Search results for: air quality health index
18192 The Use of Multivariate Statistical and GIS for Characterization Groundwater Quality in Laghouat Region, Algeria
Authors: Rouighi Mustapha, Bouzid Laghaa Souad, Rouighi Tahar
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Due to rain Shortage and the increase of population in the last years, wells excavation and groundwater use for different purposes had been increased without any planning. This is a great challenge for our country. Moreover, this scarcity of water resources in this region is unfortunately combined with rapid fresh water resources quality deterioration, due to salinity and contamination processes. Therefore, it is necessary to conduct the studies about groundwater quality in Algeria. In this work consists in the identification of the factors which influence the water quality parameters in Laghouat region by using statistical analysis Principal Component Analysis (PCA), Hierarchical Cluster Analysis (HCA) and geographic information system (GIS) in an attempt to discriminate the sources of the variation of water quality variations. The results of PCA technique indicate that variables responsible for water quality composition are mainly related to soluble salts variables; natural processes and the nature of the rock which modifies significantly the water chemistry. Inferred from the positive correlation between K+ and NO3-, NO3- is believed to be human induced rather than naturally originated. In this study, the multivariate statistical analysis and GIS allows the hydrogeologist to have supplementary tools in the characterization and evaluating of aquifers.Keywords: cluster, analysis, GIS, groundwater, laghouat, quality
Procedia PDF Downloads 32418191 Effect of 16 Weeks Walking with Different Dosages on Psychosocial Function Related Quality of Life among 60 to 75 Years Old Men
Authors: Mohammad Ehsani, Elham Karimi, Hashem Koozechian
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Aim: The purpose of current semi-experimental study was a survey on effect of 16 week walking on psychosocial function related quality of life among 60 to 75 years old men. Methodology: For this reason, short from of health – related quality of life questionnaire (SF – 36) and Geriatric Depression Scale (GDS) had been distributed to the subjects at 2 times of pre – test and posttest. Statistical sample of current study was 60 to 75 years old men who placed at Kahrizak house and assessed by considering physically and medical background. Also factors of entrance to the intervention like age range, have satisfaction and have intent to participating in walking program, lack of having diabetic, cardiovascular, Parkinsonism diseases and postural, neurological, musculoskeletal disorders, lack of having clinical background like visual disorders or disordering on equilibrium system, lack of motor limitation, foot print disorders, having surgery and mental health had been determined and assessed. Finally after primary studies, 80 persons selected and categorized accidentally to the 3 experimental group (1, 2, 3 sessions per week, 30 min walking with moderate intension at every sessions) and one control group (without physical activity in period of 16 weeks). Data analysed by employing ANOVA, Pearson coefficient and Scheffe Post – Hoc tests at the significance level of p < 0.05. Results: Results showed that psychosocial function of men with 60 to 75 years old increase by influence of 16 week walking and increase of exercise sessions lead to more effectiveness of walking. Also there was no significant difference between psychosocial function of subjects within 1 session and 3 sessions experimental groups (p > 0.05). Conclusion: On the basis of results, we can say that doing regular walking with efficient and standard dosage for elderly people, can increase their quality of life. Furthermore, designing and action operation regular walking program for elderly men on the basis of special, logical and systematic pattern under the supervision of aware coaches have been recommended on the basis of results.Keywords: walking, quality of life, psychosocial function, elders
Procedia PDF Downloads 59018190 Using of M Health in MCH Service during COVID-19: Application of Diffusion of Innovation Theory
Authors: Mikiyas Yonas Fufa
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- Maternal and child health service was a critical service which may have many risks and many maternal and newborn mortality is there if not managed properly. In middle and low countries like Ethiopia accessibility and quality of MCH service is low. During this COVID-19 Pandemics even the pervious access of MCH will be decreased. So many pregnant mothers are not attending their ANC, Delivery and other services in the hospital because they think they are more vulnerable to COVID-19. This condition may make an increase of maternal and neonatal morbidity and mortality. The innovation is an idea (which is development of a mobile app prepared by Maternity Foundation organization that focuses on midwifery care. The app has detailed videos on danger signs in pregnancy and procedures during labor and delivery). By telling this to clients it is planned to explore the perception, attitude towards this innovation and barriers to accepting it. What is planned to study is to explore the perceptions and barriers towards using of new idea which is innovation of mHealth on the MCH services. It is planned to interview the pregnant mothers who come for ANC at health facility and mothers who are absent from their appointment of services. In this way it is planned to explore how the mothers accept this idea and what barriers make them from accepting this idea. This is a phenomenological qualitative study and application of diffusion of innovation theory on the MCH services. The participant will be selected by using quota sampling methods for the mother who are interviewed at hospitals and snowball/quota sampling methods for the mother who are absent from their appointment/visits. Sample size of the participant depends on the saturation of data/idea. Each participant will be interviewed based the open-ended questionnaires, and the interview will be recorded then transcribed then finally analyzed by the open code 4.03. Beneficiaries: The federal ministry of health prepares them to develop the apk of mhealth. Health professionals in the MCH will have a low overload and accessibility and the quality of care will be increased during COVID-19 Different collaborations will be participated and promote the mother to enjoy the new idea.Keywords: COVID-19, m health, MCH, diffusion of innovation
Procedia PDF Downloads 2518189 Valorisation of Mango Seed: Response Surface Methodology Based Optimization of Starch Extraction from Mango Seeds
Authors: Tamrat Tesfaye, Bruce Sithole
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Box-Behnken Response surface methodology was used to determine the optimum processing conditions that give maximum extraction yield and whiteness index from mango seed. The steeping time ranges from 2 to 12 hours and slurring of the steeped seed in sodium metabisulphite solution (0.1 to 0.5 w/v) was carried out. Experiments were designed according to Box-Behnken Design with these three factors and a total of 15 runs experimental variables of were analyzed. At linear level, the concentration of sodium metabisulphite had significant positive influence on percentage yield and whiteness index at p<0.05. At quadratic level, sodium metabisulphite concentration and sodium metabisulphite concentration2 had a significant negative influence on starch yield; sodium metabisulphite concentration and steeping time*temperature had significant (p<0.05) positive influence on whiteness index. The adjusted R2 above 0.8 for starch yield (0.906465) and whiteness index (0.909268) showed a good fit of the model with the experimental data. The optimum sodium metabisulphite concentration, steeping hours, and temperature for starch isolation with maximum starch yield (66.428%) and whiteness index (85%) as set goals for optimization with the desirability of 0.91939 was 0.255w/v concentration, 2hrs and 50 °C respectively. The determined experimental value of each response based on optimal condition was statistically in accordance with predicted levels at p<0.05. The Mango seeds are the by-products obtained during mango processing and possess disposal problem if not handled properly. The substitution of food based sizing agents with mango seed starch can contribute as pertinent resource deployment for value-added product manufacturing and waste utilization which might play significance role of food security in Ethiopia.Keywords: mango, synthetic sizing agent, starch, extraction, textile, sizing
