Search results for: national family health survey-4

Authors: Addisu Tadesse Sahile, Mussie Wubshet Teka, Solomon Muluken Ayehu

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Background: Diabetes is one of the common public health problems of the century that was estimated to affect one in a tenth of the world population by the year 2030, where diabetes ketoacidosis is one of its common acute complications. Objectives: The aim of this review was to assess the magnitude of diabetes ketoacidosis among patients with type 1 diabetes in Ethiopia. Methods: A systematic data search was done across Google Scholar, PubMed, Web of Science, and African Online Journals. Two reviewers carried out the selection, reviewing, screening, and extraction of the data independently by using a Microsoft Excel Spreadsheet. The Joanna Briggs Institute's prevalence critical appraisal tool was used to assess the quality of evidence. All studies conducted in Ethiopia that reported diabetes ketoacidosis rates among type 1 diabetes were included. The extracted data was imported into the comprehensive meta-analysis version 3.0 for further analysis. Heterogeneity was checked by Higgins’s method, whereas the publication bias was checked by using Beggs and Eggers’s tests. A random-effects meta-analysis model with a 95% confidence interval was computed to estimate the pooled prevalence. Furthermore, subgroup analysis based on the study area (Region) and the sample size was carried out. Result and Conclusion: After review made across a total of 51 articles, of which 12 articles fulfilled the inclusion criteria and were included in the meta-analysis. The pooled prevalence of diabetes ketoacidosis among type 1 diabetes in Ethiopia was 53.2% (95%CI: 43.1%-63.1%). The highest prevalence of DKA was reported in the Tigray region of Ethiopia, whereas the lowest was reported in the Southern region of Ethiopia. Concerned bodies were suggested to work on the escalated burden of diabetes ketoacidosis in Ethiopia.

Keywords: DKA, Type 1 diabetes, Ethiopia, systematic review, meta-analysis

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Authors: Dimphna Ezikanyi, Gloria Sakwari

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Airborne pollen and fungal spores are major triggers of allergies, and their abundance and seasonality depend on plant responses to climatic and meteorological variables. A survey of seasonal prevalence of airborne pollen and fungal spores in Nsukka, Enugu, South- East Nigeria and relationship to climatic variables were carried out from Jan-June, 2017. The aim of the study was to access climate change and variability over time in the area and their accrued influence on modern pollen and spores rain. Decadal change in climate was accessed from variables collected from meteorological centre in the study area. Airborne samples were collected monthly using a modified Tauber-like pollen samplers raised 5 ft above ground level. Aerosamples collected were subjected to acetolysis. Dominant pollen recorded were those of Poaceae, Elaeis guinensis Jacq. and Casuarina equisetifolia L. Change in weather brought by onset of rainfall evoked sporulation and dispersal of diverse spores into ambient air especially potent allergenic spores with the spores of Ovularia, Bispora, Curvularia, Nigrospora, Helminthosporium preponderant; these 'hydrophilic fungi' were abundant in the rainy season though in varying quantities. Total fungal spores correlated positively with monthly rainfall and humidity but negatively with temperature. There was a negative though not significant correlation between total pollen count and rainfall. The study revealed a strong influence of climatic variables on abundance and spatial distribution of pollen and fungal spores in the ambient atmosphere.

Keywords: allergy, fungal spores, pollen, weather parameters

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Authors: Ahmed Assem Abd El Rahim

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Background: Mechanical low back pain is serious physical and social health problem. Purpose: To examine impact of shock wave therapy versus intermittent mechanical traction on mechanical LBP, and disabilities. Subjects: 60 mechanical LBP male studied cases years old 20-35 years were assigned randomly into 3 groups, Picked up from Sohag university orthopedic hospital outpatient clinic. Methods: (Study Group) A: 20 studied cases underwent shock wave therapy plus conventional physical therapy. (Study Group) B: twenty studied cases underwent intermittent mechanical traction plus conventional physical therapy. (Control Group) C: 20 patients underwent conventional physical therapy alone. Three sessions were applied weekly for four weeks. Pain was quantified using McGill Pain Questionnaire, Roland Morris Disability Questionnaire was used for measuring disability, and the ROM was evaluated by (BROM) device pre- & post-therapy. Results: Groups (A, B & C) found a reduction in pain & disability & rise in their in flexion and extension ROM after end of 4 weeks of program. Mean values of pain scale after therapy were 15.3, 9.47, and 23.07 in groups A, B, & C. mean values of Disability scale after therapy were 8.44, 4.87, 11.8in groups A, B & C. mean values of ROM of flexion were 25.53, 29.06, & 23.9 in groups A, B & C. mean values of ROM of extension were 11.73, 15.53 & 9.85 in groups A, B & C. studied cases who received intermittent mechanical traction & conventional physical therapy (group B), found reduction in pain & disability & improvement in ROM of flexion & extension value (P<0.001) after therapy program. Conclusion: Shock wave therapy and intermittent mechanical traction, as well as conventional physical treatment, can be beneficial in studied cases with mechanical LBP.

Keywords: mechanical low back pain, shock wave, mechanical, low back pain

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Authors: Elizabeth Farquhar, Erich Ritter

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Studying shark's interaction with humans and their behavioral responses will have enormous implications for other fields of marine biology and oceanography. The health of sharks has direct impacts on the stability of human society with a reported 3.5 billion people depending on the ocean for food and/or livelihood. Discovering how sharks behave and interact with people, will have enormous implications for future studies, along with the development of more effective ways to reduce negative shark/human interactions. This specific study investigates the effects of contrasting ponchos worn by divers on the approach distances of Carcharhinus perezi. Data was collected over a two week period at a test site off the shore of Eleuthera Island in the Bahamas, with a depth of approximately 55 feet during mid-August. Sixty-minute dive trials were conducted and videoed from above with 5-meter radius markers on the ocean floor surrounding the two divers, kneeling back-to-back. Five poncho colors were worn by the two divers (black, navy blue, dark green, yellow and orange), rotating the color permutations randomly to test the distance a shark will approach each color. Results indicate significantly closer approach patterns when divers were wearing orange ponchos, and the combination of orange with black and blue ponchos were found to be statistically significant. These results are relevant to understanding how sharks perceive contrast and dive equipment in the marine environment, which could have the potential to prevent negative shark/human interactions.

