Search results for: primary care physicians

Authors: Nam-Phuong T. Hoang, Divna Haslam, Matthew Sanders

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Parenting psychological control (PPC) is a parenting manner of which intrusive tactics such as guilt induction, shaming or love withdrawal is adopted to manipulate the child's behavior, emotion and beliefs. PPC has been widely reported to be associated with both psychological dysfunction and low self-esteem in adolescents. Highly demanding and restrictive parenting was also found to related to high rate of risk behaviors, depression, anxiety and anti-social behaviors in adults who co-live with their parents. In many cultures like that of Asia, adults keep on co-live with their parents even after having their own families, and this is not an uncommon practice. Due to the culture obligation of family relationship and the filial piety, children are expected to stay with their parents to taking care of them when they get older, and the parents are also expected to co-live with their children in order to support them with grandchild care. As one become a grandparent, however, it does not means one stop being the parent to their own child. The effect of PPC if exist thus might continue to interfere one’s relationship with their adult children and also their adult child’s parenting. This study was designed to examine that effect of PPC on adults’ life as parents. Data was collected from 501 Vietnamese parents whose children between the age of 2 to 12 and having their parent living with them or taking care of the grandchild on daily basic. Findings show that grandparent psychological control (GPPC) is significantly associated with parent’s harsh parenting, parent’s well-being, and parent-grandparent coparenting relationship. Significantly, GPPC is the strongest predictor for the coparenting conflict between parent and grandparent.

Keywords: parenting psychological control, grandparent, coparenting, well-being

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Authors: E. Njuguna, S. Ilovi, P. Muiruri, K. Mutai, J. Kinuthia, P. Njoroge

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Introduction: Cervical cancer is the commonest cause of cancer-related morbidity and mortality among women in developing countries in Sub Saharan Africa. Screening for cervical cancer in all women regardless of HIV status is crucial for the early detection of cancer of the cervix when treatment is most effective in curing the disease. It is particularly more important to screen HIV infected women as they are more at risk of developing the disease and progressing faster once infected with HPV (Human Papilloma Virus). We aimed to determine the factors affecting the utilization of cervical cancer screenings among HIV infected women above 18 years of age at Kenyatta National Hospital (KNH) Comprehensive Care Center (CCC). Materials and Methods: A cross-sectional mixed quantitative and qualitative study involving randomly and purposefully selected HIV positive female respectively was conducted. Qualitative data collection involved 4 focus group discussions of eligible female participants while quantitative data were acquired by one to one interviewer administered structured questionnaires. The outcome variable was the utilization of cervical cancer screening. Data were entered into Access data base and analyzed using Stata version 11.1. Qualitative data were analyzed after coding for significant clauses and transcribing to determine themes arising. Results: We enrolled a total of 387 patients, mean age (IQ range) 40 years (36-44). Cervical cancer screening utilization was 46% despite a health care provider recommendation of 85%. The screening results were reported as normal in 72 of 81 (88.9%) and abnormal 7 of 81(8.6%) of the cases. Those who did not know their result were 2 of 81(2.5%). Patients were less likely to utilize the service with increasing number of years attending the clinic (OR 0.9, 95% CI 0.86-0.99, p-value 0.02), but more likely to utilize the service if recommendation by a staff was made (OR 10, 95% CI 4.2-23.9, p<0.001), and if cervical screening had been done before joining KNH CCC (OR 2.9, 95% CI 1.7-4.9, p < 0.001). Similarly, they were more likely to rate the services on cervical cancer screening as good (OR 5.0, 95% CI 1.7-3.4, p <0.001) and very good (OR 8.1, 95% CI 2.5-6.1, p<0.001) if they had utilized the service. The main barrier themes emerging from qualitative data included fear of screening due to excessive pain or bleeding, lack of proper communication on screening procedures and increased waiting time. Conclusions: Utilization of cervical cancer screening services was low despite health care recommendation. Patient socio-demographic characteristics did not influence whether or not they utilized the services, indicating the important role of the health care provider in the referral and provision of the service.

Keywords: cervical, cancer, HIV, women, comprehensive care center

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Authors: Tsegahun Manyazewal, Francesco Marinucci, Getachew Belay, Abraham Tesfaye, Gonfa Ayana, Amaha Kebede, Tsegahun Manyazewal, Francesco Marinucci, Getachew Belay, Abraham Tesfaye, Gonfa Ayana, Amaha Kebede, Yewondwossen Tadesse, Susan Lehman, Zelalem Temesgen

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In-service health trainings in Sub-Saharan Africa are mostly content-centered with higher disconnection with the real practice in the facility. This study intended to evaluate in-service training approach aimed to strengthen health care human resources. A combined web-based and face-to-face training was designed and piloted in Ethiopia with the diagnosis of tuberculosis. During the first part, which lasted 43 days, trainees accessed web-based material and read without leaving their work; while the second part comprised a one-day hands-on evaluation. Trainee’s competency was measured using multiple-choice questions, written-assignments, exercises and hands-on evaluation. Of 108 participants invited, 81 (75%) attended the course and 71 (88%) of them successfully completed. Of those completed, 73 (90%) scored a grade from A to C. The approach was effective to transfer knowledge and turn it into practical skills. In-service health training should transform from a passive one-time-event to a continuous behavioral change of participants and improvements on their actual work.

