Search results for: health services

Authors: Vera Lúcia Raposo

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The right to health care – usually known as the right to health – is recognized in many national laws and Constitutions, as well as in international human rights documents. The kind of health care that citizens are entitled to receive, especially in the framework of the National Health Service, is usually identified with conventional medicine. However, since ancient times that a different form of medicine – alternative, traditional or nonconventional medicine – exists. In recent times it is attracting increasing interest, as it is demonstrated by the use of its specific knowledge either by pharmaceutical companies either by modern health technologies. Alternative medicine refers to a holistic approach to body and mind using herbal products, animal parts and minerals instead of technology and pharmaceutical drugs. These notes contributed to a sense of distrust towards it, accusing alternative medicine of being based on superstition and ignorance. However, and without denying that some particular practices lack indeed any kind of evidence or scientific grounds, the fact is that a substantial part of alternative medicine can actually produce satisfactory results. The paper will not advocate the substitution of conventional medicine by alternative medicine, but the complementation between the two and their specific knowledge. In terms of the right to health, as a fundamental right and a human right, this thesis leads to the implementation of a wider range of therapeutic choices for patients, who should be entitled to receive different forms of health care that complement one another, both in public and private health facilities. This scenario would demand a proper regulation for alternative medicine, which nowadays does not exist in most countries, but it is essential to protect patients and public health in general and to reinforce confidence in alternative medicine.

Keywords: alternative medicine, conventional medicine, patient’s rights, right to health

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Authors: Rosemary Saunders, Courtney Glass, Karla Seaman, Karen Gullick, Julie Andrew, Anne Wilkinson, Ashwini Davray

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Current literature demonstrates that most Australians receive end-of-life care in a hospital setting, despite most hoping to die within their own home. The necessity for high quality end-of-life care has been emphasised by the Australian Commission on Safety and Quality in Health Care and the National Safety and Quality in Health Services Standards depict the requirement for comprehensive care at the end of life (Action 5.20), reinforcing the obligation for continual organisational assessment to determine if these standards are suitably achieved. Limited research exploring clinical staff perspectives of end-of-life care delivery has been conducted within an Australian private health context. This study aimed to investigate clinical staff member perceptions of end-of-life care delivery at a private hospital in Western Australia. The study comprised of a multi-faceted mixed-methods methodology, part of a larger study. Data was obtained from clinical staff utilising surveys and focus groups. A total of 133 questionnaires were completed by clinical staff, including registered nurses (61.4%), enrolled nurses (22.7%), allied health professionals (9.9%), non-palliative care consultants (3.8%) and junior doctors (2.2%). A total of 14.7% of respondents were palliative care ward staff members. Additionally, seven staff focus groups were conducted with physicians (n=3), nurses (n=26) and allied health professionals including social workers (n=1), dietitians (n=2), physiotherapists (n=5) and speech pathologists (n=3). Key findings from the surveys highlighted that the majority of staff agreed it was part of their role to talk to doctors about the care of patients who they thought may be dying, and recognised the importance of communication, appropriate training and support for clinical staff to provide quality end-of-life care. Thematic analysis of the qualitative data generated three key themes: creating the setting which highlighted the importance of adequate resourcing and conducive physical environments for end-of-life care and to support staff and families; planning and care delivery which emphasised the necessity for collaboration between staff, families and patients to develop care plans and treatment directives; and collaborating in end-of-life care, with effective communication and teamwork leading to achievable care delivery expectations. These findings contribute to health professionals better understanding of end-of-life care provision and the importance of collaborating with patients and families in care delivery. It is crucial that health care providers implement strategies to overcome gaps in care, so quality end-of-life care is provided. Findings from this study have been translated into practice, with the development and implementation of resources, training opportunities, support networks and guidelines for the delivery of quality end-of-life care.

Keywords: clinical staff, end-of-life care, mixed-methods, private hospital.

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Authors: Hanieh Sakha, Nader Nader, Haleh Farzin

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Introduction: Throughout history, pain theories have been supposed by biomedicine, especially regarding its diagnosis and treatment aspects. Therefore, the feeling of pain is not only a personal experience and is affected by social background; therefore, it involves extensive systems of signals. The challenges in emotional and sentimental dimensions of pain originate from scientific medicine (i.e., the dominant theory is also referred to as the specificity theory); however, this theory has accepted some alterations by emerging physiology. Then, Von Frey suggested the theory of cutaneous senses (i.e., Muller’s concept: the common sensation of combined four major skin receptors leading to a proper sensation) 50 years after the specificity theory. The pain pathway was composed of spinothalamic tracts and thalamus with an inhibitory effect on the cortex. Pain is referred to as a series of unique experiences with various reasons and qualities. Despite the gate control theory, the biological aspect overcomes the social aspect. Vrancken provided a more extensive definition of pain and found five approaches: Somatico-technical, dualistic body-oriented, behaviorist, phenomenological, and consciousness approaches. The Western model combined physical, emotional, and existential aspects of the human body. On the other hand, Kotarba felt confused about the basic origins of chronic pain. Freund demonstrated and argued with Durkhemian about the sociological approach to emotions. Lynch provided a piece of evidence about the correlation between cardiovascular disease and emotionally life-threatening occurrences. Helman supposed a distinction between private and public pain. Conclusion: The consideration of the emotional aspect of pain could lead to effective, emotional, and social responses to pain. On the contrary, the theory of embodiment is based on the sociological view of health and illness. Social epidemiology shows an imbalanced distribution of health, illness, and disability among various social groups. The social support and socio-cultural level can result in several types of pain. It means the status of athletes might define their pain experiences. Gender is one of the important contributing factors affecting the type of pain (i.e., females are more likely to seek health services for pain relief.) Chronic non-cancer pain (CNCP) has become a serious public health issue affecting more than 70 million people globally. CNCP is a serious public health issue which is caused by the lack of awareness about chronic pain management among the general population.