Keywords: shark behavior, animal behavior, marine biology, conservation

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Authors: Kedir Teji Roba, Thomas P. O’Connor, Tefera Belachew, Nora M. O’Brien

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Micronutrient deficiencies of ferritin, zinc and haemoglobin are prevalent among the mothers and their infants in developing countries. But little attention has been given to these vulnerable groups. No study has been done on co-existence of the deficiencies among lactating mothers and their breast feeding infants in two different agro-ecological zones of rural Ethiopia. Methods: Data were collected from 162 lactating mothers and their breast feeding infants (aged 6-23 months) who were living in two different agro-ecological zones. The data were collected via a structured interview, anthropometric measurements, and blood test for Zinc, ferritin and anaemia. Correlation and Chi square test were used to determine the association among nutritional status and agro ecological zones. Results: Iron deficiency was found in 44.4% of the infants and 19.8% of the mothers. Zinc deficiency was found in 72.2% of the infants and 67.3% of the mothers. Of the study subject 52.5% of the infants and 19.1% of the mothers were anaemic, and 29.6% of the infants and 10.5% of the mothers had iron deficiency anaemia. Among the mothers with iron deficiency, 81.2% and 56.2% of their children were deficient in zinc and iron respectively. Similarly, among the zinc deficient mothers, 75.2% and 45.3% of their children were deficient in zinc and iron. There was a strong correlation between the micronutrient status of the mothers and the infants on status of ferritin, zinc and anaemia (P < 0.001). There is also statistically significant association between micronutrient deficiency and agro-ecological zones among the mothers (p < 0.001) but not with their infants. Deficiency in one, two, or three, micronutrients was observed in 48.1%, 16.7% and 9.9% of the mothers and 35.8%, 29.0%, and 23.5%, of their infants respectively. Conclusion: This study shows that iron and zinc deficiencies are the prevalent micronutrient deficiencies among the lactating mothers and their infants, with variation of the magnitude across the agro-ecological zones. This finding calls for a need to design effective preventive public health nutrition programs to address both the mothers’ and their infants’ needs.

Keywords: ferritin/iron, zinc, anaemia, agroecology, malnutrition

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Authors: Harish Bisht, Bahadur Singh Kotlia, Kireet Kumar

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In order to reconstruct past retreating rates, total area loss, volume change and shift in snout position were measured through multi-temporal satellite data from 1989 to 2016 and kinematic GPS survey from 2015 to 2016. The results obtained from satellite data indicate that in the last 27 years, Chaturangi glacier snout has retreated 1172.57 ± 38.3 m (average 45.07 ± 4.31 m/year) with a total area and volume loss of 0.626 ± 0.001 sq. Km and 0.139 Km³, respectively. The field measurements through differential global positioning system survey revealed that the annual retreating rate was 22.84 ± 0.05 m/year. The large variations in results derived from both the methods are probably because of higher difference in their accuracy. Snout monitoring of the Gangotri glacier during the ablation season (May to September) in the years 2005 and 2015 reveals that the retreating rate has been comparatively more declined than that shown by the earlier studies. The GPS dataset shows that the average recession rate is 10.26 ± 0.05 m/year. In order to determine the possible causes of decreased retreating rate, a relationship between debris thickness and melt rate was also established by using ablation stakes. The present study concludes that remote sensing method is suitable for large area and long term study, while kinematic GPS is more appropriate for the annual monitoring of retreating rate of glacier snout. The present study also emphasizes on mapping of all the tributary glaciers in order to assess the overall changes in the main glacier system and its health.

Keywords: Chaturangi glacier, Gangotri glacier, glacier snout, kinematic global positioning system, retreat rate

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Authors: Nicolas Georges, Akiki Simon, Bassil Naim, Nawfal Georges, Abi Fares Georges

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Introduction: Dyslipidemia has been recognized as a risk factor for cardiovascular diseases. While the development of atherosclerotic lesions begins in childhood and progresses throughout life, data on the prevalence of dyslipidemic children in Lebanon is lacking. Objectives: This study was conducted to assess the benefit of a protocol for universal screening for lipid disorder in Lebanese children aged between two and ten years old. Materials and Methods: A total of four hundred children aged 2 to 10 years old (51.5% boys) were included in the study. The subjects were recruited from private pediatric clinics after parental consent. Fasting total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL) levels were measured and non-HDL cholesterol was calculated. The values were categorized according to 2011 Expert on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. Results: The overall prevalence of high TC ( ≥ 200 mg/dL), high non-HDL-C ( ≥ 145 mg/dL), high LDL ( ≥ 130 mg/dL), high TG ( ≥ 100 mg/dL) and low HDL ( < 40 mg/dL) was respectively 19.5%, 23%, 19%, 31.8% and 20%. The overall frequency of dyslipidemia was 51.7%. In a bivariate analysis, dyslipidemia in children was associated with a BMI ≥ 95ᵗʰ percentile and parents having TC > 240 mg/dL with a P value respectively of 0.006 and 0.0001. Furthermore, high TG was independently associated with a BMI ≥ 95ᵗʰ percentile (P=0.0001). Children with parents having TC > 240 mg/dL was significantly correlated with high TC, high non-HDL-C and high LDL (P=0.0001 for all variables). Finally, according to the Pediatric dyslipidemia screening guidelines from the 2011 Expert Panel, 62.3% of dyslipidemic children had at least 1 risk factor that qualified them for screening while 37.7% of them didn’t have any risk factor. Conclusions: It is preferable to review the latest pediatric dyslipidemia screening guidelines by performing a universal screening program since a third of our dyslipidemic Lebanese children have been missed.

Keywords: cardiovascular risk factors, dyslipidemia, Lebanese children, screening

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Authors: Zerubabel Mihret

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Background: Work-related stress is a pattern of reactions to work demands unmatched by worker’s knowledge, skills, or abilities. Healthcare institutions are considered high-risk and intensive work areas for work-related stress. However, there is the nonexistence of clear and strong data about the magnitude of work-related stress on sanitation workers in hospitals in Ethiopia. The aim of this study was to determine the magnitude of work-related stress among sanitation workers in public hospitals during COVID-19 in Addis Ababa, Ethiopia. Methods: Institution-based cross-sectional study was conducted from October 2021 to February 2022 among 494 sanitation workers who were selected from 4 hospitals. HSE (Health and Safety Executive of UK) standard data collection tool was used, and an interviewer-administered questionnaire was used to collect the data using KOBO collect application. The collected data were cleaned and analyzed using SPSS version 20.0. Both binary and multivariable logistic regression analyses were done to identify important factors having an association with work-related stress. Variables with p-value ≤ 0.25 in the bivariate analysis were entered into the multivariable logistic regression model. A statistically significant level was declared at a p-value ≤ 0.05. Results: This study revealed that the magnitude of work-related stress among sanitation workers was 49.2% (95% CI 45-54). Significant proportions (72.7%) of sanitation workers were dissatisfied with their current job. Sex, age, experience, and chewing khat were significantly associated with work-related stress. Conclusion: Work-related stress is significantly high among sanitation workers. Sex, age, experience, and chewing khat were identified as factors associated with work-related stress. Intervention program focusing on the prevention and control of stress is desired by hospitals.

