Search results for: anxiety/depression

Authors: Babarina Maria, Andropova Margarita

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Introduction: Hypoparathyroidism (HypoPT) is a rare endocrine disorder with an estimated prevalence of 0.25 per 1000 individuals. The most common cause of HypoPT is the loss of active parathyroid tissue following thyroid or parathyroid surgery. Sometimes permanent postoperative HypoPT occures, manifested by hypocalcemia in combination with low levels of PTH during 6 months or more after surgery. Cognitive impairments in patients with hypocalcemia due to chronic HypoPT are observed, and this can lead to problems and challenges in everyday living: memory loss and impaired concentration, that may be the cause of poor compliance. Clinical case: Patient K., 66 years old, underwent thyroidectomy in 2013 (at the age of 55) because of papillary thyroid cancer T1NxMx, histopathology findings confirmed the diagnosis. 5 years after the surgery, she was followed up on an outpatient basis, TSH levelsonly were monitored, and the dose of levothyroxine was adjusted. In 2018 due to, increasing complaints include tingling and cramps in the arms and legs, memory loss, sleep disorder, fatigue, anxiety, hair loss, muscle pain, tachycardia, positive Chvostek, and Trousseau signs were diagnosed during examination, also in blood analyses: total Ca 1.86 mmol/l (2.15-2.55), Ca++ 0.96 mmol/l (1.12-1.3), P 1.55 mmol/l (0.74-1.52), Mg 0.79 mmol/l (0.66-1.07) - chronic postoperative HypoPT was diagnosed. Therapy was initiated: alfacalcidol 0.5 mcg per day, calcium carbonate 2000 mg per day, cholecalciferol 1000 IU per day, magnesium orotate 3000 mg per day. During the case follow-up, hypocalcemia, hyperphosphatemia persisted, hypercalciuria15.7 mmol/day (2.5-6.5) was diagnosed. Dietary recommendations were given because of the high content of phosphorus rich foods, and therapy was adjusted: the dose of alfacalcidol was increased to 2.5 mcg per day, and the dose of calcium carbonate was reduced to 1500 mg per day. As part of the screening for complications of hypoPT, data for cataracts, Fahr syndrome, nephrocalcinosis, and kidney stone disease were not obtained. However, HypoPT compensation was not achieved, and therefore hydrochlorothiazide 25 mg was initiated, the dose of alfacalcidol was increased to 3 mcg per day, calcium carbonate to 3000 mg per day, magnesium orotate and cholecalciferol were continued at the same doses. Therapeutic goals were achieved: calcium phosphate product <4.4 mmol2/l2, there were no episodes of hypercalcemia, twenty-four-hour urinary calcium excretion was significantly reduced. Conclusion: Timely prescription, careful explanation of drugs usage rules, and monitoring and maintaining blood and urine parameters within the target contribute to the prevention of HypoPT complications development and life-threatening events.

Keywords: hypoparathyroidism, hypocalcemia, hyperphosphatemia, hypercalciuria

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Authors: Era Dorihi Kale, Sabina Gero, Uly Agustine

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Asylum seekers are people who come to other countries to get asylum. In line with that, they also carry the culture and health behavior of their country, which is very different from the new country they currently live in. This situation raises problems, also in the health sector. The approach taken must also be a culturally sensitive approach, where the culture and habits of the refugee's home area are also valued so that the health services provided can be right on target. Some risk factors that already exist in this group are lack of activity, consumption of fast food, smoking, and stress levels that are quite high. Overall this condition will increase the risk of an increased incidence of cardiovascular disease. This research is a descriptive and experimental study. The purpose of this study is to identify health status and develop a culturally sensitive health promotion model, especially related to the risk of cardiovascular disease for asylum seekers in detention homes in the city of Kupang. This research was carried out in 3 stages, stage 1 was conducting a survey of health problems and the risk of asylum seeker cardiovascular disease, Stage 2 developed a health promotion model, and stage 3 conducted a testing model of health promotion carried out. There were 81 respondents involved in this study. The variables measured were: health status, risk of cardiovascular disease and, health promotion models. Method of data collection: Instruments (questionnaires) were distributed to respondents answered for anamnese health status; then, cardiovascular risk measurements were taken. After that, the preparation of information needs and the compilation of booklets on the prevention of cardiovascular disease is carried out. The compiled booklet was then translated into Farsi. After that, the booklet was tested. Respondent characteristics: average lived in Indonesia for 4.38 years, the majority were male (90.1%), and most were aged 15-34 years (90.1%). There are several diseases that are often suffered by asylum seekers, namely: gastritis, headaches, diarrhea, acute respiratory infections, skin allergies, sore throat, cough, and depression. The level of risk for asylum seekers experiencing cardiovascular problems is 4 high risk people, 6 moderate risk people, and 71 low risk people. This condition needs special attention because the number of people at risk is quite high when compared to the age group of refugees. This is very related to the level of stress experienced by the refugees. The health promotion model that can be used is the transactional stress and coping model, using Persian (oral) and English for written information. It is recommended for health practitioners who care for refugees to always pay attention to aspects of culture (especially language) as well as the psychological condition of asylum seekers to make it easier to conduct health care and promotion. As well for further research, it is recommended to conduct research, especially relating to the effect of psychological stress on the risk of cardiovascular disease in asylum seekers.

Keywords: asylum seekers, health status, cardiovascular disease, health promotion

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Authors: Suteera Pradubwong, Pattama Surit, Sumalee Pongpagatip, Tharinee Pethchara, Bowornsilp Chowchuen

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Background: Cleft lip and palate (CLP) is a congenital anomaly of the lip and palate that is caused by several factors. It was found in approximately one per 500 to 550 live births depending on nationality and socioeconomic status. The Tawanchai Center and out-patients surgical room of Srinagarind Hospital are responsible for providing care to patients with CLP (starting from birth to adolescent) and their caregivers. From the observations and interviews with nurses working in these units, they reported that both patients and their caregivers confronted many problems which affected their physical and mental health. Based on the Soukup’s model (2000), the researchers used evidence triggers from clinical practice (practice triggers) and related literature (knowledge triggers) to investigate the problems. Objective: The purpose of this study was to investigate the problems of care for patients with CLP in the Tawanchai Center and out-patient surgical room of Srinagarind Hospital. Material and Method: The descriptive method was used in this study. For practice triggers, the researchers obtained the data from medical records of ten patients with CLP and from interviewing two patients with CLP, eight caregivers, two nurses, and two assistant workers. Instruments for the interview consisted of a demographic data form and a semi-structured questionnaire. For knowledge triggers, the researchers used a literature search. The data from both practice and knowledge triggers were collected between February and May 2016. The quantitative data were analyzed through frequency and percentage distributions, and the qualitative data were analyzed through a content analysis. Results: The problems of care gained from practice and knowledge triggers were consistent and were identified as holistic issues, including 1) insufficient feeding, 2) risks of respiratory tract infections and physical disorders, 3) psychological problems, such as anxiety, stress, and distress, 4) socioeconomic problems, such as stigmatization, isolation, and loss of income, 5)spiritual problems, such as low self-esteem and low quality of life, 6) school absence and learning limitation, 7) lack of knowledge about CLP and its treatments, 8) misunderstanding towards roles among the multidisciplinary team, 9) no available services, and 10) shortage of healthcare professionals, especially speech-language pathologists (SLPs). Conclusion: From evidence-triggers, the problems of care affect the patients and their caregivers holistically. Integrated long-term care by the multidisciplinary team is needed for children with CLP starting from birth to adolescent. Nurses should provide effective care to these patients and their caregivers by using a holistic approach and working collaboratively with other healthcare providers in the multidisciplinary team.

Keywords: evidence-triggers, cleft lip, cleft palate, problems of care

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Authors: Anisuzzaman Khan, A. J. K. Masud

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Bangladesh is the largest delta in the world predominantly comprising large network of rives and wetlands. Wetlands in Bangladesh are represented by inland freshwater, estuarine brakishwater and tidal salt-water coastal wetlands. Bangladesh possesses enormous area of wetlands including rivers and streams, freshwater lakes and marshes, haors, baors, beels, water storage reservoirs, fish ponds, flooded cultivated fields and estuarine systems with extensive mangrove swamps. The past, present, and future of Bangladesh, and its people’s livelihoods are intimately connected to its relationship with water and wetlands. More than 90% of the country’s total area consists of alluvial plains, crisscrossed by a complex network of rivers and their tributaries. Floodplains, beels (low-lying depressions in the floodplain), haors (deep depression) and baors (oxbow lakes) represent the inland freshwater wetlands. Over a third of Bangladesh could be termed as wetlands, considering rivers, estuaries, mangroves, floodplains, beels, baors and haors. The country’s wetland ecosystems also offer critical habitats for globally significant biological diversity. Of these the deeply flooded basins of north-east Bangladesh, known as haors, are a habitat of wide range of wild flora and fauna unique to Bangladesh. The haor basin lies within the districts of Sylhet, Sunamgonj, Netrokona, Kishoregonj, Habigonj, Moulvibazar, and Brahmanbaria in the Northeast region of Bangladesh comprises the floodplains of the Meghna tributaries and is characterized by the presence of numerous large, deeply flooded depressions, known as haors. It covers about around 8,568 km2 area of Bangladesh. The topography of the region is steep at around foothills in the north and slopes becoming mild and milder gradually at downstream towards south. Haor is a great reservoir of aquatic biological resources and acts as the ecological safety net to the nature as well as to the dwellers of the haor. But in reality, these areas are considered as wastelands and to make these wastelands into a productive one, a one sided plan has been implementing since long. The programme is popularly known as Flood Control, Drainage and Irrigation (FCDI) which is mainly devoted to increase the monoculture rice production. However, haor ecosystem is a multiple-resource base which demands an integrated sustainable development approach. The ongoing management approach is biased to only rice production through FCDI. Thus this primitive mode of action is diminishing other resources having more economic potential ever thought.

