Search results for: inclusive health care

Authors: J. Al-Dmour, A. Sagahyroon, A. Al-Ali, S. Abusnana

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Radio Frequency Based Identification Systems have emerged as one of the possible valuable solutions that can be utilized in healthcare systems. Nowadays, RFID tags are available with built-in human vital signs sensors such as Body Temperature, Blood Pressure, Heart Rate, Blood Sugar level and Oxygen Saturation in Blood. This work proposes the design, implementation, and testing of an integrated mobile RFID-based health care system. The system consists of a wireless mobile vital signs data acquisition unit (RFID-DAQ) integrated with a fuzzy-logic–based software algorithm to monitor and assess patients conditions. The system is implemented and tested in ‘Rashid Center for Diabetes and Research’, Ajman, UAE. System testing results are compared with the Modified Early Warning System (MEWS) that is currently used in practice. We demonstrate that the proposed and implemented system exhibits an accuracy level that is comparable and sometimes better than the widely adopted MEWS system.

Keywords: healthcare, fuzzy logic, MEWS, RFID

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Authors: Heena Akbar, Winnie Niumata, Danielle Gallegos

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Type 2 diabetes is a significant public health problem for Māori and Pasifika communities in Queensland, who are experiencing a higher burden of morbidity and mortality from the condition. Despite this higher burden, there are few initiatives that are culturally tailored to improve prevention and management. Modification of personal behaviors through women’s wellness programs aimed at early intervention has been shown to reduce the risk of developing complications in established type 2 diabetes and may reduce hospitalization rates from preventable complications related to this disease. The 24-week Pasifika Women’s Diabetes Wellness Program (PWDWP) was culturally co-designed and co-developed with Māori and Pasifika women with type 2 diabetes through a community-academia partnership in Queensland. Underpinned by Social Cognitive Theory and the Indigenous Pacific Health frameworks to include family culture & spirituality and integrating a collectivist and whānau (family) centered approach to self-care, the program takes into consideration the cultural shame associated with acknowledging the disease and tailors the interventions using talanoa (storytelling or conversation in a relational context) as the key strategy to come to a shared meaning for behavior change. The pilot trial is a 12-week intervention followed by a 12-week follow-up period conducted with 50 women with type 2 diabetes, 25 women who will receive the intervention and 25 women who will receive usual care. The pilot program provides in-person and virtual access to culturally supported prevention and self-management of Māori and Pasifika women with type 2 diabetes with the aim to improve healthy lifestyles and reduce late hospital presentations from diabetes-related complications for better diabetes-related outcomes. This study will test and evaluate the effectiveness of the PWDWP pilot trial in partnership with Māori & Pasifika community organizations and key stakeholders for improved glycated hemoglobin (HbA1c) levels associated with poor management of type 2 diabetes.

Keywords: culturally co-designed intervention, Indigenous methodology, Māori and Pasifika communities, type 2 diabetes self-management

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Authors: Juntip Kanjanasilp, Ratree Sawangjit, Kanokporn Meelap, Kwanchanok Kruthakool