Keywords: pain, sociology, sociological, body

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Authors: A. Aguezzoul

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The Logistics Services Providers (LSPs) selection and performance is a strategic decision that affects the overall performance of any company as well as its supply chain. It is a complex process, which takes into account various conflicting quantitative and qualitative factors, as well as outsourced logistics activities. This article focuses on the evolution of the weights associated to these factors over the last years in order to better understand the change in the importance that logistics professionals place on them criteria when choosing their LSPs. For that, an analysis of 17 main studies published during 2014-2017 period was carried out and the results are compared to those of a previous literature review on this subject. Our analysis allowed us to deduce the following observations: 1) the LSPs selection is a multi-criteria process; 2) the empirical character of the majority of studies, conducted particularly in Asian countries; 3) the criteria importance has undergone significant changes following the emergence of information technologies that have favored the work in close collaboration and in partnership between the LSPs and their customers, even on a worldwide scale; 4) the cost criterion is relatively less important than in the past; and finally 5) with the development of sustainable supply chains, the factors associated with the logistic activities of return and waste processing (reverse logistics) are becoming increasingly important in this multi-criteria process of selection and evaluation of LSPs performance.

Keywords: logistics outsourcing, logistics providers, multi-criteria decision making, performance

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Authors: Chander Shekhar, Jeetendra Yadav, Shaziya Allarakha

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Hypertension has been described as an 'iceberg disease' as those who suffered are ignored and hence usually seek healthcare services at a very late stage. It is estimated that more than 2 million Indians are suffering from hypertensive heart disease that contributed to above 0.13 million deaths in 2016. The paper study aims to know the prevalence of Hypertension in India and its variation by socioeconomic backgrounds and to find out risk factors discriminating hypertension with special emphasis on consumption of tobacco and alcohol among men aged 15-54 years in India. The paper uses NFHS (2015-16) data. The paper used binary logistic regression and discriminant analysis to find significant predictors and discriminants of interest. The prevalence of hypertension was 16.5% in the study population. The results suggest that consumption of alcohol and tobacco are significant discriminant characteristics in carrying hypertension irrespective of what socioeconomic background characteristic he possesses.

Keywords: hypertention, alcohol, tobacco, discriminant

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Authors: Saidou Hassidou, Laminou Ary Mahaman Moustapha

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Uncontrolled urbanization of African cities, plus the lack of municipal waste management services in these cities, generate landscapes become places of multiple and varied interactions between health and environment. In this sense, under strong urban growth in a context of sub-equipment sanitation, the city of Maradi doesn’t escape to this situation which results in the spread of pollution (release of unpleasant odors, proliferation of mosquitoes) and many diseases posing multiple health problems. Our study focuses only on liquid waste especially domestic wastewater. To study the different domestic wastewater management options in the town of Maradi, a survey was conducted among 340 households in 17 districts. We note in most cases a crucial of waste management infrastructure (drainage and wastewater treatment) at the city. Thus, only the individual sanitation facilities are used. In the town of Maradi, in addition to the storm drains, there are, in old districts, ditches that discharge wastewater and unfortunately end up in rivers without treatment. Domestic wastewater total production is estimated at 86,761.28 m3 per day. This water is mostly from laundry activities, bathing, dishes, and is discharged in large part through the streets, by more than 60% of households. Also, pit emptying is performed at 39.11% by the vehicle Peugeot tank. The quality of service rendered by an actor is very important to encourage households to join. Existing autonomous sanitation facilities are poorly designed and poorly maintained. Fecal sludge is dumped in a hole near saturated latrines; this work is mainly done by manual scavengers or dumped in fields or on nearby vacant land concessions.

Keywords: management, urban wastewater, domestic wastewater, Maradi, Niger

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Authors: Farhood Rismanchian, Seong Hyeon Park, Young Hoon Lee

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During the recent years, demand for healthcare services has dramatically increased. As the demand for healthcare services increases, so does the necessity of constructing new healthcare buildings and redesigning and renovating existing ones. Increasing demands necessitate the use of optimization techniques to improve the overall service efficiency in healthcare settings. However, high complexity of care processes remains the major challenge to accomplish this goal. This study proposes a method based on process mining results to address the high complexity of care processes and to find the optimal layout of the various medical centers in an emergency department. ProM framework is used to discover clinical pathway patterns and relationship between activities. Sequence clustering plug-in is used to remove infrequent events and to derive the process model in the form of Markov chain. The process mining results served as an input for the next phase which consists of the development of the optimization model. Comparison of the current ED design with the one obtained from the proposed method indicated that a carefully designed layout can significantly decrease the distances that patients must travel.

Keywords: Mixed Integer programming, Facility layout problem, Process Mining, Healthcare Operation Management

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Authors: Pedro G. Rodrigues, Maria J. Bárrios, Sara A. Ambrósio

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The digitalisation of health is a profoundly transformative economic, political, and social process. As is often the case, such processes need to be carefully managed if misunderstandings, policy misalignments, or outright conflicts between the government and a wide gamut of stakeholders with competing interests are to be avoided. Thus, ensuring open lines of communication where all parties know what each other’s concerns are is key to good governance, as well as efficient and effective policymaking. This project aims to make a small but still significant contribution in this regard in that we seek to determine the extent to which health managers’ perceptions of what is a priority for digital health in Portugal are aligned with official policy perspectives. By applying state-of-the-art artificial intelligence technology first to the indexed literature on digital health and then to a set of official policy documents on the same topic, followed by a survey directed at health managers working in public and private hospitals in Portugal, we obtain two priority rankings that, when compared, will allow us to produce a synthesis and toolkit on digital health policy in Portugal, with a view to identifying areas of policy convergence and divergence. This project is also particularly peculiar in the sense that sophisticated digital methods related to text analytics are employed to study good governance aspects of digitalisation applied to health care.