Keywords: freshwater wetlands, biological diversity, biological resources, conservation and sustainable development

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Authors: Angela Evans, Gabriel Gijon-Nogueron, Alfonso Martinez-Nova

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Background The health sector, whose mission is protecting health, also contributes to the climate crisis, the greatest health threat of the 21st century. The carbon footprint from healthcare exceeds 5% of emissions globally, surpassing 7% in the USA and Australia. Global recognition has led to the Paris Agreement, the United Nations Sustainable Development Goals, and the World Health Organization's Climate Change Action Plan. It is agreed that the majority of health impacts stem from energy and resource consumption, as well as the production of greenhouse gases in the environment and deforestation. Many professional medical associations and healthcare providers advocate for their members to take the lead in environmental sustainability. Objectives To avail and expand ‘Green Podiatry’ via the three pillars of: Exercise ; Evidence ; Everyday changes; to highlight the benefits of physical activity and exercise for both human health and planet health. Walking and running are beneficial for health, provide low carbon transport, and have evidence-based health benefits. Podiatrists are key healthcare professionals in the physical activity space and can influence and guide their patients to increase physical activity and avert the many non-communicable diseases that are decimating public health, eg diabetes, arthritis, depression, cancer, obesity. Methods Publications, conference presentations, and pilot projects pertinent to ‘Green Podiatry’ have been activated since 2021, and a survey of podiatrist’s knowledge and awareness has been undertaken.The survey assessed attitudes towards environmental sustainability in work environment. The questions addressed commuting habits, hours of physical exercise per week, and attitudes in the clinic, such as prescribing unnecessary treatments or emphasizing sports as primary treatment. Results Teaching and Learning modules have been developed for podiatric medicine students and graduates globally. These will be availed. A pilot foot orthoses recycling project has been undertaken and will be reported, in addition to established footwear recycling. The preliminary survey found almost 90% of respondents had no knowledge of green podiatry or footwear recycling. Only 30% prescribe sports/exercise as the primary treatment for patients, and 45% do not to prescribe unnecessary treatments. Conclusions Podiatrists are in a good position to lead in the crucial area of healthcare and climate change implications. Sufficient education of podiatrists is essential for the profession to beneficially promote health and physical activity, which is beneficial for the health of all peoples and all communities.

Keywords: climate change, gait, green, healthcare, sustainability

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Authors: Yesim Sucullu Karadag, Pinar Kurt, Sule Bilen, Nese Subutay Oztekin, Fikri Ak

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Background: Primary cervical dystonia is thought to be a purely motor disorder. But recent studies revealed that patients with dystonia had additional non-motor features. Sensory and psychiatric disturbances could be included into the non-motor spectrum of dystonia. The Basal Ganglia receive inputs from all cortical areas and throughout the thalamus project to several cortical areas, thus participating to circuits that have been linked to motor as well as sensory, emotional and cognitive functions. However, there are limited studies indicating cognitive impairment in patients with cervical dystonia. More evidence is required regarding neurocognitive functioning in these patients. Objective: This study is aimed to investigate neurocognitive profile of cervical dystonia patients in comparison to healthy controls (HC) by employing a detailed set of neuropsychological tests in addition to self-reported instruments. Methods: Totally 29 (M/F: 7/22) cervical dystonia patients and 30 HC (M/F: 10/20) were included into the study. Exclusion criteria were depression and not given informed consent. Standard demographic, educational data and clinical reports (disease duration, disability index) were recorded for all patients. After a careful neurological evaluation, all subjects were given a comprehensive battery of neuropsychological tests: Self report of neuropsychological condition (by visual analogue scale-VAS, 0-100), RAVLT, STROOP, PASAT, TMT, SDMT, JLOT, DST, COWAT, ACTT, and FST. Patients and HC were compared regarding demographic, clinical features and neurocognitive tests. Also correlation between disease duration, disability index and self report -VAS were assessed. Results: There was no difference between patients and HCs regarding socio-demographic variables such as age, gender and years of education (p levels were 0.36, 0.436, 0.869; respectively). All of the patients were assessed at the peak of botulinum toxine effect and they were not taking an anticholinergic agent or benzodiazepine. Dystonia patients had significantly impaired verbal learning and memory (RAVLT, p<0.001), divided attention and working memory (ACTT, p<0.001), attention speed (TMT-A and B, p=0.008, 0.050), executive functions (PASAT, p<0.001; SDMT, p= 0.001; FST, p<0.001), verbal attention (DST, p=0.001), verbal fluency (COWAT, p<0.001), visio-spatial processing (JLOT, p<0.001) in comparison to healthy controls. But focused attention (STROOP-spontaneous correction) was not different between two groups (p>0.05). No relationship was found regarding disease duration and disability index with any neurocognitive tests. Conclusions: Our study showed that neurocognitive functions of dystonia patients were worse than control group with the similar age, sex, and education independently clinical expression like disease duration and disability index. This situation may be the result of possible cortical and subcortical changes in dystonia patients. Advanced neuroimaging techniques might be helpful to explain these changes in cervical dystonia patients.

Keywords: cervical dystonia, neurocognitive impairment, neuropsychological test, dystonia disability index

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Authors: Shawn P. Daly

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Communities heavily engaged in the tourism industry discover their values intersect, meld, and conflict with those of visitors. Maintaining cultural integrity in the face of powerful external pressures causes stress among society members. This effect represents a less studied aspect of sustainable tourism. The present paper brings a perspective unique to the tourism literature: biculturalism. The grounded theories, coherent hypotheses, and validated constructs and indicators of biculturalism represent a sound base from which to consider sociocultural issues in sustainable tourism. Five models describe the psychological state of individuals operating at cultural crossroads: assimilation (joining the new culture), acculturation (grasping the new culture but remaining of the original culture), alternation (varying behavior to cultural context), multicultural (maintaining distinct cultures), and fusion (blending cultures). These five processes divide into two units of analysis (individual and society), permitting research questions at levels important for considering sociocultural sustainability. Acculturation modelling has morphed into dual processes of acculturation (new culture adaptation) and enculturation (original culture adaptation). This dichotomy divides sustainability research questions into human impacts from assimilation (acquiring new culture, throwing away original), separation (rejecting new culture, keeping original), integration (acquiring new culture, keeping original), and marginalization (rejecting new culture, throwing away original). Biculturalism is often cast in terms of its emotional, behavioral, and cognitive dimensions. Required cultural adjustments and varying levels of cultural competence lead to physical, psychological, and emotional outcomes, including depression, lowered life satisfaction and self-esteem, headaches, and back pain—or enhanced career success, social skills, and life styles. Numerous studies provide empirical scales and research hypotheses for sustainability research into tourism’s causality and effect on local well-being. One key issue in applying biculturalism to sustainability scholarship concerns identification and specification of the alternative new culture contacting local culture. Evidence exists for tourism industry, universal tourist, and location/event-specific tourist culture. The biculturalism paradigm holds promise for researchers examining evolving cultural identity and integrity in response to mass tourism. In particular, confirmed constructs and scales simplify operationalization of tourism sustainability studies in terms of human impact and adjustment.

Keywords: biculturalism, cultural integrity, psychological and sociocultural adjustment, tourist culture

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Authors: Charles Masulani Mwale

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Background: It is argued that 85% of children with the disability live in resource-poor countries where there are few available disability services. A majority of these children, including their parents, suffer a lot as a result of the disability and its associated stigmatization, leading to a marginalized life. These parents also experience more stress and mental health problems such as depression, compared with families of normal developing children. There is little research from Africa addressing these issues especially among parents of intellectually disabled children. WHO encourages research on the impact that child with a disability have on their family and appropriate training and support to the families so that they can promote the child’s development and well-being. This study investigated the parenting experiences, mechanisms of coping with these challenges and psychosocial needs while caring for children with intellectual disabilities in both rural and urban settings of Lilongwe and Mzuzu. Methods: This is part of a larger Mixed-methods study aimed at developing a contextualized psychosocial intervention for parents of intellectually disabled children. 16 focus group discussions and four in-depth interviews were conducted with parents in catchments areas for St John of God and Children of Blessings in Mzuzu and Lilongwe cities respectively. Ethical clearance was obtained from COMREC. Data were stored in NVivo software for easy retrieval and management. All interviews were tape-recorded, transcribed and translated into English. Note-taking was performed during all the observations. Data triangulation from the interviews, note taking and the observations were done for validation and reliability. Results: Caring for intellectually disabled children comes with a number of challenges. Parents experience stigma and discrimination; fear for the child’s future; have self-blame and guilt; get coerced by neighbors to kill the disabled child; and fear violence by and to the child. Their needs include respite relief, improved access to disability services, education on disability management and financial support. For their emotional stability, parents cope by sharing with others and turning to God while other use poor coping mechanisms like alcohol use. Discussion and Recommendation: Apart from neighbors’ coercion to eliminate the child life, the findings of this study are similar to those done in other countries like Kenya and Pakistan. It is recommended that parents get educated on disability, its causes, and management to array fears of unknown. Community education is also crucial to promote community inclusiveness and correct prevailing myths associated with disability. Disability institutions ought to intensify individual as well as group counseling services to these parents. Further studies need to be done to design culturally appropriate and specific psychosocial interventions for the parents to promote their psychological resilience.