Keywords: Ethiopia, health care, Mycobacterium tuberculosis, training

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Authors: Happy Kumar Das, Md. Shahriar Shafiq

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This paper portrays an assumed change in the primary teacher education program in Bangladesh. An initiative has been taken with a vision to ensure an integrated approach to developing trainee teachers’ knowledge and understanding about learning at a deeper level, and with that aim, the Diploma in Primary Education (DPEd) program replaces the Certificate-in-Education (C-in-Ed) program in Bangladeshi context for primary teachers. The stated professional values of the existing program such as ‘learner-centered’, ‘reflective’ approach to pedagogy tend to contradict the practice exemplified through the delivery mechanism. To address the challenges, through the main two components (i) Training Institute-based learning and (ii) School-based learning, the new program tends to cover knowledge and value that underpin the actual practice of teaching. These two components are given approximately equal weighting within the program in terms of both time, content and assessment as the integration seeks to combine theoretical knowledge with practical knowledge and vice versa. The curriculum emphasizes a balance between the taught modules and the components of the practicum. For example, the theories of formative and summative assessment techniques are elaborated through focused reflection on case studies as well as observation and teaching practice in the classroom. The key ideology that is reflected through this newly developed program is teacher’s belief in ‘holistic education’ that can lead to creating opportunities for skills development in all three (Cognitive, Social and Affective) domains simultaneously. The proposed teacher education program aims to address these areas of generic skill development alongside subject-specific learning outcomes. An exploratory study has been designed in this regard where 7 Primary Teachers’ Training Institutes (PTIs) in 7 divisions of Bangladesh was used for experimenting DPEd program. The analysis was done based on document analysis, periodical monitoring report and empirical data gathered from the experimental PTIs. The findings of the study revealed that the intervention brought positive change in teachers’ professional beliefs, attitude and skills along with improvement of school environment. Teachers in training schools work together for collective professional development where they support each other through lesson study, action research, reflective journals, group sharing and so on. Although the DPEd program addresses the above mentioned factors, one of the challenges of the proposed program is the issue of existing capacity and capabilities of the PTIs towards its effective implementation.

Keywords: Bangladesh, effective implementation, primary teacher education, reflective approach

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Authors: J. M. Cruz, X. Vecıno, L. Rodrıguez-López, J. M. Dominguez, A. B. Moldes

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The cosmetic and personal care industry are the fields where biosurfactants could have more possibilities of success because in this kind of products the replacement of synthetic detergents by natural surfactants will provide an additional added value to the product, at the same time that the harmful effects produced by some synthetic surfactants could be avoided or reduced. Therefore, nowadays, consumers are disposed to pay and additional cost if they obtain more natural products. In this work we provide data about the potential of biosurfactants in the cosmetic and personal care industry. Biosurfactants from corn steep liquor, that is a fermented and condensed stream, have showed good surface-active properties, reducing substantially the surface tension of water. The bacteria that usually growth in corn steep liquor comprises Lactobacillus species, generally recognize as safe. The biosurfactant extracted from CSL consists of a lipopeptide, composed by fatty acids, which can reduce the surface tension of water in more than 30 units. It is a yellow and viscous liquid with a density of 1.053 mg/mL and pH=4. By these properties, they could be introduced in the formulation of cosmetic creams, hair conditioners or shampoos. Moreover this biosurfactant extracted from corn steep liquor, have showed a potent antimicrobial effect on different strains of Streptococcus. Some species of Streptococcus are commonly found weakly living in the human respiratory and genitourinary systems, producing several diseases in humans, including skin diseases. For instance, Streptococcus pyogenes produces many toxins and enzymes that help to stabilize skin infections; probably biosurfactants from corn steep liquor can inhibit the mechanisms of the S. pyogenes enzymes. S. pyogenes is an important cause of pharyngitis, impetigo, cellulitis and necrotizing fasciitis. In this work it was observed that 50 mg/L of biosurfactant extract obtained from corn steep liquor is able to inhibit more than 50% the growth of S. pyogenes. Thus, cosmetic and personal care products, formulated with biosurfactants from corn steep liquor, could have prebiotic properties. The natural biosurfactant presented in this work and obtained from corn milling industry streams, have showed a high potential to provide an interesting and sustainable alternative to those, antibacterial and surfactant ingredients used in cosmetic and personal care manufacture, obtained by chemical synthesis, which can cause irritation, and often only show short time effects.

Keywords: antimicrobial activity, biosurfactants, cosmetic, personal care

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Authors: Oluwaseun Adeleke, Samuel O. Ikani, Fidelis Edet, Anthony Nwala, Mopelola Raji, Simeon Christian Chukwu

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Introduction: Digital innovations have been useful in supporting a client’s contraceptive user journey from awareness to method initiation. The concept of contraceptive self-care is being promoted globally as a means for achieving universal access to quality contraceptive care; however, information about this approach is limited. An important determinant of the scale of awareness is the message construct, choice of information channel, and an understanding of the socio-epidemiological dynamics within the target audience. Significant gains have been made recently in expanding the awareness base of DMPA-SC -a relatively new entrant into the family planning method mix. The cornerstone of this success is a multichannel promotion campaign themed Discover your Power (DYP). The DYP campaign combines content marketing across select social media platforms, chatbots, Cyber-IPC, Interactive Voice Response (IVR), and radio campaigns. Methodology: During implementation, the project monitored predefined metrics of awareness and intent, such as the number of persons reached with the messages, the number of impressions, and meaningful engagement (link-clicks). Metrics/indicators are extracted through native insight/analytics tools across the various platforms. The project also enlists community mobilizers (CMs) who go door-to-door and engage WRA to advertise DISC’s online presence and support them to engage with IVR, digital companion (chatbot), Facebook page, and DiscoverYourPower website. Results: The result showed that the digital platforms recorded 242 million impressions and reached 82 million users with key DMPA-SC self-injection messaging in the three countries. As many as 3.4 million persons engaged (liked, clicked, shared, or reposted) digital posts -an indication of intention. Conclusion: Digital solutions and innovations are gradually becoming the archetype for the advancement of the self-care agenda. Digital innovations can also be used to increase awareness and normalize contraceptive self-care behavior amongst women of reproductive age if they are made an integral part of reproductive health programming.