Keywords: digital health, health informatics, text analytics, governance, natural language understanding

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Authors: Didem Kepir Savoly, Selen Demirtas Zorbaz

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This research focuses on the unique developmental stage of university students, known as emerging adulthood, which can be filled with stressors relating to academics, career aspirations, and relationships. The impact of these factors on the wellbeing and mental health of students is not well understood and requires further investigation. The aim of this study is to investigate the influence of career optimism and relationship status on the wellbeing/life satisfaction of university students. The specific hypotheses being tested are: 1) University students with higher career optimism will exhibit a higher level of life satisfaction, and 2) University students in relationships will report a higher level of life satisfaction. This research adopts a quantitative approach, utilizing scales and questionnaires to collect data from university students in Turkey. The data was collected from university students in Turkey through the administration of the Career Optimism Scale, The Satisfaction with Life Scale, and the Perceived Romantic Relationship Quality Scale. The data is then analyzed using scale implementation, correlational analysis, and group comparison. One-way ANOVA, regression, and t-test analysis techniques are employed. The research findings provide insights into the relationship between career optimism and university students’ life satisfaction, as well as the influence of relationship status on their life satisfaction. The results suggest that life satisfaction was predicted by career optimism but not by relationship status. Moreover, significant relationships between life satisfaction and relationship quality were found among the university students who were in a relationship. These results can be utilized by practitioners, particularly those in counseling centers and career services at universities, to develop tailored psychoeducational and intervention programs aimed at promoting the mental health of university students.

Keywords: career optimism, relationship status, university students, wellbeing

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Authors: Aditya Purohit, Neha Bansal

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Unplanned urbanization and multidirectional sprawl of the cities have resulted in increased motorization and deteriorating transport conditions like traffic congestion, longer commuting, pollution, increased carbon footprint, and above all increased fatalities. In order to overcome these problems, various practices have been adopted including– promoting and implementing mass transport; traffic junction channelization; smart transport etc. However, these methods are found to be primarily focusing on vehicular mobility rather than people accessibility. With this research gap, this paper tries to resolve the mobility issues for Ahmedabad city in India, which being the economic capital Gujarat state has a huge commuter and visitor inflow. This research aims to resolve the traffic congestion and urban mobility issues focusing on Gujarat State Regional Transport Corporation (GSRTC) for the city of Ahmadabad by analyzing the existing operations and network structure of GSRTC followed by finding possibilities of integrating it with other modes of urban transport. The network restructuring (NR) methodology is used with appropriate variations, based on commuter demand and growth pattern of the city. To do these ‘scenarios’ based on priority issues (using 12 parameters) and their best possible solution, are established after route network analysis for 2700 population sample of 20 traffic junctions/nodes across the city. Approximately 5% sample (of passenger inflow) at each node is considered using random stratified sampling technique two scenarios are – Scenario 1: Resolving mobility issues by use of Special Purpose Vehicle (SPV) in joint venture to GSRTC and Private Operators for establishing feeder service, which shall provide a transfer service for passenger for movement from inner city area to identified peripheral terminals; and Scenario 2: Augmenting existing mass transport services such as BRTS and AMTS for using them as feeder service to the identified peripheral terminals. Each of these has now been analyzed for the best suitability/feasibility in network restructuring. A desire-line diagram is constructed using this analysis which indicated that on an average 62% of designated GSRTC routes are overlapping with mass transportation service routes of BRTS and AMTS in the city. This has resulted in duplication of bus services causing traffic congestion especially in the Central Bus Station (CBS). Terminating GSRTC services on the periphery of the city is found to be the best restructuring network proposal. This limits the GSRTC buses at city fringe area and prevents them from entering into the city core areas. These end-terminals of GSRTC are integrated with BRTS and AMTS services which help in segregating intra-state and inter-state bus services. The research concludes that absence of integrated multimodal transport network resulted in complexity of transport access to the commuters. As a further scope of research comparing and understanding of value of access time in total travel time and its implication on generalized cost on trip and how it varies city wise may be taken up.

Keywords: mass transportation, multi-modal integration, network restructuring, travel behavior, urban transport

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Authors: Fahimeh Rafiezade, Fatemeh Kakoyi Dinaki, Maryam Soufi

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This research studies and identifies the important elements of the living style of the residents of one of the neighborhoods of Tehran. The study will also study the role, the degree, and extent of the influence of neighborhood trainings in the lives of these people. Saraymahaleh is one of the centers established by Tehran municipality in various neighborhoods of Tehran in order to provide educational, cultural, etc. services. We carried out our study according to demography, field study, observation, 30 interviews, and 2 focus group discussions (FGD) at Sahebalzaman neighborhood in district 18 of Tehran municipality. We interpreted our observations and interviews with the neighborhoods’ supervisors and city council assistants (Shorayar), supervisor of Saraymahaleh and people who refer to them. We used this information to study the citizens’ lifestyle, values, behavioral, motivational, and attitude preferences in their religious and environmental orientations, cultural consumptions, and spare times, and the influence of Saraymahaleh on these aspects according to specific economic, cultural, and ethnic characteristics. Sahebalzaman neighborhood is considered an underprivileged district in terms of economy, high illiteracy, and low but structured migration of young people. The interviews we made helped us classify the people referring to Saraymahaleh based on their demographic attributes and attitudes and the reason of referring and finally the influence of the rendered services on their lifestyles. The studies indicate that women made the most part of people referring to Saraymahaleh Sahebalzaman. They were mostly young, in their midlives, and generally unemployed without a specialized skill. People referred to Saraymahaleh Sahebalzaman mostly to receive services or for entertainment and recreation purposes, i.e. they did not take part actively. In addition to creating welfare and cultural facilities, Saraymahaleh increases the level of skill training, empowerment, innovation and creativity, and issues skill certificates and documents that helps to increase job and income producing opportunities for the neighborhood residents, improve the quality of their live, and increase their hope for life.