Keywords: work-related stress, sanitation workers, Likert scale, public hospitals, Ethiopia

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Authors: Vagolu S. Krishna, Shan Zheng, Estharla M. Rekha, Luke W. Guddat, Dharmarajan Sriram

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Tuberculosis (TB) remains a major threat to human health. This due to the fact that current drug treatments are less than optimal as well as the rising occurrence of multi drug-resistant and extensively drug-resistant strains of the etiological agent, Mycobacterium tuberculosis (Mt). Given the wide-spread significance of this disease, we have undertaken a design and evaluation program to discover new anti-TB drug leads. Here, our attention is focused on ketol-acid reductoisomerase (KARI), the second enzyme in the branched-chain amino acid biosynthesis pathway. Importantly, this enzyme is present in bacteria but not in humans, making it an attractive proposition for drug discovery. In the present work, we used high-throughput virtual screening to identify seventeen potential inhibitors of KARI using the Birla Institute of Technology and Science in-house database. Compounds were selected based on high docking scores, which were assigned as the result of favourable interactions between the compound and the active site of KARI. The Ki values for two leads, compounds 14 and 16 are 3.71 and 3.06 µM, respectively for Mt KARI. To assess the mode of binding, 100 ns molecular dynamics simulations for these two compounds in association with Mt KARI were performed and showed that the complex was stable with an average RMSD of less than 2.5 Å for all atoms. Compound 16 showed an MIC of 2.06 ± 0.91 µM and a 1.9 fold logarithmic reduction in the growth of Mt in an infected macrophage model. The two compounds exhibited low toxicity against murine macrophage RAW 264.7 cell lines. Thus, both compounds are promising candidates for development as an anti-TB drug leads.

Keywords: ketol-acid reductoisomerase, macrophage, molecular docking and dynamics, tuberculosis

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Authors: Kebede Gamo Sebehanie, Olu Emmanuel Femi, Alberto Velázquez Del Rosario, Abubeker Yimam Ali, Gudeta Jafo Muleta

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Water pollution is one of the most serious worldwide issues today. Among water pollution, heavy metals are becoming a concern to the environment and human health due to their non-biodegradability and bioaccumulation. In this study, a magnetite-cellulose nanocomposite derived from renewable resources is employed for hexavalent chromium elimination by adsorption. Magnetite nanoparticles were synthesized directly from iron ore using solvent extraction and co-precipitation technique. Cellulose nanofiber was extracted from sugarcane bagasse using the alkaline treatment and acid hydrolysis method. Before and after the adsorption process, the MNPs-CNF composites were evaluated using X-ray diffraction (XRD), Scanning electron microscope (SEM), Fourier transform infrared (FTIR), and Vibrator sample magnetometer (VSM), and Thermogravimetric analysis (TGA). The impacts of several parameters such as pH, contact time, initial pollutant concentration, and adsorbent dose on adsorption efficiency and capacity were examined. The kinetic and isotherm adsorption of Cr (VI) was also studied. The highest removal was obtained at pH 3, and it took 80 minutes to establish adsorption equilibrium. The Langmuir and Freundlich isotherm models were used, and the experimental data fit well with the Langmuir model, which has a maximum adsorption capacity of 8.27 mg/g. The kinetic study of the adsorption process using pseudo-first-order and pseudo-second-order equations revealed that the pseudo-second-order equation was more suited for representing the adsorption kinetic data. Based on the findings, pure MNPs and MNPs-CNF nanocomposites could be used as effective adsorbents for the removal of Cr (VI) from wastewater.

Keywords: magnetite-cellulose nanocomposite, hexavalent chromium, adsorption, sugarcane bagasse

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Authors: Hecson Christian, Joel Macwan

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Landfill site selection in an urban area is a critical issue in the planning process. With the growth of the urbanization, it has a mammoth impact on the economy, ecology, and environmental health of the region. Outsized amount of wastes are produced and the problem gets soared every day. Hence, selection of ideal site for sanitary landfill is a challenge for urban planners and solid waste managers. Disposal site is a function of many parameters. Among all, Geotechnical parameters are very vital as the same is related to surrounding open land. Moreover, the accessible safe and acceptable land is also scarce. Therefore, in this paper geotechnical parameters are used to develop a GIS model to identify an ideal location for landfill purpose. Metropolitan city of Surat is highly populated and fastest growing urban area in India. The research objectives are to conduct field experiments to collect data and to transfer the facts in GIS platform to evolve a model, to find ideal location. Planners’ preferences were obtained to use analytical hierarchical process (AHP) to find weights of each parameter. Integration of GIS and Multi-Criteria Decision Analysis (MCDA) techniques are applied to improve decision-making. It augments an environment for transformation and combination of geographical data and planners’ preferences. GIS performs deterministic overlay and buffer operations. MCDA methods evaluate alternatives based on the decision makers’ subjective values and priorities. Research results have shown many alternative locations. Economic analysis of selected site from actual operations point of view is not included in this research.