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Depression is a common mental health disorder. Antidepressants are effective pharmacological treatments, but most patients have low medication adherence. This study aims to systematic review and meta-analysis what method increase the antidepressants adherence efficiently and improve clinical outcome. Systematic review of articles of randomized controlled trials obtained by a computerized literature search of The Cochrane, Library, Pubmed, Embase, PsycINFO, CINAHL, Education search, Web of Science and ThaiLIS (28 December 2017). Twenty-three studies were included and assessed the quality of research by ROB 2.0. The results reported that printing media improved in number of people who had medication adherence statistical significantly (p= 0.018), but education, phone call, and program utilization were no different (p=0.172, p=0.127, p=0.659). There was no significant difference in pharmacist’s group, health care team’s group and physician’s group (p=0.329, p=0.070, p=0.040). Times of intervention at 1 month and 6 months improved medication adherence significantly (p= 0.0001, p=0.013). There was significantly improved adherence in single intervention (p=0.027) but no different in multiple interventions (p=0.154). When we analyzed medication adherence with the mean score, no improved adherence was found, not relevant with who gives the intervention and times to intervention. However, the multiple interventions group was statistically significant improved medication adherence (p=0.040). Phone call and the physician’s group were statistically significant improved clinical outcomes in number of improved patients (0.025 and 0.020, respectively). But in the pharmacist’s group and physician’s group were not found difference in the mean score of clinical outcomes (p=0.993, p=0.120, respectively). Times to intervention and number of intervention were not significant difference than usual care. The overall intervention can increase antidepressant adherence, especially the printing media, and the appropriate timing of the intervention is at least 6 months. For effective treatment, the provider should have experience and expert in caring for patients with depressive disorders, such as a psychiatrist. Medical personnel should have knowledge in caring for these patients also.

Keywords: depression, medication adherence, clinical outcomes, systematic review, meta-analysis

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Authors: Sri Widati, Ira Nurmala

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The Se’i Tradition was considered to contribute highly to the high maternal mortality rate in South Amanuban, East Nusa Tenggara. This tradition is still preserved due to the social support that has influenced the decision to carry out the Se’i to pregnant women and post-partum women. The purpose of this study is to analyze this social support towards the Se’i Tradition on pregnant women in East Nusa Tenggara. This research was an explorative study with in-depth interviews, observations, and focus group discussions (FGD) in collecting the data. This study showed that emotional support towards Se’i was commonly given by families, specifically by the mother-in laws. Instrumental support was shown by the husbands and the traditional midwives who helped delivered the babies. Informational support was found on the pregnant women and their mother-in laws. Appraisal support was given by all the neighbors and relatives of the pregnant women by telling how comfortable it was to go through this tradition which eventually affected those women to carry it out themselves. The Se’i Tradition is still carried out and mostly supported by the relatives of the pregnant women. The first recommendation of this study is to suggest people to only follow the suggestions from the local health staff to give birth in the local health centers and not to do the tradition anymore. The second recommendation is to urge the government to give support in the form of transportation facilities for pregnant women to reach the local health staff.

Keywords: the Se’i tradition, social support, pregnant women, maternal mortality, post-partum women

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Authors: Aneena Suresh, C. S. Sidharth

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Drug related problems (DRPs) are common in chronic kidney disease (CKD) patients and end stage patients undergoing hemodialysis. To treat the co-morbid conditions of the patients, more complex therapeutic regimen is required, and it leads to development of DRPs. So, this calls for frequent monitoring of the patients. Due to the busy work schedules, physicians are unable to deliver optimal care to these patients. Addition of a clinical pharmacist in the team will improve the standard of care offered to CKD patients by minimizing DRPs. In India, the role of clinical pharmacists in the improving the health outcomes in CKD patients is poorly recognized. Therefore, this study is conducted to put an insight on the role of clinical pharmacist in improving Drug Related Problems in patients with chronic kidney disease, thereby helping them to achieve desired therapeutic outcomes in the patients. A prospective interventional study was conducted for a year in a 620 bedded tertiary care hospital in India. Data was collected using an unstructured questionnaire, medication charts, etc. DRPs were categorized using Hepler and Strand classification. Relationships between the age, weight, GFR, average no of medication taken, average no of comorbidities, and average length of hospital days with the DRPs were identified using Mann Whitney U test. The study population primarily constituted of patients above the age of 50 years with a mean age of 59.91±13.59. Our study showed that 25% of the population presented with DRPs. On an average, CKD patients are prescribed at least 8 medications for the treatment in our study. This explains the high incidence of drug interactions in patients suffering from CKD (45.65%). The least common DRPs in our study were found to be sub therapeutic dose (2%) and adverse drug reactions (2%). Out of this, 60 % of the DRPs were addressed successfully. In our study, there is an association between the DRPs with the average number of medications prescribed, the average number of comorbidities, and the length of the hospital days with p value of 0.022, 0.004, and 0.000, respectively. In the current study, 86% of the proposed interventions were accepted, and 41 % were implemented by the physician, and only 14% were rejected. Hence, it is evident that clinical pharmacist interventions will contribute significantly to diminish the DRPs in CKD patients, thereby decreasing the economic burden of healthcare costs and improving patient’s quality of life.