Keywords: lifestyle, living in neighborhood, Saraymahaleh, Tehran municipality, urban life, demography

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Authors: Cindy de Frias, Erum Whyne

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Objectives: The current study examined whether the link between stress and health-related quality of life was buffered by protective factors, namely mindfulness, in a sample of middle-aged and older adults. Method: In this cross-sectional study, 134 healthy, community-dwelling adults (aged 50–85 years) were recruited from Dallas, Texas. The participants were screened for depressive symptoms and severity (using the Patient Health Questionnaire [PHQ-9]). All participants completed measures of self-reported health status (i.e., SF-36v2: mental and physical health composites), life stress (using the Elder’s Life Stress Inventory [ELSI]), and trait mindfulness (i.e., Mindful Attention Awareness Scale). Results: Hierarchical regressions (covarying for age, gender, and education) showed that life stress was inversely related to physical and mental health. Mindfulness was positively related to mental health. The negative effect of life stress on mental health was weakened for those individuals with greater trait mindfulness. Discussion: The results suggest that mindfulness is a powerful, adaptive strategy that may protect middle-aged and older adults from the well-known harmful effects of stress on healthy aging.

Keywords: health, stress, mindfulness, aging

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Authors: Gudakesh Yadav

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Utter Pradesh, which is one of the largest states of India with unequal distribution of resources and different socioeconomic and cultural characteristics, level of different new born health care indicators varies a lot from one district to another district. State shared more than 21 percent of total live births of India; whereas, it accounts for 28 percent of total infant deaths of the country, with the 53 per thousand infant mortality rate. The present paper attempts to examine tempo-spatial changes in new born care practices during NFHS-1 to NFHS-3 and DLHS-2 to DLHS-3 in Uttar Pradesh and different regions. Descriptive statistics, rate-ratios, concentration index, multivariate and decomposition analysis has been used for the study. Findings of the study reveal that new born care practices have improved over the time in the state and across all the regions because of giving more emphasis on venerable groups like poor, rural, less educated mothers and scheduled caste & tribes but still it did not achieve the desired successes. Regional analysis of third rounds of DLHS shows that, coverage of intuitional delivery was the lowest in the central region. Performance of the southern region was the lowest in terms of initiation of breastfeeding, keeping baby warm and dry after the birth. The study calls for proper follow up of new born children to accelerate new born and child health care service and prioritises increasing antenatal check-ups and institutional delivery, which helps to improve level of other new born care services. At the policy level there is need to reach venerable groups like scheduled caste and tribes, poor and uneducated, and new mother especially in rural areas. High focused district should be allocated for better implementation of new born care promotion programme in low performing districts. Partnership with the private sector health professional is necessary to reach the every part of population.

Keywords: decomposition, inequality, initiation of breastfeeding, institutional delivery

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Authors: Julio Jesus Salazar, Max Jesus De Lama

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The challenges of water management are aggravated by global change, which implies high complexity and associated uncertainty; water management is difficult because water networks cross domains (natural, societal, and political), scales (space, time, jurisdictional, institutional, knowledge, etc.) and levels (area: patches to global; knowledge: a specific case to generalized principles). In this context, we need to apply natural and non-natural measures to manage water and soil. The Basin Management Methodology considers multifunctional measures of natural water retention and erosion control and soil formation to protect water resources and address the challenges related to the recovery or conservation of the ecosystem, as well as natural characteristics of water bodies, to improve the quantitative status of water bodies and reduce vulnerability to floods and droughts. This method of water management focuses on the positive impacts of the chemical and ecological status of water bodies, restoration of the functioning of the ecosystem and its natural services; thus, contributing to both adaptation and mitigation of climate change. This methodology was applied in 7 interventions in the sub-basin of the Shullcas River in Huancayo-Junín-Peru, obtaining great benefits in the framework of the participation of alliances of actors and integrated planning scenarios. To implement the methodology in the sub-basin of the Shullcas River, a process called Climate Smart Territories (CST) was used; with which the variables were characterized in a highly complex space. The diagnosis was then worked using risk management and adaptation to climate change. Finally, it was concluded with the selection of alternatives and projects of this type. Therefore, the CST approach and process face the challenges of climate change through integrated, systematic, interdisciplinary and collective responses at different scales that fit the needs of ecosystems and their services that are vital to human well-being. This methodology is now replicated at the level of the Mantaro river basin, improving with other initiatives that lead to the model of a resilient basin.

Keywords: climate-smart territories, climate change, ecosystem services, natural measures, Climate Smart Territories (CST) approach

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Authors: Catelyn Coyle, Helena Kwakwa

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Objective: As novel and better tolerated therapies become available, effective HCV testing and care models become increasingly necessary to not only identify individuals with active infection but also link them to HCV providers for medical evaluation and treatment. Our aim is to describe an effective HCV testing and linkage to care model piloted in a network of five community health centers located in Philadelphia, PA. Methods: In October 2012, National Nursing Centers Consortium piloted a routine opt-out HCV testing model in a network of community health centers, one of which treats HCV, HIV, and co-infected patients. Key aspects of the model were medical assistant initiated testing, the use of laboratory-based reflex test technology, and electronic medical record modifications to prompt, track, report and facilitate payment of test costs. Universal testing on all adult patients was implemented at health centers serving patients at high-risk for HCV. The other sites integrated high-risk based testing, where patients meeting one or more of the CDC testing recommendation risk factors or had a history of homelessness were eligible for HCV testing. Mid-course adjustments included the integration of dual HIV testing, development of a linkage to care coordinator position to facilitate the transition of HIV and/or HCV-positive patients from primary to specialist care, and the transition to universal HCV testing across all testing sites. Results: From October 2012 to June 2015, the health centers performed 7,730 HCV tests and identified 886 (11.5%) patients with a positive HCV-antibody test. Of those with positive HCV-antibody tests, 838 (94.6%) had an HCV-RNA confirmatory test and 590 (70.4%) progressed to current HCV infection (overall prevalence=7.6%); 524 (88.8%) received their RNA-positive test result; 429 (72.7%) were referred to an HCV care specialist and 271 (45.9%) were seen by the HCV care specialist. The best linkage to care results were seen at the test and treat the site, where of the 333 patients were current HCV infection, 175 (52.6%) were seen by an HCV care specialist. Of the patients with active HCV infection, 349 (59.2%) were unaware of their HCV-positive status at the time of diagnosis. Since the integration of dual HCV/HIV testing in September 2013, 9,506 HIV tests were performed, 85 (0.9%) patients had positive HIV tests, 81 (95.3%) received their confirmed HIV test result and 77 (90.6%) were linked to HIV care. Dual HCV/HIV testing increased the number of HCV tests performed by 362 between the 9 months preceding dual testing and first 9 months after dual testing integration, representing a 23.7% increment. Conclusion: Our HCV testing model shows that integrated routine testing and linkage to care is feasible and improved detection and linkage to care in a primary care setting. We found that prevalence of current HCV infection was higher than that seen in locally in Philadelphia and nationwide. Intensive linkage services can increase the number of patients who successfully navigate the HCV treatment cascade. The linkage to care coordinator position is an important position that acts as a trusted intermediary for patients being linked to care.