Keywords: GIS, AHP, MCDA, Geo-technical

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Authors: Maria Jose Mendoza Gordillo

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Introduction: Research regarding breastfeeding is devoted to how essential breastfeeding is to guarantee wellbeing for the mother and the baby from a medical standpoint relegating the cultural, material and social barriers for breastfeeding. Consequently, worldwide breastfeeding rates are low, and Ecuador is not the exception, especially among working mothers. Worldwide, health care providers have low rates of breastfeeding due to several barriers to lactation, such as the work schedule, a lack of private places for pumping while at work, and negative emotions. Goals and Methods: This study aimed to explore how do Ecuadorian women embrace their identities as nutritionists and mothers within their breastfeeding experience. The primary data come from 20 synchronous semi-structured interviews, which follow a topic guide. The interviews were recorded and transcribed verbatim. The data analysis followed the Phronetic Iterative Approach. Results: Women shifted the preconceived idea of the ideal breastfeeding that came from the medicalized discourse of breastfeeding, and that was constructed in their training as nutritionists. Although these women believe that breast milk and breastfeeding is the best way to feed a baby, the internalized ideal of breastfeeding shifted through the experience of motherhood. When these women developed their identity as mothers, they understood that the ideal breastfeeding is different from the medicalized discourse. Although they have that clash between the ideal and the external reality, they continued breastfeeding their babies and those experiences made them improve their professional practice. Conclusions: The narratives that women shared illustrate how complex it was to manage the different roles and identities that they wanted to fulfill to keep their identity of a good mother who breastfeeds her baby and, at the same time, a good healthcare provider identity. The process of breastfeeding for this group of women who are mothers and healthcare professionals appears to be a unique relational and identity negotiation process.

Keywords: breastfeeding, identity, nutritionist, qualitative

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Authors: Kamel Abd Elaziz Mohamed

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Introduction: Drug related problems (DRPs) are of major concern, affecting patients of both sex. They impose considerable economic burden on the society and the health-care systems. Aim of the work: The aim of this work was to identify and categorize drug-related problems in adult intensive care unit. Patients and methods: The study was a prospective, observational study as eighty six patients were included. They were consecutively admitted to ICU through the emergency room or transferred from the general ward due to DRPs. Parameters included in the study as length of stay in ICU, need for cardiovascular support or mechanical ventilation, dialysis, as well as APACHE II score were recorded. Results: Drug related problems represent 3.6% of the total ICU admission. The median (range) of APACHE II score for 86 patients included in the study was 17 (10-23), and length of ICU stay was 2.4 (1.5-4.2) days. In 45 patients (52%), DRP was drug over dose (group 1), while other DRP was present in the other 41 patients (48%, group 11). Patients in group 1 were older (39 years versus 32 years in group 11), with significant impaired renal function. The need of inotropic drugs and mechanical ventilation as well as the length of stay (LOS) in ICU was significantly higher in group 1. There were no significant difference in GCS between both groups, however APACHE II score was significantly higher in group 1. Only four patients (4.6%) were admitted by suicidal attempt as well as three patients (3.4%) due to trauma drug-related admissions, all were in (group 1). Nineteen percent of the patients had drug related problem due to hypoglycaemic medication followed by tranquilizer (15%). Adverse drug effect followed by failure to receive medication were the most causes of drug problem in (group11).The total mortality rate was 4.6%, all of them were eventually non preventable. Conclusion: The critically ill patients admitted due to drug related problems represented a small proportion (3.6%) of admissions to the ICU. Hypoglycaemic medication was one of the most common causes of admission by drug related problems.

Keywords: drug related problems, ICU, cost, safety

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Authors: Ines Cherif, Ghassen Kharroubi, Leila Bouabid, Adel Gharbi, Aicha Boukthir, Margaret Mccarron, Nissaf Ben Alaya, Afif Ben Salah, Jihene Bettaieb

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Healthcare workers' flu vaccination prevents influenza disease among both patients and caregivers. We aimed in this study to assess influenza vaccine (IV) coverage in 2018-2019 among Tunisian physicians and to determine factors associated with IV receipt. A cross sectional study was carried out in Tunisian primary and secondary health care facilities in the 2018-2019 influenza season. Physicians with direct patient contact were recruited according to a self-weighted multistage sampling. Data were collected through a face to face questionnaire containing questions on knowledge, attitudes, and practices regarding IV. Bivariate analysis was used in order to determine factors associated with IV receipt. A total of 167 physicians were included in the study with a mean age of 48.2 ± 7.7 years and a sex-ratio (M: F) of 0.37. Among participants, 15.1% (95% CI: [9.7%-20.3%]) were vaccinated against influenza in the 2018-2019 influenza season. Bivariate analysis revealed that previous flu immunization in the four years preceding the 2018-2019 influenza season (OR=32.3; p < 10-3), belief that vaccinating healthcare workers may reduce work absenteeism (OR=4.7, p=0.028), belief that flu vaccine should be mandatory to healthcare workers (OR=3.3, p=0.01) and high confidence towards IV efficacy in preventing influenza among caregivers (OR= 4.5, p=0.01) were associated with a higher IV receipt in 2018-2019 among physicians. Less than one fifth of Tunisian physicians were vaccinated against influenza in 2018-2019. Higher vaccine uptake was related to a higher belief in vaccine efficacy in preventing influenza disease among both patients and caregivers. This underscores the need for periodic educational campaigns to raise physicians' awareness about IV efficacy. The switch to an IV mandatory policy should also be considered.

Keywords: influenza vaccine, physicians, Tunisia, vaccination uptake

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Authors: Oyebade K. Oyedotun

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The cardiotocogram is a technical recording of the heartbeat rate and uterine contractions of a fetus during pregnancy. During pregnancy, several complications can occur to both the mother and the fetus; hence it is very crucial that medical experts are able to find technical means to check the healthiness of the mother and especially the fetus. It is very important that the fetus develops as expected in stages during the pregnancy period; however, the task of monitoring the health status of the fetus is not that which is easily achieved as the fetus is not wholly physically available to medical experts for inspection. Hence, doctors have to resort to some other tests that can give an indication of the status of the fetus. One of such diagnostic test is to obtain cardiotocograms of the fetus. From the analysis of the cardiotocograms, medical experts can determine the status of the fetus, and therefore necessary medical interventions. Generally, medical experts classify examined cardiotocograms into ‘normal’, ‘suspect’, or ‘pathological’. This work presents an artificial neural network based decision support system which can filter cardiotocograms data, producing the corresponding statuses of the fetuses. The capability of artificial neural network to explore the cardiotocogram data and learn features that distinguish one class from the others has been exploited in this research. In this research, feedforward and radial basis neural networks were trained on a publicly available database to classify the processed cardiotocogram data into one of the three classes: ‘normal’, ‘suspect’, or ‘pathological’. Classification accuracies of 87.8% and 89.2% were achieved during the test phase of the trained network for the feedforward and radial basis neural networks respectively. It is the hope that while the system described in this work may not be a complete replacement for a medical expert in fetus status evaluation, it can significantly reinforce the confidence in medical diagnosis reached by experts.