Procedia PDF Downloads 23118188 Sildenafil Citrate (Viagra) Suppositories Are Promising Approach for Treatment of Unexplained Infertility
Authors: Shahinaz El-Shourbagy El-Shourbagy, Ahmed M. E Ossman Ossman, Ashraf El-Mohamady El-Mohamady
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Objective: To investigate if there is a role of sildenafil citrate (Viagra) in the treatment of infertile couples for idiopathic cause. Design: An observational study. Setting: Infertility outpatient clinic of Tanta University Hospital Egypt. Patient(s): 50 unexplained infertility women {endometrial thickness (EM) and the mean resistance index (RI)} compared to 50 fertile control group attended for check-up in the same period and receiving no treatment. Intervention(s): unexplained infertility women were given 25 mg of sildenafil citrate suppositories four times per day for seven days starting from the 5th day of the menstrual cycle for three cycles. Main Outcome Measures: EM and RI of endometrial spiral artery were assessed by transvaginal color-pulsed Doppler ultrasound in unexplained infertility women before and after sildenafil citrate treatment and compared with control. The conception rate and pregnancy outcome were recorded in the two groups. Result(s): Women with unexplained infertility had significantly thinner endometrium and a higher spiral artery resistance index, meaning lower peri-implantation blood flow than the fertile controls. Sildenafil citrate treated women showed a statistically significant increase in endometrial thickness (p < 0.001) and a significant decrease in the mean spiral artery resistance index (p < 0.001) giving a better conception rate. Conclusion: Sildenafil citrate suppositories treatment enhance the endometrial blood flow through decreasing spiral artery resistance index 'RI' and consequently improve endometrial growth and receptivity in cases of unexplained infertility thus giving a better conception rate.Keywords: Unexplained infertility, endometrial blood flow, endome¬trial receptivity, color-pulsed Doppler ultrasound; RI (resis¬tance index, Sildenafil citrate (Viagra)
Procedia PDF Downloads 21718187 Assessment of Green Infrastructure for Sustainable Urban Water Management
Authors: Suraj Sharma
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Green infrastructure (GI) offers a contemporary approach for reducing the risk of flooding, improve water quality, and harvesting stormwater for sustainable use. GI promotes landscape planning to enhance sustainable development and urban resilience. However, the existing literature is lacking in ensuring the comprehensive assessment of GI performance in terms of ecosystem function and services for social, ecological, and economical system resilience. We propose a robust indicator set and fuzzy comprehensive evaluation (FCE) for quantitative and qualitative analysis for sustainable water management to assess the capacity of urban resilience. Green infrastructure in urban resilience water management system (GIUR-WMS) supports decision-making for GI planning through scenario comparisons with urban resilience capacity index. To demonstrate the GIUR-WMS, we develop five scenarios for five sectors of Chandigarh (12, 26, 14, 17, and 34) to test common type of GI (rain barrel, rain gardens, detention basins, porous pavements, and open spaces). The result shows the open spaces achieve the highest green infrastructure urban resilience index of 4.22/5. To implement the open space scenario in urban sites, suitable vacant can be converted to green spaces (example: forest, low impact recreation areas, and detention basins) GIUR-WMS is easy to replicate, customize and apply to cities of different sizes to assess environmental, social and ecological dimensions.Keywords: green infrastructure, assessment, urban resilience, water management system, fuzzy comprehensive evaluation
Procedia PDF Downloads 14318186 Determinants of Child Anthropometric Indicators: A Case Study of Mali in 2015
Authors: Davod Ahmadigheidari
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The main objective of this study was to explore prevalence of anthropometric indicators as well the factors associated with the anthropometric indications in Mali. Data on 2015, downloaded from the website of Unicef, were analyzed. A total of 16,467 women (ages 15-49 years) and 16,467 children (ages 0-59 months) were selected for the sample. Different statistical analyses, such as descriptive, crosstabs and binary logistic regression form the basis of this study. Child anthropometric indicators (i.e., wasting, stunting, underweight and BMI for age) were used as the dependent variables. SPSS Syntax from WHO was used to create anthropometric indicators. Different factors, such as child’s sex, child’s age groups, child’s diseases symptoms (i.e., diarrhea, cough and fever), maternal education, household wealth index and area of residence were used as independent variables. Results showed more than forty percent of Malian households were in nutritional crises (stunting (42%) and underweight (34%). Findings from logistic regression analyses indicated that low score of wealth index, low maternal education and experience of diarrhea in last two weeks increase the probability of child malnutrition.Keywords: Mali, wasting, stunting, underweight, BMI for age and wealth index
Procedia PDF Downloads 15518185 Patterns in Fish Diversity and Abundance of an Abandoned Gold Mine Reservoirs
Authors: O. E. Obayemi, M. A. Ayoade, O. O. Komolafe
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Fish survey was carried out for an annual cycle covering both rainy and dry seasons using cast nets, gill nets and traps at two different reservoirs. The objective was to examined the fish assemblages of the reservoirs and provide more additional information on the reservoir. The fish species in the reservoirs comprised of twelve species of six families. The results of the study also showed that five species of fish were caught in reservoir five while ten fish species were captured in reservoir six. Species such as Malapterurus electricus, Ctenopoma kingsleyae, Mormyrus rume, Parachanna obscura, Sarotherodon galilaeus, Tilapia mariae, C. guntheri, Clarias macromystax, Coptodon zilii and Clarias gariepinus were caught during the sampling period. There was a significant difference (p=0.014, t = 1.711) in the abundance of fish species in the two reservoirs. Seasonally, reservoirs five (p=0.221, t = 1.859) and six (p=0.453, t = 1.734) showed there was no significant difference in their fish populations. Also, despite being impacted with gold mining the diversity indices were high when compared to less disturbed waterbodies. The study concluded that the environments recorded low abundant fish species which suggests the influence of mining on the abundance and diversity of fish species.Keywords: Igun, fish, Shannon-Wiener Index, Simpson index, Pielou index