Keywords: HCV, routine testing, linkage to care, community health centers

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Authors: Tri Murti Tugiman, Awalyya Fasha

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This research aims to analyze the magnitude of the economic losses incurred as a result of a person suffering from a particular disease of the ten highest in the productive age diseases in Hospitals Inche Abdul Moeis Samarinda. This research was a descriptive survey research and a secondary data analysis. For the analysis of economic losses populations used are all in patients who suffer from the 10 highest diseases in the productive age in hospitals IA Moeis Samarinda in 2011. Sampling was performed by using a stratified random sampling with samples of 77 people. Research results indicate that the direct cost community incurred to obtain medical services in hospitals IA Moeis is IDR 74437520. The amount of indirect costs incurred during service in a community hospital is IDR 10562000. The amount lost due to sickness fee is IDR 5377800. The amount of economic lost people to obtain medical services in hospitals IA Moeis is IDR 90377320. The number of days of hospitalization was as much as 171 respondents throughout the day. This study suggests the economic loss could be prevented by changes in the lifestyle of the people who clean and healthy along with the following insurance.

Keywords: hospitalized, economic lost, productive age diseases, secondary data analysis

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Authors: K. M. G. T. R. Waidyarathna, S. M. Vidanagamachchi

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Public Health System exists in Sri Lanka has a satisfactory complete information flow when compared to other systems in developing countries. The availability of a good health information system contributed immensely to achieve health indices that are in line with the developed countries like US and UK. The health information flow at the moment is completely paper based. In Sri Lanka, the fields like banking, accounting and engineering have incorporated information and communication technology to the same extent that can be observed in any other country. The field of medicine has behind those fields throughout the world mainly due to its complexity, issues like privacy, confidentially and lack of people with knowledge in both fields of Information Technology (IT) and Medicine. Sri Lanka’s situation is much worse and the gap is rapidly increasing with huge IT initiatives by private-public partnerships in all other countries. The major goal of the framework is to support minimizing the spreading diseases. To achieve that a web based framework should be implemented for this application domain with web mapping. The aim of this GIS based public health system is a secure, flexible, easy to maintain environment for creating and maintaining public health records and easy to interact with relevant parties.

Keywords: DHIS2, GIS, public health, Sri Lanka

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Authors: Mary L. G. S. Senna, Afonso R. Aquino

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The development of tourism causes negative impacts on the environment. It is in this context, through the Ecological Footprint (EF) method that this study aimed to characterize the impacts of ecotourism on the community of Mateiros, Jalapão, Brazil. The EF, which consisted in its original a method to construct a land use matrix, considering some major categories of human consumption such as food, housing, transportation, consumer goods and services, and six other categories from the main land use which are divided into the topics: land use, degraded environment, gardens, fertile land, pasture and forests protected by the government. The main objective of this index is to calculate the land area required for the production and maintenance of goods and services consumed by a community. The field research was conducted throughout the year of 2014 until July 2015. After the calculations of each category, these components were added according to the presented method in order to determine the annual EF of the tourism sector in Mateiros. The results show that the EF resulting from tourism in Mateiros is 2,194.22 hectares of land required for tourism activities in the region. The EF of tourism was considered high, nevertheless, if it is added the total of hectares needed annually for tourism activities, the result found would be 2,194.22 hectares needed to absorb the CO₂ emissions generated in the region directly from the tourism sector.

Keywords: sustainable tourism, tourism ecological footprint, Jalapão/TO/Brazil

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Authors: Dingiswayo Likhona, Arko-Cobbah Emmanuel, Carolina Pohl, Nthabiseng Z. Mokoena, Jolly Musoke

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A distinct strain of Klebsiella pneumoniae (K. pneumoniae), referred to as hypervirulent (hvKp), is associated with invasive infections such as an invasive pyogenic liver abscess in young and healthy individuals. In South Africa, limited information is known about the prevalence and virulence of this hvKp strain. Thus, this study aimed to determine the prevalence of hvKp and virulence-associated factors in K. pneumoniae isolates from one of the largest Tertiary hospitals in a South African province. A total of 74 K. pneumoniae isolates were received from Pelonomi National Health Laboratory Services (NHLS), Bloemfontein. Virulence-associated genes (rmpA, capsule serotype K1/K2, iroB, and irp2) were screened, and the virulence of hvKp vs. classical Klebsiella pneumoniae (cKp) was investigated using Caenorhabditis elegans nematode model. The iutA (aerobactin transporter) gene was used as a primary biomarker of hvKp. An average of 12% (9/74) of cases were defined as hvKp. Moreover, hvKp was found to be significantly more virulent in vivo Caenorhabditis elegans relative to cKp. The virulence-associated genes (rmpA, iroB, hmv phenotype, and capsule K1/K2) were significantly (p< 0.05) associated with hvKp. Findings from this study confirm the presence of hvKp in one large Tertiary hospital in South Africa. However, the low prevalence and mild to moderate clinical presentation suggest a marginal threat to public health. Further studies in different settings are required to establish the true potential impact of hvKp in developing countries.