Keywords: digital transformation, health systems, DMPA-SC, family planning, self-care

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Authors: Caglayan Pinar Demirtas, Mustafa Koc

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Objective: This study was carried out in order to find out; the methods which are used by primary school teachers to cope with stress, their psychological health, and the direction of controlling focus. The study was carried out by using the ‘school survey’ and ‘society survey’ methods. Method: The study included primary school teachers. The study group was made up of 1066 people; 511 women and 555 men who accepted volunteerly to complete; ‘the inventory for collecting data, ‘the Scale for Attitude of Overcoming Stress’ (SBTE / SAOS), ‘Rotter’s Scale for the Focus of Inner- Outer Control’ (RİDKOÖ / RSFIOC), and ‘the Symptom Checking List’ (SCL- 90). The data was collected by using ‘the Scale for Attitude of Overcoming Stress’, ‘the Scale for the Focus of Inner- Outer Control’, ‘the Symptom Checking List’, and a personal information form developed by the researcher. SPSS for Windows packet programme was used. Result: The age variable is a factor in interpersonal sensitivity, depression, anxciety, hostality symptoms but it is not a factor in the other symptoms. The variable, gender, is a factor in emotional practical escaping overcoming method but it is not a factor in the other overcoming methods. Namely, it has been found out that, women use emotional practical escaping overcoming method more than men. Marital status is a factor in methods of overcoming stress such as trusting in religion, emotional practical escaping and biochemical escaping while it is not a factor in the other methods. Namely, it has been found out that married teachers use trusting in religion method, and emotional practical escaping method more than single ones. Single teachers generally use biochemical escaping method. In primary school teachers’ direction of controlling focus, gender variable is a factor. It has been found out that women are more inner controlled while the men are more outer controlled. The variable, time of service, is a factor in the direction of controlling focus; that is, teachers with 1-5 years of service time are more inner controlled compared with teachers with 16-20 years of service time. The variable, age, is a factor in the direction of controlling focus; that is, teachers in 26-30 age groups are more outer controlled compared with the other age groups and again teachers in 26-30 age group are more inner controlled when compared with the other age groups. Direction of controlling focus is a factor in the primary school teachers’ psychological health. Namely, being outer controlled is a factor but being inner controlled is not. The methods; trusting in religion, active plannıng and biochemical escaping used by primary school teachers to cope with stress act as factors in the direction of controlling focus but not in the others. Namely, it has been found out that outer controlled teachers prefer the methods of trusting in religion and active planning while the inner controlled ones prefer biochemical escaping.

Keywords: coping with, controlling focus, psychological health, stress

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Authors: Cinzia Valente

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Over the last few years, national legislators have been forced to deal with social changes that have had important repercussions in family law and children’s law. This growing focus on minors has provoked important reforms, specifically on issues relating to the welfare and protection of children. My presentation focuses on the issue of migrant children in particular I refer to unaccompanied children, or ‘children on the move’, or separate children or any other term defining migrant minors who cross national borders seeking protection or better opportunities. They arrive often illegally, on the European territory without a responsible adult who take care of them. There is a common assumption that migrants are running away from conflicts, poverty and human rights abuse and they arrive in a foreign country hoping a better life; children without persons who takes care of them encounter some difficulties in their integration in the host country. The migration flows recorded in recent decades towards EU countries, and Italy in particular, have imposed an intense pressure to modernize institutions, services and specific legal frameworks, with the aim of responding adequately to the needs of foreign individuals, as well as ensuring a good level of living standards and facilitating integration, especially for migrant children. The object of my paper is the analysis of the Italian rules, practices and services existing in favor of unaccompanied children (foster care, reunification, acquisition of citizenship and other) in comparison with other European legal systems on the same thematic with a comparative method. Highlighting European standards to find common principles for the best solution to children's problems is the conclusive aim of my presentation.

Keywords: Children , Family Law, Migration , Uniform Law

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Authors: Tareq Oshan

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Facility location and size decisions are important to any company because they affect profitability and success. However, warehouses are exposed to various risks of failure that affect their activity. This paper presents a mixed-integer non-linear mathematical model that can be used to determine optimal warehouse locations and sizes, which warehouses to fortify, and which branches should be assigned to specific warehouses when there is a risk of warehouse failure. Every branch is assigned to a fortified primary warehouse or a nonfortified primary warehouse and a fortified backup warehouse. The standard method and an introduced method, based on the average probabilities, for linearizing this mathematical model were used. A Canadian case study was used to demonstrate the developed mathematical model, followed by some sensitivity analysis.

Keywords: supply chain network design, fortified warehouse, mixed-integer mathematical model, warehouse failure risk

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Authors: Sathvika Reddy, Devi Revathi

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Background: In India, deliberate self-harm (DSH) with poisoning agents carries a significant impact on morbidity and mortality. Changes in the patterns of poisoning vary across various geographical locations. It is important to know the patterns in a given region in order to facilitate rapid clinical diagnosis, appropriate treatment to reduce associated morbidity and mortality. Aim and Objective: To study the patterns, treatment outcomes of acute poisoning in patients admitted to emergency wards in a tertiary care hospital and to provide poison information services. Materials and Methods: This study was conducted at M.S Ramaiah Memorial and Teaching Hospital from November 2016 to March 2017. The patient’s data was obtained from patient case sheet, interaction with health care professionals, interviewing patients and their caretakers (if possible), and were documented in a suitably designed form. Results: The study involved 131 patients with a mean age of 27.76 ± 15.5 years. Majority of the patients were in the age group 21-30 years, literates (n=53) dwelling in urban (n=113) areas belonging to upper middle class (n=50). Analgesics and antipyretics were commonly utilized in intentional drug overdosage (n=49). Envenomation constituted n=21(16.03%). Furthermore, a significant relationship was observed between marital status and self-poisoning (n=64) (P < 0.001) which commonly occurred through oral ingestion. The outcomes were correlated with the GCS and PSS system and n=85 recovered, n=17 were discharged against medical advice, and n=4 died, and n=4 were lost to follow up respectively. The poison information queries include drug overdose (n=29) and management related queries (n=22) provided majorly by residents (n=45) to update knowledge (n=11) and for better patient care (n=40). Conclusion: The trend in poisoning is dynamic. Medications were identified as the main cause of poisoning in urban areas of India. Educational programs with more emphasis on preventive measures are necessary to create awareness among the general public.

