Search results for: healthcare reform

Authors: Chloé Kernaléguen, Laura Kundun, Tessie Lery, Ryan Laleg, Zhangyun Tan

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This study explores global disparities in respiratory syncytial virus (RSV) bronchiolitis incidence among children aged 0-2 years, focusing on the human development index (HDI) as a key determinant. RSV bronchiolitis poses a significant health risk to young children, influenced by factors, including socio-economic conditions captured by the HDI. Through a comprehensive systematic review and dataset selection (Switzerland, Brazil, United States of America), we formulated an HDI-SEIRS numerical model within the SEIRS framework. Results show variations in RSV bronchiolitis dynamics across countries, emphasizing the influence of HDI. Modelling reveals a correlation between higher HDI and increased bronchiolitis spread, notably in the USA and Switzerland. The ratios HDIcountry over HDImax strengthen this association, while climate disparities contribute to variations, especially in colder climates like the USA and Switzerland. The study raises the hypothesis of an indirect link between higher HDI and more frequent bronchiolitis, underlining the need for nuanced understanding. Factors like improved healthcare access, population density, mobility, and social behaviors in higher HDI countries might contribute to unexpected trends. Limitations include dataset quality and restricted RSV bronchiolitis data. Future research should encompass diverse HDI datasets to refine HDI's role in bronchiolitis dynamics. In conclusion, HDI-SEIRS models offer insights into factors influencing RSV bronchiolitis spread. While HDI is a significant indicator, its impact is indirect, necessitating a holistic approach to effective public health policies. This analysis sets the stage for further investigations into multifaceted interactions shaping bronchiolitis dynamics in diverse socio-economic contexts.

Keywords: bronchiolitis propagation, HDI influence, respiratory syncytial virus, SEIRS model

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Authors: Mona Almanasef, Dalia Almaghaslah, Geetha Kandasamy, Rajalakshimi Vasudevan, Sadia Batool

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Background: Community pharmacists are one of the most accessible healthcare practitioners worldwide and their services are used by a large proportion of the population. Expanding the roles of community pharmacists could contribute to reducing pressure on general health practice and other areas of health services. This research aimed to evaluate the contribution of community pharmacists in the provision of public health services and to investigate the perceived barriers to the provision of these services in Saudi Arabia. Materials and Methods: This study followed a cross-sectional design using an online anonymous self-administered questionnaire. The study took place in the Asir region, Saudi Arabia, between September 2019 and February 2020. A convenience sampling strategy was used to select and recruit the study participants. The questionnaire was adapted from previous research and involved three sections: demographics, involvement in public health services and barriers to practicing public health roles. Results: The total number of respondents was 193. The proportion of respondents who reported that they were “very involved” or “involved” in each service was 61.7% for weight management, 60.6% for sexual health, 57.5% for healthy eating, 53.4% for physical activity promotion, 51.3% for dental health, 46.1% for smoking cessation, 39.4% for screening for diabetes, 35.7% for screening for hypertension, 31.1% for alcohol dependence and drug misuse counseling, 30.6% for screening for dyslipidaemia, and 21.8% for vaccination and immunization. Most of the barriers in the current research were rated as having low relevance to the provision of public health services. Conclusion: Findings in the current research suggest that community pharmacists in the Asir region have varying levels of involvement in public health roles. Further research needs to be undertaken to understand the barriers to the provision of public health services and what strategies would be beneficial for enhancing the public health role of community pharmacists in Saudi Arabia.

Keywords: community pharmacist, public health, Asir region, Saudi Arabia

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Authors: Lina María Martínez Sánchez, Juliana Molina Valencia, Esteban Vallejo Agudelo, Daniel Gallego González, María Isabel Pérez Palacio, Juan Ricardo Gaviria García, María De Los Ángeles Rodríguez Gázquez, Gloria Inés Martínez Domínguez

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Alternative and complementary therapies constitute a vast and complex combination of interventions, philosophies, approaches, and therapies that acquire a holistic healthcare point of view, becoming an alternative for the treatment of patients with chronic pain. Objective: determine the characteristics of the use of alternative and complementary therapies in patients with chronic pain who consulted in a medical institution. Methodology: cross-sectional and descriptive study, with a population of patients that assisted to the outpatient consultation and met the eligibility criteria. Sampling was not conducted. A form was used for the collection of demographic and clinical variables and the Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ) was validated. The analysis and processing of information was carried out using the SPSS program vr.19. Results: 220 people with chronic pain were included. The average age was 54.7±16.2 years, 78.2% were women, and 75.5% belonged to the socioeconomic strata 1 to 3. Musculoskeletal pain (77.7%), migraine (15%) and neuralgia (9.1%) were the most frequently types of chronic pain. 33.6% of participants have used some kind of alternative and complementary therapy; the most frequent were: homeopathy (14.5%), phytotherapy (12.7%), and acupuncture (11.4%). The total average HCAMQ score for the study group was 30.2±7.0 points, which shows a moderate attitude toward the use of complementary and alternative medicine. The highest scores according to the type of pain were: neuralgia (32.4±5.8), musculoskeletal pain (30.5±6.7), fibromyalgia (29.6±7.3) and migraine (28.5±8.8). The reliability of the HCAMQ was acceptable (Cronbach's α: 0.6). Conclusion: it was noted that the types of chronic pain and the clinical or therapeutic management of patients correspond to the data available in current literature. Despite the moderate attitude toward the use of these alternative and complementary therapies, one of every three patients uses them.

Keywords: chronic pain, complementary therapies, homeopathy, acupuncture analgesia

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Authors: Irum Naz

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In the Arabian higher education context, linguistic proficiency in the English language is considered crucial for the developmental sustainability, economic growth, and stability of communities and societies. Qatar’s educational reforms package, through the 2030 vision, identifies the acquisition of English at K-12 as an essential survival communication tool for globalization, believing that Qatari students need better preparation to take on the responsibilities of leadership and to participate effectively in the country’s surging economy. The idea of introducing Qatari students to modern curricula benchmarked to high-student-performance curricula in developed countries is one of the components of reformatory design principles of Education for New Era reform project that is mutually consented to and supported by the Office of Shared Services, Communications Office, and Supreme Education Council. In appreciation of the government’s vision, the English Language Centre (ELC) at the Community College of Qatar ran an internal educational audit and conducted evaluative research to understand and appraise the value, impact, and practicality of the existing ELC language development program. This study sought to identify the type of change that could identify and improve the quality of Foundation Program courses and the manners in which second language learners could be assisted to transit smoothly between (ELC) levels. Following the interpretivist paradigm and mixed research method, the data was gathered through a bicyclic research model and a triangular design. The analyses of the data suggested that there was a need for improvement in the ELC program as a whole, and particularly in terms of curriculum, student learning outcomes, and the general learning environment in the department. Key findings suggest that the target program would benefit from significant revisions, which would include narrowing the focus of the courses, providing sets of specific learning objectives, and preventing repetition between levels. Another promising finding was about the assessment tools and process. The data suggested that a set of standardized assessments that more closely suited the programs of study should be devised. It was also recommended that students undergo a more comprehensive placement process to ensure that they begin the program at an appropriate level and get the maximum benefit from their learning experience. Although this ties into the idea of curriculum revamp, it was expected that students could leave the ELC having had exposure to courses in English for specific purposes. The idea of a more reliable exit assessment for students was raised frequently so ELC could regulate itself and ensure optimum learning outcomes. Another important recommendation was the provision of a Student Learning Center for students that would help them to receive personalized tuition, differentiated instruction, and self-driven and self-evaluated learning experience. In addition, an extra study level was recommended to be added to the program to accommodate the different levels of English language proficiency represented among ELC students. The evidence collected in the course of conducting the study suggests that significant change is needed in the structure of the ELC program, specifically about curriculum, the program learning outcomes, and the learning environment in general.