Procedia PDF Downloads 10718184 Conservation Status of a Lowland Tropical Forest in South-West, Nigeria
Authors: Lucky Dartsa Wakawa, Friday Nwabueze Ogana, Temitope Elizabeth Adeniyi
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Timely and reliable information on the status of a forest is essential for assessing the extent of regeneration and degradation. However, when such information is lacking effective forest management practices becomes impossible. Therefore, this study assessed the tree species composition, richness, diversity, structure of Oluwa forest reserve with the view of ascertaining it conservation status. A systematic line transect was used in the laying of eight (8) temporary sample plots (TSPs) of size 50m x 50m. Trees with Dbh ≥ 10cm in the selected plots were enumerated, identified and measured. The results indicate that 535 individual trees were enumerated cutting across 26 families and 58 species. The family Sterculiaceae recorded the highest number of species (10) and occurrence (112) representing 17.2% and 20.93% respectively. Celtis zenkeri is the species with the highest number of occurrence of tree per hectare and importance value index (IVI) of 59 and 53.81 respectively. The reserve has the Margalef's index of species richness, Shannon-Weiner diversity Index (H') and Pielou's Species Evenness Index (EH) of 9.07, 3.43 and 0.84 respectively. The forest has a mean Dbh (cm), mean height (m), total basal area/ha (m2) and total volume/ha (m3) of 24.7, 16.9, 36.63 and 602.09 respectively. The important tropical tree species identified includes Diospyros crassiflora Milicia excels, Mansonia altisima, Triplochiton scleroxylon. Despite the level of exploitation in the forest, the forest seems to be resilience. Given the right attention, it could regenerate and replenish to save some of the original species composition of the reserve.Keywords: forest conservation, forest structure, Lowland tropical forest, South-west Nigeria
Procedia PDF Downloads 34318183 An Algorithm Based on Control Indexes to Increase the Quality of Service on Cellular Networks
Authors: Rahman Mofidi, Sina Rahimi, Farnoosh Darban
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Communication plays a key role in today’s world, and to support it, the quality of service has the highest priority. It is very important to differentiate between traffic based on priority level. Some traffic classes should be a higher priority than other classes. It is also necessary to give high priority to customers who have more payment for better service, however, without influence on other customers. So to realize that, we will require effective quality of service methods. To ensure the optimal performance of the network in accordance with the quality of service is an important goal for all operators in the mobile network. In this work, we propose an algorithm based on control parameters which it’s based on user feedback that aims at minimizing the access to system transmit power and thus improving the network key performance indicators and increasing the quality of service. This feedback that is known as channel quality indicator (CQI) indicates the received signal level of the user. We aim at proposing an algorithm in control parameter criterion to study improving the quality of service and throughput in a cellular network at the simulated environment. In this work we tried to parameter values have close to their actual level. Simulation results show that the proposed algorithm improves the system throughput and thus satisfies users' throughput and improves service to set up a successful call.Keywords: quality of service, key performance indicators, control parameter, channel quality indicator
Procedia PDF Downloads 20318182 Relationship between the Development of Sepsis, Systemic Inflammatory Response Syndrome and Body Mass Index among Adult Trauma Patients at University Hospital in Cairo
Authors: Mohamed Hendawy Mousa, Warda Youssef Mohamed Morsy
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Background: Sepsis is a major cause of mortality and morbidity in trauma patients. Body mass index as an indicator of nutritional status was reported as a predictor of injury pattern and complications among critically ill injured patients. Aim: The aim of this study is to investigate the relationship between body mass index and the development of sepsis, systemic inflammatory response syndrome among adult trauma patients at emergency hospital - Cairo University. Research design: Descriptive correlational research design was utilized in the current study. Research questions: Q1. What is the body mass index profile of adult trauma patients admitted to the emergency hospital at Cairo University over a period of 6 months?, Q2. What is the frequency of systemic inflammatory response syndrome and sepsis among adult trauma patients admitted to the emergency hospital at Cairo University over a period of 6 months?, and Q3. What is the relationship between the development of sepsis, systemic inflammatory response syndrome and body mass index among adult trauma patients admitted to the emergency hospital at Cairo University over a period of 6 months?. Sample: A purposive sample of 52 adult male and female trauma patients with revised trauma score 10 to 12. Setting: The Emergency Hospital affiliated to Cairo University. Tools: Four tools were utilized to collect data pertinent to the study: Socio demographic and medical data tool, Systemic inflammatory response syndrome assessment tool, Revised Trauma Score tool, and Sequential organ failure assessment tool. Results: The current study revealed that, (61.5 %) of the studied subjects had normal body mass index, (25 %) were overweight, and (13.5 %) were underweight. 84.6% of the studied subjects had systemic inflammatory response syndrome and 92.3% were suffering from mild sepsis. No significant statistical relationship was found between body mass index and occurrence of Systemic inflammatory response syndrome (2= 2.89 & P = 0.23). However, Sequential organ failure assessment scores were affected significantly by body mass index was found mean of initial and last Sequential organ failure assessment score for underweight, normal and obese where t= 7.24 at p = 0.000, t= 16.49 at p = 0.000 and t= 9.80 at p = 0.000 respectively. Conclusion: Underweight trauma patients showed significantly higher rate of developing sepsis as compared to patients with normal body weight and obese. Recommendations: based on finding of this study the following are recommended: replication of the study on a larger probability sample from different geographical locations in Egypt; Carrying out of further studies in order to assess the other risk factors influencing trauma outcome and incidence of its complications; Establishment of standardized guidelines for managing underweight traumatized patients with sepsis.Keywords: body mass index, sepsis, systemic inflammatory response syndrome, adult trauma
Procedia PDF Downloads 25118181 System Devices to Reduce Particulate Matter Concentrations in Railway Metro Systems
Authors: Armando Cartenì