Keywords: poisoning, suicides, clinical pharmacist, envenomation, poison information services

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Authors: Juliet Sorensen, Anna Maitland

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Introduction: Characterized by lack of water and sanitation, food insecurity, and low access to hospitals and clinics, informal urban settlements in Lagos, Nigeria have very poor health outcomes. With little education and a general inability to demand basic rights, these communities are often disempowered and isolated from understanding, claiming, or owning their health needs. Utilizing community-based participatory research characterized by interdisciplinary, cross-cultural partnerships, evidence-based assessments, and both primary and secondary source research, a holistic health education and advocacy program was developed in Lagos to address health barriers for targeted communities. This includes a first of its kind guide formulated to teach community-based health educators how to transmit health information to low-literacy Nigerian audiences while supporting behavior change models and social support mechanisms. This paper discusses the interdisciplinary contributions to developing a health education program while also looking at the need for greater beneficiary ownership and implementation of health justice and access. Methods: In March 2016, an interdisciplinary group of medical, legal, and business graduate students and faculty from Northwestern University conduced a Health Needs Assessment (HNA) in Lagos with a partner and a local non-governmental organization. The HNA revealed that members of informal urban communities in Lagos were lacking basic health literacy, but desired to remedy this lacuna. Further, the HNA revealed that even where the government mandates specific services, many vulnerable populations are unable to access these services. The HNA concluded that a program focused on education, advocacy, and organizing around anatomy, maternal and sexual health, infectious disease and malaria, HIV/AIDS, emergency care, and water and sanitation would respond to stated needs while also building capacity in communities to address health barriers. Results: Based on the HNA, including both primary and secondary source research on integrated health education approaches and behavior change models and responsive, adaptive material development, a holistic program was developed for the Lagos partners and first implemented in November 2016. This program trained community-nominated health educators in adult, low-literacy, knowledge exchange approaches, utilizing information identified by communities as a priority. After a second training in March 2017, these educators will teach community-based groups and will support and facilitate behavior change models and peer-support methods around basic issues like hand washing and disease transmission. They will be supported by community paralegals who will help ensure that newly trained community groups can act on education around access, such as receiving free vaccinations, maternal health care, and HIV/AIDS medicines. Materials will continue to be updated as needs and issues arise, with a focus on identifying best practices around health improvements that can be shared across these partner communities. Conclusion: These materials are the first of their kind, and address a void of health information and understanding pervasive in informal-urban Lagos communities. Initial feedback indicates high levels of commitment and interest, as well as investment by communities in these materials, largely because they are responsive, targeted, and build community capacity. This methodology is an important step in dignity-based health justice solutions, albeit in the process of refinement.

Keywords: community health educators, interdisciplinary and cross cultural partnerships, health justice and access, Nigeria

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Authors: Nouf Al Harthi

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Venous thromboembolism (VTE) is one of the most common causes of hospital-related deaths in critically ill patients. Guidelines recommended VTE prophylaxis with standardized, fixed doses for most patients. The underweight population has limited data to guide the appropriate drug and dosing regimen. The aim of this study was to describe the pattern of VTE prophylaxis dose regimens for underweighted critically ill adult patients and the prevalence of associated VTE and bleeding. This study is a retrospective cohort study, conducted in King Abdulaziz Medical City, Saudi Arabia. It included all critical patients admitted to the intensive care units and were above 14 years old with weight less than 50 kg or BMI of 18.5 kg/m2 or less and were on heparin as VTE prophylaxis for more than 72 hours from January 2016 until January 2020. After screening 270 patients, only 40 patients were included in this study according to our inclusion and exclusion criteria. Only 6 patients (15%) received VTE prophylaxis as an adjusted dose of heparin 2500 U Q12, while the rest of the patients were taking standard dosing of heparin, 5000 U Q12 was given to 21 (52.50%) patients and 5000 U Q8 was given to 13 (32.50%) patients. None of the adjusted doses developed any complications such as VTE or bleeding. There was no significant difference compared with the standard dose group. This study focused on describing the pattern of heparin doses as VTE prophylaxis in underweight patients. We also compared the standard dosing and adjusted dosage of VTE prophylaxis on underweight patients and any complications. There was no significant difference in the complication’s outcome or benefits between the two groups.

Keywords: venous thromboembolism prophylaxis, heparin, underweight patients, adult, critical care units

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Authors: Pin Yu Chen, Puay Chuan Lee, Yu Jen Loo, Ju Xia Zhang, Deborah Teo, Jack Wei Chieh Tan, Biauw Chi Ong

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Background: Synchronous communication, such as telephone calls, remains the standard communication method between nurses and other healthcare professionals in Singapore public hospitals despite advances in asynchronous technological platforms, such as instant messaging. Although miscommunication is one of the most common causes of lapses in patient care, there is a scarcity of research characterizing baseline inter-professional healthcare communications in a hospital setting due to logistic difficulties. Objective: This study aims to characterize the frequency and patterns of communication behaviours among healthcare professionals. Methods: The one-week observational study was conducted on Monday through Sunday at the nursing station of a cardiovascular medicine and cardiothoracic surgery inpatient ward at the National Heart Centre Singapore. Subjects were shadowed by two physicians for sixteen hours or consecutive morning and afternoon nursing shifts. Communications were logged and characterized by type, duration, caller, and recipient. Results: A total of 1,023 communication events involving the attempted use of the common telephones at the nursing station were logged over a period of one week, corresponding to a frequency of one event every 5.45 minutes (SD 6.98, range 0-56 minutes). Nurses initiated the highest proportion of outbound calls (38.7%) via the nursing station common phone. A total of 179 face-to-face communications (17.5%), 362 inbound calls (35.39%), 481 outbound calls (47.02%), and 1 emergency alert (0.10%) were captured. Average response time for task-oriented communications was 159 minutes (SD 387.6, range 86-231). Approximately 1 in 3 communications captured aimed to clarify patient-related information. The total duration of time spent on synchronous communication events over one week, calculated from total inbound and outbound calls, was estimated to be a total of 7 hours. Conclusion: The results of our study showed that there is a significant amount of time spent on inter-professional healthcare communications via synchronous channels. Integration of patient-related information and use of asynchronous communication channels may help to reduce the redundancy of communications and clarifications. Future studies should explore the use of asynchronous mobile platforms to address the inefficiencies observed in healthcare communications.