Keywords: decision support, cardiotocogram, classification, neural networks

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Authors: Gokcen Akyurek, Hulya Kayihan, Deniz Yuce, Selen Yilmaz

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The stigma towards mental illness is still very rooted in our society, despite the number of studies, campaigns, and anti-stigma programs developed in recent years. Stigma represents a serious obstacle to recovery and social integration for people who experience a mental illness, affecting directly their well-being and quality of life. It implies that these persons have to deal with many other barriers apart from the disease symptoms (1-5). Convergent, recent literature suggests that less positive attitudes by mental health professionals interfere with the self-determination and recovery process (4-10).The aim of this study was to translate the Attribution Questionnaire-27 (AQ-27) to the Turkish language (AQ-27-T), and to examine the reliability and validity of this new Turkish version. Cultural adaptation was implemented according to the internationally suggested method. To determine the understandability and appropriateness of this measure for the Turkish culture, a pretest was administered and the final form was generated. Then, 424 randomly chosen people took part in the study. Participant’s mean age was 36.9±12.7 years and %52 of them female. Cronbach's alpha and intra-class coefficients were used to estimate instrument reliability. The AQ-27-T was assessed again 14 days later for test retest reliability. The AQ-27-T demonstrated acceptable internal consistency, with a Cronbach's alpha of 0.88 for the total scale and ranging between 0.86 and 0.89 for the items. The test-retest reliability was good, with Pearson correlation coefficients of 0.79 for the total scale and ranging between 0.35 and 0.77 for the items (p<0.05). Correlation between subscales was moderate-good, with Pearson correlation coefficients of 0.18-0.88 (p<0.05). Fit indices of the model supported the factor structure and paths. The AQ-27-T is a reliable measure to assess stigmatizing attitudes in Turkish.

Keywords: attribution questionnaire, validity, reliability, stigma

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Authors: Santosh Kumar Yadav, Shobha Keswani, Nishat Quddus, Sohrab Ahmad Khan, Zuheb Ahmad Shiddiqui, Varsha Chorsiya

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Introduction: Early onset diabetes is more aggressive than the late onset diabetes. Diabetic individual has a greater spectrum of life period to suffer from its damage, complications, and long-term disability. This study aimed at assessing knee joint muscle performance under various durations of diabetes. Method and Materials: A total of 30 diabetic subjects (18 male and 12 females) without diabetic neuropathy were included for the study. They were divided into three groups with 5 years, 10 years and 15 years of duration of disease each. Muscle performance was evaluated through strength and flexibility. Peak torque for quadriceps muscle was measured using isokinetic dynamometer. Flexibility for quadriceps and hamstring muscles were measured through Ducan’s Elys test and 90/90 test. Results: The result showed significant difference in muscle strength (p<0.05), flexibility (p≤0.05) between groups. Discussion: Optimal muscle strength and flexibility are vital for musculoskeletal health and functional independence. Conclusion: The reduced muscle performance and functional impairment in nonneuropathic diabetic patients suggest that other mechanism besides neuropathy that contribute to altered biomechanics. These findings of this study project early management of these altered parameters through disease-specific physical therapy and assessment-based intervention. Clinical Relevance: Managing disability is more costly than managing disease. Prompt and timely identification and management strategy can dramatically reduce the cost of care for diabetic patients.

Keywords: muscle flexibility, muscle performance, muscle torque, type 2 diabetes

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Authors: Francesco Ceresia

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Workplace aggression is broadly recognized as a main work-related risk for healthcare organizations the world over. Scholars underlined that nonfatal workplace aggressions can be also produced by Type II workplace aggression, that occur when the aggressor has a legitimate relationship with the organization and commits an act of hostility while being served or cared for by members of the organization. Several reviews and meta-analysis highlighted the main antecedents and consequences of Type II verbal and physical workplace aggression in the healthcare sector, also focusing on its economic and psychosocial costs. However, some scholars emphasized the need for a systemic and multi-factorial approach to deeply understand and effectively respond to such kind of aggression. The main aim of the study is to propose a qualitative model of Type II workplace aggression in a health care organization in accordance with the system thinking and multi-factorial perspective. A case study research approach, conducted in an Italian non-hospital healthcare organization, is presented. Two main data collection methods have been adopted: individual and group interviews with a sample (N = 24) of physicians, nurses and clericals. A causal loop diagram (CLD) that describes the main causal relationships among the key-variables of the proposed model has been outlined. The main feedback loops and the causal link polarities have been also defined to fully describe the structure underlining the Type II workplace aggression phenomenon. The proposed qualitative model shows how the Type II workplace aggression is related with burnout, work performance, job satisfaction, turnover intentions, work motivation and emotional dissonance. Finally, strategies and policies to reduce the strength of workplace aggression’s drivers are suggested.

Keywords: healthcare, system thinking, work motivation, workplace aggression

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Authors: Wei Wen Yang, Emily Chia Yu Su

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Dengue fever is a mosquito-borne tropical infectious disease caused by the dengue virus. After infection, symptoms usually start from three to fourteen days. Dengue virus may cause a high fever and at least two of the following symptoms, severe headache, severe eye pain, joint pains, muscle or bone pain, vomiting, feature skin rash, and mild bleeding manifestation. In addition, recovery will take at least two to seven days. Dengue fever has rapidly spread in tropical and subtropical areas in recent years. Several phenomena around the world such as global warming, urbanization, and international travel are the main reasons in boosting the spread of dengue. In Taiwan, epidemics occur annually, especially during summer and fall seasons. On the other side, Singapore government also has announced the amounts number of dengue cases spreading in Singapore. As the serious epidemic of dengue fever outbreaks in Taiwan and Singapore, countries around the Asia-Pacific region are becoming high risks of susceptible to the outbreaks and local hub of spreading the virus. To improve public safety and public health issues, firstly, we are going to use Microsoft Excel and SAS EG to do data preprocessing. Secondly, using support vector machines and decision trees builds predict model, and analyzes the infectious cases between Taiwan and Singapore. By comparing different factors causing vector mosquito from model classification and regression, we can find similar spreading patterns where the disease occurred most frequently. The result can provide sufficient information to predict the future dengue infection outbreaks and control the diffusion of dengue fever among countries.