Keywords: psychological distress, intellectual disability, psychosocial interventions, mental health, psychological resilience, children

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Authors: Emily Moore, Dora Amos, Tracy Ellimah, Natasha Parrott

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Postoperative haematoma is a well-recognised complication of thyroid surgery with an incidence of 1-5%. Haematoma formation causes progressive airway obstruction, necessitating emergency bedside haematoma evacuation in up to ¼ of patients. ENT UK, BAETS and DAS have developed consensus guidelines to improve perioperative care, recommending that all healthcare staff interacting with patients undergoing thyroid surgery should be trained in managing post-thyroidectomy haematoma. The aim was to assess the effectiveness of a hybrid simulation model in improving clinician’s confidence in dealing with this surgical emergency. A hybrid simulation was designed, consisting of a standardised patient wearing a part-task trainer to mimic a post-thyroidectomy haematoma in a real patient. The part-task trainer was an adapted C-spine collar with layers of silicone representing the skin and strap muscles and thickened jelly representing the haematoma. Both the skin and strap muscle layers had to be opened in order to evacuate the haematoma. Boxes have been implemented into the appropriate post operative areas (recovery and surgical wards), which contain a printed algorithm designed to assist in remembering a sequence of steps for haematoma evacuation using the ‘SCOOP’ method (skin exposure, cut sutures, open skin, open muscles, pack wound) along with all the necessary equipment to open the front of the neck. Small-group teaching sessions were delivered by ENT and anaesthetic trainees to members of the multidisciplinary team normally involved in perioperative patient care, which included ENT surgeons, anaesthetists, recovery nurses, HCAs and ODPs. The DESATS acronym of signs and symptoms to recognise (difficulty swallowing, EWS score, swelling, anxiety, tachycardia, stridor) was highlighted. Then participants took part in the hybrid simulation in order to practice this ‘SCOOP’ method of haematoma evacuation. Participants were surveyed using a Likert scale to assess their level of confidence pre- and post teaching session. 30 clinicians took part. Confidence (agreed/strongly agreed) in recognition of post thyroidectomy haematoma improved from 58.6% to 96.5%. Confidence in management improved from 27.5% to 89.7%. All participants successfully decompressed the haematoma. All participants agreed/strongly agreed, that the sessions were useful for their learning. Multidisciplinary team simulation teaching is effective at significantly improving confidence in both the recognition and management of postoperative haematoma. Hybrid simulation sessions are useful and should be incorporated into training for clinicians.

Keywords: thyroid surgery, haematoma, teaching, hybrid simulation

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Authors: Felipa M. Rico

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Linguistic oral competence plays a vital role in attaining effective communication. Since the English language is considered as universally used language and has a high demand skill needed in the work-place, mastery is the expected output from learners. To achieve this, learners should be given integrated differentiated tasks which help them develop and strengthen the expected skills. This study aimed to develop speaking instructional supplementary material to enhance the English linguistic competence of Grade 9 students in areas of pronunciation, intonation and stress, voice projection, diction and fluency. A descriptive analysis was utilized to analyze the speaking level of performance of the students in order to employ appropriate strategies. There were two sets of respondents: 178 Grade 9 students selected through a stratified sampling and chosen at random. The other set comprised English teachers who evaluated the usefulness of the devised teaching materials. A teacher conducted a speaking test and activities were employed to analyze the speaking needs of students. Observation and recordings were also used to evaluate the students’ performance. The findings revealed that the English pronunciation of the students was slightly unclear at times, but generally fair. There were lapses but generally they rated moderate in intonation and stress, because of other language interference. In terms of voice projection, students have erratic high volume pitch. For diction, the students’ ability to produce comprehensible language is limited, and as to fluency, the choice of vocabulary and use of structure were severely limited. Based on the students’ speaking needs analyses, the supplementary material devised was based on Nunan’s IM model, incorporating context of daily life and global work settings, considering the principle that language is best learned in the actual meaningful situation. To widen the mastery of skill, a rich learning environment, filled with a variety instructional material tends to foster faster acquisition of the requisite skills for sustained learning and development. The role of IM is to encourage information to stick in the learners’ mind, as what is seen is understood more than what is heard. Teachers say they found the IM “very useful.” This implied that English teachers could adopt the materials to improve the speaking skills of students. Further, teachers should provide varied opportunities for students to get involved in real life situations where they could take turns in asking and answering questions and share information related to the activities. This would minimize anxiety among students in the use of the English language.

Keywords: diction, fluency, intonation, instructional materials, linguistic competence

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Authors: Henry Venter, Murali Thyloth, Alceu Casseb

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Historically, mental and substance use disorders were not a global health priority. Since the 1993 World Development Report, the importance of the contribution of mental health and substance abuse on the relative global burden associated with disease morbidity has been recognized with 300 million people worldwide suffering from depression alone. This led to an international effort to improve the mental health of populations around the world. Despite these efforts some countries remain at the top of the list of countries with the highest rate of mental illness. Important research questions were asked: Would there be commonalities regarding mental health between these countries; would there be common factors leading to the high prevalence of mental illness; and how prepared are these countries with mental health delivery? Findings from this research can aid organizations and institutions preparing mental health service providers to focus training and preparation to address specific needs revealed by the study. Methods: Researchers decided to compare three distinctly different countries at the top of the list of countries with the highest rate of mental illness, the USA, India and Brazil, situated on three different continents with different economies and lifestyles. Data were collected using archival research methodology, reviewing records and findings of international and national health and mental health studies to subtract and compare data and findings. Results: The findings indicated that India is the most depressed country in the world, followed by the USA (and China) with Brazil in Latin America with the greatest number of depressed individuals. By 2020 roughly 20% of India, acountry of over one billion citizens, will suffer from some form of mental illnees, yet there are less than 4,000 experts available. In the USA 164.8 million people were substance abusers and an estimate of 47.6 million adults, 18 or older, had any mental illness in 2018. That means that about one in five adults in the USA experiences some form of mental illness each year, but only 41% of those affected received mental health care or services in the past year. Brazil has the greatest number of depressed individuals, in Latin America. Adults living in Sao Paulo megacity has prevalence of mental disorders at greater levels than similar surveys conducted in other areas of the world with more than one million adults with serious impairment levels. Discussion: The results show that, despite the vast socioeconomic differences between the three countries, there are correlations regarding mental health prevalence and difficulty to provide adequate services including a lack of awareness of how serious mental illness is, stigma for seeking mental illness, with comorbidity a common phenomenon, and a lack of partnership between different levels of service providers, which weakens mental health service delivery. The findings also indicate that mental health training institutions have a monumental task to prepare personnel to address the future mental health needs in each of the countries compared, which will constitute the next phase of the research.

Keywords: mental health epidemiology, mental health disorder, mental health prevalence, mental health treatment

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Authors: Ali A Alshraifeen, Josie Evans, Kathleen Stoddart

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End-stage renal disease (ESRD) introduces physical, psychological, social, emotional and spiritual challenges into patients’ lives. Spirituality has been found to contribute to improved health outcomes, mainly in the areas of quality of life (QOL) and well-being. No studies exist to explore the influence of spirituality on the health outcomes and general well-being in patients with end-stage renal disease receiving hemodialysis (HD) treatment in Scotland. This study was conducted to explore spirituality in the daily lives of among these patients and how it may influence their QOL and general well-being. The study employed a qualitative method. Data were collected using semi-structured interviews with a sample of 21 patients. A thematic approach using Framework Analysis informed the qualitative data analysis. Participants were recruited from 11 dialysis units across four Health Boards in Scotland. The participants were regular patients attending the dialysis units three times per week. Four main themes emerged from the qualitative interviews: ‘Emotional and Psychological Turmoil’, ‘Life is Restricted’, ‘Spirituality’ and ‘Other Coping Strategies’. The findings suggest that patients’ QOL might be affected because of the physical challenges such as unremitting fatigue, disease unpredictability and being tied down to a dialysis machine, or the emotional and psychological challenges imposed by the disease into their lives such as wholesale changes, dialysis as a forced choice and having a sense of indebtedness. The findings also revealed that spirituality was an important coping strategy for the majority of participants who took part in the qualitative component (n=16). Different meanings of spirituality were identified including connection with God or Supernatural Being, connection with the self, others and nature/environment. Spirituality encouraged participants to accept their disease and offered them a sense of protection, instilled hope in them and helped them to maintain a positive attitude to carry on with their daily lives, which may have had a positive influence on their health outcomes and general well-being. The findings also revealed that humor was another coping strategy that helped to diffuse stress and anxiety for some participants and encouraged them to carry on with their lives. The findings from this study provide a significant contribution to a very limited body of work. The study contributes to our understanding of spirituality and how people receiving dialysis treatment use it to manage their daily lives. Spirituality is of particular interest due to its connection with health outcomes in patients with chronic illnesses. The link between spirituality and many chronic illnesses has gained some recognition, yet the identification of its influence on the health outcomes and well-being in patients with ESRD is still evolving. There is a need to understand patients’ experiences and examine the factors that influence their QOL and well-being to ensure that the services available are adequately tailored to them. Hence, further research is required to obtain a better understanding of the influence of spirituality on the health outcomes and general well-being of patients with ESRD.