Keywords: chronic kidney disease, clinical pharmacist, drug related problem, intervention

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Authors: Oktia Woro Kasmini Handayani, Sri Ratna Rahayu, Efa Nugroho, Bertakalswa Hermawati

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The double burden of nutrition problem must be faced by Indonesia as developing country. The implemented program did not improve the nutritional status, therefore need to consider to utilize local potential. The objective of this research was to find out the effectivity of magnification model of early detect through local potential utilization in urban region, Semarang, Central Java, Indonesia. The research used an experimental design with the quantitative-qualitative approach. The population was all toddlers under five within the research region, sample determination by purposive sampling, as many as 216 toddlers. Quantitative data analysis used effectively criteria by Sugiono. Qualitative data was analyzed using NVivo. The optimization of local potential in the effort of nutrition status improvement shows number of nutrition case found was increased 225% (very effective), number of cases treated was increased 175% (very effective), number of cases counselled was increased 200% (effective), and number of cases that have improvement increase 75% (effective). The local potential need to be utilized in the effort of nutrition program improvement one of it is through the community empowerment, particularly health care and health high education institution as partner.

Keywords: early detection, nutrition status, local potential, health cadre

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Authors: Fadzilah Abdul Rahman

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Emotional development is developed between the parents and their child. Behavioural development is also developed between the parents and their child. Social Development is how parents can help their special needs child to adapt to society and to face challenges. In promoting a lifelong learning mindset, enhancing skill sets and readiness to face challenges, parents would be able to counter balance these challenges during their care giving process and better manage their expectations through understanding the hierarchy of needs modality towards a positive attitude, and in turn, improve their quality of life and participation in society. This paper aims to demonstrate how the hierarchy of needs can be applied in various situations of caregiving for parents with a special needs child.

Keywords: hierarchy of needs, parents, special needs, care-giving

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Authors: Fernanda Ludmilla Rossi Rocha, Thamiris Cavazzani Vegro, Silvia Helena Henriques Camelo, Carmen Silvia Gabriel, Andrea Bernardes

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Introduction: Organizations are cultural, symbolic and imaginary systems composed by values and norms. These values and norms represent the organizational culture, which determines the behavior of the workers, guides the work practices and impacts the quality of care and the safety culture of health services worldwide. Objective: To analyze the organizational culture of a public and a private hospital in Brazil. Method: Descriptive study with quantitative approach developed in a public and in a private hospital of Brazil. Sample was composed by 281 nursing workers, of which 73 nurses and 208 nursing auxiliaries and technicians. The data collection instrument comprised the Brazilian Instrument for Assessing Organizational Culture. Data were collected from March to December 2013. Results: At the public hospital, the results showed an average score of 2.85 for the values concerning cooperative professionalism (CP); 3.02 for values related to hierarchical rigidity and the centralization of power (HR); 2.23 for individualistic professionalism and competition at work (IP); 2.22 for values related to satisfaction, well-being and motivation of workers (SW); 3.47 for external integration (EI); 2.03 for rewarding and training practices (RT); 2.75 for practices related to the promotion of interpersonal relationships (IR) About the private hospital, the results showed an average score of 3.24 for the CP; 2.83 for HR; 2.69 for IP; 2.71 for SW; 3.73 for EI; 2.56 for RT; 2.83 for IR at the hospital. Discussion: The analysis of organizational values of the studied hospitals shows that workers find the existence of hierarchical rigidity and the centralization of power in the institutions; believed there was cooperation at workplace, though they perceived individualism and competition; believed that values associated with the workers’ well-being, satisfaction and motivation were seldom acknowledged by the hospital; believed in the adoption of strategic planning actions within the institution, but considered interpersonal relationship promotion, continuous education and the rewarding of workers to be little valued by the institution. Conclusion: This work context can lead to professional dissatisfaction, compromising the quality of care and contributing to the occurrence of occupational diseases.