Keywords: hypervirulent klebsiella pneumoniae, virulence, caenorhabditis elegans, aerobactin (iutA)

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Authors: Manuel Branco

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This paper argues that mainstream economics is one of the reasons that can explain the difficulty in fully realizing human rights because its logic is intrinsically contradictory to human rights, most especially economic, social and cultural rights. First, its utilitarianism, both in its cardinal and ordinal understanding, contradicts human rights principles. Maximizing aggregate utility along the lines of cardinal utility is a theoretical exercise that consists in ensuring as much as possible that gains outweigh losses in society. In this process an individual may get worse off, though. If mainstream logic is comfortable with this, human rights' logic does not. Indeed, universality is a key principle in human rights and for this reason the maximization exercise should aim at satisfying all citizens’ requests when goods and services necessary to secure human rights are at stake. The ordinal version of utilitarianism, in turn, contradicts the human rights principle of indivisibility. Contrary to ordinal utility theory that ranks baskets of goods, human rights do not accept ranking when these goods and services are necessary to secure human rights. Second, by relying preferably on market logic to allocate goods and services, mainstream economics contradicts human rights because the intermediation of money prices and the purpose of profit may cause exclusion, thus compromising the principle of universality. Finally, mainstream economics sees human rights mainly as constraints to the development of its logic. According to this view securing human rights would, then, be considered a cost weighing on economic efficiency and, therefore, something to be minimized. Fully realizing human rights needs, therefore, a different approach. This paper discusses a human rights-based political economy. This political economy, among other characteristics should give up mainstream economics narrow utilitarian approach, give up its belief that market logic should guide all exchanges of goods and services between human beings, and finally give up its view of human rights as constraints on rational choice and consequently on good economic performance. Giving up mainstream’s narrow utilitarian approach means, first embracing procedural utility and human rights-aimed consequentialism. Second, a more radical break can be imagined; non-utilitarian, or even anti-utilitarian, approaches may emerge, then, as alternatives, these two standpoints being not necessarily mutually exclusive, though. Giving up market exclusivity means embracing decommodification. More specifically, this means an approach that takes into consideration the value produced outside the market and an allocation process no longer necessarily centered on money prices. Giving up the view of human rights as constraints means, finally, to consider human rights as an expression of wellbeing and a manifestation of choice. This means, in turn, an approach that uses indicators of economic performance other than growth at the macro level and profit at the micro level, because what we measure affects what we do.

Keywords: economic and social rights, political economy, economic theory, markets

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Authors: I Putu Yuda Hananta, Inke Kusumastuti

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The latest Indonesian Biology and Behavior Surveillance (IBBS) conducted by Indonesian Ministry of Health reported a large proportion of men who have sex with men (MSM) engaging in oral sex in their recent sexual history. While it is considered as a pleasuring and safe, oral sex might facilitate the transmission of various sexually transmitted infection (STI) pathogens. This study was aimed to investigate the oral sex practice among MSM in Indonesian urban settings to help delineate demographic and behavior determinants of such practice. In 2014, 501 MSM in 8 clinic-based and outreach STI services were recruited in Jakarta, Yogyakarta and Denpasar, Indonesia. Respondents completed a self-administered questionnaire inquiring about their demographics and sexual history. Median age (interquartile range) of the respondents was 27 (24-30) years; most completed senior high school (54.3%), worked in informal jobs (57.9%), and single (60.9%); and 32.3% reported receiving money in exchange for sex. Oral sex was practiced by most respondents: insertive only (10.0%), receptive only (6.0%), and both (82.4%). A separate multivariable analysis was performed using logistic regression to identify the determinants for receptive and insertive oral sex. Factors associated with receptive oral sex were having more than 10 sex partner(s) in the preceding 6 months vs 1 partner, adjusted odds ratio (aOR) [95% CI]=3.40 [1.22-9.42], p=0.03; and history of receptive-insertive anal sex vs no history, aOR=4.37 [1.76-10.82], p=0.01. Factors associated with insertive oral sex were receiving money for sex vs. not receiving, aOR=2.98 [1.10-8.04], p=0.02; and history of receptive-insertive anal sex vs. no history, aOR=2.10 [0.51-8.74], p<0.001. Only a few respondents reported consistent condom use (11.6% and 12.0% for receptive and insertive oral sex, respectively). Our findings demonstrated that while oral sex is a common practice among MSM, the consistency of condom use in oral sex is very low. In addition, certain sex behavior (number of sex partners, sex work and history of anal sex) were associated with oral sex, and this might need to be addressed during health promotion efforts on STI prevention through oral-genital contact.

Keywords: behavior, Indonesia, men who have sex with men, oral sex

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Authors: S. Bagur, S. Verger, B. Mut

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Early childhood intervention (ECI) is understood as the set of interventions aimed at the child population with developmental disorders or disabilities from 0 to 6 years of age, the family, and the environment. Under the principles of family-centred practices, the members of the family nucleus are direct agents of intervention. Thus, the multidisciplinary team of professionals should work to improve family empowerment and the level of parenting skills. The aim of the present study is to analyse descriptively and differentially the level of parenting skills and family empowerment of parents using ECI services during the foster care phase. There were 135 families participating in the study. Three questionnaires were completed. The results show that the employment situation, the age of the child receiving an intervention, and the number of children in the family nucleus or the professional carrying out the intervention are variables that have a differential impact on different items of empowerment and parenting skills. The results are discussed and future lines of research are proposed, with the understanding that the initial analysis of the variables of empowerment and parenting skills may be predictors for the improvement of child development and family well-being. In addition, it is proposed to identify and analyse professional training in order to be able to adapt early care practices without depending on the discipline of the professional of reference.