Keywords: end-stage renal disease, general well-being, quality of life, spirituality

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Authors: Katie Dolaghan, Christina Tran, Kim Hamilton, Amanda Beresford, Vicky Adams, Jamie Toole, John Marley

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During the Covid 19 pandemic routine outpatient appointments were not possible face to face. That resulted in many branches of healthcare starting virtual clinics. These clinics have continued following the return to face to face patient appointments. With these new types of clinic it is important to ensure that a high standard of patient care is maintained. In order to improve patient and clinician experience of the telephone clinics a quality improvement project was carried out to ensure the patient and clinician experience of these clinics was enhanced whilst remaining a safe, effective and an efficient use of resources. The project began by developing a process map for the consultation process and agreed on the design of a driver diagram and tests of change. In plan do study act (PDSA) cycle1 a single consultant completed an online survey after every patient encounter over a 5 week period. Baseline patient responses were collected using a follow-up telephone survey for each patient. Piloting led to several iterations of both survey designs. Salient results of PDSA1 included; patients not receiving appointment letters, patients feeling more anxious about a virtual appointment and many would prefer a face to face appointment. The initial clinician data showed a positive response with a provisional diagnosis being reached in 96.4% of encounters. PDSA cycle 2 included provision of a patient information sheet and information leaflets relevant to the patients’ conditions were developed and sent following new patient telephone clinics with follow-up survey analysis as before to monitor for signals of change. We also introduced the ability for patients to send an images of their lesion prior to the consultation. Following the changes implemented we noted an improvement in patient satisfaction and, in fact, many patients preferring virtual clinics as it lead to less disruption of their working lives. The extra reading material both before and after the appointments eased patients’ anxiety around virtual clinics and helped them to prepare for their appointment. Following the patient feedback virtual clinics are now used for review patients as well, with all four consultants within the department continuing to utilise virtual clinics. During this presentation the progression of these clinics and the reasons that these clinics are still operating following the return to face to face appointments will be explored. The lessons that have been gained using a QI approach have helped to deliver an optimal service that is valid and reliable as well as being safe, effective and efficient for the patient along with helping reduce the pressures from ever increasing waiting lists. In summary our work in improving the quality of virtual clinics has resulted in improved patient satisfaction along with reduced pressures on the facilities of the health trust.

Keywords: clinic, satisfaction, telephone, virtual

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Authors: Elizabeth Adebomi Akinlotan, Olukemi Odukoya

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INTRODUCTION: Physical Activity is defined as activity that involves bodily movement which is done as a part of daily activity in the form of working, playing, active transportation such as walking and also as a form of recreational activity. Physical inactivity has been identified as the fourth leading risk factor for global mortality and morbidity causing an estimated 3.2 million deaths globally and 5.5% of total deaths and it remains a pressing public health issue. There is a shift in the major causes of death from communicable to non-communicable diseases in many developed countries and this is fast becoming the case in developing countries. Physical activity is an important determinant of health and has been associated with lower mortality rates as it reduces the risk of developing chronic diseases such as diabetes mellitus, hypertension, stroke, cancer and osteoporosis. It improves musculoskeletal health, controls weight and reduces symptoms of depression. AIM: The aim is to study the knowledge, attitude and practices of physical activity among adults in Alimosho local government area. METHODOLOGY: This was a descriptive cross sectional survey designed to study the knowledge, attitude and practice of physical activity among adults in Alimosho Local Government Area. The study population were 250 adults aged 18-65 who were residents of the area of more than 6 months duration and had no chronic disease condition or physical disability. A multistage sampling method was used to select the respondents and data was collected using interviewer administered questionnaires. The data was analyzed with the use of EPI-info 2007 statistical software. Chi Square was thereafter used to test the association between selected variables. The level of statistical significance was set at 5% (p<0.05). RESULTS: In general, majority (61.6%) of the respondents had a good knowledge of what physical activity entails, 34.0% had fair knowledge and 4.4% had poor knowledge. There was a favorable attitude towards physical activity among the respondents with 82.4% having an overall positive attitude. Below a third of the respondents (26.4%) reported having a high physical activity (METS > 3001) while 40.0% had moderate (601-3000 METS) levels of activity and 33.6% were inactive (<600METS). There is statistical significance between the gender of the respondent and the levels of physical activity (p=0.0007); 75.2% males reached the minimum recommendations while 24.8% were inactive and 55.0% females reached the minimum recommendations while 45.0% were inactive. Results also showed that of 95 respondents who were satisfied with their levels of physical activity, 33.7% were insufficiently active while 66.3% were either minimally active or highly active and of 110 who were unsatisfied with their levels of physical activity, 72.0% were above the minimum recommendations while 38.0% were insufficiently active. CONCLUSION: In contrast to the high level of knowledge and favorable attitude towards physical activity, there was a lower level of practice of high or moderate physical activities. It is recommended that more awareness should be created on the recommended levels of physical activity especially for the vigorous intensity and moderate intensity physical activity.

Keywords: METS, physical activity, physical inactivity, public health

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Authors: Natalia Alvarado, Myldred Hernandez-Gonzalez, Mary Laird, Madeline Phillips, Elizabeth Miller, Luis Mendez, Teresa Satterfield Linares

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Objectives: Focusing on the reported levels of depressive symptoms from Hispanic individuals in the U.S. during the ongoing COVID-19 pandemic, we analyze the psychological effects of being labeled an ‘essential worker/trabajador(a) esencial.’ We situate this attribute within the complex context of how an individual’s mental health is linked to work status and his/her community’s attitude toward such a status. Method: 336 Spanish-speaking adults (Mage = 34.90; SD = 11.00; 46% female) living in the U.S. participated in a mixed-method study. Participants completed a self-report Spanish-language survey consisting of COVID-19 prompts (e.g., Soy un trabajador esencial durante la pandemia. I am an ‘essential worker’ during the pandemic), civic engagement scale (CES) attitudes (e.g., Me siento responsable de mi comunidad. I feel responsible for my community) and behaviors (e.g., Ayudo a los miembros de mi comunidad. I help members of my community), and the Center for Epidemiological Studies Depression Scale (e.g., Me sentía deprimido/a. I felt depressed). The survey was conducted several months into the pandemic and before the vaccine distribution. Results: Regression analyses show that being labeled an essential worker was correlated to CES attitudes (b= .28, p < .001) and higher CES behaviors (b= .32, p < .001). Essential worker status also reported higher levels of depressive symptoms (b= .17, p < .05). In addition, we found that CES attitudes and CES behaviors were related to higher levels of depressive symptoms (b= .11, p <.05, b = .22, p < .001, respectively). These findings suggest that those who are on the frontlines during the COVID-19 pandemic suffer higher levels of depressive symptoms, despite their affirming community attitudes and behaviors. Discussion: Hispanics/Latinxs make up 53% of the high-proximity employees who must work in person and in close contact with others; this is the highest rate of any racial or ethnic category. Moreover, 31% of Hispanics are classified as essential workers. Our outcomes show that those labeled as trabajadores esenciales convey attitudes of remaining strong and resilient for COVID-19 victims. They also express community attitudes and behaviors reflecting a sense of responsibility to continue working to help others during these unprecedented times. However, we also find that the pressure of maintaining basic needs for others exacerbates mental health challenges and stressors, as many essential workers are anxious and stressed about their physical and economic security. As a result, community attitudes do not protect from depressive symptoms as Hispanic essential workers are failing to balance everyone’s needs, including their own (e.g., physical exhaustion and psychological distress). We conclude with a discussion on alternatives to the phrase ‘essential worker’ and of incremental steps that can be taken to address pandemic-related mental health issues targeting US Hispanic workers.