Keywords: nursing management, organizational culture, quality of care, interpersonal relationships

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Authors: Miao Yang

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PPCPs (pharmaceutical and personal care products) in water, as an environmental pollutant, becomes an issue of increasing concern. Therefore, the techniques for degradation of PPCPs has been a hotspot in water pollution control field. Since there are several disadvantages for common degradation techniques of PPCPs, such as low degradation efficiency for certain PPCPs (ibuprofen and Carbamazepine) this proposal will adopt a combined technique by using CDs (carbon nanodots)/C₃N₄ composite and ultrasonic irradiation to mitigate or overcome these shortages. There is a significant scientific problem that the mechanism including PPCPs, major reactants, and interfacial active sites is not clear yet in the study of PPCPs degradation. This work aims to solve this problem by using both theoretical and experimental methodologies. Firstly, optimized parameters will be obtained by evaluating the kinetics and oxidation efficiency under different conditions. The competition between H₂O₂ and PPCPs with HO• will be elucidated, after which the degradation mechanism of PPCPs by the synergy of CDs/C₃N₄ composite and ultrasonic irradiation will be proposed. Finally, a sonolysis-adsorption-catalysis coupling mechanism will be established which is the theoretical basis and technical support for developing new efficient degradation techniques for PPCPs in the future.

Keywords: carbon nanodots/C₃N₄, pharmaceutical and personal care products, ultrasonic irradiation, hydroxyl radical, heterogeneous catalysis

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Authors: Sangita Bharati

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Violence against women is now well recognised as a public health problem and human rights violation of worldwide significance. It is an important risk factor for women's ill health, with far reaching consequences for both their physical and mental health. Gender based violence takes many forms and results in physical, sexual and psychological harm to the women throughout their lives. Gender based violence often manifests unequal power relation between men and women in society and the secondary status of the women because of which women have to suffer a range of health problems in silence. This paper will aim at describing a few problems related to women’s health which are directly linked to their experience as victims of gender based violence.

Keywords: violence, health, women, society

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Authors: Karen Butler

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The LGBTQ youth of color face stigma related to both race and gender identity. Effectively dealing with racial/ethnic discrimination requires strong connections to family and one’s racial/ethnic group. However, LGBTQ youth of color seldom receive support from family, peer groups or church groups. Moreover, ethnic communities often perceive LGBTQ identities as a rejection of ethnic heritage. Thus, stigma places these young people at greater risk for substance use, violence, risky sexual behaviors, suicide, and homelessness. Offering a Queer Studies (QS) class is one way to facilitate a safer and more inclusive environment for LGBTQ students, faculty and staff. The discipline of Queer Studies encompasses theories and thinkers from numerous fields: cultural studies, gay and lesbian studies, race studies, women's studies, media, postmodernism, post-colonialism, psychoanalysis and more. We began our course development by researching existing programs and classes. Several course syllabi were examined and course materials such as readings, videos, and guest speakers were assessed for possible inclusion. We also employed informal survey methods with students and faculty in order to gauge interest in the course. We then developed a sample course syllabus and began the process of new course approval. Feedback thus far indicates that students of various sexual orientations and gender identities are interested in the course and understand the need to offer it; faculty in Psychology, Social Work, and Interdisciplinary Studies are interested in cross-listing the course; library staff is willing to assist with course material acquisition, and the administration is supportive. The purpose of this session is to 1) explore the various health and wellness issues facing LGBTQ students of color and 2) share our experience of developing a QS course in health education in order to address these needs. This process, from initial recognition of the need to a course offering, will be described and discussed in the hopes that participants will increase their awareness of the issues. A QS course would be an appropriate requirement for any number of majors as well as an elective for any major.