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Within the design of sustainable transportation engineering, the problem of reducing particulate matter (PM) concentrations in railways metro system was not much discussed. It is well known that PM levels in railways metro system are mainly produced by mechanical friction at the rail-wheel-brake interactions and by the PM re-suspension caused by the turbulence generated by the train passage, which causes dangerous problems for passenger health. Starting from these considerations, the aim of this research was twofold: i) to investigate the particulate matter concentrations in a ‘traditional’ railways metro system; ii) to investigate the particulate matter concentrations of a ‘high quality’ metro system equipped with design devices useful for reducing PM concentrations: platform screen doors, rubber-tyred and an advanced ventilation system. Two measurement surveys were performed: one in the ‘traditional’ metro system of Naples (Italy) and onother in the ‘high quality’ rubber-tyred metro system of Turin (Italy). Experimental results regarding the ‘traditional’ metro system of Naples, show that the average PM10 concentrations measured in the underground station platforms are very high and range between 172 and 262 µg/m3 whilst the average PM2,5 concentrations range between 45 and 60 µg/m3, with dangerous problems for passenger health. By contrast the measurements results regarding the ‘high quality’ metro system of Turin show that: i) the average PM10 (PM2.5) concentrations measured in the underground station platform is 22.7 µg/m3 (16.0 µg/m3) with a standard deviation of 9.6 µg/m3 (7.6 µg/m3); ii) the indoor concentrations (both for PM10 and for PM2.5) are statistically lower from those measured in outdoors (with a ratio equal to 0.9-0.8), meaning that the indoor air quality is greater than those in urban ambient; iii) that PM concentrations in underground stations are correlated to the trains passage; iv) the inside trains concentrations (both for PM10 and for PM2.5) are statistically lower from those measured at station platform (with a ratio equal to 0.7-0.8), meaning that inside trains the use of air conditioning system could promote a greater circulation that clean the air. The comparison among the two case studies allow to conclude that the metro system designed with PM reduction devices allow to reduce PM concentration up to 11 times against a ‘traditional’ one. From these results, it is possible to conclude that PM concentrations measured in a ‘high quality’ metro system are significantly lower than the ones measured in a ‘traditional’ railway metro systems. This result allows possessing the bases for the design of useful devices for retrofitting metro systems all around the world.Keywords: air quality, pollutant emission, quality in public transport, underground railway, external cost reduction, transportation planning
Procedia PDF Downloads 21018180 Source Separation for Global Multispectral Satellite Images Indexing
Authors: Aymen Bouzid, Jihen Ben Smida
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In this paper, we propose to prove the importance of the application of blind source separation methods on remote sensing data in order to index multispectral images. The proposed method starts with Gabor Filtering and the application of a Blind Source Separation to get a more effective representation of the information contained on the observation images. After that, a feature vector is extracted from each image in order to index them. Experimental results show the superior performance of this approach.Keywords: blind source separation, content based image retrieval, feature extraction multispectral, satellite images
Procedia PDF Downloads 40318179 Visibility Measurements Using a Novel Open-Path Optical Extinction Analyzer
Authors: Nabil Saad, David Morgan, Manish Gupta
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Visibility has become a key component of air quality and is regulated in many areas by environmental laws such as the EPA Clean Air Act and Regional Haze Rule. Typically, visibility is calculated by estimating the optical absorption and scattering of both gases and aerosols. A major component of the aerosols’ climatic effect is due to their scattering and absorption of solar radiation, which are governed by their optical and physical properties. However, the accurate assessment of this effect on global warming, climate change, and air quality is made difficult due to uncertainties in the calculation of single scattering albedo (SSA). Experimental complications arise in the determination of the single scattering albedo of an aerosol particle since it requires the simultaneous measurement of both scattering and extinction. In fact, aerosol optical absorption, in particular, is a difficult measurement to perform, and it’s often associated with large uncertainties when using filter methods or difference methods. In this presentation, we demonstrate the use of a new open-path Optical Extinction Analyzer (OEA) in conjunction with a nephelometer and two particle sizers, emphasizing the benefits that co-employment of the OEA offers to derive the complex refractive index of aerosols and their single scattering albedo parameter. Various use cases, data reproducibility, and instrument calibration will also be presented to highlight the value proposition of this novel Open-Path OEA.Keywords: aerosols, extinction, visibility, albedo
Procedia PDF Downloads 9118178 Impact of Coal Mining on River Sediment Quality in the Sydney Basin, Australia
Authors: A. Ali, V. Strezov, P. Davies, I. Wright, T. Kan
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The environmental impacts arising from mining activities affect the air, water, and soil quality. Impacts may result in unexpected and adverse environmental outcomes. This study reports on the impact of coal production on sediment in Sydney region of Australia. The sediment samples upstream and downstream from the discharge points from three mines were taken, and 80 parameters were tested. The results were assessed against sediment quality based on presence of metals. The study revealed the increment of metal content in the sediment downstream of the reference locations. In many cases, the sediment was above the Australia and New Zealand Environment Conservation Council and international sediment quality guidelines value (SQGV). The major outliers to the guidelines were nickel (Ni) and zinc (Zn).Keywords: coal mine, environmental impact, produced water, sediment quality guidelines value (SQGV)
Procedia PDF Downloads 30418177 Assessment of Drinking Water Quality in Relation to Arsenic Contamination in Drinking Water in Liberia: Achieving the Sustainable Development Goal of Ensuring Clean Water and Sanitation
Authors: Victor Emery David Jr., Jiang Wenchao, Daniel Mmereki, Yasinta John
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The fundamentals of public health are access to safe and clean drinking water. The presence of arsenic and other contaminants in drinking water leads to the potential risk to public health and the environment particularly in most developing countries where there’s inadequate access to safe and clean water and adequate sanitation. Liberia has taken steps to improve its drinking water status so as to achieve the Sustainable Development Goals (SDGs) target of ensuring clean water and effective sanitation but there is still a lot to be done. The Sustainable Development Goals are a United Nation initiative also known as transforming our world: The 2030 agenda for sustainable development. It contains seventeen goals with 169 targets to be met by respective countries. Liberia is situated within in the gold belt region where there exist the presence of arsenic and other contaminants in the underground water due to mining and other related activities. While there are limited or no epidemiological studies conducted in Liberia to confirm illness or death as a result of arsenic contamination in Liberia, it remains a public health concern. This paper assesses the drinking water quality, the presence of arsenic in groundwater/drinking water in Liberia, and proposes strategies for mitigating contaminants in drinking water and suggests options for improvement with regards to achieving the Sustainable Development Goals of ensuring clean water and effective sanitation in Liberia by 2030.Keywords: arsenic, action plan, contaminants, environment, groundwater, sustainable development goals (SDGs), Monrovia, Liberia, public health, drinking water