Keywords: educational audit, ESL, optimum learning outcomes, Qatar’s educational reforms, self-driven and self-evaluated learning experience, Student Learning Center

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Authors: Mukondi Nethavhakone

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The high prevalence of violence against women is a global public health problem. Our societies have become dangerous places for women. Women during their child-bearing ages are at a higher risk of experiencing emotional, physical, and sexual violence. What makes it more concerning is that these violent acts are perpetrated by family members or partners, or ex-partners. Intimate Partner Violence (IPV) is associated with long-lasting physical, reproductive, sexual, mental, and maternal health implications. Expectedly women’s mental health would dimmish as a result of experiencing IPV. The burden of violence against women is seen to be heavier in low- and middle-income countries (LMICs) compared to the rest of the world. Countries have committed to eliminating all forms of violence against women through the sustainable development goal, aiming to see changes by the year 2030. As such, various countries have implemented psychosocial interventions of different levels of impact. However, little is known, especially in low- and middle-income countries, with regard to the potential of psychosocial interventions for IPV to improve the mental health outcomes for the survivors and/or victims of IPV. Analysing the risk for IPV through a social-ecological theoretical approach, low- and middle-income countries still readdressing gender inequality which is the cause of intimate partner violence. That is why it is taking time for these countries to shift psychosocial interventions to focus more on the improvement of the mental health of the survivors. It is, therefore, against this backdrop that the researcher intends to undertake a scoping review to understand the nature and characteristics of psychosocial interventions that have been implemented in low- and middle-income countries. With the findings from the scoping review, the researcher aims to develop a conceptual framework that may be a useful resource for healthcare practitioners and researchers in low- and middle-income countries. As this area of research has not been thoroughly reviewed, the results from this scoping will determine whether a systematic review will be justifiable. Additionally, the researcher will identify gaps and opportunities for future research in this area.

Keywords: mental health improvement, psychosocial interventions, intimate partner violence, LMICs

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Authors: Zak Maas, Daniel Carson, Rachel McIntyre, Mark Omundsen, Teresa Holm

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Aim: After hemicolectomy a period of obligatory bowel dysfunction is expected, termed postoperative ileus (POI). Prolonged postoperative ileus (PPOI), typically four or more days, is associated with higher morbidity and extended inpatient stay. This leads to significant financial and resource-related burdens on healthcare systems. Several studies including a meta-analysis have compared rates of PPOI in left vs right hemicolectomy, which suggest that right-sided resections may be more likely to result in PPOI. Our study aims to further investigate whether significant differences in PPOI and obligatory POI exist between right versus extended right hemicolectomy. Methods: This is a retrospective review assessing rates of PPOI in patients who underwent right vs extended right hemicolectomy at Tauranga Hospital. Patients were divided and compared depending on approach (open versus laparoscopic) and acuity (acute versus elective). Exclusion criteria included synchronous major operations and patients preoperatively on parenteral nutrition. Primary outcome was PPOI as pre-defined in contemporary literature. Secondary outcomes were time to passage of flatus, passage of stool, toleration of oral diet and rate of complications. Results: There were 669 patients identified for analysis (507 laparoscopic vs 162 open; 194 acute vs 475 elective). Early analysis indicates rates of PPOI was significantly increased in patients undergoing extended right hemicolectomy. Factors including age, gender, ethnicity, preoperative haemaglobin, preoperative albumin and diagnosis of inflammatory bowel disease were examined by multivariate analysis to determine correlation with PPOI. Conclusion: PPOI is a common complication of hemicolectomy surgery. Higher rates of PPOI in extended right vs right hemicolectomy warrants further research into determining the cause. This study examines some other factors which may contribute to PPOI.

Keywords: hemicolectomy, colorectal, complications, postoperative ileus

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Authors: Zachary Pan

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Our general mission is to solve the problem of classifying images into different body part types and deciding if each of them is healthy or not. However, for now, we will determine healthiness for only one-sixth of the body parts, specifically the chest. We will detect pneumonia in X-ray scans of those chest images. With this type of AI, doctors can use it as a second opinion when they are taking CT or X-ray scans of their patients. Another ad-vantage of using this machine learning classifier is that it has no human weaknesses like fatigue. The overall ap-proach to this problem is to split the problem into two parts: first, classify the image, then determine if it is healthy. In order to classify the image into a specific body part class, the body parts dataset must be split into test and training sets. We can then use many models, like neural networks or logistic regression models, and fit them using the training set. Now, using the test set, we can obtain a realistic accuracy the models will have on images in the real world since these testing images have never been seen by the models before. In order to increase this testing accuracy, we can also apply many complex algorithms to the models, like multiplicative weight update. For the second part of the problem, to determine if the body part is healthy, we can have another dataset consisting of healthy and non-healthy images of the specific body part and once again split that into the test and training sets. We then use another neural network to train on those training set images and use the testing set to figure out its accuracy. We will do this process only for the chest images. A major conclusion reached is that convolutional neural networks are the most reliable and accurate at image classification. In classifying the images, the logistic regression model, the neural network, neural networks with multiplicative weight update, neural networks with the black box algorithm, and the convolutional neural network achieved 96.83 percent accuracy, 97.33 percent accuracy, 97.83 percent accuracy, 96.67 percent accuracy, and 98.83 percent accuracy, respectively. On the other hand, the overall accuracy of the model that de-termines if the images are healthy or not is around 78.37 percent accuracy.