Keywords: black colleges, health education, LGBTQ, queer studies

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Authors: Wenhsuan Lee, Yachi Chang, Yingyih Shih

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In clinical practices, it is common that while facing the unknown progress of their disease, palliative care patients may easily feel anxious and depressed. These types of reactions are a cause of psychosomatic diseases and may also influence treatment results. However, the purpose of palliative care is to provide relief from all kinds of pains. Therefore, how to make patients more comfortable is an issue worth studying. This study adopted the “bio-psycho-social model” proposed by Engel and applied spontaneous breathing training, in the hope of seeing patients’ psychological state changes caused by their physiological state changes, improvements in their anxious conditions, corresponding adjustments of their cognitive functions, and further enhancement of their social functions and the social support system. This study will be a one-year study. Palliative care outpatients will be recruited and assigned to the experimental group or the control group for six outpatient visits (once a month), with 80 patients in each group. The patients of both groups agreed that this study can collect their physiological quantitative data using an HRV device before the first outpatient visit. They also agreed to answer the “Beck Anxiety Inventory (BAI)”, the “Taiwanese version of the WHOQOL-BREF questionnaire” before the first outpatient visit, to fill a self-report questionnaire after each outpatient visit, and to answer the “Beck Anxiety Inventory (BAI)”, the “Taiwanese version of the WHOQOL-BREF questionnaire” after the last outpatient visit. The patients of the experimental group agreed to receive the breathing training under HRV monitoring during the first outpatient visit of this study. Before each of the following three outpatient visits, they were required to fill a self-report questionnaire regarding their breathing practices after going home. After the outpatient visits, they were taught how to practice breathing through an HRV device and asked to practice it after going home. Later, based on the results from the HRV data analyses and the pre-tests and post-tests of the “Beck Anxiety Inventory (BAI)”, the “Taiwanese version of the WHOQOL-BREF questionnaire”, the influence of the breathing training in the bio, psycho, and social aspects were evaluated. The data collected through the self-report questionnaires of the patients of both groups were used to explore the possible interfering factors among the bio, psycho, and social changes. It is expected that this study will support the “bio-psycho-social model” proposed by Engel, meaning that bio, psycho, and social supports are closely related, and that breathing training helps to transform palliative care patients’ psychological feelings of anxiety and depression, to facilitate their positive interactions with others, and to improve the quality medical care for them.

Keywords: palliative care, breathing training, bio-psycho-social model, heart rate variability

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Authors: Sue S. Feldman, Bradley Tipper, Benjamin Schooley

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Nearly every community in the US has been impacted by opioid related addictions/deaths; it is a national problem that is threatening our social and economic welfare. Most believe that tackling this problem from a prevention perspective advances can be made toward breaking the chain of addiction. One mechanism, community based participatory research, involves the community in the prevention approach. This project combines that approach with a design science approach to develop an integrated solution. Findings suggested accountable care communities, transpersonal psychology, and social exchange theory as product kernel theories. Evaluation was conducted on a prototype.

Keywords: substance use and abuse recovery, community resource centers, accountable care communities, community based participatory research

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Authors: Emily Purdom, Rachel Robinson

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As the number of students worldwide requiring speech-language therapy, occupational therapy and mental health services during their school day increases, innovation is becoming progressively more important to meet the demand. Telepractice can be used to reach a greater number of students requiring specialized therapy while maintaining the highest quality of care. It can be provided in a way that is not only effective but ultimately more convenient for student, teacher and therapist without the added burden of travel. Teletherapy eradicates many hurdles to traditional on-site service delivery and helps to solve the pervasive shortage of certified professionals. Because location is no longer a barrier to specialized education plans for students with disabilities when teletherapy is conducted, there are many advantages that can be deployed. Increased frequency of engagement is possible along with students receiving specialized care from a clinician that may not be in their direct area. Educational teams, including parents, can work together more easily and engage in face-to-face, student-centered collaboration through videoconference. Practical strategies will be provided for connecting students with qualified therapists without the typical in-person dynamic. In most cases, better therapy outcomes are going to be achieved when treatment is most convenient for the student and educator. This workshop will promote discussion in the field of education to increase advocacy for remote service delivery. It will serve as a resource for those wanting to expand their knowledge of options for students with special needs afforded through innovation.