Procedia PDF Downloads 26118176 Ethnic Identity as an Asset: Linking Ethnic Identity, Perceived Social Support, and Mental Health among Indigenous Adults in Taiwan
Authors: A.H.Y. Lai, C. Teyra
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In Taiwan, there are 16 official indigenous groups, accounting for 2.3% of the total population. Like other indigenous populations worldwide, indigenous peoples in Taiwan have poorer mental health because of their history of oppression and colonisation. Amid the negative narratives, the ethnic identity of cultural minorities is their unique psychological and cultural asset. Moreover, positive socialisation is found to be related to strong ethnic identity. Based on Phinney’s theory on ethnic identity development and social support theory, this study adopted a strength-based approach conceptualising ethnic identity as the central organising principle that linked perceived social support and mental health among indigenous adults in Taiwan. Aims. Overall aim is to examine the effect of ethnic identity and social support on mental health. Specific aims were to examine : (1) the association between ethnic identity and mental health; (2) the association between perceived social support and mental health ; (3) the indirect effect of ethnic identity linking perceived social support and mental health. Methods. Participants were indigenous adults in Taiwan (n=200; mean age=29.51; Female=31%, Male=61%, Others=8%). A cross-sectional quantitative design was implemented using data collected in the year 2020. Respondent-driven sampling was used. Standardised measurements were: Ethnic Identity Scale(6-item); Social Support Questionnaire-SF(6 items); Patient Health Questionnaire(9-item); and Generalised Anxiety Disorder(7-item). Covariates were age, gender and economic satisfaction. A four-stage structural equation modelling (SEM) with robust maximin likelihood estimation was employed using Mplus8.0. Step 1: A measurement model was built and tested using confirmatory factor analysis (CFA). Step 2: Factor covariates were re-specified as direct effects in the SEM. Covariates were added. The direct effects of (1) ethnic identity and social support on depression and anxiety and (2) social support on ethnic identity were tested. The indirect effect of ethnic identity was examined with the bootstrapping technique. Results. The CFA model showed satisfactory fit statistics: x^2(df)=869.69(608), p<.05; Comparative ft index (CFI)/ Tucker-Lewis fit index (TLI)=0.95/0.94; root mean square error of approximation (RMSEA)=0.05; Standardized Root Mean Squared Residual (SRMR)=0.05. Ethnic identity is represented by two latent factors: ethnic identity-commitment and ethnic identity-exploration. Depression, anxiety and social support are single-factor latent variables. For the SEM, model fit statistics were: x^2(df)=779.26(527), p<.05; CFI/TLI=0.94/0.93; RMSEA=0.05; SRMR=0.05. Ethnic identity-commitment (b=-0.30) and social support (b=-0.33) had direct negative effects on depression, but ethnic identity-exploration did not. Ethnic identity-commitment (b=-0.43) and social support (b=-0.31) had direct negative effects on anxiety, while identity-exploration (b=0.24) demonstrated a positive effect. Social support had direct positive effects on ethnic identity-exploration (b=0.26) and ethnic identity-commitment (b=0.31). Mediation analysis demonstrated the indirect effect of ethnic identity-commitment linking social support and depression (b=0.22). Implications: Results underscore the role of social support in preventing depression via ethnic identity commitment among indigenous adults in Taiwan. Adopting the strength-based approach, mental health practitioners can mobilise indigenous peoples’ commitment to their group to promote their well-being.Keywords: ethnic identity, indigenous population, mental health, perceived social support
Procedia PDF Downloads 10318175 Structural Reliability of Existing Structures: A Case Study
Authors: Z. Sakka, I. Assakkaf, T. Al-Yaqoub, J. Parol
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A reliability-based methodology for the analysis assessment and evaluation of reinforced concrete structural elements of concrete structures is presented herein. The results of the reliability analysis and assessment for structural elements are verified by the results obtained from the deterministic methods. The analysis outcomes of reliability-based analysis are compared against the safety limits of the required reliability index β according to international standards and codes. The methodology is based on probabilistic analysis using reliability concepts and statistics of the main random variables that are relevant to the subject matter, and for which they are to be used in the performance-function equation(s) related to the structural elements under study. These methodology techniques can result in reliability index β, which is commonly known as the reliability index or reliability measure value that can be utilized to assess and evaluate the safety, human risk, and functionality of the structural component. Also, these methods can result in revised partial safety factor values for certain target reliability indices that can be used for the purpose of redesigning the reinforced concrete elements of the building and in which they could assist in considering some other remedial actions to improve the safety and functionality of the member.Keywords: structural reliability, concrete structures, FORM, Monte Carlo simulation
Procedia PDF Downloads 51818174 Comparing the Trophic Structure of the Moroccan Mediterranean Sea with the Moroccan Atlantic Coast Using Ecopath Model
Authors: Salma Aboussalam, Karima Khalil, Khalid Elkalay
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To describe the structure, functioning, and state of the Moroccan Mediterranean Sea ecosystem, an Ecopath mass balance model has been applied. The model is based on 31 functional groups, containing 21 fishes, 7 invertebrates, 2 primary producers, and one dead group (detritus), which are considered in this work to explore the trophic interaction. The system's average trophic transfer efficiency was 23%. Both the total primary production and total respiration were calculated to be >1, suggesting that more energy is produced than respired in the system. The structure of our system is based on high respiration and consumption flows. Indicators of ecosystem stability and development showed low values of the Finn cycle index (13.97), system omnivory index (0.18), and average Finn path length (3.09), suggesting that our system is disturbed and has a more linear than web-like trophic structure. The keystone index and mixed trophic impact analysis indicated that other demersal invertebrates, zooplankton, and cephalopods had a tremendous impact on other groups and were recognized as keystone species.Keywords: Ecopath, food web, trophic flux, Moroccan Mediterranean Sea
Procedia PDF Downloads 9118173 Description of Geotechnical Properties of Jabal Omar
Authors: Ibrahim Abdel Gadir Malik, Dafalla Siddig Dafalla, Osama Abdelgadir El-Bushra
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Geological and engineering characteristics of intact rock and the discontinuity surfaces was used to describe and classify rock mass into zones based on mechanical and physical properties. Many conditions terms that affect the rock mas; such as Rock strength, Rock Quality Designation (RQD) value, joint spacing, and condition of joint, water condition with block size, joint roughness, separation, joint hardness, friction angle and weathering were used to classify the rock mass into: Good quality (class II) (RMR values range between 75% and 56%), Good to fair quality (class II to III) (RMR values range between 70% and 55%), Fair quality (class III) (RMR values range between 60% and 50%) and Fair to poor quality (Class III to IV) (RMR values, range between (50% and 35%).Keywords: rock strength, RQD, joints, weathering