Keywords: body part, healthcare, machine learning, neural networks

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Authors: Sophie Del Fa, Loup Ducol

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This presentation will focus on the discursive practices of Les Soulèvements de la Terre (hereafter SdlT), a French environmentalist group mobilized against agribusiness. More specifically, we will use, as a case study, the violently repressed demonstration that took place in Sainte-Soline on March 25, 2023 (see after for details). The SdlT embodies the renewal of anti-capitalist and environmentalist struggles that began with Occupy Wall Street in 2009 and in France with the Nuit debout in 2016 and the yellow vests movement from 2019 to 2020. These struggles have three things in common: they are self-organized without official leaders, they rely mainly on occupations to reappropriate public places (squares, roundabouts, natural territories) and they are anti-capitalist. The SdlT was created in 2021 by activists coming from the Zone-to-Defend of Notre-Dame-des-Landes, a victorious 10 yearlong occupation movement against an airport near Nantes, France (from 2009 to 2018). The SdlT is not labeled as a formal association, nor as a constituted group, but as an anti-capitalist network of local struggles at the crossroads of ecology and social issues. Indeed, although they target agro-industry, land grabbing, soil artificialization and ecology without transition, the SdlT considers ecological and social questions as interdependent. Moreover, they have an encompassing vision of ecology that they consider as a concern for the living as a whole by erasing the division between Nature and Culture. Their radicality is structured around three main elements: federative and decentralized dimensions, the rhetoric of living alliances and militant creatives strategies. The objective of this reflexion is to understand how these three dimensions are articulated through the SdlT’s discursive practices. To explore these elements, we take as a case study one specific event: the demonstration against the ‘basins’ held in Sainte-Soline on March 25, 2023, on the construction site of new water storage infrastructure for agricultural irrigation in western France. This event represents a turning point for the SdlT. Indeed, the protest was violently repressed: 5000 grenades were fired by the police, hundreds of people were injured, and one person was still in a coma at the time of writing these lines. Moreover, following Saint-Soline’s events, the Minister of Interior Affairs, Gérald Darmin, threatened to dissolve the SdlT, thus adding fuel to the fire in an already tense social climate (with the ongoing strikes against the pensions reform). We anchor our reflexion on three types of data: 1) our own experiences (inspired by ethnography) of the Sainte-Soline demonstration; 2) the collection of more than 500 000 Tweets with the #SainteSoline hashtag and 3) a press review of texts and articles published after Sainte-Soline’s demonstration. The exploration of these data from a turning point in the history of the SdlT will allow us to analyze how the three dimensions highlighted earlier (federative and decentralized dimensions, rhetoric of living alliances and creatives militant strategies) are materialized through the discursive practices surrounding the Sainte-Soline event. This will allow us to shed light on how a new contemporary movement implements contemporary environmental struggles.

Keywords: discursive practices, Sainte-Soline, Ecology, radical ecology

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Authors: Abdela Zeinu Yasin

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The current research aimed to assess the status of IMC in providing treatment for malnourished children and programs in water, sanitation, and hygiene (WASH), food and livelihood security, and comprehensive healthcare through Mobile health and nutrition programs during the last 5 years period. We have conducted 60 in-depth interviews with women during the period from conception to a child’s birthday, health facility staff, and female community health volunteers (FCHVs), as well as 12 focus group discussions with health facility staff and other household decision-makers. We employed thematic analysis using framework matrices and analytical memorandums. The study revealed that 78% of the respondents, of whom 97% were women, have benefited from the selected vulnerable areas. The use of the clear water and sanitization program has reached the 81% of selected households. The use of a modern baby delivery system among the respondent has been 68% of the women and health facilities among the decision-makers/focal person. More than 8 in 10 participants (84%) could read and understand the health facility instructions, and the majority (82%) of women, health facility staff, and male decision-makers can also read and write bulletins and instructions. We found that decision-maker women preferred participative education, whereas health facilities and the IMC desired educational and motivational bulletins. A Mobile Health and Nutrition program intervention by the IMC is acceptable in the conditions of the Ethiopian community and has the potential to improve community health and nutrition service utilization, particularly by providing clean water and sanitization; women’s birth control, and health improvement in the vulnerable regions of the country. The current research findings shall contribute to text IMC Mobile Health and Nutritional intervention design in under-resourced settings.

Keywords: clean water, health and nutrition services, hygiene, IMC, mobile health, sanitation

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Authors: Kalimah Ibrahiim, Israa Elmousa

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This study employed the world café method alongside semi-structured interviews within a 'conversation café' setting to engage stakeholders from the public health and primary care sectors. The objective was to collaboratively explore strategies to improve outcomes for young people not in education, employment, or training (NEET). The discussions were aimed at identifying the underlying causes of disparities faced by NEET individuals, exchanging experiences, and formulating community-driven solutions to bolster preventive efforts and shape policy initiatives. A thematic analysis of the qualitative data gathered emphasized the importance of community problem-solving through the exchange of ideas and reflective discussions. Healthcare professionals reflected on their potential roles, pinpointing a significant gap in understanding the specific needs of the NEET population and the unclear distribution of responsibilities among stakeholders. The results underscore the necessity for a unified approach in primary care and the fostering of multi-agency collaborations that focus on addressing social determinants of health. Such strategies are critical not only for the immediate improvement of health outcomes for NEET individuals but also for informing broader policy decisions that can have long-term benefits. Further research is ongoing, delving deeper into the unique challenges faced by this demographic and striving to develop more effective interventions. The study advocates for continued efforts to integrate insights from various sectors to create a more holistic and effective response to the needs of the NEET population, ensuring that future strategies are informed by a comprehensive understanding of their circumstances and challenges.

Keywords: multi-agency working, primary care, public health, social inequalities

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Authors: Muhammed Ordu, Eren Demir, Chris Tofallis

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The number of inpatient admissions in the UK has been significantly increasing over the past decade. These increases cause bed occupancy rates to exceed the target level (85%) set by the Department of Health in England. Therefore, hospital service managers are struggling to better manage key resource such as beds. On the other hand, this severe demand pressure might lead to confusion in wards. For example, patients can be admitted to the ward of another inpatient specialty due to lack of resources (i.e., bed). This study aims to develop a simulation-optimization model to reallocate the available number of beds in a mid-sized hospital in the UK. A hospital simulation model was developed to capture the stochastic behaviours of the hospital by taking into account the accident and emergency department, all outpatient and inpatient services, and the interactions between each other. A couple of outputs of the simulation model (e.g., average length of stay and revenue) were generated as inputs to be used in the optimization model. An integer linear programming was developed under a number of constraints (financial, demand, target level of bed occupancy rate and staffing level) with the aims of maximizing number of admitted patients. In addition, a sensitivity analysis was carried out by taking into account unexpected increases on inpatient demand over the next 12 months. As a result, the major findings of the approach proposed in this study optimally reallocate the available number of beds for each inpatient speciality and reveal that 74 beds are idle. In addition, the findings of the study indicate that the hospital wards will be able to cope with 14% demand increase at most in the projected year. In conclusion, this paper sheds a new light on how best to reallocate beds in order to cope with current and future demand for healthcare services.