Keywords: education technology, innovation, student support services, telepractice

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Authors: Anteneh Berhane Yeyi, Tefera Belachew

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Any woman who could become pregnant is at risk of having a baby with neural tube defects (NTDs). A spontaneous aborted women with immediately preceding pregnancy may have an increased risk of develop NTDs. Ethiopia has one of the highest rates of micronutrient deficiencies, including folate and iron deficiency. Currently, in Ethiopia, NTDs is emerged as a public health concern. Even if Ethiopia, has implement different strategies for reducing maternal and neonatal mortality and morbidity, there is no room in the health care system and lack of integration for preventing the risk of NTDs for those women who aborted spontaneously and women who discontinue long acting contraception to become pregnant. The purpose of this study was to evaluate the effect of preconception picture-based nutrition education on knowledge and adherence to iron-folic acid supplement (IFAS) intake to reduce the risk of developing neural tube defects (NTDs) and iron deficiency anemia (IDA) among women who had a planned to pregnancy in Ethiopia, a country with a high burden of NTDs. Methodology: This study was conducted in Eastern Ethiopia. A double blinded parallel randomized controlled trial design was employed among women in the age group of 18-45 years who requested to interrupt modern contraceptive who have an intention to be pregnant and women with spontaneous abortion who refused to take a contraceptive. The interventional arm (n=122) received a preconception picture-based nutrition education with iron-folic acid supplement, and the control arm (n=122) received only preconception IFAS. In this study male partners were participated. Result: After three months of intervention the proportion of adherence to IFAS was 23% (n=56). With regard to adherence within the groups, 42.6% (n=52) in the intervention group and 3.3% (n=4) in the control group and the intervention group were significantly higher than in control group. In the intervention group the proportion of adherence to IFAS intake among participants increased by 40.1% and there were statistically difference (P<0.0001). The difference in difference between the two groups of adherence to IFAS intake was 37.6% and there were a statistical significance (P<0.0001). Level of knowledge between the groups did differ before and after intervention (P= 0.87 Vs P<0.0001). The overall the mean change in knowledge Mean (+SE) between group was 0.9 (+3.04 SE) and there were significant differences between two groups (P<0.001). Conclusion: In general this intervention is effective toward adherence to IFAS and a critical milestone to improve maternal health and reduce the neonate mortality due to NTDs and other advert effect of pregnancy and birth outcomes. This intervention is very short, simple, and cost effective and has potential for adaptation, feasible development to large-scale implementation in the existing health care system. Furthermore, this type of interventional approach has the potential to reduce the country's ANC program dropout rates and increase male partner’s participation on reproductive health.

Keywords: NTDs, IFAS, WRA, Ethiopia

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Authors: Ola A. Nassr, Ali M. Abd Alridha, Rua A. Naser, Rasha S. Abbas