Keywords: healthcare communication, healthcare management, nursing, qualitative observational study

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Authors: Umran Erciyes, Filiz Okumus

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The purpose of this study was the determination of factors which impact the pregnancy, birth experience and the opinions regarding the delivery type of the puerperants, after vaginal birth. This descriptive study includes 349 patients who gave births with normal birth in one of the hospital in İstanbul in May- November 2014. After birth, we interview with these women face to face. The descriptive information form and Perception of Birth Scale were used as data collection tool. SPSS (Statistical Package for the Social Sciences) was used for statistical analysis. The average age of patients was 27.13, and the average score was 76.93±20.22. The patients are primary school graduate, and they do not have a job. They expressed an income outcome equality. More than half of women did not get educated before birth. Among educated patients, few women got educated overcoming the pain during labor process. As the time spent in the hospital for the birth increases, the birth perception of mothers is affected negatively. %86.8 of participants gave assisted delivery. Spontaneous vaginal birth has positive effects on birth perception. Establishing a vascular access, induction of labor performing enema, restriction of orally intake and movement, fundal pressure, episiotomy, nor to perform skin to skin contact with the baby after birth has adverse effects on the birth perceptions.

Keywords: antenatal care, birth experience, perception of birth, vaginal birth

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Authors: N. Varsamis, M. Gerasimou, P. Christodoulou, S. Mantzoukis, G. Kolliopoulou, N. Zotos

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Purpose: Body fluids (pleural, peritoneal, synovial, pericardial, cerebrospinal) are an important element in the detection of microorganisms. For this reason, it is important to examine them in the Intensive Care Unit (ICU) patients. Material and Method: Body fluids are transported through sterile containers and enriched as soon as possible with Tryptic Soy Broth (TSB). After one day of incubation, the broth is poured into selective media: Blood, Mac Conkey No. 2, Chocolate, Mueller Hinton, Chapman and Saboureaud agar. The above selective media are incubated directly for 2 days. After this period, if any number of microbial colonies are detected, gram staining is performed. After that, the isolated organisms are identified by biochemical techniques in the automated Microscan system (Siemens) and followed by a sensitivity test on the same system using the minimum inhibitory concentration MIC technique. The sensitivity test is verified by Kirby Bauer-based plate test. Results: In 2017 the Laboratory of Microbiology received 60 samples of body fluids from the ICU. More specifically the Microbiology Department received 6 peritoneal fluid specimens, 18 pleural fluid specimens and 36 cerebrospinal fluid specimens. 36 positive cultures were tested. S. epidermidis was identified in 18 specimens, S. haemolyticus in 6, and E. faecium in 12. Conclusions: The results show low detection of microorganisms in body fluid cultures.

Keywords: body fluids, culture, intensive care unit, microorganisms

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Authors: Franklin Chu Buh, Irene Ule Ngole Sumbele, Andrew I. R. Maas, Mathieu Motah, Jogi V. Pattisapu, Eric Youm, Basil Kum Meh, Firas H. Kobeissy, Kevin W. Wang, Peter J. A. Hutchinson, Germain Sotoing Taiwe

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Introduction: Studying TBI characteristics and their relation to outcomes can identify initiatives to improve TBI prevention and care. The objective of this study was to define the features and outcomes of TBI patients seen over a 1-year period in a level-I trauma center in Cameroon. Methods: Data on demographics, causes, injury mechanisms, clinical aspects, and discharge status were prospectively collected over a period of 12 months. The Glasgow Outcome Scale-Extended (GOSE) and the Quality of Life Questionnaire after Brain Injury (QoLIBRI) were used to evaluate outcomes 6-months after TBI. Categorical variables were described as frequencies and percentages. Comparisons between 2 categorical variables were done using Pearson's Chi-square test or Fisher's exact test. Results: A total of 160 TBI patients participated in the study. The age group 15-45 years (78%; 125) was most represented. Males were more affected (90%; 144). Low educational level was recorded in 122 (76%) cases. Road traffic incidents (RTI) were the main cause of TBI (85%), with professional bike riders being frequently involved (27%, 43/160). Assaults (7.5%) and falls (2.5%) represent the second and third most common causes of TBI in Cameroon, respectively. Only 15 patients were transported to the hospital by ambulance, and 14 of these were from a referring hospital. CT-imaging was performed in 78% (125/160) of cases intracranial traumatic abnormality was identified in 77/125 (64%) cases. Financial constraints were the main reason for not performing a CT scan on 35 patients. A total of 46 (33%) patients were discharged against medical advice (DAMA) due to financial constraints. Mortality was 14% (22/160) but disproportionately high in patients with severe TBI (46%). DAMA had poor outcomes with QoLIBRI. Only 4 patients received post-injury physiotherapy services. Conclusion: TBI in Cameroon mainly results from RTIs and commonly affects young adult males, and low educational or socioeconomic status and commercial bike riding appear to be predisposing factors. Lack of pre-hospital care, financial constraints limiting both CT-scanning and medical care, and lack of acute physiotherapy services likely influenced care and outcomes adversely.

Keywords: characteristics, traumatic brain injury, outcome, disparities in care, prospective study

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Authors: Jefrey Pilusa, Tumisang Seodigeng

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This research discusses a South African case study for the potential of utilizing refuse-derived fuel (RDF) obtained from non-burn treatment of health care risk waste (HCRW) as potential feedstock for green energy production. This specific waste stream can be destroyed via non-burn treatment technology involving high-speed mechanical shredding followed by steam or chemical injection to disinfect the final product. The RDF obtained from this process is characterised by a low moisture, low ash, and high calorific value which means it can be potentially used as high-value solid fuel. Due to the raw feed of this RDF being classified as hazardous, the final RDF has been reported to be non-infectious and can blend with other combustible wastes such as rubber and plastic for waste to energy applications. This study evaluated non-burn treatment technology as a possible solution for on-site destruction of HCRW in South African private and public health care centres. Waste generation quantities were estimated based on the number of registered patient beds, theoretical bed occupancy. Time and motion study was conducted to evaluate the logistics viability of on-site treatment. Non-burn treatment technology for HCRW is a promising option for South Africa, and successful implementation of this method depends upon the initial capital investment, operational cost and environmental permitting of such technology; there are other influencing factors such as the size of the waste stream, product off-take price as well as product demand.