Keywords: COVID-19, essential worker, mental health, race and ethnicity

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Authors: Anne-Margré C. Vink

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Background: Food-related allergies and intolerances are frequently occurring in dogs. Diagnosis and monitoring according to ‘Golden Standard’ of elimination efficiency are time-consuming, expensive, and requires expert clinical setting. In order to facilitate rapid and robust, quantitative testing of intolerance, and determining the individual offending foods, a serological test is implicated. Method: As we developed Medisynx IgG Human Screening Test ELISA before and the dog’s immune system is most similar to humans, we were able to develop Medisynx IgG Dog Screening Test ELISA as well. In this study, 47 dogs suffering from Canine Atopic Dermatitis (CAD) and several secondary induced reactions were included to participate in serological Medisynx IgG Dog Screening Test ELISA (within < 0,02 % SD). Results were expressed as titers relative to the standard OD readings to diagnose alimentary induced diseases and monitoring the efficacy of an individual eliminating diet in dogs. Split sample analysis was performed by independently sending 2 times 3 ml serum under two unique codes. Results: The veterinarian monitored these dogs to check dog’ results at least at 3, 7, 21, 49, 70 days and after period of 6 and 12 months on an individual negative diet and a positive challenge (retrospectively) at 6 months. Data of each dog were recorded in a screening form and reported that a complete recovery of all clinical manifestations was observed at or less than 70 days (between 50 and 70 days) in the majority of dogs(44 out of 47 dogs =93.6%). Conclusion: Challenge results showed a significant result of 100% in specificity as well as 100% positive predicted value. On the other hand, sensitivity was 95,7% and negative predictive value was 95,7%. In conclusion, an individual diet based on IgG ELISA in dogs provides a significant improvement of atopic dermatitis and pruritus including all other non-specific defined allergic skin reactions as erythema, itching, biting and gnawing at toes, as well as to several secondary manifestations like chronic diarrhoea, chronic constipation, otitis media, obesity, laziness or inactive behaviour, pain and muscular stiffness causing a movement disorders, excessive lacrimation, hyper behaviour, nervous behaviour and not possible to stay alone at home, anxiety, biting and aggressive behaviour and disobedience behaviour. Furthermore, we conclude that a relatively more severe systemic candidiasis, as shown by relatively higher titer (class 3 and 4 IgG reactions to Candida albicans), influence the duration of recovery from clinical manifestations in affected dogs. These findings are consistent with our preliminary human clinical studies.

Keywords: allergy, canine atopic dermatitis, CAD, food allergens, IgG-ELISA, food-incompatibility

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Authors: Susan Hall, Gary D. Grant, Catherine McDermott, Devinder Arora

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Introduction /Aim: The kynurenine pathway is thought to play an important role in the pathophysiology of numerous neurodegenerative diseases including depression, Alzheimer’s disease, and Parkinson’s disease. Numerous neuroactive compounds, including the neurotoxic 3-hydroxyanthranilic acid, 3-hydroxykynurenine and quinolinic acid and the neuroprotective kynurenic acid and picolinic acid, are produced through the metabolism of kynurenine and are thought to be the causative agents responsible for neurodegeneration. The toxicity of 3-hydroxykynurenine, 3-hydroxyanthranilic acid and quinolinic acid has been widely evaluated and demonstrated in primary cell cultures but to date only 3-hydroxykynurenine and 3-hydroxyanthranilic acid have been shown to cause toxicity in immortal tumour cells. The aim of this study was to evaluate the toxicity of kynurenine metabolites, both individually and in combination, on SH-SY5Y neuroblastoma cells after 24 and 72 h exposure in order to explore a cost-effective model to study their neurotoxic effects and potential protective agents. Methods: SH-SY5Y neuroblastoma cells were exposed to various concentrations of the neuroactive kynurenine metabolites, both individually and in combination, for 24 and 72 h, and viability was subsequently evaluated using the Resazurin (Alamar blue) proliferation assay. Furthermore, the effects of these compounds, alone and in combination, on specific death pathways including apoptosis, necrosis and free radical production was evaluated using various assays. Results: Consistent with literature, toxicity was shown with short-term 24-hour treatments at 1000 μM concentrations for both 3-hydroxykynurenine and 3-hydroxyanthranilic acid. Combinations of kynurenine metabolites showed modest toxicity towards SH-SY5Y neuroblastoma cells in a concentration-dependent manner. Specific cell death pathways, including apoptosis, necrosis and free radical production were shown to be increased after both 24 and 72 h exposure of SH-SY5Y neuroblastoma cells to 3-hydroxykynurenine and 3-hydroxyanthranilic acid and various combinations of neurotoxic kynurenine metabolites. Conclusion: It is well documented that neurotoxic kynurenine metabolites show toxicity towards primary human neurons in the nanomolar to low micromolar concentration range. Results show that the concentrations required to show significant cell death are in the range of 1000 µM for 3-hydroxykynurenine and 3-hydroxyanthranilic acid and toxicity of quinolinic acid towards SH-SY5Y was unable to be shown. This differs significantly from toxicities observed in primary human neurons. Combinations of the neurotoxic metabolites were shown to have modest toxicity towards these cells with increased toxicity and activation of cell death pathways observed after 72 h exposure. This study suggests that the 24 h model is unsuitable for use in neurotoxicity studies, however, the 72 h model better represents the observations of the studies using primary human neurons and may provide some benefit in providing a cost-effective model to assess possible protective agents against kynurenine metabolite toxicities.

Keywords: kynurenine metabolites, neurotoxicity, quinolinic acid, SH-SY5Y neuroblastoma

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Authors: Sergio A. Navarro Tuch, Martin Rogelio Bustamante Bello, Leopoldo Julian Lechuga Lopez

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In recent years, Mexico’s population has seen a rise of different physiological and mental negative states. Two main consequences of this problematic are deficient work performance and high levels of stress generating and important impact on a person’s physical, mental and emotional health. Several approaches, such as the use of audiovisual stimulus to induce emotions and modify a person’s emotional state, can be applied in an effort to decreases these negative effects. With the use of different non-invasive physiological sensors such as EEG, luminosity and face recognition we gather information of the subject’s current emotional state. In a controlled environment, a subject is shown a series of selected images from the International Affective Picture System (IAPS) in order to induce a specific set of emotions and obtain information from the sensors. The raw data obtained is statistically analyzed in order to filter only the specific groups of information that relate to a subject’s emotions and current values of the physical variables in the controlled environment such as, luminosity, RGB light color, temperature, oxygen level and noise. Finally, a neural network based control algorithm is given the data obtained in order to feedback the system and automate the modification of the environment variables and audiovisual content shown in an effort that these changes can positively alter the subject’s emotional state. During the research, it was found that the light color was directly related to the type of impact generated by the audiovisual content on the subject’s emotional state. Red illumination increased the impact of violent images and green illumination along with relaxing images decreased the subject’s levels of anxiety. Specific differences between men and women were found as to which type of images generated a greater impact in either gender. The population sample was mainly constituted by college students whose data analysis showed a decreased sensibility to violence towards humans. Despite the early stage of the control algorithm, the results obtained from the population sample give us a better insight into the possibilities of emotional domotics and the applications that can be created towards the improvement of performance in people’s lives. The objective of this research is to create a positive impact with the application of technology to everyday activities; nonetheless, an ethical problem arises since this can also be applied to control a person’s emotions and shift their decision making.

Keywords: data analysis, emotional domotics, performance improvement, neural network

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Authors: Sijie Chen, Xiaofang Chen, Juan Wang, Yingying Zhang, Yu Hong, Wanyu Zhuang, Xinxin Huang, Ping Ou, Longsheng Huang

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Purpose: Autistic symptom improvement can be observed in children treated with acupuncture, but the mechanism is still being explored. In the present study, we used scalp acupuncture to treat autism rat model, and then their improvement in the abnormal behaviors and specific mechanisms behind were revealed by detecting animal behaviors, analyzing the RNA sequencing of the prefrontal cortex(PFC), and observing the ultrastructure of PFC neurons under the transmission electron microscope. Methods: On gestational day 12.5, Wistar rats were given valproic acid (VPA) by intraperitoneal injection, and their offspring were considered to be reliable rat models of autism. They were randomized to VPA or VPA-acupuncture group (n=8). Offspring of Wistar pregnant rats that were simultaneously injected with saline were randomly selected as the wild-type group (WT). VPA_acupuncture group rats received acupuncture intervention at 23 days of age for 4 weeks, and the other two groups followed without intervention. After the intervention, all experimental rats underwent behavioral tests. Immediately afterward, they were euthanized by cervical dislocation, and their prefrontal cortex was isolated for RNA sequencing and transmission electron microscopy. Results: The main results are as follows: 1. Animal behavioural tests: VPA group rats showed more anxiety-like behaviour and repetitive, stereotyped behaviour than WT group rats. While VPA group rats showed less spatial exploration ability, activity level, social interaction, and social novelty preference than WT group rats. It was gratifying to observe that acupuncture indeed improved these abnormal behaviors of autism rat model. 2. RNA-sequencing: The three groups of rats differed in the expression and enrichment pathways of multiple genes related to synaptic function, neural signal transduction, and circadian rhythm regulation. Our experiments indicated that acupuncture can alleviate the major symptoms of ASD by improving these neurological abnormalities. 3. Under the transmission electron microscopy, several lysosomes and mitochondrial structural abnormalities were observed in the prefrontal neurons of VPA group rats, which were manifested as atrophy of the mitochondrial membran, blurring or disappearance of the mitochondrial cristae, and even vacuolization. Moreover, the number of synapses and synaptic vesicles was relatively small. Conversely, the mitochondrial structure of rats in the WT group and VPA_acupuncture was normal, and the number of synapses and synaptic vesicles was relatively large. Conclusion: Acupuncture effectively improved the abnormal behaviors of autism rat model and the ultrastructure of the PFC neurons, which might worked by improving their abnormal synaptic function, synaptic plasticity and promoting neuronal signal transduction.