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Background: Excessive and inappropriate use of antimicrobial agents among hospitalized patients remains an important patient safety and public health issue worldwide. Not only does this behavior incur unnecessary cost but it is also associated with increased morbidity and mortality. The objective of this study is to obtain an insight into the prescribing patterns of antibiotics in surgical and medical wards, to help identify a scope for improvement in service delivery. Method: A simple point prevalence survey included a convenience sample of 200 patients admitted to medical and surgical wards in a government teaching hospital in Baghdad between October 2017 and April 2018. Data were collected by a trained pharmacy intern using a standardized form. Patient’s demographics and details of the prescribed antibiotics, including dose, frequency of dosing and route of administration, were reported. Patients were included if they had been admitted at least 24 hours before the survey. Patients under 18 years of age, having a diagnosis of cancer or shock, or being admitted to the intensive care unit, were excluded. Data were checked and entered by the authors into Excel and were subjected to frequency analysis, which was carried out on anonymized data to protect patient confidentiality. Results: Overall, 88.5% of patients (n=177) received 293 antibiotics during their hospital admission, with a small variation between wards (80%-97%). The average number of antibiotics prescribed per patient was 1.65, ranging from 1.3 for medical patients to 1.95 for surgical patients. Parenteral third-generation cephalosporins were the most commonly prescribed at a rate of 54.3% (n=159) followed by nitroimidazole 29.4% (n=86), quinolones 7.5% (n=22) and macrolides 4.4% (n=13), while carbapenems and aminoglycosides were the least prescribed together accounting for only 4.4% (n=13). The intravenous route was the most common route of administration, used for 96.6% of patients (n=171). Indications were reported in only 63.8% of cases. Culture to identify pathogenic organisms was employed in only 0.5% of cases. Conclusion: Broad-spectrum antibiotics are prescribed at an alarming rate. This practice may provoke antibiotic resistance and adversely affect the patient outcome. Implementation of an antibiotic stewardship program is warranted to enhance the efficacy, safety and cost-effectiveness of antimicrobial agents.

Keywords: Acute care, Antibiotic misuse, Iraq, Prescribing

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Authors: Mario M. J. Musonda

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Access to health care is a human right, which includes having timely access to affordable and quality essential medicines at the right place and in sufficient quantity. However, inefficient public sector supply chain management contributes to constant shortages of essential medicines at health facilities. Literature review involved a desktop study of published research studies and reports on risk management, supply chain management of essential medicines and their integration to increase the efficiency of the latter. The research was conducted on a sample population of offices under Ministry of Health Headquarters, Lusaka Provincial and District Offices, selected health facilities in Lusaka, Medical Stores Limited, Zambia Medicines Regulatory Authority and Cooperating Partners. Individuals involved in study were selected judgmentally by their functions under selection and quantification, regulation, procurement, storage, distribution, quality assurance, and dispensing of essential medicines. Structured interviews and discussions were held with selected experts and self-administered questionnaires were distributed. Collected and analysed data of 35 returned and usable questionnaires from the 50 distributed. The highest prioritised risks were; inadequate and inconsistent fund disbursements, weak information management systems, weak quality management systems and insufficient resources (HR and infrastructure) among others. The results for this research can be used to increase the efficiency of the public sector supply chain of essential medicines and other pharmaceuticals. The results of the study showed that there is need to implement effective risk management systems by participating institutions and organisations to increase the efficiency of the entire supply chain in order to avoid and/or reduce shortages of essential medicines at health facilities.

Keywords: essential medicine, risk assessment, risk management, supply chain, supply chain risk management

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Authors: Hasan Al Banna, Nazmus Sakib, Anjan Roy