Keywords: bed occupancy rate, bed reallocation, discrete event simulation, inpatient admissions, integer linear programming, projected usage

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Authors: Ying-Lun Tseng Chiu-Ying Chen

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Taiwan's Mental Health Act was amended at the end of 2022; they added regulations regarding refusing compulsory treatment by patients with mental illnesses. In addition, not only by an examination committee, the judge must also assess the patient's need for compulsory treatment. Additionally, the maximum of compulsory hospitalization has been reduced from an unlimited period to a maximum of 60 days. They aim to promote the healthcare autonomy of individuals with mental illnesses in Taiwan and prevent their silenced voice in medical decision-making while they still possess rationality. Furthermore, they plan to use community support and social care networks to replace the current practice of compulsory treatment in Taiwan. This study uses qualitative research methodology, utilizing interview guidelines to inquire about the experiences of Taiwanese who have undergone compulsory hospitalization, compulsory community treatment, and compulsory medical care. The interviews aimed to explore their feelings when they were subjected to compulsory medical intervention, the inside of their illness, their opinions after treatments, and whether alternative medical interventions proposed by them were considered. Additionally, participants also asked about their personal life history and their support networks in their lives. We collected 12 Taiwanese who had experienced compulsory medical interventions and were interviewed 14 times. The findings indicated that participants still possessed rationality during the onset of their illness. However, when they have other treatments to replace compulsory medical, they sometimes diverge from those of the doctors and their families. Finally, doctors prefer their professional judgment and patients' families' option. Therefore, Taiwanese mental health patients' power of decision-making still needs to improve. Because this research uses qualitative research, so difficult to find participants, and the sample size rate was smaller than Taiwan's population, it may have biases in the analysis. So, Taiwan still has significant progress in enhancing the decision-making rights of participants in the study.

Keywords: medical decision making, compulsory treatment, medical ethics, mental health act

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Authors: Nithra Kitreerawutiwong, Sunsanee Mekrungrongwong, Artitaya Wongwonsin, Chakkraphan Phetphoom, Buaploy Phromjang

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Background: Thailand has implemented a district health system based on the concept of primary health care. Since 2014, Family Care Team (FCT) was launched to improve the quality of care through a multidisciplinary team include not only the health sector but also social sector work together. FCT classified into 3 levels: district, sub-district, and community. This system now consists of 66,353 teams, including 3,890 teams at district level, 12,237 teams at the sub-district level, and 50,326 teams at the community level. There is a report regarding assessment the situation and perception on FCT, however, relatively few examined the operationality of this policy. This study aimed to explore the perception of district manager on the process of the implementation of FCT policy and the factors associating to implement FCT in the district health system. Methods/Results: Forty in-depth interviews were performed: 5 of primary care manager at the provincial medical health office, 5 of community hospital director, 5 of district administrative health office, 10 of sub-district health promoting hospital, and 10 of local organization. Semi-structure interview guidelines were used in the discussions. The data was analyzed by thematic analysis. This policy was formulated based on the demographic change and epidemiology transition to serve a long term care for elderly. Facilitator factors are social capital in district health systems such as family health leader and multidisciplinary team. Barrier factors are communication to the frontline provider and local organization. The output of this policy in relation to the structure of FCT is well-defined. Unanticipated effects include training of FCT in community level. Conclusion: Early feedback from healthcare manager is valuable information for the improvement of FCT to function optimally. Moreover, in the long term, health outcome need to be evaluated.

Keywords: family care team, district health system, primary care, qualitative study

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Authors: Kunal K. S., Shwetashri K. R., Keerthan G., Ajinkya R.

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Background: Normal pressure hydrocephalus is a condition caused by abnormal accumulation of cerebrospinal fluid (CSF) within the brain resulting in enlarged cerebral ventricles due to a disruption of CSF formation, absorption, or flow. Over the course of time, ventriculoperitoneal shunt under general anesthesia has become a standard of care. Yet only a finite number of centers have started the inclusion of regional anesthesia techniques for the such patient cohort. Stem Case: We report a case of a 75-year-old male with underlying aortic sclerosis and cardiomyopathy who presented with complaints of confusion, forgetfulness, and difficulty in walking. Neuro-imaging studies revealed disproportionally enlarged subarachnoid space hydrocephalus (DESH). The baseline blood pressure was 116/67 mmHg with a heart rate of 106 beats/min and SpO2 of 96% on room air. The patient underwent smooth induction followed by sonographically guided superficial cervical plexus block and transverse abdominis plane block. Intraoperative pain indices were monitored with Analgesia nociceptive index monitor (ANI, MdolorisTM) and surgical plethysmographic index (SPI, GE Healthcare, Helsinki, FinlandTM). These remained stable during the application of the block and the entire surgical duration. No significant hemodynamic response was observed during the tunneling of the skin by the surgeon. The patient underwent a smooth recovery and emergence. Conclusion: Our decision to incorporate peripheral nerve blockade in conjunction with general anesthesia resulted in opioid-sparing anesthesia and decreased post-operative analgesic requirement by the patient. This blockade was successful in suppressing intraoperative stress responses. Our patient recovered adequately and underwent an uncomplicated post-operative stay.

Keywords: desh, NPH, VP shunt, cervical plexus block, transversus abdominis plane block

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Authors: Geeta, Richa, M. L. Sharma

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Himachal Pradesh, a hilly State of India located in the Western Himalayas, with varied altitudinal gradients and climatic conditions, is a repository of plant diversity and the traditional knowledge associated with plants. The State is inhabited by various tribal communities who usually depend upon local plants for curing various ailments. Utilization of plant resources in their day-to-day life has been an age old practice of the people inhabiting this State. The present study pertains to the tribal district Kinnaur of Himachal Pradesh, located between 77°45’ and 79°00’35” east longitudes and between 31°05’50” and 32°05’15” north altitudes. Being a remote area with only very basic medical facilities, local people mostly use traditional herbal medicines for primary healthcare needs. Traditional healers called “Amji” are usually very secretive in revealing their medicinal knowledge to novice and pass on their knowledge to next generation orally. As a result, no written records of healing herbs are available. The aim of present study was to collect and consolidate the ethno-medicinal knowledge of local people of the district about the use of plants for treating gastrointestinal ailments. The ethnobotanical information was collected from the local practitioners, herbal healers and elderly people having rich knowledge about the medicinal herbs through semi-structured questionnaire and key informant discussions. A total 46 plant species belonging to 40 genera and 24 families have been identified which are used as cure for gastrointestinal ailments. Among the parts used for gastointestinal ailments, aerial parts (14%) were followed by the whole plant (13%), root (8%), leaves (6%), flower (5%), fruit and seed (3%) and tuber (1%). These plant species could be prioritized for conservation and subject to further studies related to phytochemical screening for their authenticity. Most of the medicinal plants of the region are collected from the wild and are often harvested for trade. Sustainable harvesting and domestication of the highly traded species from the study area is needed.

