared will be done these groups, as a result of these questionnaire recreational activities in water necessities will determine and we are going to develop different suggestion for this reservoir.

Keywords: dam, dam lakes, Deriner, recreation, water based activities

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Authors: Javeria Arain, Saad Malik

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The management of solid waste is a crucial and essential aspect of urban environmental management especially in a city with an ever increasing population such as Karachi. The total amount of municipal solid waste generated from Gulshan e Iqbal town on average is 444.48 tons per day and landfill sites are a widely accepted solution for final disposal of this waste. However, an improperly selected site can have immense environmental, economical and ecological impacts. To select an appropriate landfill site a number of factors should be kept into consideration to minimize the potential hazards of solid waste. The purpose of this research is to analyse the study area for the construction of an appropriate landfill site for disposal of municipal solid waste generated from Gulshan e-Iqbal Town by using geospatial techniques considering hydrological, geological, social and geomorphological factors. This was achieved using analytical hierarchy process and fuzzy analysis as a decision support tool with integration of geographic information sciences techniques. Eight most critical parameters, relevant to the study area, were selected. After generation of thematic layers for each parameter, overlay analysis was performed in ArcGIS 10.0 software. The results produced by both methods were then compared with each other and the final suitability map using AHP shows that 19% of the total area is Least Suitable, 6% is Suitable but avoided, 46% is Moderately Suitable, 26% is Suitable, 2% is Most Suitable and 1% is Restricted. In comparison the output map of fuzzy set theory is not in crisp logic rather it provides an output map with a range of 0-1, where 0 indicates least suitable and 1 indicates most suitable site. Considering the results it is deduced that the northern part of the city is appropriate for constructing the landfill site though a final decision for an optimal site could be made after field survey and considering economical and political factors.

Keywords: Analytical Hierarchy Process (AHP), fuzzy set theory, Geographic Information Sciences (GIS), Multi-Criteria Decision Analysis (MCDA)

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Authors: Arash Dara, Mahsa Mokhtari, Nafiseh Zamindar

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The aim of this study was to determine the effect of thermal resistance, temperature, voltage, and pH changes in an ohmic heating system on reducing the logarithmic number of Byssochlamys fulva species (PTCC 5062) in tomato juice water and to investigate the quantitative properties of tomato juice in the ohmic heating pasteurization system. The percentage of thermal degradation by ohmic heating was determined in tomato juice for the kinetics of Byssochlamys fulva in ohmic chamber at the temperatures of 88, 93, and 98°C, with two voltages of 30 and 40 volts and two pH levels of 3.5 and 4.5; this was done using Weibull frequency distribution model. Three different parameters (pH = 3.5, two voltages of 30 and 40, at three temperatures 88, 93, and 98) and (pH = 4.5, two voltages 30 and 40, at three temperatures 88, 93, and 98) in three replications were considered in the ohmic system. Heating time for the temperature of 88°C was 20 minutes once every 2 minutes, while for the temperature of 93°C, it was 10 minutes once every 1 minute. At the temperature of 98°C, the first time was 0.5 minutes, and for other times, sampling was done every 1 minute. In each condition, the qualitative characteristics, including acidity, Brix, and pH, were measured before and after the ohmic process in the tomato juice. This study demonstrates that the differences in pH and voltage due to different temperatures in the ohmic process can greatly affect the inactivation of Byssochlamys fulva fungus and the qualitative characteristics of the tomato juice. This is the first study using the Weibull frequency method to model the inactivation of Byssochlamys fulva in tomato juice. Variation in parameters such as temperature, voltage, and pH can prevent the presence of Byssochlamys fulva in the pasteurized juices.

Keywords: pasteurization, ohmic heating process, Byssochlamys fulva, tomato juice, heat resistance, voltage, pH

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Authors: Diana K. Kwok

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Despite the fact that Hong Kong government aims to develop an inclusive society, sexual minority students continue to encounter sexual prejudice without legal protection. They also have difficulties accessing relevant services from mental health and educational professionals, who do not receive systematic training to work with sexual minority students. Informed by the literature on sexual prejudice, heterosexual hegemony, genderism, as well as code of practice for frontline practitioners, the authors explored self-perceived knowledge of teachers and sexual minorities on sexuality and sexual prejudice, and how they perceive prejudice towards sexual minorities in Chinese cultural context. Semi-structure qualitative interviews were carried out with 31 school personnel informants (school teachers and counseling team members) and 25 sexual minority informants on their understanding of sexuality knowledge, their perception of sexual prejudice within school context in Hong Kong, as well as their suggested themes on teachers training on sexual prejudice reduction. This presentation specifically focuses on transcripts from sexual minority informants. Data analysis was carried out through NVivo, and followed the procedures spelt out in the qualitative research literature. Trustworthiness of the study was addressed through various strategies. Preliminary themes emerged from transcript content analysis: 1) A gap of knowledge between sexual minority informants and teachers; 2) Perception on sexual prejudice within cultural context; 3) Heterosexual hegemony and genderism within school system; 4) Needs for mandatory training: contents and strategies. The sexual minority informants found that teachers they encountered were predominantly adopted concepts of binary sex and dichotomous gender. Informants also indicated that the teachings of Confucianism cultural values, religiosity in Hong Kong might well be important cultural forces contributing to sexual prejudice manifested in school context. Although human rights and social justice concepts were embedded in professional code of practice of teachers and school helping professionals, informants found that teachers they encountered may face a dilemma when supporting sexual minority students navigating heterosexual hegemony and genderism in, as a consequence of their personal, institutional, cultural and religious backgrounds. Acknowledgments: The sexual prejudice project was funded by the Hong Kong Research Grant Council (ECS28401614), 2015 to 2017.