Keywords: autism spectrum disorder, acupuncture, animal behavior, RNA sequencing, transmission electron microscope

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Authors: Theoni Soublis

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The COVID-19 pandemic created a severe interruption in teaching and learning in K-12 schools. It is essential that educational researchers, teachers, and administrators understand the long term effects that COVID-19 had on a variety of stakeholders in education. This investigation aims to analyze the research since the beginning of the pandemic that focuses specifically on teacher retention, resilience, and training. The results of this investigation will help to inform future research in order to better understand how the institution of education can continue to be prepared and to better prepare for future significant shifts in the modalities of instruction. The results of this analysis will directly impact the field of education as it will broaden the scope of understanding regarding how COVID- 19 impacted teaching and learning. The themes that will emerge from the data analysis will directly inform policy makers, administrators, and researchers about how to best implement training and curriculum design in order to support teacher effectiveness this in the classroom. Educational researchers have written about how teacher morale plummeted and how many teachers reported early burnout and higher stress levels. Teachers’ stress and anxiety soared during the COVID-19 pandemic, but so has their resilience and dedication to the field of education. This research aims to understand how public-school teachers overcame teaching obstacles presented to them during COVID-19. Research has been conducted to identify a variety of information regarding the impact the pandemic has had on K-12 teachers, students, and families. This research aims to understand how teachers continued to pursue their teaching objectives without significant training of effective online instruction methods. Not many educators even heard of the video conferencing platform Zoom before the spring of 2020. Researchers are interested in understanding how teachers used their expertise, prior knowledge, and training to institute immediate and effective online learning environments, what types of relationships did teachers build with students while teaching 100% remotely, and how did relationships change with students while teaching remotely? Furthermore, did the teacher-student relationship propel teacher resolve to be successful while teaching during a pandemic. Recent world events have significantly impacted the field of public-school teaching. The pandemic forced teachers to shift their paradigm about how to maintain high academic expectations, meet state curriculum standards, and assess students learning gains to make data-informed decisions while simultaneously adapting modes of instruction through multiple outlets with little to no training on remote, synchronous, asynchronous, virtual, and hybrid teaching. While it would be very interesting to study how teaching positively impacted students learning during the pandemic, I am more interested in understanding how teaches stayed the course and maintained their mental health while dealing with the stress and pressure of teaching during COVID-19.

Keywords: teacher retention, COVID-19, teacher education, teacher moral

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Authors: Mathilde Blondon, Salla Aicha Dieng, Catherine Pfister

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In a paradoxical way, teenagers nowadays seem to use suicidal attempts to elaborate on their trauma abuses and regain some kind of control in their lives. As their behavior becomes life-threatening, the hospital offers a variety of expertise to address their need, with Child Protective Services also joining in, to a point when teenagers could have a feeling of losing control of their lives, which results in them making more suicidal attempts. Our goal here is to walk with these foster teenagers long enough to step therapy up first, then as their mental health is restored enough to step the therapy down in a way that is secure and will give them their life back. This would prevent them from making suicidal attempts to get a feeling of control over their life. We’ll present a clinical case of a 14-year-old girl named Sofia, who was suffering from parental deprivation, an identity disorder, and severe depression disorder. Our intervention took place in January 2024, after Sofia had undergone four hospitalizations, including a two-month period in a specialized clinic. In a stepping-up effort, a substantial setting has been built around Sofia. She was coming three days a week to therapeutic activities at the Child Psychiatry Day Hospital, she had one psychotherapy session a week at the Medical-Psychological Center, and she was meeting with the Adolescent Psychiatrist on a regular basis. However, her suicidal attempts frequency continued to increase to the point when she couldn’t stay more than four days outside the hospital unit without harming herself and being brought back to the Emergency Unit. We were all stuck in some kind of medical deadlock, writing to clinics that had no room for her while social workers were calling foster homes that wouldn’t even accept her either. At some point, a clinical decision was made by the psychiatrist to stop what appeared to be a global movement of traumatic repetition, which involved Sofia’s family, the medical team and the social workers as one. This decision to step therapy down created a surprise and put an end to the cycle. It provided a new path, a new solution where Sofia could securely settle without being unfaithful to her family. Her suicidal attempts stopped for four weeks. She had one relapse, then didn’t make another attempt so far. There is a fine line between too little and too much, a pathway with the right amount of care and support. We believe it is not a steady line but rather a path up and down the hill. It’s about building up this moment when medication and mental processes have improved the subject’s condition enough to allow the medical team to step therapy down and give more control back to the subject. These needed variations used to come from a change of hospital or medical team. Stepped care avoids any breaking of bonds and appears to be decisive in stopping teenagers’ suicidal attempts.

Keywords: child protection, adolescent psychiatry, teenager suicidal attempt, foster teenagers, parental deprivation, stepped care

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Authors: Jonathon Smith, Alba Agostino

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Autism, also referred to as autism spectrum disorder (ASD), is commonly associated with difficulties in social and communication skills. Other characteristics common to autistic individuals include repetitive behaviours, difficulties adhering to routine, as well as paying attention. Recent findings indicate that autism is the fastest-growing neurodevelopmental disorder in North America, yet programming aimed at improving the quality of autistic individual’s real-world social interactions is limited. Although there are social skills programs for autistic youth, participation appears to improve social knowledge, but that knowledge does not improve social competence or transfer to the participant’s daily social interactions. Peers are less likely to interact with autistic people based thin slice judgements, meaning that even when an autistic youth has successfully completed a social skills program, they most likely will still be rejected by peers and not have a social group to participate in. Recently, many researchers are exploring therapeutic interventions using Dungeon and Dragons (D&D) for conditions such as social anxiety, loneliness, and identity exploration. D&D is a table-top role-playing game (TTRPG) based on social play experience where the players must communicate, plan, negotiate, and compromise with other players to achieve a shared goal. The game encourages players to assume the role of their character and act out their play within the rules of the game with the guidance of the games dungeon master. The popularity Dungeons and Dragons has increased at a rapid rate, and many suggest that there social-emotional benefits of joining and participating in these types of gaming experiences, however this is an under researched topic and studies examining the benefits of such games is lacking in the field. The main purpose of this exploratory study is to examine the autistic youth’s experiences of participating in a D&D club. Participants of this study were four high functioning autistic youth between the ages of 14-18 (average age – 16) enrolled in a D&D Club that was specifically designed for neurodiverse youth. The youth participation with the club ranged from 4 months to 8 months. All participants completed a 30–40-minute semi-structured interview where they were able to express their perceptions as participants of the D&D club. Preliminary findings suggest that the game provided a place for the youth to engage in authentic social interactions. Additionally, preliminary results suggest that the youth report being in a positive space with other neurodivergent youth created an atmosphere where they felt confident and could connect with others. The findings from this study will aid clinicians, researchers, and educators in developing programming aimed at improving social interactions and connections for autistic youth.

Keywords: autism, social connection, dungeons and dragons, neurodivergent affirming space

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Authors: Daniel Gredig, Annabelle Bartelsen-Raemy

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Social work services offered to people living with diabetes tend to be moulded by the prevailing understanding that social work is to support people living with diabetes in their adherence to medical prescription and/or life style changes. As diabetes has been conceived as a condition facing no stigma, discrimination of people living with diabetes has not been considered. However, there is growing evidence of stigma. To our knowledge, nevertheless, there have been no comprehensive, in-depth studies of stigma and its impact. Against this background and challenging the present layout of services for people living with diabetes, the present study aimed to establish whether: -people living with diabetes in Switzerland experience stigma, and if so, in what context and to what extent; -experiencing stigma impacts the quality of life of those affected. It was hypothesized that stigma would impact on their quality of life. It was further hypothesized that low self-esteem, psychological distress, depression, and a lack of social support would be mediating factors. For data collection an anonymous paper-and-pencil self-administered questionnaire was used which drew on a qualitative elicitation study. Data were analysed using descriptive statistics and structural equation modelling. To generate a large and diverse convenience sample the questionnaire was distributed to the readers of journal destined to diabetics living in Switzerland issued in German and French. The sample included 3347 people with type 1 and 2 diabetes, aged 16–96, living in diverse living conditions in the German- and French-speaking areas of Switzerland. Respondents reported experiences of discrimination in various contexts and stereotyping based on the belief that diabetics have a low work performance; are inefficient in the workplace; inferior; weak-willed in their ability to manage health-related issues; take advantage of their condition and are viewed as pitiful or sick people. Respondents who reported higher levels of perceived stigma reported higher levels of psychological distress (β = .37), more pronounced depressive symptoms (β=.33), and less social support (β = -.22). Higher psychological distress (β = -.29) and more pronounced depressive symptoms (β = -.28), in turn, predicted lower quality of life. These research findings challenge the prevailing understanding of social work services for people living with diabetes in Switzerland and beyond. They call for a less individualistic approach, the consideration of the social context service users are placed in their everyday life, and addressing stigma. So, social work could partner with people living with diabetes in order to fight against discrimination and stereotypes. This could include identifying and designing educational and public awareness strategies. In direct social work with people living with diabetes, this could include broaching experiences of stigma and modes of coping with. This study was carried out in collaboration with the Swiss Diabetes Association. The association accepted the challenging conclusions from this study. It connected to the results and is currently discussing the priorities and courses of action to be taken.