Keywords: autoclave, disposal, fuel, incineration, medical waste

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Authors: Sina Keyhanian, Abbas Ahmadi, Behrooz Karimi

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We present a multi-objective binary programming model which considers surgical cases are scheduling among operating rooms and the configuration of surgical instruments in limited capacity hospital trays, simultaneously. Many mathematical models have been developed previously in the literature addressing different challenges in health-care logistics such as assigning operating rooms, leveling beds, etc. But what happens inside the operating rooms along with the inventory management of required instruments for various operations, and also their integration with surgical scheduling have been poorly discussed. Our model considers the minimization of movements between trays during a surgery which recalls the famous cell formation problem in group technology. This assumption can also provide a major potential contribution to robotic surgeries. The tray configuration problem which consumes surgical instruments requirement plan (SIRP) and sequence of surgical procedures based on required instruments (SIRO) is nested inside the bin packing problem. This modeling approach helps us understand that most of the same-output solutions will not be necessarily identical when it comes to the rearrangement of surgeries among rooms. A numerical example has been dealt with via a proposed nested simulated annealing (SA) optimization approach which provides insights about how various configurations inside a solution can alter the optimal condition.

Keywords: health-care logistics, hospital tray configuration, off-line bin packing, simulated annealing optimization, surgical case scheduling

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Authors: Genevieve R. Kan, Jolyon Ford

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Background: Caesarean section has become the routine route of delivery for breech fetuses, but breech cesarean deliveries are hypothesized to have poorer immediate neonatal outcomes when compared to cephalic deliveries. In accordance with this, in many Australian hospitals, the pediatric team is routinely required to attend every elective breech cesarean section in case urgent resuscitation is required. Our study aimed to determine whether term elective breech deliveries indeed had worse immediate neonatal outcomes at delivery, which will justify the necessity of pediatric staff presence at every elective breech cesarean delivery and influence the workload for the pediatric team. Objective: Elective breech cesarean deliveries were compared to elective cephalic cesarean deliveries at 37 weeks gestation or above to evaluate the immediate neonatal outcomes (Apgar scores <7 at 5 minutes, and Special Care Nursery admissions on Day 1 of life) of each group. Design: A retrospective cohort study Method: This study examined 2035 elective breech and cephalic singleton cesarean deliveries at term over 5 years from July 2017 to July 2022 at Frankston Hospital, a metropolitan hospital in Melbourne, Australia. There were 260 breech deliveries and 1775 cephalic deliveries. De-identified patient data were collected retrospectively from the hospital’s electronically integrated pregnancy and birth records to assess demographics and neonatal outcomes. Results: Apgar scores <7 at 5 minutes of life were worse in the breech group compared to the cephalic group (3.4% vs 1.6%). Special Care Nursery admissions on Day 1 of life were also higher for the breech cohort compared to the cephalic cohort (9.6% vs 8.7%). Conclusions: Our results support the expected findings that breech deliveries are associated with worse immediate neonatal outcomes. It, therefore, suggests that routine attendance at elective breech cesarean deliveries by the pediatric team is indeed required to assist with potentially higher needs for neonatal resuscitation and special care nursery admission.

Keywords: breech, cesarean section, Apgar scores, special care nursery admission

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Authors: Anthony Townsend, Robyn Fasser

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While complete objectivity is a desirable scientific position from which to conduct a care and contact evaluation (CCE), it is precisely the recognition that we are inherently incapable of operating objectively that is the foundation of ethical practice and skilled assessment. Drawing upon recent research from Daniel Kahneman (2021) on the differences between noise and bias, as well as different inherent biases collectively termed “The Elephant in the Brain” by Kevin Simler and Robin Hanson (2019) from Oxford University, this presentation addresses both the various ways in which our judgments, perceptions and even procedures can be distorted and contaminated while conducting a CCE, but also considers the value of second order cybernetics and the psychodynamic concept of ‘ambivalence’ as a conceptual basis to inform our assessment methodologies to limit such errors or at least better identify them. Both a conceptual framework for ambivalence, our higher-order capacity to allow for the convergence and consideration of multiple emotional experiences and cognitive perceptions to inform our reasoning, and a practical methodology for assessment relying on data triangulation, Bayesian inference and hypothesis testing is presented as a means of promoting ethical practice for health care professionals conducting CCEs. An emphasis on widening awareness and perspective, limiting ‘splitting’, is demonstrated both in how this form of emotional processing plays out in alienating dynamics in families as well as the assessment thereof. In addressing this concept, this presentation aims to illuminate the value of ambivalence as foundational to ethical practice for assessors.

Keywords: ambivalence, forensic, psychology, noise, bias, ethics

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Authors: Saira Mehnaz, Ali Jafar Abedi, Shazia Farooq Fazli, Sakeena Mushfiq, Zulfia Khan, M. Athar Ansari

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Introduction: Public health spending is a necessity in an underdeveloped country like India. The people are already suffering from poverty and that clubbed with out of pocket expenditure leads them to a very catastrophic situation, reducing the overall access to healthcare. Objectives: This study was designed to determine the usual source of medical care opted, the illness pattern, the expenditure incurred on illness and its source of procurement by the study population. It also intended to assess this expenditure as a determinant of access to health care. Methodology: Cities like Aligarh, which are classified as B grade cities in India are thought to be ripe sites for getting livelihood and hence are almost half filled with migrants living in urban slums. A cross sectional study was done to study the newer slum pockets. 3409 households with a population of 16,978 were studied with the help of pretested questionnaire; SPSS 20 was used for statistical analysis. Results and Conclusions: In our study, we found that almost all the households suffered from catastrophic health expenditure. The study population, which was already vulnerable owing to their low socio-economic and migrant status was further being forced with into poverty and indebtedness on account of expenditure on illness. This lead to a significant decrease in access to health. National health financing systems should be designed to protect households from financial catastrophe, by reducing out-of-pocket spending.