Keywords: sexual prejudice, Chinese teachers, Chinese sexual minorities, teacher training

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Authors: Tomasz Zarebski

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A very important element of the education system is its evaluation procedure. Each education system should be systematically evaluated and improved. Among the criteria subject to evaluation, attention should be paid to the following: structure of the study programme, implementation of the study programme, admission to studies, verification of learning outcomes achievement by students, giving credit for individual semesters and years, and awarding diplomas, competence, experience, qualifications and the number of staff providing education, staff development, and in-service training, education infrastructure, cooperation with social and economic stakeholders on the development, conditions for and methods of improving the internationalisation of education provided as part of the degree programme, supporting learning, social, academic or professional development of students and their entry on the labour market, public access to information about the study programme and quality assurance policy. Concerning the assessment process and the individual assessment indicators, the participation of students in these processes is essential. The purpose of this paper is to analyse the rules of student participation in accreditation processes on the example of individual countries in Europe. The rules of students' participation in the work of accreditation committees and their influence on the final grade of the committee were analysed. Most of the higher education institutions follow similar rules for accreditation. The general model gives the individual institution freedom to organize its own quality assurance, as long as the system lives up to the criteria for quality and relevance laid down in the particular provisions. This point also applies to students. The regulations of the following countries were examined in the legal-comparative aspect: Poland (Polish Accreditation Committee), Denmark (The Danish Accreditation Institution), France (High Council for the Evaluation of Research and Higher Education), Germany (Agency for Quality Assurance through Accreditation of Study Programmes) and Italy (National Agency for the Evaluation of Universities and Research Institutes).

Keywords: accreditation, student, study programme, quality assurance in higher education

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Authors: Greg Fetzer

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One of the fundamental tensions of creative work is between the need to be passionate and persistent in advancing novel and risky ideas and the need to be flexible, revising, or even abandoning ideas in favor of others. The tension becomes fraught in part because of the attachment that creators have toward their ideas. Idea attachment is defined here as a multifaceted concept referring to affection, passion, and connection toward a target—in this case, one’s projects or ideas. Yet feeling attached can make creators resistant to feedback, making them less flexible and leading them to escalate commitment. Despite a growing understanding of how attachment develops and evolves in response to project changes, feedback, and creative jolts, we still know relatively little about the organizational dynamics that may shape idea attachment. Through a qualitative, inductive study of early-stage R&D scientists in the pharmaceutical industry, this research finds that scientists develop bounded attachment, a mindset that limits emotional attachment to ideas while still fostering engagement in idea development. This research develops a process model of how bounded attachment is developed and enacted across three stages of the creative process, idea generation, idea evaluation, and outcome assessment, as well as the role that organizational practices and professional identity play in shaping this process: these collective practices provided structures to ensure ideas were evaluated in a rational (i.e. non-emotional way) while also providing socioemotional support in the face of setbacks. Together, this process led to continued creative engagement across ideas in a portfolio and helped scientists construct a sense of meaningful work despite a high likelihood (and frequency) of failure.

Keywords: creativity, innovation, organizational practices, qualitative, attachment

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Authors: Lydia Ouma Radoli

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The paradox of documenting history through visuals that objectify gruesome images to depict the prominence of stories intrigues media researchers. In East Africa, the topic has been captured in a variety of media frames, but scantly in scholarly work. This paper adopts Visual Rhetoric and Framing Theories to tease out the drivers behind the criteria for the selection of violent visuals. The paper projects that quantitative and qualitative literature regarding journalists’ personal and work-related exposure to PSTD will give insights into the concept of trauma journalism - reporting of horrific events, e.g., violent crime and terror. The data will be collected through methods such as document analysis (photographs and videos) and in-depth interviews to summarize the informational contents with respect to the research objectives and questions. The study is hinged on the background that the criterion for news production is constructed from the idea that ‘if there’s violence, conflict, and death involved, the story gets top priority.’ The anticipated outcome is to establish trauma experiences of visual rhetors, suggest mitigations, and address gaps in academic research. The findings of the study will sustain the critical role of visual rhetors. Further, media practitioners may find the study useful in assessing the effects and values of visual witnessing. Historically, the criterion for visual news production has been that if there’s violence, conflict, and death involved, the story gets top priority. To capture the goriness of the images, media theorists and sociologists have used the expression: “If it bleeds, it leads.” The statement assumes that audiences are attracted to pictures that show violent images. Further, research on visual aspects of Television news has shown its ability to hold viewers’ attention and cause aggression. This paper samples images and narratives from Journalists who have covered trauma-related events. The samples are indicative of the problem under study, which depicts journalists exposed to traumatic events as not receiving any Psycho-social support within newsrooms. It is hoped that the study could inform policy and practice within developing countries through the interpretations of theoretical and empirical explanations of existing trauma phenomena among journalists.