Keywords: developmental disabilities, early childhood intervention, family empowerment, parenting skills

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Authors: Tang Jiacheng, Fang Tianyu, Liu Yicen, Xiang Xingzhou

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The proportion of healthcare services is increasing throughout the globe. The convergence of mobile technology is driving new business opportunities, innovations in healthcare service delivery and the promise of a better life tomorrow for different populations with various healthcare needs. One of the most important phases for the combination of health care and mobile applications is to elicit requirements correctly. In this paper, four articles from different research directions with four topics on healthcare were detailed analyzed and summarized. We identified the underlying problems in guidance to develop mobile applications to provide healthcare service for Older adults, Women in menopause, Patients undergoing covid. These case studies cover several elicitation methods: survey, prototyping, focus group interview and questionnaire. And the effectiveness of these methods was analyzed along with the advantages and limitations of these methods, which is beneficial to adapt the elicitation methods for future software development process.

Keywords: healthcare, software requirement elicitation, mobile applications, prototyping, focus group interview

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Authors: Shamsuddeen Muhammad Ahmad

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The emergence and operations of Islamic Financial Institutions (IFIs) are being regarded as the new economic and financial pride at the global stage today. Admittedly, therefore, the IFIs has continued to impact positively on the economies of its host countries, especially the Gulf Cooperation Council (GCC) region, Asian and Western countries as well as making a steady in-road into the sub-Saharan Africa. Hence, the number of countries that adopted Islamic financial system in Africa has continued to increase. As a matter of fact, this paper examines the role and contributions of Islamic Financial Institutions (IFIs) to the economic growth and financial development of the big emerging markets in the African continent i.e. South Africa, Nigeria, and Egypt. The methods adopted for this study are descriptive, comparative and analytical in nature. Essentially, the findings from this study reveal that the three sampled countries are benefitting from the presence of IFIs in their economies in terms of contributions to economic growth and real sector participation, particularly for Egypt and South Africa. Similarly, they reap from foreign direct investments and economic diversification among others. However, this study recommends that African countries should integrate IFIs as part and parcel of their economic and financial systems, in order to benefit optimally from this new economic phenomenon.

Keywords: Islamic financial services, Africa, emerging markets, development, operation

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Authors: Eetedal Alanjem, Majedah Alnajem

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The importance of innovation in entrepreneurship can be seen in the invention of new ways to produce products or improved solutions. A service industry can expand with new or improved types of services to fulfill the ever changing needs of their clients. Manufacturers can come up with new products from raw materials and by-products. Innovation is vital for the durability of any business. Innovation usually begins with a need. Small businesses are generally directly involved in their communities and they know exactly what the communities need and strive to come up with solutions to fulfill those needs. They seize the opportunity to innovate to ease communal problems and make lives more comfortable. And then, these solutions keep getting better, easier and more useful as entrepreneurs and their small businesses come up with improved formulas and solutions. Keeping abreast with current trends and demands is an important factor for entrepreneurs to fuel their creativity and innovation. Manufacturers are constantly innovating to produce more without sacrificing quality. Small businesses should make innovation as a fundamental part of their organisational development since innovation creates business success. Entrepreneurs must not see just one solution to a need. They should come up with ideas for multiple solutions. It is imperative for small businesses to encourage growth of innovation among their employees. Competition is another factor that elevates the importance of innovation in entrepreneurship. It motivates entrepreneurs to come up with better, improved products and services than their competitors for a higher share of the market. In this paper will go in-depth for each factor and will discuss some of cases studies to know how innovation it’s important for entrepreneurs by facts & lessons?

Keywords: innovation, entrepreneurship, creativity, organisational development

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Authors: Katarina Lazarević, Mirjana Todosijević, Tijana Vulević, Natalija Momirović, Ranka Erić

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Due to increasing demand, climate change, and world population growth, natural resources are getting exploit fast. One of the most important natural resources is soil, which is susceptible to degradation. Erosion as one of the forms of land degradation is also one of the most global environmental problems. Ecosystem services are often defined as benefits that nature provides to humankind. Soil, as the foundation of basic ecosystem functions, provides benefits to people, erosion control, water infiltration, food, fuel, fibers… This research is using the ecosystem approach as a strategy for natural resources management for promoting sustainability and conservation. The research was done on the Topčiderska River basin (Belgrade, Serbia). The InVEST Sediment Delivery Ratio model was used, to quantify erosion intensity with a spatial distribution output map of overland sediment generation and delivery to the stream. InVEST SDR, a spatially explicit model, is using a method based on the concept of hydrological connectivity and (R) USLE model. This, combined with socio-economic and law and policy analysis, gives a full set of information to decision-makers helping them to successfully manage and deliver sustainable ecosystems.

Keywords: ecosystem services, InVEST model, soil erosion, sustainability

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Authors: Aschenaki Zerihun Kea, Bernt Lindtjorn, Achamyelesh Gebretsadik, Sven Gudmund Hinderaker

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Introduction: Maternal mortality studies conducted at the national level do not provide the information needed for planning and monitoring health programs at lower administrative levels. The aim of this study was to measure maternal mortality, identify risk factors and district-level variations in Sidama National Regional State, southern Ethiopia. Methods: A cross sectional population-based survey was carried out in households where women reported pregnancy and birth outcomes in the past five years. The study was conducted in the Sidama National Regional State, southern Ethiopia, from July 2019 to May 2020. Multi-stage cluster sampling technique was employed. The outcome variable of the study was maternal mortality. Complex sample logistic regression analysis was applied to assess variables independently associated with maternal mortality. Results: We registered 10602 live births (LB) and 48 maternal deaths, yielding an overall maternal mortality ratio (MMR) of 419; 95% CI: 260-577 per 100,000 LB. Aroresa district had the highest MMR with 1142 (95% CI: 693-1591) per 100,000 LB. Leading causes of death were haemorrhage 21 (41%) and eclampsia 10 (27%). Thirty (59%) mothers died during labour, or within 24 hours after delivery, 25 (47%) died at home and 17 (38%) at a health facility. Mothers who did not have formal education had a higher risk of maternal death (AOR: 4.4; 95% CI: 1.7 – 11.0). The risk of maternal death was higher in districts with a low midwife-to-population ratio (AOR: 2.9; 95% CI: 1.0-8.9). Conclusion: The high maternal mortality with district-level variations in Sidama Region highlights the importance of improving obstetric care and employing targeted interventions in areas with high mortality rates. Due attention should be given to improving access to female education. Additional midwives have to be trained and deployed to improve maternal health services and consequently save the lives of mothers.