Keywords: Amji, gastrointestinal, Kinnaur, medicinal plants, traditional knowledge

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Authors: Debalke Dale, Bezabh Geneta, Yohannes Amene, Yordanos Bergene, Mohammed Yimam

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Background: A drug therapy problem (DTP) is an event or circumstance that involves drug therapies that actually or potentially interfere with the desired outcome and requires professional judgment to resolve. Heart failure is an emerging worldwide threat whose prevalence and health loss burden constantly increase, especially in the young and in low-to-middle-income countries. There is a lack of population-based incidence and prevalence of heart failure (HF) studies in sub-Saharan African countries, including Ethiopia. Objective: The aim of this study was designed to assess drug therapy problems and associated factors among patients with HF in the medical ward of Arba Minch General Hospital(AGH), Ethiopia, from June 5 to August 20, 2022. Methods: A retrospective cross-sectional study was conducted among 180 patients with HF who were admitted to the medical ward of AGH. Data were collected from patients' cards by using questionnaires. The data were categorized and analyzed by using SPSS version 25.0 software, and data were presented in tables and words based on the nature of the data. Result: Out of the total, 85 (57.6%) were females, and 113 (75.3%) patients were aged over fifty years. Of the 150 study participants, 86 (57.3%) patients had at least one DTP identified, and a total of 116 DTPs were identified, which is 0.77 DTPs per patient. The most common types of DTP were unnecessary drug therapy (32%), followed by the need for additional drug therapy (36%), and dose too low (15%). Patients who used polypharmacy were 5.86 (AOR) times more likely to develop DTPs than those who did not (95% CI = 1.625–16.536, P = 0.005), and patients with more co-morbid conditions developed 3.68 (AOR) times more DTPs than those who had fewer co-morbidities (95% CI = 1.28–10.5, P = 0.015). Conclusion: The results of this study indicated that drug therapy problems were common among medical ward patients with heart failure. These problems are adversely affecting the treatment outcomes of patients, so it requires the special attention of healthcare professionals to optimize them.

Keywords: heart failure, drug therapy problems, Arba Minch general hospital, Ethiopia

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Authors: Sisay Tiroro Salato

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Background: Ethiopia has been implementing the maternal death surveillance and response system to provide real-time actionable information, including causes of death and contributing factors. Analysis of maternal mortality surveillance data was conducted to identify the causes and underlying factors in Addis Ababa, Ethiopia. Methods: We carried out a retrospective surveillance data analysis of 324 maternal deaths reported in Addis Ababa, Ethiopia, from 2017 to 2021. The data were extracted from the national maternal death surveillance and response database, including information from case investigation, verbal autopsy, and facility extraction forms. The data were analyzed by computing frequency and presented in numbers, proportions, and ratios. Results: Of 324 maternal deaths, 92% died in the health facilities, 6.2% in transit, and 1.5% at home. The mean age at death was 28 years, ranging from 17 to 45. The maternal mortality ratio per 100,000 live births was 77for the five years, ranging from 126 in 2017 to 21 in 2021. The direct and indirect causes of death were responsible for 87% and 13%, respectively. The direct causes included obstetric haemorrhage, hypertensive disorders in pregnancy, puerperal sepsis, embolism, obstructed labour, and abortion. The third delay (delay in receiving care after reaching health facilities) accounted for 57% of deaths, while the first delay (delay in deciding to seek health care) and the second delay (delay in reaching health facilities) and accounted for 34% and 24%, respectively. Late arrival to the referral facility, delayed management after admission, andnon-recognition of danger signs were underlying factors. Conclusion: Over 86% of maternal deaths were attributed by avoidable direct causes. The majority of women do try to reach health services when an emergency occurs, but the third delays present a major problem. Improving the quality of care at the healthcare facility level will help to reduce maternal death.

Keywords: maternal death, surveillance, delays, factors

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Authors: Magdalena Barbara Kaziuk, Waldemar Kosiba

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Introduction: Despite the development of technologies and improvements in the interior of dialysis stations, dialysis remains an unpleasant procedure, difficult to accept by the patients (who undergo it 2 to 3 times a week, a single treatment lasting several hours). Haemodialysis is one of the renal replacement therapies, in Poland most commonly used in patients with chronic or acute kidney failure. Purpose: An attempt was made to evaluate the quality of life in haemodialysed patients using the WHOQOL-BREF questionnaire. Material and methods: The study covered 422 patients (200 women and 222 men, aged 60.5 ± 12.9 years) undergoing dialysis at three selected stations in Poland. The patients were divided into 2 groups, depending on the duration of their dialysis treatment. The evaluation was conducted with the WHOQOL-BREF questionnaire containing 26 questions analysing 4 areas of life, as well as the perception of the quality of life and health self-assessment. A 5-point scale is used to answer them. The maximum score in each area is 20 points. The results in individual areas have a positive direction. Results: In patients undergoing dialysis for more than 3 years, a reduction in the quality of life was found in the physical area and in their environment versus a group of patients undergoing dialysis for less than 3 years, where a reduced quality of life was found in the areas of social relations and mental well-being (p < 0.05). A significant correlation (p < 0.01) between the two groups was found in self-perceived general health, while no significant differences were observed in the general perception of the quality of life (p > 0.05). Conclusions: The study confirmed that in patients undergoing dialysis for more than three years, the quality of life is especially reduced in their environment (access to and quality of healthcare, financial resources, and mental and physical safety). The assessment of the quality of life should form a part of the therapeutic process, in which the role of the patient in chronic renal care should be emphasised, reflected in the quality of services provided by dialysis stations.

Keywords: haemodialysis, perception of quality of life, quality of services provided, dialysis station

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Authors: Biniam Bahiru Tufa, Hana Delil Tesfaye, Seife Demisse Legesse, Manaye Tamire

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The healthcare industry is witnessing a digital transformation, with artificial intelligence (AI) offering potential solutions for challenges in health supply chain management (HSCM). However, the adoption of AI in this field remains limited. This research aimed to assess the knowledge, attitude, and practice of AI among students and employees in the health supply chain sector in Ethiopia. Using an explanatory case study research design with a concurrent mixed approach, quantitative and qualitative data were collected simultaneously. The study included 153 participants comprising students and employed health supply chain professionals working in various sectors. The majority had a pharmacy background, and one-third of the participants were male. Most respondents were under 35 years old, and around 68.6% had less than 10 years of experience. The findings revealed that 94.1% of participants had prior knowledge of AI, but only 35.3% were aware of its application in the supply chain. Moreover, the majority indicated that their training curriculum did not cover AI in health supply chain management. Participants generally held positive attitudes toward the necessity of AI for improving efficiency, effectiveness, and cost savings in the supply chain. However, many expressed concerns about its impact on job security and satisfaction, considering it as a burden Graduate students demonstrated higher knowledge of AI compared to employed staff, while graduate students also exhibited a more positive attitude toward AI. The study indicated low previous utilization and potential future utilization of AI in the health supply chain, suggesting untapped opportunities for improvement. Overall, while supply chain experts and graduate students lacked sufficient understanding of AI and its significance, they expressed favorable views regarding its implementation in the sector. The study recommends that the Ethiopian government and international organizations consider introducing AI in the undergraduate pharmacy curriculum and promote its integration into the health supply chain field.