Keywords: visual-witnessing, media culture, visual rhetoric, imaging violence in East Africa

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Authors: Neeru Deep, Kimberly McAlister

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Mental health issues have been increasing worldwide for many decades, but the COVID-19 pandemic has brought mental health issues into the spotlight. Within higher education, promoting the well-being of students has dramatically increased in focus. The Northwestern State University of Louisiana opened the Center for Positivity, Well-being, and Hope using the action research process of reflecting, planning, acting, and observing. The study’s purpose is two-fold: First, it highlights how to create a collaborative team to reflect, plan, and act to develop a well-being culture in higher education institutions. Second, it investigates the efficacy of the center through Seligman’s lenses. The researchers shared their experience in the first three phases of the action research process and then applied an identical concurrent mixed methods design. A purposive sample evaluated the efficacy of the center through Seligman’s lenses. The researcher administered PERMA-Profiler Measure, the PERMA-Profiler Measure overview, the CoPWH Evaluation I, and the CoPWH Evaluation II questionnaires to collect qualitative and quantitative data. The thematic analysis for qualitative and descriptive statistics for quantitative data concluded that the center creates a well-being culture and promotes well-being in college students. In conclusion, this action research shares the successful implementation of the cyclic process of research in promoting a well-being culture in higher education with the implications for promoting a well-being culture in various educational settings, workplaces, and communities.

Keywords: action research, mixed methods research design, Seligman, well-being.

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Authors: Waepa Wanhussen

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The Ministry of Public Health has established policies accelerating health promotion to prevent public health problems in five border provinces of Thailand. One of these policies employs the religion to guide the community development and solve health issues consistent with the lifestyle and culture of those people. This policy is an important strategy to solve the problems due to the unrest and conflicts in the southern border provinces. This participatory action research aimed to develop mosques as healthy religion places in Narathiwat Province. In the development, the participatory action, consisting of 5 stages, was conducted from October 2012 - May 2013. Stage I: Conducting a survey for problems and needs for developing healthy religion places by employing community participation. Stage II: Analyzing problems and situations at a workshop containing informal interviews and group conversations with 200 participants (health providers at district level, Imams (the Muslim leaders), and community leaders). Stage III: Planning for developing healthy religion places by health providers, Imams, community leaders. Stage IV: Implementing the plan according to the conditions of problems and needs of the community in order to develop healthy religion places. Stage V: Evaluating the implementation by using the instrument, a criteria of being healthy religion place, for collecting data. Data were analyzed by using percentage. It was found that out of 630 mosques 575 (90.12%) passed the criteria of being a healthy religion place. Among these mosques, 190 mosques (30.15%) were in good and very good level, in which, after the implementation, the number of being good and very good healthy mosques increased by 22.58%. The researcher suggested that the developing sustainably healthy religion places require the participation of residences in the community and agencies such as local government, the Islamic Council of Narathiwat Province, and Council of Culture of Narathiwat Province. The healthy religion places can be used to strengthen and sustain health promotion and disease prevention in the community as health learning centers.

Keywords: healthy religion places, development of community participation, nursing informatics, health

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Authors: Tania Vasquez Mata, Luis A. Herrera, Cristian Arriaga Canon

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Background: Locally advanced breast cancer of the luminal B phenotype, poses challenges due to its variable response to neoadjuvant chemotherapy. A predictive biomarker is needed to identify patients who will not respond to treatment, allowing for alternative therapies. This study aims to validate the use of the lncRNA GATA3-AS1, as a predictive biomarker using RNA in situ hybridization. Research aim: The aim of this study is to determine if GATA3-AS1 can serve as a biomarker for resistance to neoadjuvant chemotherapy in patients with locally advanced luminal B breast cancer. Methodology: The study utilizes RNA in situ hybridization with predesigned probes for GATA3-AS1 on Formalin-Fixed Paraffin-Embedded tissue sections. The samples underwent pretreatment and protease treatment to enable probe penetration. Chromogenic detection and signal evaluation were performed using specific criteria. Findings: Patients who did not respond to neoadjuvant chemotherapy showed a 3+ score for GATA3-AS1, while those who had a complete response had a 1+ score. Theoretical importance: This study demonstrates the potential clinical utility of GATA3-AS1 as a biomarker for resistance to neoadjuvant chemotherapy. Identifying non-responders early on can help avoid unnecessary treatment and explore alternative therapy options. Data collection and analysis procedures: Tissue samples from patients with locally advanced luminal B breast cancer were collected and processed using RNA in situ hybridization. Signal evaluation was conducted under a microscope, and scoring was based on specific criteria. Questions addressed: Can GATA3-AS1 serve as a predictive biomarker for neoadjuvant chemotherapy response in locally advanced luminal B breast cancer? Conclusion: The lncRNA GATA3-AS1 can be used as a biomarker for resistance to neoadjuvant chemotherapy in patients with locally advanced luminal B breast cancer. Its identification through RNA in situ hybridization of tissue obtained from the initial biopsy can aid in treatment decision-making.

Keywords: biomarkers, breast neoplasms, genetics, neoadjuvant therapy, tumor

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Authors: Yananda Siraphatthada

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The current study was the succession of a previous study on value added of recycling business management. Its aims are to 1) explore conditions on how to increasing value add of Thai recycling business, and 2) exam the implementation of the 3-staged plan (short, medium, and long term), suggested by the former study, to increase value added of the recycling business as immediate mechanisms to accelerate government operation. Quantitative and qualitative methods were utilized in this research. A qualitative research consisted of in-depth interviews and focus group discussions. Responses were obtained from owners of the waste separation plants, and recycle shops, as well as officers in relevant governmental agencies. They were randomly selected via Quota Sampling. Data was analyzed via content analysis. The sample used for quantitative method consisted of 1,274 licensed recycling operators in eight provinces. The operators were randomly stratified via sampling method. Data were analyzed via descriptive statistics frequency, percentage, average (mean), and standard deviation. The study recommended three-staged plan: short, medium, and long terms. The plan included the development of logistics, the provision of quality market/plants, the amendment of recycling rules/regulation, the restructuring recycling business, the establishment of green-purchasing recycling center, support for the campaigns run by the International Green Purchasing Network (IGPN), conferences/workshops as a public forum to share insights among experts/concern people.