Procedia PDF Downloads 41618172 The Healthcare Costs of BMI-Defined Obesity among Adults Who Have Undergone a Medical Procedure in Alberta, Canada
Authors: Sonia Butalia, Huong Luu, Alexis Guigue, Karen J. B. Martins, Khanh Vu, Scott W. Klarenbach
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Obesity is associated with significant personal impacts on health and has a substantial economic burden on payers due to increased healthcare use. A contemporary estimate of the healthcare costs associated with obesity at the population level are lacking. This evidence may provide further rationale for weight management strategies. Methods: Adults who underwent a medical procedure between 2012 and 2019 in Alberta, Canada were categorized into the investigational cohort (had body mass index [BMI]-defined class 2 or 3 obesity based on a procedure-associated code) and the control cohort (did not have the BMI procedure-associated code); those who had bariatric surgery were excluded. Characteristics were presented and healthcare costs ($CDN) determined over a 1-year observation period (2019/2020). Logistic regression and a generalized linear model with log link and gamma distribution were used to assess total healthcare costs (comprised of hospitalizations, emergency department visits, ambulatory care visits, physician visits, and outpatient prescription drugs); potential confounders included age, sex, region of residence, and whether the medical procedure was performed within 6-months before the observation period in the partial adjustment, and also the type of procedure performed, socioeconomic status, Charlson Comorbidity Index (CCI), and seven obesity-related health conditions in the full adjustment. Cost ratios and estimated cost differences with 95% confidence intervals (CI) were reported; incremental cost differences within the adjusted models represent referent cases. Results: The investigational cohort (n=220,190) was older (mean age: 53 standard deviation [SD]±17 vs 50 SD±17 years), had more females (71% vs 57%), lived in rural areas to a greater extent (20% vs 14%), experienced a higher overall burden of disease (CCI: 0.6 SD±1.3 vs 0.3 SD±0.9), and were less socioeconomically well-off (material/social deprivation was lower [14%/14%] in the most well-off quintile vs 20%/19%) compared with controls (n=1,955,548). Unadjusted total healthcare costs were estimated to be 1.77-times (95% CI: 1.76, 1.78) higher in the investigational versus control cohort; each healthcare resource contributed to the higher cost ratio. After adjusting for potential confounders, the total healthcare cost ratio decreased, but remained higher in the investigational versus control cohort (partial adjustment: 1.57 [95% CI: 1.57, 1.58]; full adjustment: 1.21 [95% CI: 1.20, 1.21]); each healthcare resource contributed to the higher cost ratio. Among urban-dwelling 50-year old females who previously had non-operative procedures, no procedures performed within 6-months before the observation period, a social deprivation index score of 3, a CCI score of 0.32, and no history of select obesity-related health conditions, the predicted cost difference between those living with and without obesity was $386 (95% CI: $376, $397). Conclusions: If these findings hold for the Canadian population, one would expect an estimated additional $3.0 billion per year in healthcare costs nationally related to BMI-defined obesity (based on an adult obesity rate of 26% and an estimated annual incremental cost of $386 [21%]); incremental costs are higher when obesity-related health conditions are not adjusted for. Results of this study provide additional rationale for investment in interventions that are effective in preventing and treating obesity and its complications.Keywords: administrative data, body mass index-defined obesity, healthcare cost, real world evidence
Procedia PDF Downloads 10818171 Multi-Temporal Urban Land Cover Mapping Using Spectral Indices
Authors: Mst Ilme Faridatul, Bo Wu
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Multi-temporal urban land cover mapping is of paramount importance for monitoring urban sprawl and managing the ecological environment. For diversified urban activities, it is challenging to map land covers in a complex urban environment. Spectral indices have proved to be effective for mapping urban land covers. To improve multi-temporal urban land cover classification and mapping, we evaluate the performance of three spectral indices, e.g. modified normalized difference bare-land index (MNDBI), tasseled cap water and vegetation index (TCWVI) and shadow index (ShDI). The MNDBI is developed to evaluate its performance of enhancing urban impervious areas by separating bare lands. A tasseled cap index, TCWVI is developed to evaluate its competence to detect vegetation and water simultaneously. The ShDI is developed to maximize the spectral difference between shadows of skyscrapers and water and enhance water detection. First, this paper presents a comparative analysis of three spectral indices using Landsat Enhanced Thematic Mapper (ETM), Thematic Mapper (TM) and Operational Land Imager (OLI) data. Second, optimized thresholds of the spectral indices are imputed to classify land covers, and finally, their performance of enhancing multi-temporal urban land cover mapping is assessed. The results indicate that the spectral indices are competent to enhance multi-temporal urban land cover mapping and achieves an overall classification accuracy of 93-96%.Keywords: land cover, mapping, multi-temporal, spectral indices
Procedia PDF Downloads 15318170 The Relationships between Physical Activity Levels, Enjoyment of Physical Activity, and Body Mass Index among Bruneian Secondary School Adolescents
Authors: David Xiaoqian Sun, Khairunnisa Binti Haji Sibah, Jr., Lejak Anak Ambol
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The purpose of the study was to examine the relationships between objectively measured physical activity levels (PALs), enjoyment of physical activity (EPA), and body mass index (BMI) among adolescents. A total of 188 12-14-year-old Bruneian secondary school adolescents (88 boys and 100 girls) voluntarily took part in this study. Subjects wore the RT3 accelerometer for seven consecutive days in order to measure their PALs. Times of students’ engagement in total (TPA), light (LPA), moderate (MPV), and vigorous PA (VPA) were obtained from the accelerometer. Their BMIs were calculated from their body height and weight. Physical Activity Enjoyment Scale (PACES) was administrated to obtain their EPA levels. Four key enjoyment factors including fun factors, positive perceptions, unexciting in doing activities, and negative perceptions were identified. Subjects’ social economic status (SES) was provided by school administration. Results show that all the adolescents did not meet the recommended PA guidelines even though boys were engaged in more MVPA than girls. No relationships were found between BMI and all PALs in both boys and girls. BMI was significantly related to the PACES scores (r = -.22, p = 0.01), fun factors (r = -.20, p = 0.05) and positive perceptions (r =-.21, p < 0.05). The PACES scores were significantly related to LPA (r = .18, p = 0.01) but not related to MVPA (r = .04, p > 0.05). After controlling for age and SES, BMI was only significantly related to the PACES scores in girls (r = -.27, p < .01) but boys (r = -.06, p > 0.05). Fun factors were significantly related to LPA and MVPA (p < .01) in girls while negative perceptions were significantly related to LPA and MVPA (p < .01) in boys. This study provides evidence that enjoyment may be a trigger of LPA but MVPA and may be influenced by their BMI status particularly in girls. Based on these findings, physical and health educators are suggested to not only make PA more enjoyable, but also consider gender differences in promoting adolescents' participation in MVPA.Keywords: accelerometer, body mass index, enjoyment of physical activity, moderate to vigorous physical activity