Keywords: knowledge, attitude, practice, supply chain, articifial intellegence

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Authors: R. Gwynn, P. Panwalkar, K. Veravalli , M. Tofighi, R. Clement, A. Mofidi

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The aim of this study was to access the impact of Covid-19 and lockdown on the incidence, injury pattern, and treatment of tibial plateau fractures in a combined rural and urban population in wales. Methods: Retrospective study was performed to identify tibial plateau fractures in 15-month period of Covid-19 lockdown 15-month period immediately before lockdown. Patient demographics, injury mechanism, injury severity (based on Schatzker classification), and associated injuries, treatment methods, and outcome of fractures in the Covid-19 period was studied. Results: The incidence oftibial plateau fracture was 9 per 100000 during Covid-19, and 8.5 per 100000, and both were similar to previous studies. The average age was 52, and female to male ratio was 1:1 in both control and study group. High energy injury was seen in only 20% of the patients and 35% in the control groups (2=12, p<0025). 14% of the covid-19 population sustained other injuries as opposed 16% in the control group(2=0.09, p>0.95). Lower severity isolated lateral condyle fracturesinjury (Schatzker 1-3) were seen in 40% of fractures this was 60% in the control populations. Higher bicondylar and shaft fractures (Schatzker 5-6) were seen in 60% of the Covid-19 group and 35% in the control groups(2=7.8, p<0.02). Treatment mode was not impacted by Covid-19. The complication rate was low in spite of higher number of complex fractures and the impact of covid-19 pandemic. Conclusion: The associated injuries were similar in spite of a significantly lower mechanism of injury. There were unexpectedly worst tibial plateau fracture based Schatzker classification in the Covid-19 period as compared to the control groups. This was especially relevant for medial condyle and shaft fractures. This was postulated to be caused by reduction in bone density caused by lack of vitamin D and reduction in activity. The treatment mode and outcome was not impacted by the impact of Covid-19 on care for tibial plateau fractures.

Keywords: Covid-19, knee, tibial plateau fracture, trauma

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Authors: Cleto J. Sauer Jr., Rita C. Sauer, Chaider G. Andrade, Dóris F. Rabelo

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Some patients with COVID-19 disease and difficult airway characteristics undergo to endotracheal intubation (ETI) procedure. The tracheal introducer, known as the bougie guide, can aid ETI in patients with difficult airway pattern. Realistic simulation (RS) is a methodology utilized for healthcare professionals training. To improve skills in using the bougie guide of physicians from Recôncavo da Bahia region in Brazil, during COVID-19 outbreak, RS training was carried out. Simulated scenario included the Nasco Lifeform realistic simulator for ETI and a bougie guide introducer. Training was a capacitation program organized by the Health Department of Bahia State. Objective: To report effects in participants´ self-confidence perception for using bougie guide after a RS based training. Methods: Descriptive study, secondary data extracted from questionnaires. Priority workplace and previous knowledge about bougie were reported on a preparticipation formulary. Participants also completed pre- and post-training qualitative self-assessment (10-point Likert scale) regarding to self-confidence in using bougie guide. Distribution analysis for qualitative data was performed with Wilcoxon Signed Rank Test, and self-confidence increase analysis in frequency contingency tables with Fisher's exact test. Results: From May to June 2020 a total of 36 physicians participated of training, 25 (69%) from primary care setting, 32 (89%) with no previous knowledge about the bougie guide utilization. For those who had previous knowledge about bougie pre-training self-confidence median was 6,5, and 2 for participants who had not. In overall there was an increase in self-confidence median for bougie utilization. Median (variation) before and after training was 2.5 (1-7) vs. 8 (4-10) (p <0.0001). Among those who had no previous knowledge about bougie (n = 32) an increase in self-confidence greater than 3 points for bougie utilization was reported by 31 vs. 1 participants (p = 0.71). Conclusions: Most of participants had no previous knowledge about using the bougie guide. RS training contributed to self-confidence increase for using bougie for ETI procedure. RS methodology can contribute for training in using the bougie guide for ETI procedure during COVID-19 outbreak.

Keywords: bougie, confidence, COVID-19, endotracheal intubation, realistic simulation

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Authors: Elaine Wong

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This research protocol aims to explore and justify the need for nutrition and physical activity intervention to improve health outcomes among SME (Small Medium Enterprise) employees. It was found that the worksite is an ideal and convenient setting for employees to take charge of their health thru active participation in health programmes since they spent a great deal of time at their workplace. This study will examine the impact of both general or/and targeted health interventions in both SME and non-SME companies utilizing the Workplace Health Promotion (WHP) grant over a 12 months period and assessed the improvement in chronic health disease outcomes in Singapore. Random sampling of both non-SME and SME companies will be conducted to undergo health intervention and statistical packages such as Statistical Package for Social Science (SPSS) 25 will be used to examine the impact of both general and targeted interventions on employees who participate and those who do not participate in the intervention and their effects on blood glucose (BG), blood lipid, blood pressure (BP), body mass index (BMI), and body fat percentage. Using focus groups and interviews, the data results will be transcribed to investigate enablers and barriers to workplace health intervention revealed by employees and WHP coordinators that could explain the variation in the health screening results across the organisations. Dietary habits and physical activity levels of the employees participating and not participating in the intervention will be collected before and after intervention to assess any changes in their lifestyle practices. It makes economic sense to study the impact of these interventions on health screening outcomes across various organizations that are existing grant recipients to justify the sustainability of these programmes by the local government. Healthcare policy makers and employers can then tailor appropriate and relevant programmes to manage these escalating chronic health disease conditions which is integral to the competitiveness and productivity of the nation’s workforce.