Keywords: dengue fever, Taiwan, Singapore, Aedes aegypti

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Authors: Akudo Ejelonu, Sarah Willig, J. Anthony Sauder, Heather Murphy, Frances Shofer

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Background: The high prevalence of diarrheal diseases in the village of Tzununá, Guatemala is linked to lack of sanitation facilities and handwashing practices. Diarrheal diseases are preventable and improved access to latrines, hygiene education and clean water may improve sanitation by reducing the spread of disease. Objective: Between May 2015-January 2017, the University of Pennsylvania Chapter of Engineers Without Border (PennEWB) and local partners designed an intervention to reduce diarrheal disease by building pour flush latrines in 50 individual households and providing education on the importance of handwashing practice. Design/Methods: Through convenient sampling, we surveyed 45 households to evaluate the community’s knowledge of diarrheal disease, handwashing practices, and maintenance of the latrines. Results: 92% of the study participants experienced decrease of new cases of diarrheal disease after receiving a latrine. Only 11% washed their hands after defecating in the latrine. There was gap in understanding the health outcome of latrine sanitation and handwashing education. The respondents did not connect the reduction of diarrheal disease with latrine use and maintenance. Instead, they associated their motivation for latrine use with aesthetics, proximity to their home, ease and comfort, and reduction of shame. We recommend that PennEWB adopt UNICEF or WHO education on hand washing practice. Conclusion: Social interaction and social pressure drove the household use of latrines. The latrines are being valued and cleaned. The education that the residents received did not target norms and behaviors. Latrines could be used to create a new social norm that supports behavioral change.

Keywords: diarrheal disease, latrine, open defecation, water, sanitation and hygiene

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Authors: Piluntana Panpluem, Monticha Putsakum

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The objectives of this study were to investigate 1) consumers’ behaviors in buying organic products; and 2) the relationships between personal factors, cultural factors, social factors, psychological factors and marketing mix factors, and the behavior in buying organic products of consumers in the greater Bangkok metropolitan area. The sample group was 400 consumers at the age of 15 and older, who bought organic agricultural products from green markets and green shops in Bangkok, including its suburbs. The data were collected by using a questionnaire, which were analyzed by descriptive statistics and chi-square test. The results showed that the consumers bought 3 – 4 types of fresh vegetables with a total expenditure of less than 499 Baht each time. They purchased organic products mainly at a supermarket, 2 – 4 times per month, most frequently on Sundays, which took less than 30 minutes of shopping each time. The purpose of the purchase was for self-consuming. Gaining or retaining good health was the reason for the consumption of the products. Additionally, the first considered factor in the organic product selection was the quality. The decisions in purchasing the products were made directly by consumers, who were influenced mainly by advertising media on television. For the relationships among personal, cultural, social, psychological and marketing mix factors, and consumers’ behavior in buying organic products, the results showed the following: 1) personal factors, which were gender, age and educational level, were related to the behavior in terms of “What”, “Why”, and “Where” the consumers bought organic products (p<0.05); 2) cultural factors were related to “Why” the consumers bought organic products (p<0.05); 3) social factors were related to “Where” and “How” the consumers bought organic products (p<0.05); 4) psychological factors were related to “When” the consumers bought organic products (p<0.05). 5) For the marketing mix factors, “Product” was related to “Who participated” in buying, “What” and “Where” the consumers bought organic products (p<0.05), while “Price” was related to “What” and “When” the consumers bought organic products (p<0.05). “Place” was related to “What” and “How” the consumers bought organic products (p<0.05). Furthermore, “Promotion” was related to “What” and “Where” the consumers bought organic products (p<0.05).

Keywords: consumer behavior, organic products, Bangkok Metropolis and Vicinity

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Authors: Veliswa Nonfundo Hoho, Jabulani Gilford Kheswa

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HIV/AIDS has been a long-term condition worldwide, which does not only affect physical health but also causes psychological and social challenges in people living with this condition. In Sub-Saharan countries, namely; Nigeria, Uganda, Zimbabwe and South Africa, people living with HIV/AIDS come across different challenges especially after one has disclosed his/her status. They experience stigma and discrimination, isolation, lack of accessing and receiving treatment, lack of support and experience psychological distress. By using the evidence-based systematic review as a form of methodology, journal articles, dissertations, internet, and books were explored. This paper seeks to describe the challenges faced by people living with HIV/AIDS after disclosure, which forms a critical component of HIV/AIDS prevention and treatment interventions. The disclosure process model is used to underpin the study. This theory allows one to understand when and why interpersonal and verbal self-disclosure is beneficial for individuals who live with concealable stigmatized identities such as HIV/AIDS. Literature findings advocate that both negative and positive results were noted after disclosing one’s HIV status and psychosocial well-being of the majority of people living with HIV/AIDS also get affected especially in societies which subscribe HIV/AIDS pandemic to witchcraft. As for the infected homosexuals, research indicates that they suffer in silence and to cover their emotional emptiness due to ostracism, they often report low- self-efficacy with regard to condom use and become susceptible to reinfections which further place their lives at heightened risk for low immune system. In this regard, this paper challenges the policies which protect the dignity of people living with HIV/AIDS and calls for unity and financial support in favour of psychoeducational programmes and support groups aimed at curbing discrimination.

Keywords: disclosure, discrimination, homosexuality, self-efficacy

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Authors: Soufiane Fal, Abderahim Aasfar, Ali Ouhssain, Hasnae Choukri, Abelaziz Smouni, Hicham El Arroussi

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Heavy metals contamination is a major environmental concern around the world. It has a harmful impact on plant productivity and poses a serious risk to humans and animals health. In the present study, the effect of Microalgae Crude Extract (MCE) on tomato growth and nutrients uptake exposed to 2 mM Pb2+ and Cd2+ was investigated. In results, 2 mM Pb2+ and Cd2+ showed a significant reduction of tomatobiomass and perturbation in nutrients absorption. Moreover, MCE application in tomato plant exposed to Pb2+ and Cd2+ showed a significant enhancement of biomass compared to tomato plants under Pb2+ and Cd2+. On the other hand, MCE application favoured heavy metals accumulation in root and inhibited their translocation to shoot as phytostabilisation mechanism. Tomato plants showed biochemical responses to Pb2+ and Cd2+ stress with elevation of scavenging enzymes and molecules such as POD, CAT, SOD, Proline, and polyphenols, etc. In addition, the treatment by MCE showed a significant reduction level of the majority of these parameters. Furthermore, the metabolomic analysis revealed a significant change in important metabolites. Pb2+ and Cd2+ showed decrease in SFA and increase of UFA, VLFA, alkanes, alkenes, sterols, which known accumulated as tolerance and resistance mechanism to heavy metal (H.M) stress. However, MCE treatment showed the inverse of these response to return tomato plants to normal state and enhanced tolerance and resistance to heavy metal stress. In the present study, we emphasized that MCE can alleviate H.M stress, enhance tomato plant growth nutrients absorption and improve biochemical responses.