Procedia PDF Downloads 37718169 Proposals for Continuous Quality Improvement of Public Transportation Federal District Using SERVQUAL
Authors: Rodrigo Guimarães Santos
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The quality of public transport services has been considered as a critical factor by their users and also by users of individual transport. Thus, this dissertation aims to adapt a model that assesses the quality of public transport and determines its level of service based on the views of its users. The methodology is widely used by marketers and allows measuring the quality of services by assessing the perceptions and expectations of users. The adapted SERVQUAL was tested with users of public transport service users and car in Brasília-DF, city of Brazil. This research involved 241 questionnaires answered by people living in the various administrative regions of Brasília-DF. The analysis of the determinants pointed out that the quality of the public transport service offered in the city is low and users of public transport and cars have a high degree of expectations for improvement in all tested determinants. This method enabled the identification of the most critical determinants and those needing strategic actions for continuous improvement of quality. Adapting the SERVQUAL for a public transport service was satisfactory and demonstrated applicability to internal and external services, including measuring the public transport services in other cities with the opinion of the users.Keywords: transportation services, quality services, servqual scale and marketing services
Procedia PDF Downloads 38818168 Experts' Perception of Secondary Education Quality Management Challenges in Ethiopia
Authors: Aklilu Alemu, Tak Cheung Chan
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Following the intensification of secondary education in the developing world, the attention of Ethiopia has currently shifted to its quality education and its management. This study is aimed to explore experts’ perceptions of quality management challenges in secondary education in Ethiopia. The researchers employed a case study design recruiting participating supervisors from the Ministry of Education, region, zone, wereda, and cluster by using a purposeful sampling technique. Twenty-six interviewees took part in this study. The researchers employed NVivo 8 versions together with a thematic analysis process to analyze the data. This study revealed that major problems that affected quality management practices in Ethiopia were: lack of qualified experts at all levels; lack of accountability in every echelon; the changing nature of teacher education; the ineffectiveness of teacher-licensing programs; and lack of educational budget and the problem of utilizing this limited budget. The study concluded that the experts at different levels were not genuinely fulfilling their roles and responsibilities. Therefore, the Ministry of Finance and Economic Development, together with the concerned parties, needs to reconsider budget allocation for secondary education.Keywords: education quality, Ethiopia, quality challenge, quality management, secondary education
Procedia PDF Downloads 21618167 Association between Healthy Eating Index-2015 Scores and the Probability of Sarcopenia in Community-Dwelling Iranian Elderly
Authors: Zahra Esmaeily, Zahra Tajari, Shahrzad Daei, Mahshid Rezaei, Atefeh Eyvazkhani, Marjan Mansouri Dara, Ahmad Reza Dorosty Motlagh, Andriko Palmowski
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Objective: Sarcopenia (SPA) is associated with frailty and disability in the elderly. Adherence to current dietary guidelines in addition to physical activity could play a role in the prevention of muscle wasting and weakness. The Healthy Eating Index-2015 (HEI) is a tool to assess diet quality as recommended in the U.S. Dietary Guidelines for Americans. This study aimed to investigate whether there is a relationship between HEI scores and the probability of SPA (PS) among the Tehran elderly. Method: A previously validated semi-quantitative food frequency questionnaire was used to assess HEI and the dietary intake of randomly selected elderly people living in Tehran, Iran. Handgrip strength (HGS) was measured to evaluate the PS. Statistical evaluation included descriptive analysis and standard test procedures. Result: 201 subjects were included. Those probably suffering from SPA (as determined by HGS) had significantly lower HEI scores (p = 0.02). After adjusting for confounders, HEI scores and HGS were still significantly associated (adjusted R2 = 0.56, slope β = 0.03, P = 0.09). Elderly people with a low probability of SPA consumed more monounsaturated and polyunsaturated fatty acids (P = 0.06) and ingested less added sugars and saturated fats (P = 0.01 and P = 0.02, respectively). Conclusion: In this cross-sectional study, HEI scores are associated with the probability of SPA. Adhering to current dietary guidelines might contribute to ameliorating muscle strength and mass in aging individuals.Keywords: aging, HEI-2015, Iranian, sarcopenic
Procedia PDF Downloads 20818166 Feasibility and Impact of the Community Based Supportive Housing Intervention for Individuals with Chronic Mental Illness in Bangladesh
Authors: Rubina Jahan, Mohammad Zayeed Bin Alam, Razia Sultana, Md. Faroque Miah
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Mental health remains a significant global public health challenge, profoundly affecting millions worldwide. In Bangladesh, the situation is dire, with the National Mental Health Survey 2018-19 indicating that 19% of adults suffer from any kind of mental disorders, including severe mental disorder of around 2%. Despite these high prevalence rates, there is a substantial treatment gap in low- and middle-income countries, including Bangladesh, where up to 92% of individuals with mental illnesses do not receive adequate care. This gap is exacerbated by social barriers such as stigma, discrimination, social exclusion, poverty, homelessness, and human rights violations. To address these challenges, the SAJIDA Foundation launched the Proshanti in November 2022. Proshanti is a community based supportive housing intervention designed to provide cost-effective, sustainable, long-term care for individuals with chronic mental illnesses. It aims to rehabilitate participants by improving their mental health, quality of life, and equipping them with skills necessary for independent living and social mobility. Currently, Proshanti operates seven houses in Manikganj and Habiganj districts of Bangladesh, accommodating up to 40 individuals. Over a two-year period, individuals have received personalized support from trained personal assistants and care coordinators, regular health checkups, and opportunities for vocational training and community engagement. In this presentation, we will present the outcome of such intervention on individual’s functionality, quality of life and psychological health generated from 24 months of journey. Additionally, a qualitative approach will be employed to understand the facilitators and barriers of program implementation. The Proshanti program represents a promising model for addressing the significant mental health treatment gap in Bangladesh at the community level. Our findings will provide crucial insights into the program's feasibility, effectiveness, and the factors influencing its implementation, potentially guiding future mental health interventions in similar contexts.Keywords: mental health, community based supportive housing, treatment gap, bangladesh