Keywords: chronic diseases, health screening, nutrition and fitness intervention , workplace health

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Authors: S. M. C. Kelly, A. Hargreaves, S. Hargreaves

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Introduction: The Can’t intubate, Can’t ventilate emergency scenario is one which has been shown to be managed badly in the past. Reasons identified included gaps in knowledge of the procedure and the emergency equipment used. We aimed to show an increase in confidence amongst anesthetists and operating department practitioners in the technique following a short tea trolley style teaching intervention. Methods: We carried out the teaching on a one-to-one basis. Two Anaesthetists visited each operating theatre during normal working days. One carried out the teaching session and one took over the intra‐operative care of the patient, releasing the listed anaesthetist for a short teaching session. The teaching was delivered to mixture of students and healthcare professionals, both anaesthetists and anaesthetic practitioners. The equipment includes a trolley, an airway manikin, size 10 scalpel, bougie and size 6.0 tracheal tube. The educator discussed the equipment, performed a demonstration and observed the participants performing the procedure. We asked each person to fill out a pre and post teaching questionnaire, stating their confidence with the procedure. Results: The teaching was delivered to 63 participants in total, which included 21 consultant anaesthetists, 23 trainee doctors and 19 anaesthetic practitioners. The teaching sessions lasted on average 9 minutes (range 5– 15 minutes). All participants reported an increase in confidence in both the equipment and technique in front of neck access. Anaesthetic practitioners reported the greatest increase in confidence (53%), with trainee anaesthetists reporting 27% increase and consultant anaesthetists 22%. Overall, confidence in the performance of emergency front of neck access increased by 31% after the teaching session. Discussion: Short ‘Trolley style’ teaching improves confidence in the equipment and technique used for the emergency front of neck access. This is true for students and for consultant anaesthetists. This teaching style is quick with minimal running costs and is relevant for all anesthetic departments.

Keywords: airway teaching, can't intubate can't ventilate, cricothyroidotomy, front-of-neck

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Authors: N. Al Khashan, H. Al Shammari, W. Al Bahli

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Patients who are eligible to receive treatment at the National Guard Health Affairs (NGHA), Saudi Arabia will typically have four medical record numbers (MRN), one in each of the geographical areas. More hospitals and primary healthcare facilities in other geographical areas will launch soon which means more MRNs. When patients own four MRNs, this will cause major drawbacks in patients’ quality of care such as creating new medical files in different regions for relocated patients and using referral system among regions. Consequently, the access to a patient’s medical record from other regions and the interoperability of health information between the four hospitals’ information system would be challenging. Thus, there is a need to unify medical records among these five facilities. As part of the effort to increase the quality of care, a new Hospital Information Systems (HIS) was implemented in all NGHA facilities by the end of 2016. NGHA’s plan is put to be aligned with the Saudi Arabian national transformation program 2020; whereby 70% citizens and residents of Saudi Arabia would have a unified medical record number that enables transactions between multiple Electronic Medical Records (EMRs) vendors. The aim of the study is to explore the plan, the challenges and barriers of unifying the 4 MRNs into one Enterprise Patient Identifier (EPI) in NGHA hospitals by December 2018. A descriptive study methodology was used. A journey map and a project plan are created to be followed by the project team to ensure a smooth implementation of the EPI. It includes the following: 1) Approved project charter, 2) Project management plan, 3) Change management plan, 4) Project milestone dates. Currently, the HIS is using the regional MRN. Therefore, the HIS and all integrated health care systems in all regions will need modification to move from MRN to EPI without interfering with patient care. For now, the NGHA have successfully implemented an EPI connected with the 4 MRNs that work in the back end in the systems’ database.

Keywords: consumer health, health informatics, hospital information system, universal medical record number

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Authors: Khachen Kongpakwattana, Charungthai Dejthevaporn, Orapitchaya Krairit, Piyameth Dilokthornsakul, Devi Mohan, Nathorn Chaiyakunapruk

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Background: Although an increase in the burden of Alzheimer’s disease (AD) is evident worldwide, knowledge of costs and health-related quality of life (HR-QoL) associated with AD in Low- and Middle-Income Countries (LMICs) is still lacking. We, therefore, aimed to collect real-world cost and HR-QoL data, and investigate their associations with multiple disease-severity indicators among AD patients in Thailand. Methods: We recruited AD patients aged ≥ 60 years accompanied by their caregivers at a university-affiliated tertiary hospital. A one-time structured interview was conducted to collect disease-severity indicators, HR-QoL and caregiving information using standardized tools. The hospital’s database was used to retrieve healthcare resource utilization occurred over 6 months preceding the interview date. Costs were annualized and stratified based on cognitive status. Generalized linear models were employed to evaluate determinants of costs and HR-QoL. Results: Among 148 community-dwelling patients, average annual total societal costs of AD care were 8,014 US$ [95% Confidence Interval (95% CI): 7,295 US$ - 8,844 US$] per patient. Total costs of patients with severe stage (9,860 US$; 95% CI: 8,785 US$ - 11,328 US$) were almost twice as high as those of mild stage (5,524 US$; 95% CI: 4,649 US$ - 6,593 US$). The major cost driver was direct medical costs, particularly those incurred by AD prescriptions. Functional status was the strongest determinant for both total costs and patient’s HR-QoL (p-value < 0.001). Conclusions: Our real-world findings suggest the distinct major cost driver which results from expensive AD treatment, emphasizing the demand for country-specific cost evidence. Increases in cognitive and functional status are significantly associated with decreases in total costs of AD care and improvement on patient’s HR-QoL.

Keywords: Alzheimer's disease, associations, costs, disease-severity indicators, health-related quality of life

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Authors: Nikhil A. Gavhane, Sachin Shah, Ishant S. Mahajan, Pawan D. Bahekar

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Introduction: Millions of people are affected with dengue fever every year, which drives up healthcare expenses in many low-income countries. Organ failure and other serious symptoms may result. Another worldwide public health problem is sickle cell anaemia, which is most prevalent in Africa, the Caribbean, and Europe. Dengue epidemics have reportedly occurred in locations with a high frequency of sickle cell disease, compounding the health problems in these areas. Aims and Objectives: This study examines dengue infection in sickle cell disease-afflicted pre-schoolers. Method:This Retrospective cohort study examined paediatric patients. Young people with sickle cell disease (SCD), dengue infection, and a control group without SCD or dengue were studied. Data on demographics, SCD consequences, medical treatments, and laboratory findings were gathered to analyse the influence of SCD on dengue severity and clinical outcomes, classified as severe or non-severe by the 2009 WHO classification. Using fever or admission symptoms, the research estimated acute illness duration. Result: Table 1 compares haemoglobin genotype-based dengue episode features in SS, SC, and controls. Table 2 shows that severe dengue cases are older, have longer admission delays, and have particular symptoms. Table 3's multivariate analysis indicates SS genotype's high connection with severe dengue, multiorgan failure, and acute pulmonary problems. Table 4 relates severe dengue to greater white blood cell counts, anaemia, liver enzymes, and reduced lactate dehydrogenase. Conclusion: This study is valuable but confined to hospitalised dengue patients with sickle cell illness. Small cohorts limit comparisons. Further study is needed since findings contradict predictions.