Keywords: microalgae crude extract, heavy metal stress, nutrient uptake, metabolomic analysis, solanum lycopersicum (Tomato), phytostabilisation

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Authors: P. Acosta-Santamaría, A. Ibatá-Soto, A. López-Vásquez

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Organic compounds in wastewaters coming from textile and pharmaceutical industry generated multiple harmful effects on the environment and the human health. One of them is the methyl orange (MeO), an azoic dye considered to be a recalcitrant compound. The heterogeneous photocatalysis emerges as an alternative for treating this type of hazardous compounds, through the generation of OH radicals using radiation and a semiconductor oxide. According to the author’s knowledge, catalysts such as TiO₂ doped with metals show high efficiency in degrading MeO; however, this presents economic limitations on industrial scale. Black sand can be considered as a naturally doped catalyst because in its structure is common to find compounds such as titanium, iron and aluminum oxides, also elements such as zircon, cadmium, manganese, etc. This study reports the photocatalytic activity of the mineral black sand used as semiconductor in the discoloration of MeO by oxidation and reduction photocatalytic techniques. For this, magnetic composites from the mineral were prepared (RM, M1, M2 and NM) and their activity were tested through MeO discoloration while TiO₂ was used as reference. For the fractions, chemical, morphological and structural characterizations were performed using Scanning Electron Microscopy with Energy Dispersive X-Ray (SEM-EDX), X-Ray Diffraction (XRD) and X-Ray Fluorescence (XRF) analysis. M2 fraction showed higher MeO discoloration (93%) in oxidation conditions at pH 2 and it could be due to the presence of ferric oxides. However, the best result to reduction process was using M1 fraction (20%) at pH 2, which contains a higher titanium percentage. In the first process, hydrogen peroxide (H₂O₂) was used as electron donor agent. According to the results, black sand mineral can be used as natural semiconductor in photocatalytic process. It could be considered as a photocatalyst precursor in such processes, due to its low cost and easy access.

Keywords: black sand mineral, methyl orange, oxidation, photocatalysis, reduction

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Authors: Morlu Stevens, Bareki Batlokwa

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The use of treated wastewater is widely employed to compensate for the scarcity of safe and uncontaminated freshwater. However, the existence of toxic heavy metal ions in the wastewater pose a health hazard to animals and the environment, hence, the importance for an effective technique to tackle the challenge. A multi-templated ion imprinted sorbent (Fe,Ni,Cu-IIP) for the simultaneous removal of heavy metal ions from waste water was synthesised employing molecular imprinting technology (MIT) via thermal free radical bulk polymerization technique. Methacrylic acid (MAA) was employed as the functional monomer, and ethylene glycol dimethylacrylate (EGDMA) as cross-linking agent, azobisisobutyronitrile (AIBN) as the initiator, Fe, Ni, Cu ions as template ions, and 1,10-phenanthroline as the complexing agent. The template ions were exhaustively washed off the synthesized polymer by solvent extraction in several washing steps, while periodically increasing solvent (HCl) concentration from 1.0 M to 10.0 M. The physical and chemical properties of the sorbents were investigated using Fourier Transform Infrared Spectroscopy (FT-IR), X-ray Diffraction (XRD) and Atomic Force Microscopy (AFM) were employed. Optimization of operational parameters such as time, pH and sorbent dosage to evaluate the effectiveness of sorbents were investigated and found to be 15 min, 7.5 and 666.7 mg/L respectively. Selectivity of ion-imprinted polymers and competitive sorption studies between the template and similar ions were carried out and showed good selectivity towards the targeted metal ion by removing 90% - 98% of the templated ions as compared to 58% - 62% of similar ions. The sorbents were further applied for the selective removal of Fe, Ni and Cu from real wastewater samples and recoveries of 92.14 ± 0.16% - 106.09 ± 0.17% and linearities of R2 = 0.9993 - R2 = 0.9997 were achieved.

Keywords: ion imprinting, ion imprinted polymers, heavy metals, wastewater

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Authors: Juni C. Kim, Anna R. Robuck, Douglas I. Walker

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The human exposome, which includes chemical exposures over the lifetime and their effects, is now recognized as an important measure for understanding human health; however, the complexity of the data makes the identification of environmental chemicals challenging. The goal of our project was to establish a computational workflow for the improved identification of environmental pollutants containing chlorine or bromine. Using the “pattern. search” function available in the R package NonTarget, we wrote a multifunctional script that searches mass spectral clusters from untargeted gas-chromatography high-resolution mass spectrometry (GC-HRMS) for the presence of spectra consistent with chlorine and bromine-containing organic compounds. The “pattern. search” function was incorporated into a different function that allows the evaluation of clusters containing multiple analyte fragments, has multi-core support, and provides a simplified output identifying listing compounds containing chlorine and/or bromine. The new function was able to process 46,000 spectral clusters in under 8 seconds and identified over 150 potential halogenated spectra. We next applied our function to a deidentified dataset from patients diagnosed with primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and healthy controls. Twenty-two spectra corresponded to potential halogenated compounds in the PSC and PBC dataset, including six significantly different in PBC patients, while four differed in PSC patients. We have developed an improved algorithm for detecting halogenated compounds in GC-HRMS data, providing a strategy for prioritizing exposures in the study of human disease.