Keywords: strategies, value added, recycle, business

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Authors: George Fomunyam Kehdinga

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Assessment is a vital part of the educational process, and formative assessment is a way of ensuring that higher education achieves the desired effects. Different factors influence how students perform in assessments in general, and formative assessment in particular and temperament is one of such determining factors. This paper which is a qualitative case study of four universities in four different countries examines how the temperamental make up of students either empowers them to perform excellently in formative assessment or incapacitates their performance. These four universities were chosen from Cameroon, South Africa, United Kingdom and the United States of America and three students were chosen from each institution, six of which were undergraduate student and six postgraduate students. Data in this paper was generated through qualitative interviews and document analyses which was preceded by a temperament test. From the data generated, it was discovered that cholerics who are natural leaders, hence do not struggle to express themselves often perform excellently in formative assessment while sanguines on the other hand who are also extroverts like cholerics perform relatively well. Phlegmatics and melancholics performed averagely and poorly respectively in formative assessment because they are naturally prone to fear and hate such activities because they like keeping to themselves. The paper, therefore, suggest that temperament is a success determinant in formative assessment. It also proposes that lecturers need and understanding of temperaments to be able to fully administer formative assessment in the lecturer room. It also suggests that assessment should be balance in the classroom so that some students because of their temperamental make-up are not naturally disadvantaged while others are performing excellently. Lastly, the paper suggests that since formative assessment is a process of generating data, it should be contextualised or given and individualised approach so as to ensure that trustworthy data is generated.

Keywords: temperament, formative assessment, academic success, students

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Authors: Siti Ayu Ningsih

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This study aims to find the differences outcomes in learning reading comprehension with text and film as media on Indonesian Language for foreign speaker (BIPA) learning at intermediate level. By using quantitative and qualitative research methods, the respondent of this study is a single respondent from D'Royal Morocco Integrative Islamic School in grade nine from secondary level. Quantitative method used to calculate the learning outcomes that have been given the appropriate action cycle, whereas qualitative method used to translate the findings derived from quantitative methods to be described. The technique used in this study is the observation techniques and testing work. Based on the research, it is known that the use of the text media is more effective than the film for intermediate level of Indonesian Language for foreign speaker learner. This is because, when using film the learner does not have enough time to take note the difficult vocabulary and don't have enough time to look for the meaning of the vocabulary from the dictionary. While the use of media texts shows the better effectiveness because it does not require additional time to take note the difficult words. For the words that are difficult or strange, the learner can immediately find its meaning from the dictionary. The presence of the text is also very helpful for Indonesian Language for foreign speaker learner to find the answers according to the questions more easily. By matching the vocabulary of the question into the text references.

Keywords: Indonesian language for foreign speaker, learning outcome, media, reading comprehension

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Authors: Maureen Kamau, Gulnaz Mohamoud, Adelaide Lusambili, Njeri Nyanja

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Life expectancy has increased over the last century amongst older individuals, and in particular, those 60 years and over. The World Health Organization estimates that the world's population of persons over 60 years will rise to 22 per cent by the year 2050. Ageing is associated with increasing disability, multiple chronic conditions, and an increase in the use of health services. These multiple chronic conditions are managed with polypharmacy. Polypharmacy has numerous adverse effects including non-adherence, poor compliance to the various medications, reduced appetite, and risk of fall. Studies on polypharmacy and ageing are few and poorly understood especially in low and middle - income countries. The aim of this study was to explore the knowledge, attitudes and beliefs of older people towards polypharmacy. A qualitative study of 15 patients aged 60 years and above, taking more than five medications per day were conducted at the Aga Khan University using Semi-structured in-depth interviews. Three interviews were pilot interviews, and data analysis was performed on 12 interviews. Data were analyzed using NVIVO 12 software. A thematic qualitative analysis was carried out guided by Braun and Clarke (2006) framework. Themes identified; - knowledge of their co-morbidities and of the medication that older persons take, sources of information about medicines, and storage of the medication, experiences and attitudes of older patients towards polypharmacy both positive and negative, older peoples beliefs and their coping mechanisms with polypharmacy. The study participants had good knowledge on their multiple co-morbidities, and on the medication they took. The patients had positive attitudes towards medication as it enhanced their health and well-being, and enabled them to perform their activities of daily living. There was a strong belief among older patients that the medications were necessary for their health. All these factors enhanced compliance to the multiple medication. However, some older patients had negative attitudes due to the pill burden, side effects of the medication, and stigma associated with being ill. Cost of healthcare was a concern, with most of the patients interviewed relying on insurance to cover the cost of their medication. Older patients had accepted that the medication they were prescribed were necessary for their health, as it enabled them to complete their activities of daily living. Some concerns about the side effects of the medication arose, and brought about the need for patient education that would ensure that the patients are aware of the medications they take, and potential side effects. The effect that the COVID 19 pandemic had in the healthcare of the older patients was evident by the number of the older patients avoided coming to the hospital during the period of the pandemic. The relationship with the primary care physician and the older patients is an important one, especially in LMICs such as Kenya, as many of the older patients trusted the doctors wholeheartedly to make the best decision about their health and about their medication. Prescription review is important to avoid the use of potentially inappropriate medication.