Keywords: access to healthcare, catastrophic health expenditure, new urban slums, out of pocket expenditure

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Authors: Yuthapoom Thanakijborisut

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This paper studies consumption insurance against the chronic illness in Thailand. The study estimates the impact of household consumption in the chronic illness on consumption growth. Chronic illness is the health care costs of a person or a household’s decision in treatment for the long term; the causes and effects of the household’s ability for smooth consumption. The chronic illnesses are measured in health status when at least one member within the household faces the chronic illness. The data used is from the Household Social Economic Panel Survey conducted during 2007 and 2012. The survey collected data from approximately 6,000 households from every province, both inside and outside municipal areas in Thailand. The study estimates the change in household consumption by using an ordinary least squares (OLS) regression model. The result shows that the members within the household facing the chronic illness would reduce the consumption by around 4%. This case indicates that consumption insurance in Thailand is quite sufficient against chronic illness.

Keywords: consumption insurance, chronic illness, health care, Thailand

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Authors: A. Erragh, K. Amanzoui, M. Elharit, H. Salem, M. Ababneh, K. Elfakhr, S. Kalouch, A. Chlilek

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Guillain-Barre syndrome (GBS) is the most common form of acute polyradiculoneuritis (PRNA). It is a medical emergency in pediatrics that requires rapid diagnosis and immediate assessment of the severity criteria for the implementation of appropriate treatment. Retrospective, descriptive study in 24 patients under the age of 18 who presented with GBS between September 2017 and July 2021 and were hospitalized in the multipurpose pediatric intensive care unit of the Abderrahim EL Harouchi children's hospital in Casablanca. The average age was 7.91 years, with extremes ranging from 18 months and 14 years and a male predominance of 75%. After a prodromal event, most often infectious (80%) and a free interval of 12 days on average, 2 types of motor disorders begin either hypo or arereflectic flaccid paralysis of the lower limbs (45.8%) or flaccid quadriplegia hypo or arereflectic (54.2%). During GBS, the most formidable complication is respiratory distress, which can occur at any time. In our study, respiratory impairment was observed in 70.8% of cases. In addition, other signs of severity, such as swallowing disorders (75%) and dysautonomic disorders (8.33%), were also observed, which justified care in the intensive care unit for all of our patients. The use of invasive ventilation was necessary in 76.5% of cases, and specific treatments based on immunoglobulins were administered in all our patients. Despite everything, the death rate remains high (25%) and is mainly due to complications related to hospitalization. Guillain Barré syndrome is, therefore, a pediatric emergency that requires rapid diagnosis and immediate assessment of severity criteria for the implementation of appropriate treatment.

Keywords: guillain barre syndrome, emergency, children, medical

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Authors: Gabriela Wasileski, Debra L. Stanley

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Maryland efforts to decrease the juvenile criminality and recidivism shifts towards evidence based sentencing. While in theory the evidence based sentencing has an impact on the reduction of juvenile delinquency and drug abuse; the assessment of juveniles’ risk and needs usually lacks crucial information about juvenile’s prior victimization. The Maryland Comprehensive Assessment and Service Planning (MCASP) Initiative is the primary tool for developing and delivering a treatment service plan for juveniles at risk. Even though it consists of evidence-based screening and assessment instruments very little is currently known regarding the effectiveness and the impact of the assessment in general. In keeping with Maryland’s priority to develop successful evidence-based recidivism reduction programs, this study examined results of assessments based on MCASP using a representative sample of the juveniles at risk and their assessment results. Specifically, it examined: (1) the results of the assessments in an electronic database (2) areas of need that are more frequent among delinquent youth in a system/agency, (3) the overall progress of youth in an agency’s care (4) the impact of child victimization and trauma experiences reported in the assessment. The project will identify challenges regarding the use of MCASP in Maryland, and will provide a knowledge base to support future research and practices.

Keywords: Juvenile Justice, assessment of risk and need, victimization and crime, recidivism

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Authors: Phang Moon Leng

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Automated Early Warning Scores is a newly developed clinical decision tool that is used to streamline and improve the process of obtaining a patient’s vital signs so a clinical decision can be made at an earlier stage to prevent the patient from further deterioration. This technology provides immediate update on the score and clinical decision to be taken based on the outcome. This paper aims to study the use of an automated early warning score system on whether the technology has assisted the hospital in early detection and escalation of clinical condition and improve patient outcome. The hospital adopted the Modified Early Warning Scores (MEWS) Scoring System and MEWS Clinical Response into Philips IntelliVue Guardian Automated Early Warning Score equipment and studied whether the process has been leaned, whether the use of technology improved the usage & experience of the nurses, and whether the technology has improved patient care and outcome. It was found the steps required to obtain vital signs has been significantly reduced and is used more frequently to obtain patient vital signs. The number of deaths, and length of stay has significantly decreased as clinical decisions can be made and escalated more quickly with the Automated EWS. The automated early warning score equipment has helped improve work efficiency by removing the need for documenting into patient’s EMR. The technology streamlines clinical decision-making and allows faster care and intervention to be carried out and improves overall patient outcome which translates to better care for patient.