Keywords: maternal mortality variation, maternal death, Sidama, Ethiopia

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Authors: Ming Ma, Rui Li

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In the highly urbanized district, green open space is playing an important role in human’s health and wellbeing as a physical, aesthetic and natural environment resources. The aim of this paper is to close this gap through providing a comprehensive, qualitative meta-analysis of existing studies related to this issue. A systematic scoping of current quantitative research is conducted which mostly focused on cross-sectional survey and experimental studies. Health benefits from contact with green open space could be categorized into physical health, psychological health and social wellbeing. Mechanism for the health related to green open space could be clearly identified with the regard to natural restoration, physical activities and social capital. These results indicate a multiple pathways framework between the health benefits and mechanism. In order to support design and planning, the most evident relationship was picked up that people could psychologically benefit from green open space through outdoors physical activities. Additionally, three design and planning strategies are put forward. Various and multi-level contacts with green open space would be considered as an explanation of the pathway results and tie to bridge the health to design and planning. There is a need to carry out long-term research emphasizing on causal relationship between health and green open space through excluding cofounding factors such as self-selection.

Keywords: urban green open space, planning and design, health benefit, mechanism, pathway framework

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Authors: Amberly Brigden, Ali Heawood, Emma C. Anderson, Richard Morris, Esther Crawley

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Background: Paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) is characterised by persistent, disabling fatigue. Health services see patients below the age of 12. This age group experience high levels of disability, with low levels of school attendance, high levels of fatigue, anxiety, functional disability and pain. CFS/ME interventions have been developed for adolescents, but the developmental needs of younger children suggest treatment should be tailored to this age group. Little is known about how intervention should be delivered to this age group, and further work is needed to explore this. Qualitative research aids patient-centered design of health intervention. Methods: Five to 11-year-olds and their parents were recruited from a specialist CFS/ME service. Semi-structured interviews explored the families’ experience of the condition and perspectives on treatment. Interactive and arts-based methods were used. Interviews were audio-recorded, transcribed and analysed thematically. Qualitative Results: 14 parents and 7 children were interviewed. Early analysis of the interviews revealed the importance of the social-ecological setting of the child, which led to themes being developed in the context of Systems Theory. Theme one relates to the level of the child, theme two the family system, theme three the organisational and societal systems, and theme four cuts-across all levels. Theme1: The child’s capacity to describe, understand and manage their condition. Younger children struggled to describe their internal experiences, such as physical symptoms. Parents felt younger children did not understand some concepts of CFS/ME and did not have the capabilities to monitor and self-regulate their behaviour, as required by treatment. A spectrum of abilities was described; older children (10-11-year-olds) were more involved in clinical sessions and had more responsibility for self-management. Theme2: Parents’ responsibility for managing their child’s condition. Parents took responsibility for regulating their child’s behaviour in accordance with the treatment programme. They structured their child’s environment, gave direct instructions to their child, and communicated the needs of their child to others involved in care. Parents wanted their child to experience a 'normal' childhood and took steps to shield their child from medicalization, including diagnostic labels and clinical discussions. Theme3: Parental isolation and the role of organisational and societal systems. Parents felt unsupported in their role of managing the condition and felt negative responses from primary care health services and schools were underpinned by a lack of awareness and knowledge about CFS/ME in younger children. This sometimes led to a protracted time to diagnosis. Parents felt that schools have the potential important role in managing the child’s condition. Theme4: Complexity and uncertainty. Many parents valued specialist treatment (which included activity management, physiotherapy, sleep management, dietary advice, medical management and psychological support), but felt it needed to account for the complexity of the condition in younger children. Some parents expressed uncertainty about the diagnosis and the treatment programme. Conclusions: Interventions for younger children need to consider the 'systems' (family, organisational and societal) involved in the child’s care. Future research will include interviews with clinicians and schools supporting younger children with CFS/ME.

Keywords: chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME), pediatric, qualitative, treatment

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Authors: S. Tavuyanago

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Cartels within the international competition law framework have been dubbed the most egregious of competition law violations; this is because they entail a concerted effort by two or more competitor firms to knowingly ‘rob’ consumers of their welfare through their cooperation instead of competition. The net effect of cartel conduct is that the market is distorted as the colluding firms gain enough market power to constrain the supply of goods or services, ultimately driving up prices. As a result, consumers end up paying inflated prices for goods and services, which eventually affects their welfare. It is against this backdrop that competition authorities worldwide have mounted a robust fight against the proliferation of cartels. In South Africa, the fight against cartels saw an amendment to the Competition Act to allow for criminal prosecution of individuals who cause their firms to take part in cartels. The Competition Amendment Act 1 of 2009 introduced section 73A into the principal Competition Act, making it a criminal offence to engage in cartel conduct. This paper assesses the rationale for criminalisation of cartel conduct, discusses the challenges or potential challenges associated with criminalisation, and provides an evaluation of the efficacy of criminalisation of cartel conduct. It questions whether criminal sanctions for cartel conduct as a competition enforcement tool aimed at deterring such conduct are generally effective and whether they have been effective in South Africa specifically. It concludes by offering recommendations on how to effectively root out cartels.

Keywords: cartels, criminalisation, competition, deterrence, South Africa

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