Keywords: exposome, metabolome, computational metabolomics, high-resolution mass spectrometry, exposure, pollutants

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Authors: Nasir Ullah

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Marketing strategies are important factors in the success of a company. Local pharmaceutical companies in Pakistan face several issues, such as low-level budgets, lack of skilled human resources, and challenges to competing with multinational competitors that have negative impacts on their success. However, still there exist local companies with great levels of success in the pharmaceutical sector. This study aims to evaluate the marketing strategies of successful local companies in the pharmaceutical sector of Khyber Pakhtunkhwa, Pakistan. The study employed a constructivist approach to know about successful strategies of the marketing managers that worked well. For this purpose, in-depth interviews were conducted with marketing managers of four pharmaceutical companies which were deemed as successful on the basis of their annual target achievements. Thematic analysis was conducted using Nvivo to devise major themes from the collected data. Four major themes or successful strategies were identified. These are i) share in the profit to marketing and sales staff, ii) invitation to the doctors for participation in free medical camps and health awareness seminars, iv) incentives for the Doctors and retailers, v) utilization of traditional capital (local social relationships) by the marketing officers. The study concludes that profit share to the employees, valuing doctors through their involvement and utilization of traditional capital are the successful marketing strategies of the successful pharmaceutical companies in the Pakhtun society of Pakistan. The study suggests hiring local staff that can utilize their traditional capital to influence doctors' decisions regarding the prescription of their medicine to the patients. The study also suggests profit share or increased bonuses to the marketing and sales staff as a measure of success.

Keywords: successful marketing strategies, pharmaceutical industry, traditional social capital, local companies

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Authors: Vedat Kurt, Tansel Koyunoglu, Gamze Kurt, Ozgen Aras

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Low back pain is one of the most common health problem in public. Common symptoms that can be associated with low back pain include; pain, functional disability, gait disturbances. The aim of the study was to investigate the differences between disability scores and gait parameters in subjects with low back pain. Sixty participants are included in our study, (35 men, 25 women, mean age: 37.65±10.02 years). Demographic characteristics of participants were recorded. Pain (visual analog scale) and disability level (Oswestry Disability Index(ODI)) were evaluated. Gait parameters were measured with Zebris-FDM-2 platform. Independent samples t-test was used to analyse the differences between subjects with under 40 points (n=31, mean age:35.8±11.3) and above 40 points (n=29, mean age:39.6±8.1) of ODI scores. Significant level in statistical analysis was accepted as 0.05. There was no significant difference between the ODI scores and groups’ ages. Statistically significant differences were found in step width between subjects with under 40 points of ODI and above 40 points of ODI score(p < 0.05). But there were non-significant differences with other gait parameters (p > 0.05). The differences between gait parameters and pain scores were not statistically significant (p > 0.05). Researchers generally agree that individuals with LBP walk slower and take shorter steps and have asymmetric step lengths when compared with than their age-matched pain-free counterparts. Also perceived general disability may have moderate correlation with walking performance. In the current study, the patients classified as minimal/moderate and severe disability level by using ODI scores. As a result, a patient with LBP who have higher disability level tends to increase support surface. On the other hand, we did not find any relation between pain intensity and gait parameters. It may be caused by the classification system of pain scores. Additional research is needed to investigate the effects of functionality level and pain intensity on gait in subjects with low back pain under different classification types.

Keywords: functionality, low back pain, gait, pain

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Authors: William Cheng, Rini Sekartini

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Background: Sleep is essential for children because it provides enhancement for the neural system activities that give physiologic effects for the body to support growth and development. One of the modifiable factors that relates with sleep is nutrition, which includes nutritional status, iron intake, and magnesium intake. Nutritional status represents the balance between nutritional intake and expenditure, while iron and magnesium are micronutrients that are related to sleep regulation. The aim of this study is to identify prevalence of sleep disturbance among Indonesian children and to evaluate its relation with aspect to nutrition. Methods : A cross-sectional study involving children aged 5 to 7-years-old in an urban primary health care between 2012 and 2013 was carried out. Related data includes anthropometric status, iron intake, and magnesium intake. Iron and magnesium intake was obtained by 24-hours food recall procedure. Sleep Disturbance Scale for Children (SDSC) was used as the diagnostic tool for sleep disturbance, with score under 39 indicating presence of problem. Results: Out of 128 school-aged children included in this study, 28 (23,1%) of them were found to have sleep disturbance. The majority of children had good nutritional status, with only 15,7% that were severely underweight or underweight, and 12,4% that were identified as stunted. On the contrary, 99 children (81,8%) were identified to have inadequate magnesium intake and 56 children (46,3%) with inadequate iron intake. Our analysis showed there was no significant relation between all of the nutritional status indicators and sleep disturbance (p>0,05%). Moreover, inadequate iron and magnesium intake also failed to prove significant relation with sleep disturbance in this population. Conclusion: Almost fourth of school-aged children in Indonesia were found to have sleep disturbance and further study are needed to overcome this problem. According to our finding, there is no correlation between nutritional status, iron intake, magnesium intake, and sleep disturbance.

Keywords: iron intake, magnesium intake, nutritional status, school-aged children, sleep disturbance

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Authors: Ragi Poyyara, V. Vivek, Ashish Khaparde

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The Product Development Process (PDP) in the technology group plays a very important role in the launch of any product. While a manufacturing process encourages the use of certain measures to reduce Health, Safety and Environmental (HSE) risks on the shop floor, the PDP concentrates on the use of Geometric Dimensioning and Tolerancing (GD&T) to develop a flawless design. Furthermore, PDP distributes and coordinates activities between different departments such as marketing, purchasing, and manufacturing. However, it is seldom realized that PDP makes a significant contribution to developing a product that reduces HSE risks by encouraging the Technology group to use effective GD&T. The GD&T is a precise communication tool that uses a set of symbols, rules, and definitions to mathematically define parts to be manufactured. It is a quality assurance method widely used in the oil and gas sector. Traditionally it is used to ensure the interchangeability of a part without affecting its form, fit, and function. Parts that do not meet these requirements are rejected during quality audits. This paper discusses how the Technology group integrates this quality assurance tool into the PDP and how the tool plays a major role in helping the HSE department in its goal towards eliminating HSE incidents. The PDP involves a thorough risk assessment and establishes a method to address those risks during the design stage. An illustration shows how GD&T helped reduce safety risks by ergonomically improving assembling operations. A brief discussion explains how tolerances provided on a part help prevent finger injury. This tool has equipped Technology to produce fixtures, which are used daily in operations as well as manufacturing. By applying GD&T to create good fits, HSE risks are mitigated for operating personnel. Both customers and service providers benefit from reduced safety risks.

Keywords: HSE risks, product development process, geometric dimensioning and tolerances, mechanical engineering

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