Keywords: polypharmacy, older patients, multiple chronic conditions, Kenya, Africa, qualitative study, indepth interviews, primary care

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Authors: Anne Prip, Kirsten Alling Møller, Dorte Lisbet Nielsen, Mary Jarden, Marie-Helene Olsen, Anne Kjaergaard Danielsen

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Background: The development in cancer care has shifted towards shorter hospital stays and more outpatient treatment. Today, cancer care and treatment predominantly takes place in outpatient settings where encounters between patients and health care professionals are often brief. This development will probably continue internationally as the global cancer burden seems to be growing significantly. Furthermore, the number of patients who require ambulatory treatments such as chemotherapy is increasing. Focusing on the encounters between health care professionals and patients during oncology treatment has thus become increasingly important due to a growing trend in outpatient cancer management. Objective: The aim of the systematic review was to summarize the literature from the perspective of the patient, on experiences of and the need for communication and relationships with the health care professional during chemotherapy treatment in an outpatient setting. Method: The review was designed and carried out according to the PRISMA guidelines and PICO framework. The systematic search was conducted in Medline, CINAHL, The Cochrane Library and Joanna Briggs Institute Evidence Based Practice Database. Results: In all, 1174 studies were identified by literature search. After duplicates were removed, the remaining studies (n = 1053) were screened for inclusion. Nine studies were included; qualitative (n = 5) and quantitative (n = 4) as they met the inclusions criteria. The review identified that communication and relationships between health care professionals and patients were important for the patients’ ability to cope with cancer and also had an impact on patients’ satisfaction with care in the outpatient clinic. Furthermore, the review showed that hope and positivity was a need and strategy for patients with cancer and was facilitated by health care professionals. Finally, it revealed that outpatient clinic visits framed and influenced communication and relationships. Conclusions: This review identified the significance of communication and the relationships between patients and health care professionals in the outpatient setting as it supports patients’ ability to cope with cancer. The review showed the need for health care professionals to pay attention to the relational aspects of communication in an outpatient clinic as encounters are often brief. Furthermore, the review helps to specify which elements of the communication are central in the patient-health care professional interaction from the patients' perspective. Finally, it shows a need for more research to investigate which type of interaction and intervention would be the most effective in supporting patients’ coping during chemotherapy in an outpatient clinic.

Keywords: ambulatory chemotherapy, communication, health care professional-patient relation, nurse-patient relation, outpatient care, systematic review

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Authors: Shradha Parsekar, Suma Nair, Ajay Bailey, Binu V. S.

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Background: Concealing of cancer-related information is seen in many low-and-middle-income countries and may be associated with multiple factors. Comparatively, there is lack of information about, how breast cancers diagnosed women disclose cancer-related information to their social contacts and vice versa. To get more insights on the participant’s experience, opinions, expectations, and attitudes, a qualitative study is a suitable approach. Therefore, this study involving in-depth interviews was planned to lessen this gap. Methods: Interviews were conducted separately among breast cancer patients and their caregivers with semi-structured qualitative interview guide. Purposive and convenient sampling was being used to recruit patients and caregivers, respectively. Ethical clearance and permission from the tertiary hospital were obtained and participants were selected from the Udupi district, Karnataka, India. After obtaining a list of breast cancer diagnosed cases, participants were contacted in person and their willingness to take part in the study was taken. About 39 caregivers and 35 patients belonging to different breast cancer stages were recruited. Interviews were recorded with prior permission. Data was managed by Atlas.ti 8 software. The recordings were transcribed, translated and coded in two cycles. Most of the patients belonged to stage II and III cancer. Codes were grouped together into to whom breast cancer status was concealed to and underneath reason for the same. Main findings: followings are the codes and code families which emerged from the data. 1) Concealing the breast cancer status from social contacts other than close family members (such as extended family, neighbor and friends). Participants perceived the reasons as, a) to avoid questions which people probe (which doesn’t have answers), b) to avoid people paying courtesy visit (to inquire about the health as it is Indian culture to visit the sick person) making it inconvenient for patient and caregivers have to offer something and talk to them, c) to avoid people getting shocked (react as if cancer is different from other diseases) or getting emotional/sad, or getting fear of death d) to avoid getting negative suggestion or talking anything in front of patient as it may affect patient negatively, e) to avoid getting stigmatized, f) to avoid getting obstacle in child’s marriage. 2) Participant concealed the breast cancer status of young children as they perceived that it may a) affect studies, b) affect emotionally, c) children may get scared. 3) Concealing the breast cancer status from patients as the caregivers perceived that they have fear of a) worsening patient’s health, b) patient getting tensed, c) patient getting shocked, and d) patient getting scared. However, some participants stressed important in disclosing the cancer status to social contact/patient to make the people aware of the disease. Conclusion: The news of breast cancer spreads like electricity in the wire, therefore, patient or family avoid it for many reasons. Although, globally, due to physicians’ ethical obligations, there is an inclination towards more disclosure of cancer diagnosis and status of prognosis to the patient. However, it is an ongoing argument whether patient/social contacts should know the status especially in a country like India.