Keywords: automated early warning score, clinical quality and safety, patient safety, medical technology

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Authors: Habtamu Wolde Engudai

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Background: Sedation can be provided to facilitate a procedure or to stabilize patients admitted in pediatric intensive care unit (PICU). Sedation is often necessary to maintain optimal care for critically ill children requiring mechanical ventilation. However, if sedation is too deep or too light, it has its own adverse effects, and hence, it is important to monitor the level of sedation and maintain an optimal level. Objectives: The objective is to assess the level of sedation and associated factors among intubated critically ill children admitted to PICU of JUMC, Jimma. Methods: A prospective observation study was conducted in the PICU of JUMC in September 2021 in 105 patients who were going to be admitted to the PICU aged less than 14 and with GCS >8. Data was collected by residents and nurses working in PICU. Data entry was done by Epi data manager (version 4.6.0.2). Statistical analysis and the creation of charts is going to be performed using SPSS version 26. Data was presented as mean, percentage and standard deviation. The assumption of logistic regression and the result of the assumption will be checked. To find potential predictors, bi-variable logistic regression was used for each predictor and outcome variable. A p value of <0.05 was considered as statistically significant. Finally, findings have been presented using figures, AOR, percentages, and a summary table. Result: in this study, 105 critically ill children had been involved who were started on continuous or intermittent forms of sedative drugs. Sedation level was assessed using a comfort scale three times per day. Based on this observation, we got a 44.8% level of suboptimal sedation at the baseline, a 36.2% level of suboptimal sedation at eight hours, and a 24.8% level of suboptimal sedation at sixteen hours. There is a significant association between suboptimal sedation and duration of stay with mechanical ventilation and the rate of unplanned extubation, which was shown by P < 0.05 using the Hosmer-Lemeshow test of goodness of fit (p> 0.44).

Keywords: level of sedation, critically ill children, Pediatric intensive care unit, Jimma university

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Authors: Marwa Hanafy

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The objective of linking the museum with school curriculum is to focus on the values and principles of the educational standards of the fourth grade as "equality, cooperation, allegiance, belonging, participation, peace, tolerance, pride and patriotism, etc." through activities, discussion, exhibits, etc., which can help the students to develop their characters and be useful for their society. For example, there is a lesson in Module 3 assess the role of women as mothers and queens, here this research will focus on the value of women and respect them through statues or images of women which support and affect positively on the students who will apply these Morals to themselves and to the community by dependency. It cannot be denied that the students have to be a part of the museum educational programs which have designed for them, by giving them the opportunity to participate, talk, discuss and express their opinions and hear them in the museums, this may be an effective way to confirm that the interests of children are taken into account.

Keywords: museum education, primary school education, school curriculum, informal learning

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Authors: Thandeka Y. S. Jwara, Paul Musonge

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Traditionally, the complexity associated with implementing and controlling biological nutrient removal (BNR) in wastewater works (WWW) has been primarily in terms of balancing competing requirements for nitrogen and phosphorus removal, particularly with respect to the use of influent chemical oxygen demand (COD) as a carbon source for the microorganisms. Successful BNR optimization and modelling using WEST (Worldwide Engine for Simulation and Training) depend largely on the accurate fractionation of the influent COD. The different COD fractions have differing effects on the BNR process, and therefore, the influent characteristics need to be well understood. This study presents the fractionation results of primary wastewater effluent COD at one of South Africa’s wastewater works treating 65ML/day of mixed industrial and domestic effluent. The method used for COD fractionation was the oxygen uptake rate/respirometry method. The breakdown of the results of the analysis is as follows: 70.5% biodegradable COD (bCOD) and 29.5% of non-biodegradable COD (iCOD) in terms of the total COD. Further fractionation led to a readily biodegradable soluble fraction (SS) of 75%, a slowly degradable particulate fraction (XS) of 24%, a particulate non-biodegradable fraction (XI) of 50.8% and a non-biodegradable soluble fraction (SI) of 49.2%. The fractionation results demonstrate that the primary effluent has good COD characteristics, as shown by the high level of the bCOD fraction with Ss being higher than Xs. This means that the microorganisms have sufficient substrate for the BNR process and that these components can now serve as inputs to the WEST Model for the plant under study.

Keywords: chemical oxygen demand, COD fractionation, wastewater modelling, wastewater optimization

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Authors: Nidhal K. Azawi, John M. Gauch

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Colorectal cancer is one of the leading causes of cancer death in the US and the world, which is why millions of colonoscopy examinations are performed annually. Unfortunately, noise, specular highlights, and motion artifacts corrupt many images in a typical colonoscopy exam. The goal of our research is to produce automated techniques to detect and correct or remove these noninformative images from colonoscopy videos, so physicians can focus their attention on informative images. In this research, we first automatically extract features from images. Then we use machine learning and deep neural network to classify colonoscopy images as either informative or noninformative. Our results show that we achieve image classification accuracy between 92-98%. We also show how the removal of noninformative images together with image alignment can aid in the creation of image panoramas and other visualizations of colonoscopy images.

Keywords: colonoscopy classification, feature extraction, image alignment, machine learning

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Authors: Ali Kuzu

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There are about 800 thousand chemicals in our environment and the number is increasing more than a thousand every year. While most of these chemicals are used as components in various consumer products, some are faced as industrial waste in the environment. Unfortunately, many of these chemicals are hazardous and affect humans. According to the “International Program on Chemical Safety” of World Health Organization; Among the chronic health effects of chemicals, cancer is of major concern. Many substances have found in recent years to be carcinogenic in one or more species of laboratory animals. Especially with respect to long-term effects, the response to a chemical may vary, quantitatively or qualitatively, in different groups of individuals depending on predisposing conditions, such as nutritional status, disease status, current infection, climatic extremes, and genetic features, sex and age of the individuals. Understanding the response of such specific risk groups is an important area of toxicology research. People with age 65+ is defined as “aged (or elderly)”. The elderly population in the world is about 600 million, which corresponds to ~8 percent of the world population. While every 1 of each 4 people is aged in Japan, the elderly population is quite close to 20 percent in many developed countries. And elderly population in these countries is growing more rapidly than the total population. The negative effects of chemicals on elderly take an important place in health-care related issues in last decades. The aged population is more susceptible to the harmful effects of environmental chemicals. According to the poor health of the organ systems in elderly, the ability of their body to eliminate the harmful effects and chemical substances from their body is also poor. With the increasing life expectancy, more and more people will face problems associated with chemical residues.

Keywords: elderly, chemicals’ effects, aged care, care need

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