Procedia PDF Downloads 5118165 The Effect of Photochemical Smog on Respiratory Health Patients in Abuja Nigeria
Authors: Christabel Ihedike, John Mooney, Monica Price
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Summary: This study aims to critically evaluate effect of photochemical smog on respiratory health in Nigeria. Cohort of chronic obstructive pulmonary disease (COPD) patients was recruited from two large hospitals in Abuja Nigeria. Respiratory health questionnaires, daily diaries, dyspnoea scale and lung function measurement were used to obtain health data and investigate the relationship with air quality data (principally ozone, NOx and particulate pollution). Concentrations of air pollutants were higher than WHO and Nigerian air quality standard. The result suggests a correlation between measured air quality and exacerbation of respiratory illness. Introduction: Photochemical smog is a significant health challenge in most cities and its effect on respiratory health is well acknowledged. This type of pollution is most harmful to the elderly, children and those with underlying respiratory disease. This study aims to investigate impact of increasing temperature and photo-chemically generated secondary air pollutants on respiratory health in Abuja Nigeria. Method and Result: Health data was collected using spirometry to measure lung function on routine attendance at the clinic, daily diaries kept by patients and information obtained using respiratory questionnaire. Questionnaire responses (obtained using an adapted and internally validated version of St George’s Hospital Respiratory Questionnaire), shows that ‘time of wheeze’ showed an association with participants activities: 30% had worse wheeze in the morning: 10% cannot shop, 15% take long-time to get washed, 25% walk slower, 15% if hurry have to stop and 5% cannot take-bath. There was also a decrease in Forced expiratory volume in the first second and Forced Vital Capacity, and daily change in the afternoon–morning may be associated with the concentration level of pollutants. Also, dyspnoea symptoms recorded that 60% of patients were on grade 3, 25% grade 2 and 15% grade 1. Daily frequency of the number of patients in the cohort that cough /brought sputum is 78%. Air pollution in the city is higher than Nigerian and WHO standards with NOx and PM10 concentrations of 693.59ug/m-3 and 748ugm-3 being measured respectively. The result shows that air pollution may increase occurrence and exacerbation of respiratory disease. Conclusion: High temperature and local climatic conditions in urban Nigeria encourages formation of Ozone, the major constituent of photochemical smog, resulting also in the formation of secondary air pollutants associated with health challenges. In this study we confirm the likely potency of the pattern of secondary air pollution in exacerbating COPD symptoms in vulnerable patient group in urban Nigeria. There is need for better regulation and measures to reduce ozone, particularly when local climatic conditions favour development of photochemical smog in such settings. Climate change and likely increasing temperatures add impetus and urgency for better air quality standards and measures (traffic-restrictions and emissions standards) in developing world settings such as Nigeria.Keywords: Abuja-Nigeria, effect, photochemical smog, respiratory health
Procedia PDF Downloads 22418164 Exploring Affordable Care Practs in Nigeria’s Health Insurance Discourse
Authors: Emmanuel Chinaguh, Kehinde Adeosun
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Nigerians die untimely, with 55.75 years of life expectancy, which is 17.45 below the world average of 73.2 (Worldometer, 2020). This is due, among other factors, to the country's limited access to high-quality healthcare. To increase access to good and affordable healthcare services, the National Health Insurance Authority (NHIA) Bill 2022 – which repealed the National Health Insurance Scheme Act 2004 – was passed into law. Applying Jacob Mey’s (2001) pragmatics act (pract) theory, this study explores how NHIA seeks to actualise these healthcare goals by characterising the general situational prototype or pragmemes and pragmatic acts in institutional communications. Data was sourced from the NHIA operational guidelines, which has 147 pages and four sections, and shared posters on NHIA Nigeria Twitter Handle with 14,200 followers. Digital humanities tools, like AntConc and Voyant, were engaged in the data analysis for text encoding and data visualisation. This study identifies these discourse tokens in the data: advertisement and programmes, standards and accreditation, records and information, and offences and penalties. Advertisement and programmes pract facilitating, propagating, prospecting, advising and informing; standards and accreditation, and records and information pract stating, informing and instructing; and offences and penalties pract stating and sanctioning. These practs combined to advance the goals of affordable care and universal accessibility to quality healthcare services. The pragmatic acts were marked by these pragmatic tools: shared situational knowledge (SSK), relevance (REL), reference (REF) and inference (INF). This paper adds to the understanding of health insurance discourse in Nigeria as a mediated social practice that promotes the health of Nigerians.Keywords: affordable care, NHIA, Nigeria’s health insurance discourse, pragmatic acts.
Procedia PDF Downloads 8518163 Physical, Psychological, and Sexual Implications of Living with Rheumatoid Arthritis among Women in Re
Authors: Anwaar Anwar Tayel
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Background: Rheumatic arthritis (RA) affect all aspects of patients' life, lead to various degrees of disability, and ultimately has a profound impact on the social, economic, psychological, and sexual aspects of the patient's life. Aim of the study: Identify physical, psychological, and sexual implications of rheumatoid arthritis among women in reproductive age. In addition to investigating the correlations between physical functional disability, psychological problems, and sexual dysfunction.Settings: The study was conducted at Rheumatology Clinic at the Main University Hospital of Alexandria. Subjects: Purposive sample was chosen from women patients with rheumatoid arthritis to be subjects of this study (n=250). Tools: Four tools were used to collect data. Tool I: Socio-demographic questionnaire. Tool II: Stanford Health Assessment Questionnaire Disability Index (HAQ- DI). Tool III: Depression Anxiety Stress Scale (DASS). Tool IV: The Sexual Dysfunction Questionnaire (SDQ) Results: The majority of the studied women suffer from severe physical disability, extreme level of depression, anxiety, and about half of them had an extreme level of stress. Also, the majority of the studied women had a severe level of sexual dysfunction. Also, statistically significant correlations between women's physical disability index, psychological problems, and sexual dysfunction were detected. Conclusion: The findings from this study confirm that women patients with RA suffer from multiple negative implications on the physical, psychological and sexual functions. Recommendations: Provide ongoing support to the patients from the time of diagnosis throughout their care and management. To help them to manage their pain and disabilities, improve their sexual function, promote their mental health, and optimize psychosocial functioningKeywords: pysical, spycholgical, sexual, implication, rheumatic arthritis
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