Keywords: breast cancer, concealing cancer status, India, qualitative study

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Authors: Zayed Freah Zeadat

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The wellbeing of urban dwellers is strongly associated with the quality and quantity of green infrastructure. Nevertheless, urban green infrastructure is still lagging in many Arab cities, and Jordan is no exception. The capital city of Jordan, Amman, is becoming more urban dense with limited green spaces. The unplanned urban growth in Amman has caused several environmental problems such as urban heat islands, air pollution, and lack of green spaces. This study aims to investigate the most suitable drivers to leverage the implementation of urban green infrastructure in Jordan through qualitative and quantitative analysis. The qualitative research includes an extensive literature review to discuss the most common drivers used internationally to promote urban green infrastructure implementation in the literature. The quantitative study employs a questionnaire survey to rank the suitability of each driver. Consultants, contractors, and policymakers were invited to fill the research questionnaire according to their judgments and opinions. Relative Importance Index has been used to calculate the weighted average of all drivers and the Kruskal-Wallis test to check the degree of agreement among groups. This study finds that research participants agreed that indirect financial incentives (i.e., tax reductions, reduction in stormwater utility fee, reduction of interest rate, density bonus, etc.) are the most effective incentive policy whilst granting sustainability certificate policy is the least effective driver to ensure widespread of UGI is elements in Jordan.

Keywords: urban green infrastructure, relative importance index, sustainable urban development, urban Jordan

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Authors: B. Orser, A. Riding, Y. Li

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To inform government about how gender gaps in SME ( small and medium-sized enterprise) contracting might be redressed, the research question was: What are the key obstacles to, and response strategies for, increasing the engagement of women business owners among SME suppliers to the government of Canada? Thirty-five interviews with senior policymakers, supplier diversity organization executives, and expert witnesses to the Canadian House of Commons, Standing Committee on Government Operations and Estimates. Qualitative data were conducted and analysed using N’Vivo 11 software. High order response categories included: (a) SME risk mitigation strategies, (b) SME procurement program design, and (c) performance measures. Primary obstacles cited were government red tape and long and complicated requests for proposals (RFPs). The majority of 'common' complaints occur when SMEs have questions about the federal procurement process. Witness responses included use of outcome-based rather than prescriptive procurement practices, more agile procurement, simplified RFPs, making payment within 30 days a procurement priority. Risk mitigation strategies included provision of procurement officers to assess risks and opportunities for businesses and development of more agile procurement procedures and processes. Recommendations to enhance program design included: improved definitional consistency of qualifiers and selection criteria, better co-ordination across agencies; clarification about how SME suppliers benefit from federal contracting; goal setting; specification of categories that are most suitable for women-owned businesses; and, increasing primary contractor awareness about the importance of subcontract relationships. Recommendations also included third-party certification of eligible firms and the need to enhance SMEs’ financial literacy to reduce financial errors. Finally, there remains the need for clear and consistent pre-program statistics to establish baselines (by sector, issuing department) performance measures, targets based on percentage of contracts granted, value of contract, percentage of target employee (women, indigenous), and community benefits including hiring local employees. The study advances strategies to enhance federal procurement programs to facilitate socio-economic policy objectives.

Keywords: procurement, small business, policy, women

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Authors: Hami-Ziniman Revital, Ashwall Rachelly

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The conflict resolution realm has developed tremendously during the last half-decade. Three main approaches should be mentioned: an Alternative Dispute Resolution (ADR) suggesting processes such as Arbitration or Interests-based Negotiation was developed as an answer to obligations and rights-based conflicts. The Pragmatic mediation approach focuses on the gap between interests and needs of disputants. The Transformative mediation approach focusses on relations and suits identity-based conflicts. In the current study, we examine the conflictual relations between religious and non-religious Jews in Israel and the impact of three transformative mechanisms: Inter-group recognition, In-group empowerment and Value-based reframing on the relations between the participants. The research was conducted during four facilitated joint mediation classes. A unique finding was found. Using both transformative mechanisms and the Contact Hypothesis criteria, we identify transformation in participants’ relations and a considerable change from anger, alienation, and suspiciousness to an increased understanding, affection and interpersonal concern towards the out-group members. Intergroup Recognition, In-group empowerment, and Values-based reframing were the skills discovered as the main enablers of the change in the relations and the research participants’ fostered mutual recognition of the out-group values and identity-based issues. We conclude this transformation was possible due to a constant intergroup contact, based on the Contact Hypothesis criteria. In addition, as Interests-based mediation uses “Reframing” as a skill to acknowledge both mutual and opposite needs of the disputants, we suggest the use of “Value-based Reframing” in intergroup identity-based conflicts, as a skill contributes to the empowerment and the recognition of both mutual and different out-group values. We offer to implement those insights and skills to assist conflict resolution facilitators in various intergroup identity-based conflicts resolution efforts and to establish further research and knowledge.