Keywords: diabetes, discrimination, quality of life, services, stigma

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Authors: Jenny Fairthorne, Yuka Mori, Helen Leonard

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Background: Primary care-givers of children with autism spectrum disorder (ASD) or intellectual disability (ID) have poorer health and quality of life (QoL) than primary care-givers (hereafter referred to as just care-givers) of typically developing children. We aimed to review original research which described factors impacting the health of care-givers of children with ASD or ID and to discuss how these factors might influence care-giver health. Methods: We searched Web of Knowledge, Medline, Scopus and Google Scholar using selections of words from each of three groups. The first comprised terms associated with ASD and ID and included autism, pervasive development disorder, intellectual disability, mental retardation, disability, disabled, Down and Asperger. The second included terms related to health such as depression, physical, mental, psychiatric, psychological and well-being. The third was terms related to care-givers such as mother, parent and care-giver. We included an original paper in our review if it was published between 1st January 1990 and 31st December, 2016, described original research in a peer-reviewed journal and was written in English. Additional criteria were that the research used a study population of 15 persons or more; described a risk or protective factor for the health of care-givers of a child with ASD, ID or a sub-type (such as ASD with ID or Down syndrome). Using previous research, we developed a simple and objective five-level tool to assess the strength of evidence provided by the reviewed papers. Results: We retained 33 papers. Factors impacting primary care-giver health included child behaviour, level of support, socio-economic status (SES) and diagnostic issues. Challenging child behaviour, the most commonly identified risk factor for poorer care-giver health and QoL was reported in ten of the studies. A higher level of support was associated with improved care-giver health and QoL. For example, substantial evidence indicated that family support reduced care-giver burden in families with a child with ASD and that family and neighbourhood support was associated with improved care-giver mental health. Higher socio-economic status (SES) was a protective factor for care-giver health and particularly maternal health. Diagnostic uncertainty and an unclear prognosis are factors which can cause the greatest concern to care-givers of children with ASD and those for whom a cause of their child’s ID has not been identified. We explain how each of these factors might impact caregiver health and how they might act differentially in care-givers of children with different types of ASD or ID (such as Down syndrome and ASD without ID). Conclusion: Care-givers of children with ASD may be more likely to experience many risk factors and less likely to experience the protective factors we identified for poorer mental health. Interventions to reduce risk factors and increase protective factors could pave the way for improved care-giver health. For example, workshops to train care-givers to better manage challenging child behaviours and earlier diagnosis of ASD (and particularly ASD without ID) would seem likely to improve care-giver well-being. Similarly, helping to expand support networks might reduce care-giver burden and stress leading to improved health.

Keywords: autism, caregivers, health, intellectual disability, mothers, review

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Authors: Ichiro Takahashi

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One conundrum that macroeconomic theory faces is to explain how an economy can revive from depression, in which the aggregate demand has fallen substantially below its productive capacity. This paper examines an autonomous stabilizing mechanism using an agent-based Wicksell-Keynes macroeconomic model. This paper focuses on the effects of the number of firms and the length of the gestation period for investment that are often assumed to be one in a mainstream macroeconomic model. The simulations found the virtual economy was highly unstable, or more precisely, collapsing when these parameters are fixed at one. This finding may even suggest us to question the legitimacy of these common assumptions. A perpetual decline in capital stock will eventually encourage investment if the capital stock is short-lived because an inactive investment will result in insufficient productive capacity. However, for an economy characterized by a roundabout production method, a gradual decline in productive capacity may not be able to fall below the aggregate demand that is also shrinking. Naturally, one would then ask if our economy cannot rely on an external stimulus such as population growth and technological progress to revive investment, what factors would provide such a buoyancy for stimulating investments? The current paper attempts to answer this question by employing the artificial macroeconomic model mentioned above. The baseline model has the following three features: (1) the multi-period gestation for investment, (2) a large number of heterogeneous firms, (3) demand-constrained firms. The instability is a consequence of the following dynamic interactions. (a) A multiple-period gestation period means that once a firm starts a new investment, it continues to invest over some subsequent periods. During these gestation periods, the excess demand created by the investing firm will spill over to ignite new investment of other firms that are supplying investment goods: the presence of multi-period gestation for investment provides a field for investment interactions. Conversely, the excess demand for investment goods tends to fade away before it develops into a full-fledged boom if the gestation period of investment is short. (b) A strong demand in the goods market tends to raise the price level, thereby lowering real wages. This reduction of real wages creates two opposing effects on the aggregate demand through the following two channels: (1) a reduction in the real labor income, and (2) an increase in the labor demand due to the principle of equality between the marginal labor productivity and real wage (referred as the Walrasian labor demand). If there is only a single firm, a lower real wage will increase its Walrasian labor demand, thereby an actual labor demand tends to be determined by the derived labor demand. Thus, the second positive effect would not work effectively. In contrast, for an economy with a large number of firms, Walrasian firms will increase employment. This interaction among heterogeneous firms is a key for stability. A single firm cannot expect the benefit of such an increased aggregate demand from other firms.

Keywords: agent-based macroeconomic model, business cycle, demand constraint, gestation period, representative agent model, stability

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Authors: Alba Barbara-i-Molinero, Rosalia Cascon-Pereira, Ana Beatriz Hernandez

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Students’ transitions from high school to the university have been challenged by the lack of continuity between both contexts. This mismatch directly affects students by generating feelings of anxiety and uncertainty, which increases the dropout rates and reduces students’ academic success. This discontinuity emanates because ‘transitions concern a restructuring of what the person does and who the person perceives him or herself to be’. Hence, identity becomes essential in these transitions. Generally, identity is the answer to questions such as who am I? or who are we? This is integrated by personal identity, and as many social identities as groups, the individual feels he/she is a part. A case in point to construct a social identity is the identification with a profession. For this reason, a way to lighten the generated tension during transitions is applying strategies orientated to enhance students’ professional identity in their point of entry to the higher education institution. That would create a sense of continuity between high school and higher education contexts, increasing their Professional Identity Strength. To develop the strategies oriented to enhance students Professional Identity, it is important to analyze what influences it. There exist several influencing factors that influence Professional Identity (e.g., professional status, the recommendation of family and peers, the academic environment, or the chosen bachelor degree). There is a gap in the literature analyzing the impact of these factors on more than one bachelor degree. In this regards, our study takes an additional step with the aim of evaluating the influence of several factors on Professional Identity using a cohort of university students from multiple degrees between the ages of 17-19 years. To do so, we used hierarchical regression analyses to assess the impact of the following factors: External Motivation Conditionals (EMC), Educational Experience Conditionals (EEC) and Personal Motivational Conditional (PMP). After conducting the analyses, we found that the assessed factors influenced students’ professional identity differently according to their bachelor degree and discipline. For example, PMC and EMC positively affected science students, while architecture, law and economics and engineering students were just influenced by PMC. Basing on that influences, we proposed three different strategies aimed to enhance students’ professional identity, in the short and long term. These strategies are: to enhance students’ professional identity before the incorporation to university through campuses and icebreaker activities; to apply recruitment strategies aimed to provide realistic information of the bachelor degree; and to incorporate different activities, such as in-vitro, in situ and self-directed activities aimed to enhance longitudinally students’ professional identity from the university. From these results, theoretical contributions and practical implications arise. First, we contribute to the literature by identifying which factors influence students from different bachelor degrees since there is still no evidence. And, second, using as a benchmark the obtained results, we contribute from a practical perspective, by proposing several alternative strategies to increase students’ professional identity strength aiming to lighten their transition from high school to higher education.