Keywords: dengue, chills, headache, severe myalgia, vomiting, nausea, prostration

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Authors: James Ladzekpo

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Background: The urgent need to identify new pharmacological targets for diabetes treatment and prevention has been amplified by the disease's extensive impact on individuals and healthcare systems. A deeper insight into the biological underpinnings of diabetes is crucial for the creation of therapeutic strategies aimed at these biological processes. Current predictive models based on genetic variations fall short of accurately forecasting diabetes. Objectives: Our study aims to pinpoint key epigenetic factors that predispose individuals to diabetes. These factors will inform the development of an advanced predictive model that estimates diabetes risk from genetic profiles, utilizing state-of-the-art statistical and data mining methods. Methodology: We have implemented a recursive feature elimination with cross-validation using the support vector machine (SVM) approach for refined feature selection. Building on this, we developed six machine learning models, including logistic regression, k-Nearest Neighbors (k-NN), Naive Bayes, Random Forest, Gradient Boosting, and Multilayer Perceptron Neural Network, to evaluate their performance. Findings: The Gradient Boosting Classifier excelled, achieving a median recall of 92.17% and outstanding metrics such as area under the receiver operating characteristics curve (AUC) with a median of 68%, alongside median accuracy and precision scores of 76%. Through our machine learning analysis, we identified 31 genes significantly associated with diabetes traits, highlighting their potential as biomarkers and targets for diabetes management strategies. Conclusion: Particularly noteworthy were the Gradient Boosting Classifier and Multilayer Perceptron Neural Network, which demonstrated potential in diabetes outcome prediction. We recommend future investigations to incorporate larger cohorts and a wider array of predictive variables to enhance the models' predictive capabilities.

Keywords: diabetes, machine learning, prediction, biomarkers

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Authors: Ouassila Bekkal Brikci Benhabib, Zahia Boucherit Otmani, Kebir Boucherit, A. Seghir

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The establishment of intravenous catheters in hospitalized patient is an act common in many clinical situations. These therapeutic tools, from their insertion in the body, represent gateways including fungal germs prone. The latter can generate the growth of biofilms, which can be the cause of fungal infection. Faced with this problem, we conducted a study at the University Hospital of Tlemcen in the neurosurgery unit and aims to isolate and identify Candida yeasts from intravenous catheters. Then test their ability to form biofilms. Materials and methods: 256 patient hospitalized in surgery of the hospital in west Algeria were submitted to this study. All samples were taken from peripheral venous catheters implanted for 72 hours or more days. A total of 31 isolates of Candida species were isolated. MIC and SMIC are determined at 80% inhibition by the test XTT tetrazolium measured at 490 nm. The final concentrations of antifungal agent being between 0.03 and 16 mg / ml for amphotericin B and from 0.015 to 8 mg / mL caspofungin. Results: 31 Candida species isolates from catheters including 14 Candida albicans and 17 Candida non albicans . 21 strains of all the isolates were able to form biofilms. In their form of Planktonic cells, all isolates are 100% susceptible to antifungal agents tested. However, in their state of biofilms, more isolates have become tolerant to the tested antifungals. Conclusion: Candida yeasts isolated from intravascular catheters are considered an important virulence factor in the pathogenesis of infections. Their involvement in catheter-related infections can be disastrous for their potential to generate biofilms. They survive high concentrations of antifungal where treatment failure. Pending the development of a therapeutic approach antibiofilm related to catheters, their mastery is going through: -The risk of infection prevention based on the training and awareness of medical staff, -Strict hygiene and maximum asepsis, and -The choice of material limiting microbial colonization.

Keywords: candida, biofilm, hospital, infection, amphotericin B, caspofungin

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Authors: Maria Karidakis, Barbara Kelly

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The challenges precipitated by the advent of COVID-19 have brought to the fore the task governments and key stakeholders are faced with; ensuring public health communication is readily accessible to vulnerable populations. COVID-19 has presented challenges for the provision and reception of timely, accessible, and accurate health information pertaining to vaccine health messaging to Aboriginal and Torres Strait Islander peoples. The aim of this qualitative study was to explore strategies used by Aboriginal-led organisations to improve communication about COVID-19 and vaccination for their communities and to explore how these mediation and outreach strategies were received by community members. We interviewed 6 Aboriginal-led organisations and 15 community members from several states across Australian, and these interviews were analysed thematically. The findings suggest that effective public health communication is enhanced when aFirst nations-led response defines the governance that happens in First Nations communities. Pro-active and self-determining Aboriginal leadership and decision-making helps drive the response to counter a growing trend towards vaccine hesitancy. Other strategies include establishing partnerships with government departments and relevant non-governmental organisations to ensure services are implemented and culturally appropriate. The outcomes of this research will afford policymakers, stakeholders in healthcare, and cultural mediators the capacity to identify strengths and potential problems associated with pandemic health information and to subsequently implement creative and culturally specific solutions that go beyond the provision of written documentation via translation or interpreting. It will also enable governing bodies to adjust multilingual polices and to adopt mediation strategies that will improve information delivery and intercultural services on a national and international level.

Keywords: intercultural communication, qualitative, public health communication, COVID-19, pandemic, mediated communication, first nations people

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Authors: Stefanache Stefania, Ioana R. Podina

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Background: Embodied Conversational Agents (ECAs) are revolutionizing education and healthcare by offering cost-effective, adaptable, and portable solutions. Research on the Uncanny Valley effect (UVE) involves various embodied agents, including ECAs. Achieving the optimal level of anthropomorphism, no consensus on how to overcome the uncanniness problem. Objectives: This systematic review aims to identify the user characteristics, agent features, and context factors that influence the UVE. Additionally, this review provides recommendations for creating effective ECAs and conducting proper experimental studies. Methods: We conducted a systematic review following the PRISMA 2020 guidelines. We included quantitative, peer-reviewed studies that examined human-ECA interaction. We identified 17,122 relevant records from ACM Digital Library, IEE Explore, Scopus, ProQuest, and Web of Science. The quality of the predictors, mediators, and moderators adheres to the guidelines set by prior systematic reviews. Results: Based on the included studies, it can be concluded that females and younger people perceive the ECA as more attractive. However, inconsistent findings exist in the literature. ECAs characterized by extraversion, emotional stability, and agreeableness are considered more attractive. Facial expressions also play a role in the UVE, with some studies indicating that ECAs with more facial expressions are considered more attractive, although this effect is not consistent across all studies. Few studies have explored contextual factors, but they are nonetheless crucial. The interaction scenario and exposure time are important circumstances in human-ECA interaction. Conclusions: The findings highlight a growing interest in ECAs, which have seen significant developments in recent years. Given this evolving landscape, investigating the risk of the UVE can be a promising line of research.

Keywords: human-computer interaction, uncanny valley effect, embodied conversational agent, systematic review

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