Keywords: empowerment, identity-based conflict, intergroup recognition, intergroup relations, mediation skills, multi-cultural society, reframing, value-based recognition

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Authors: Szu Mei Hsiao

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This study explores the spiritual needs of inpatients with advanced cancer and their family caregivers in one southern regional teaching hospital in Taiwan and elucidates the differences and similarities of spiritual needs between them. Little research reports the different phases of spiritual needs and the potential impact of Chinese cultural values on the spiritual needs. Qualitative inquiry was used. Twenty-one patients with advanced cancer and twenty-two family caregivers were recruited. During hospitalization, all participants identified spiritual needs both the palliative phase and the dying phase: (a) the need to foster faith/confidence and hope for medicine and/or God; (b) to understand the meaning and values of life; (c) to experience more reciprocal human love and forgiveness; and (d) to obey God’s/Heaven will. Furthermore, the differences of spiritual needs between patients with advanced cancer and their family caregivers are as follows: (a) family caregivers emphasized the need to inform relatives and say goodbye in order to die peacefully; (b) patients highlighted a need to maintain a certain physical appearance in order to preserve their dignity; nurture one’s willpower; learn about the experiences of cancer survivors; and identify one’s own life experience for understanding the meaning and values of life. Moreover, the dissimilarity of spiritual needs is that the patients pointed out the need to understand God’s will during the palliative treatment phase. However, the family caregivers identified the need to forgive each other, and inform relatives and say goodbye to patients in the dying phase. This research has shown that the needs of meaning/values of life and facing death peacefully are different between two groups. Health professionals will be encouraged to detect and to develop individualized care strategies to meet spiritual needs.

Keywords: advanced cancer, Chinese culture, family caregivers, qualitative research, spiritual needs

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Authors: Ergün Şakalar, Şeyma Özçirak Ergün

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Pistachio nuts, the fruits of the pistachio tree (Pistacia vera), are edible tree nuts highly valued for their organoleptic properties. Pistachio nuts used in snack foods, chocolates, baklava, meat products, ice-cream industries and other gourmet products as ingredients. Undeclared pistachios may be present in food products as a consequence of fraudulent substitution. Control of food samples is very important for safety and fraud. Mix of pistachio, peanut (Arachis hypogaea), pea (Pisum sativum L.) used instead of pistachio in food products, because pistachio is a considerably expensive nut. To solve this problem, a sensitive polymerase chain reaction PCR has been developed. A real-time PCR assay for the detection of pea, peanut and pistachio in baklava was designed by using EvaGreen fluorescence dye. Primers were selected from powerful regions for identification of pea, peanut and pistachio. DNA from reference samples and industrial products were successfully extracted with the GIDAGEN® Multi-Fast DNA Isolation Kit. Genomes were identified based on their specific melting peaks (Mp) which are 77°C, 85.5°C and 82.5°C for pea, peanut and pistachio, respectively. Homogenized mixtures of raw pistachio, pea and peanut were prepared with the ratio of 0.01%, 0.1%, 1%, 10%, 40% and 70% of pistachio. Quantitative detection limit of assay was 0.1% for pistachio. Also, real-time PCR technique used in this study allowed the qualitative detection of as little as 0.001% level of peanut DNA, 0,000001% level of pistachio DNA and 0.000001% level of pea DNA in the experimental admixtures. This assay represents a potentially valuable diagnostic method for detection of nut species adulterated with pistachio as well as for highly specific and relatively rapid detection of small amounts of pistachio in food samples.

Keywords: pea, peanut, pistachio, real-time PCR

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Authors: D. Visuwan, B. Phruksaphanrat

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In this research, computer simulation is used for Electronic Manufacturing Service (EMS) plant layout analysis. The current layout of this manufacturing plant is a process layout, which is not suitable due to the nature of an EMS that has high-volume and high-variety environment. Moreover, quick response and high flexibility are also needed. Then, cellular manufacturing layout design was determined for the selected group of products. Systematic layout planning (SLP) was used to analyse and design the possible cellular layouts for the factory. The cellular layout was selected based on the main criteria of the plant. Computer simulation was used to analyse and compare the performance of the proposed cellular layout and the current layout. It is found that the proposed cellular layout can generate better performances than the current layout. In this research, computer simulation is used for Electronic Manufacturing Service (EMS) plant layout analysis. The current layout of this manufacturing plant is a process layout, which is not suitable due to the nature of an EMS that has high-volume and high-variety environment. Moreover, quick response and high flexibility are also needed. Then, cellular manufacturing layout design was determined for the selected group of products. Systematic layout planning (SLP) was used to analyse and design the possible cellular layouts for the factory. The cellular layout was selected based on the main criteria of the plant. Computer simulation was used to analyse and compare the performance of the proposed cellular layout and the current layout. It found that the proposed cellular layout can generate better performances than the current layout.

Keywords: layout, electronic manufacturing service plant, computer simulation, cellular manufacturing system

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Authors: Julia Wong, Hua Beng Lim, Petrina Goh, Johanna Foo, Caleb Ng, Nurul ‘Aqilah Bte Mohd Taufek