Keywords: professional identity, higher education, educational strategies , students

Procedia PDF Downloads 139

Authors: Huang Wei-Yi

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Objective: This article explores the intensive care nursing experience of a lung cancer patient with pulmonary embolism who was placed on ECMO. Following a sudden change in the patient’s condition and a consensus reached during a family meeting, the decision was made to withdraw life-sustaining equipment and collaborate with the palliative care team. Methods: The nursing period was from October 20 to October 27, 2023. The author monitored physiological data, observed, provided direct care, conducted interviews, performed physical assessments, and reviewed medical records. Together with the critical care team and bypass personnel, a comprehensive assessment was conducted using Gordon's Eleven Functional Health Patterns to identify the patient’s health issues, which included pain related to lung cancer and invasive devices, fear of death due to sudden deterioration, and altered tissue perfusion related to hemodynamic instability. Results: The patient was admitted with fever, back pain, and painful urination. During hospitalization, the patient experienced sudden discomfort followed by cardiac arrest, requiring multiple CPR attempts and ECMO placement. A subsequent CT angiogram revealed a pulmonary embolism. The patient's condition was further complicated by severe pain due to compression fractures, and a diagnosis of terminal lung cancer was unexpectedly confirmed, leading to emotional distress and uncertainty about future treatment. Throughout the critical care process, ECMO was removed on October 24, stabilizing the patient’s body temperature between 36.5-37°C and maintaining a mean arterial pressure of 60-80 mmHg. Pain management, including Morphine 8mg in 0.9% N/S 100ml IV drip q6h PRN and Ultracet 37.5 mg/325 mg 1# PO q6h, kept the pain level below 3. The patient was transferred to the ward on October 27 and discharged home on October 30. Conclusion: During the care period, collaboration with the medical team and palliative care professionals was crucial. Adjustments to pain medication, symptom management, and lung cancer-targeted therapy improved the patient’s physical discomfort and pain levels. By applying the unique functions of nursing and the four principles of palliative care, positive encouragement was provided. Family members, along with social workers, clergy, psychologists, and nutritionists, participated in cross-disciplinary care, alleviating anxiety and fear. The consensus to withdraw ECMO and life-sustaining equipment enabled the patient and family to receive high-quality care and maintain autonomy in decision-making. A follow-up call on November 1 confirmed that the patient was emotionally stable, pain-free, and continuing with targeted lung cancer therapy.

Keywords: intensive care, lung cancer, pulmonary embolism, ECMO

Procedia PDF Downloads 26

Authors: M. Louise Humbert, Karen E. Chad, Natalie E. Houser, Marta E. Erlandson

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Physical literacy is the motivation, confidence, physical competence, knowledge, and understanding to value and takes responsibility for engagement in physical activities for life. In recent years, physical literacy has emerged as a determinant of health, promoting a positive lifelong physical activity trajectory. Physical literacy’s holistic approach and emphasis on the intrinsic valuation of movement provide an encouraging avenue for intervention among children to develop competent and confident movers. Although there is research on physical literacy interventions, no evidence exists on the outcomes of multi-sectoral interventions involving a combination of home, school, and community contexts. Since children interact with and in a wide range of contexts (home, school, community) daily, interventions designed to address a combination of these contexts are critical to the development of physical literacy. Working with school administrators and teachers, sports and recreation leaders, and community members, our team of university and community researchers conducted and evaluated one of the first multi-contextual and multi-sectoral physical literacy interventions in Canada. Schools played a critical role in this multi-sector intervention, and in this project, teachers and administrators focused their actions on developing physical literacy in students 10 to 14 years of age through the instruction of physical literacy-focused physical education lessons. Little is known about the experiences of educators when they work alongside an array of community representatives to develop physical literacy in school-aged children. Given the uniqueness of this intervention, we sought to answer the question, ‘What were the experiences of school-based educators involved in a multi-sectoral partnership focused on creating a physical literacy enriched community intervention?’ A thematic analysis approach was used to analyze data collected from interviews with educators and administrators, informal conversations, documents, and observations at workshops and meetings. Results indicated that schools and educators played the largest role in this multi-sector intervention. Educators initially reported a limited understanding of physical literacy and expressed a need for resources linked to the physical education curriculum. Some anxiety was expressed by the teachers as their students were measured, and educators noted they wanted to increase their understanding and become more involved in the assessment of physical literacy. Teachers reported that the intervention’s focus on physical literacy positively impacted the scheduling and their instruction of physical education. Administrators shared their desire for school and division-level actions targeting physical literacy development like the current focus on numeracy and literacy, treaty education, and safe schools. As this was one of the first multi-contextual and multi-sectoral physical literacy interventions, it was important to document creation and delivery experiences to encourage future growth in the area and develop suggested best practices.

Keywords: physical literacy, multi sector intervention, physical education, teachers

Procedia PDF Downloads 101

Authors: Mahdi Farajzadeh Ajirlou

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Prior evidence of normal cardiac anatomy is desirable to relieve the anxiety of cases with a family history of congenital heart disease or to offer the option of early gestation termination or close follow-up should a cardiac anomaly be proved. Fetal heart discovery plays an important part in the opinion of the fetus, and it can reflect the fetal heart function of the fetus, which is regulated by the central nervous system. Acquisition of ventricular volume and inflow data would be useful to quantify more valve regurgitation and ventricular function to determine the degree of cardiovascular concession in fetal conditions at threat for hydrops fetalis. This study discusses imaging the fetal heart with transvaginal ultrasound, Doppler ultrasound, three-dimensional ultrasound (3DUS) and four-dimensional (4D) ultrasound, spatiotemporal image correlation (STIC), glamorous resonance imaging and cardiac catheterization. Doppler ultrasound (DUS) image is a kind of real- time image with a better imaging effect on blood vessels and soft tissues. DUS imaging can observe the shape of the fetus, but it cannot show whether the fetus is hypoxic or distressed. Spatiotemporal image correlation (STIC) enables the acquisition of a volume of data concomitant with the beating heart. The automated volume accession is made possible by the array in the transducer performing a slow single reach, recording a single 3D data set conforming to numerous 2D frames one behind the other. The volume accession can be done in a stationary 3D, either online 4D (direct volume scan, live 3D ultrasound or a so-called 4D (3D/ 4D)), or either spatiotemporal image correlation-STIC (off-line 4D, which is a circular volume check-up). Fetal cardiovascular MRI would appear to be an ideal approach to the noninvasive disquisition of the impact of abnormal cardiovascular hemodynamics on antenatal brain growth and development. Still, there are practical limitations to the use of conventional MRI for fetal cardiovascular assessment, including the small size and high heart rate of the mortal fetus, the lack of conventional cardiac gating styles to attend data accession, and the implicit corruption of MRI data due to motherly respiration and unpredictable fetal movements. Fetal cardiac MRI has the implicit to complement ultrasound in detecting cardiovascular deformations and extracardiac lesions. Fetal cardiac intervention (FCI), minimally invasive catheter interventions, is a new and evolving fashion that allows for in-utero treatment of a subset of severe forms of congenital heart deficiency. In special cases, it may be possible to modify the natural history of congenital heart disorders. It's entirely possible that future generations will ‘repair’ congenital heart deficiency in utero using nanotechnologies or remote computer-guided micro-robots that work in the cellular layer.

Keywords: fetal, cardiac MRI, ultrasound, 3D, 4D, heart disease, invasive, noninvasive, catheter

Procedia PDF Downloads 37

Authors: Beverly Black

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Background: Adolescent dating abuse (ADA) is widespread throughout the world and negatively impacts many adolescents. ADA is associated with lower self-esteem, poorer school performance, lower employment opportunities, higher rates of depression, absenteeism from school, substance abuse, bullying, smoking, suicide, pregnancy, eating disorders, and risky sexual behaviors, and experiencing domestic violence later in life. ADA prevention is sometimes addressed through school programming; yet, parental responses to ADA can also be an important vehicle for its prevention. In this exploratory study, the author examined how mothers, including abused mothers, responded to scenarios of ADA involving their children. Methods: Six focus groups were conducted between December, 2013 and June, 2014 with mothers (n=31) in the southern part of the United States. Three of the focus groups were comprised of mothers (n=17) who had been abused by their partners. Mothers were recruited from local community family agencies. Participants were provided a series of four scenarios about ADA and they were asked to explain how they would respond. Focus groups lasted approximately 45 minutes. All participants were given a gift card to a major retailer as a ‘thank you’. Using QSR-N10, two researchers’ analyzed the focus group data first using open and axial coding techniques to find overarching themes. Researchers triangulated the coded data to ensure accurate interpretations of the participants’ messages and used the scenario questions to structure the coded results. Results: Almost 30% of 699 comments coded as mothers’ recommendations for responding to ADA focused on the importance of providing advice to their children. Advice included breaking up, going to police, ignoring or avoiding the abusive partner, and setting boundaries in relationships. About 22% of comments focused on the need for educating teens about healthy and unhealthy relationships and seeking additional information. About 13% of the comments reflected the view that parents should confront abuser and/or abusers’ parents, and less than 2% noted the need to take their child to counseling. Mothers who had been abused offered similar responses as parents who had not experienced abuse. However, their responses were more likely to focus on sharing their own experience exercising caution in their responses, as they knew from their own experiences that authoritarian responses were ineffective. Over half of the comments indicated that parents would react stronger, quicker, and angrier if a girl was being abused by a boy than vice versa; parents expressed greater fear for their daughters than their sons involved in ADA. Conclusions. Results suggest that mothers have ideas about how to respond to ADA. Mothers who have been abused draw from their experiences and are aware that responding in an authoritarian manner may not be helpful. Because parental influence on teens is critical in their development, it is important for all parents to respond to ADA in a helpful manner to break the cycle of violence. Understanding responses to ADA can inform prevention programming to work with parents in responding to ADA.

Keywords: abused mothers' responses to dating abuse, adolescent dating abuse, mothers' responses to dating abuse, teen dating violence

Procedia PDF Downloads 217