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Animal-assisted therapy (AAT) utilizes human-animal interaction to achieve specific therapeutic goals, and its efficacy has been demonstrated across various settings overseas. The use of AAT in Singapore, however, is still limited. Ang Mo Kio-Thye Hua Kwan (AMKH) is one of the first community hospitals in Singapore to use AAT to complement its occupational therapy services with elderly patients. This study explored the perspectives of AMKH’s occupational therapists (OTs) in relation to AAT to understand barriers and enablers in implementing and practising AAT. We also examined how OTs at-large across practice settings perceive AAT. A mixed method design was used. 64 OTs at-large participated in on online survey, and 7 AMKH OTs were interviewed individually via Zoom. Survey results were analysed with descriptive and Mann-Whitney U tests. Interviews were thematically analysed. AMKH OTs perceived various benefits of AAT articulated in overseas studies in domains such as motivation and participation, emotional, social interaction, sensory tactile stimulation, and cognition. Interestingly, this perception was also supported by 67% of OTs who had responded to the survey, even though most of the OTs who had participated in the survey had no experience in AAT. Despite the perceived benefits of AAT, both OTs from AMKH and those at-large articulated concerns on risks pertaining to AAT (e.g., allergies, unexpected animal behaviour, infections, etc). However, AMKH OTs shared several ways to mitigate these risks, demonstrating their ability to develop a safe program. For e.g., volunteers and their dogs must meet specific recruitment criteria, stringent protocols are used to screen and match dogs with patients, and there are strict exclusion criteria for patients participating in AAT. AMKH OTs’ experience suggests that additional skills and knowledge are required to implement AAT, therefore, healthcare institutions should first consider improving their staff training and risk mitigation knowledge before implementing AAT. They can also refer to AMKH’s AAT protocols and those found in overseas studies, but institutions must adapt the protocols to fit their institutional settings and patients’ profiles.

Keywords: animal-assisted therapy, dog-assisted therapy, occupational therapy, complementary therapy

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Authors: O. Katz-Shufan, T. Simon-Tuval, L. Sabag, L. Granek, D. R. Shahar

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Meals provided at catering systems are a common source of workers' nutrition and were found as contributing high amounts calories and fat. Thus, eating daily catering food can lead to overweight and chronic diseases. On the other hand, the institutional dining room may be an ideal environment for implementation of intervention programs that promote healthy eating. This may improve diners' lifestyle and reduce their prevalence of overweight, obesity and chronic diseases. The significance of this study is in developing an intervention program based on the diners’ dietary habits, preferences and their attitudes towards various intervention programs. In addition, a successful catering-based intervention program may have a significant effect simultaneously on a large group of diners, leading to improved nutrition, healthier lifestyle, and disease-prevention on a large scale. In order to develop the intervention program, we conducted a qualitative study. We interviewed 13 diners who eat regularly at catering systems, using a semi-structured interview. The interviews were recorded, transcribed and then analyzed by the thematic method, which identifies, analyzes and reports themes within the data. The interviews revealed several major themes, including expectation of diners to be provided with healthy food choices; their request for nutrition-expert involvement in planning the meals; the diners' feel that there is a conflict between sensory attractiveness of the food and its' nutritional quality. In the context of the catering-based intervention programs, the diners prefer scientific and clear messages focusing on labeling healthy dishes only, as opposed to the labeling of unhealthy dishes; they were interested in a nutritional education program to accompany the intervention program. Based on these findings, we have developed an intervention program that includes: changes in food served such as replacing several menu items and nutritional improvement of some of the recipes; as well as, environmental changes such as changing the location of some food items presented on the buffet, placing positive nutritional labels on healthy dishes and an ongoing healthy nutrition campaign, all accompanied by a nutrition education program. The intervention program is currently being tested for its impact on health outcomes and its cost-effectiveness.

Keywords: catering system, food services, intervention, nutrition policy, public health, qualitative research

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Authors: Jennifer Hunter, Francisco Ramirez, Neil A. Nedley, Thania Solorio, Christian Freed, Erica Kinjo

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People who have autoimmune disease are often at an increased risk for psychological disorders such as anxiety. Untreated psychological conditions can affect the development of disease and can affect one’s general quality of life. In this study, it was hypothesized that an educational community-based intervention would be useful in decreasing the anxiety levels of participants with autoimmune disease. Programs, 2-hours long each, were held weekly over a period of eight weeks. During every meeting, a 45-minute DVD presentation by a skilled physician was shown, a small group discussion was guided by trained facilitators, and weekly practical assignments were given to each participant. The focus of the program was to educate participants about healthy lifestyle behaviors such as exercise, nutrition, sleep hygiene, helpful thought patterns etc., and to provide a group environment in which each participant was supported. Participants were assessed pre-post program for anxiety using the Depression and Anxiety Assessment Test (registration TX 7-398-022), a validated mental health test based on DSM-5 criteria and demographics. Anxiety scores were classified according to the DSM-5 criteria into 4 categories: none (0-6), mild (7-10), moderate (11-19) or severe (20 or more). Out of the participants who participated in programs conducted in the manner explained above (n=431), the average age was 54.9 (SD 16.6) and 81.9% were female. At baseline, the mean group anxiety level was 9.4 (SD 5.4). Within the baseline group, anxiety levels were as follows: none (21.1%), mild (22.0%), moderate (27.1%) and severe (29.7%). After the program, mean group anxiety decreased to 4.7 (SD 4.0). Post-program anxiety levels were as follows: none (54.8%), mild (27.1%), moderate (12.5%), severe (5.6%). The decrease in overall anxiety levels was significant t(431)=19.3 p<.001, 95% CI [0.815, 1.041]. It was concluded that the eight-week intensive was beneficial in decreasing the anxiety levels of participants. A long-term follow-up study would be beneficial in determining how lasting such improvements are especially since autoimmune diseases are often chronic. Additionally, future studies that utilize a control group would aid in establishing whether the improvements seen are due to the use of this specific lifestyle-educational program.

Keywords: anxiety, auto-immune disease, community-based educational program, lifestyle

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