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From the perspective of the underdeveloped countries such as Bangladesh, health issue can readily be pointed out as the most demanding but the least promoted concern due to lack of initiatives from both government and NGOs. Furthermore an worldwide scenario is that most death and suffering from various pathogenic and non-pathogenic diseases occur due to delay diagnosis, and this happen for the lacking of regular health check-up facility or tradition. In this epistle, an innovative proposal on social business can be introduced to ensure the one-stop medical facility to the door-step of the rural society and create jobs for the educated rural youths to serve their own people. To illustrate the policy, this newly proposed organization will work as a health club which will offer a life-time membership to villagers within a very affordable fee of 250 BDT (2.63 Euro) per month. In this package the members will get the facility of tri-monthly full health check-up by specialist doctors, a health record book and computerized health database for each member and anytime medical consultancy for the members only. We will also organize free medical campaign and workshops on nutrition, sanitation, adulteration, pregnancy-care, child-health etc with the assistance of different sponsors. Among other services that will be provided on payment include emergency ambulance facility in low rents, quality diagnostic lab and 24-hour dispensary facility. Likewise, this policy will involve local educated people by recruiting them after providing intensive courses on nursing and other medical instrumental skills. Henceforth, the engagement of local youth will make the program more acceptable to the rural community. In the later part of this paper, a survey report on Daragram union of Manikganj district, Bangladesh, having population above 25000, will be presented to delineate the scenario how this policy can repay the initial capital expense of BDT 7 million (around 73381 Euro) within 5 years and how I can realistically earn handsome revenue from the first month of business. To recapitulate, this policy is very promising to enlighten the underprivileged community by providing health assurance, and alleviating unemployment besides the investor’s financial profit.

Keywords: create job for the rural people, handsome financial profit, quality health services, underprivileged areas of underdeveloped countries

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Authors: Suheyla Demi̇rkol Orak

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The requirement of inclusive education is one of the utmost important results of both regular and irregular immigration. The matter in the case of Syrian immigrants is even worse than the other immigrants cases in world history since a massive immigration wave has affected all world countries' socio-economic profiles. When Syrians immigrated from Syria all over the world, they aimed to survive and left behind the war, but surviving is not optional occasion without handling language-related problems. Humans exist and preserve their existence with their language. That is a matter of concern for the integration of Syrians into the hosting countries. Many countries are proceeding with various programs to integrate Syrians into the majority groups by either assimilation or adaptation policies. Turkey has got the lion's share of the Syrian immigration apple, and in the same vein with this situation, its language education system should be analyzed severely in order to come up with a perfect match program for the integration of Syrians. It aimed to generate an inclusive education model for catalyzing the integration process of immigrant Syrian students into the majority socio-economic group via overcoming the language barrier. The identity of the immigrants is prioritized. The study follows a narrative literature review, which aims to review and critique relevant literature and offers a new conceptualization derived from the previous literature. The study derives a critical localized bilingual education model. As the outcome of the narrative literature review, a bilingual education model which prioritized the identity of the target community was designed. In the present study, main bilingual education programs and most of the countries' bilingual education policies were reviewed critically and suggestions were listed for the Syrian immigrants dominantly in Turkey and suggested to be benefitted by the other countries through localizing the practices.

Keywords: bi/multilingual education, sheltered education, immigrants, glocalization, submersion program, immersion program

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Authors: Uvais Qidwai, Mohamed Shakir

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This paper presents an initial study related to the use of robotic toys as teaching and therapeutic aid tools for teachers and care-givers as well as parents of children with various levels of autism spectrum disorder (ASD). Some of the most common features related to the behavior of a child with ASD are his/her social isolation, living in their own world, not being physically active, and not willing to learn new things. While the teachers, parents, and all other related care-givers do their best to improve the condition of these kids, it is usually quite an uphill task. However, one remarkable observation that has been reported by several teachers dealing with ASD children is the fact that the same children do get attracted to toys with lights and sounds. Hence, this project targets the development/modifications of such existing toys into appropriate behavior training tools which the care-givers can use as they would desire. Initially, the remote control is in hand of the trainer, but after some time, the child is entrusted with the control of the robotic toy to test for the level of interest. It has been found during the course of this study that children with quite low learning activity got extremely interested in the robot and even advanced to controlling the robot with the Electromyography (EMG). It has been observed that the children did show some hesitation in the beginning 5 minutes of the very first sessions of such interaction but were very comfortable afterwards which has been considered as a very strong indicator of the potential of this technique in teaching and rehabilitation of children with ASD or similar brain disorders.

Keywords: Autism Spectrum Disorder (ASD), robotic toys, IR control, electromyography, LabVIEW based remote control

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Authors: Amina Salem Attia

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This east project consists in studying The child's mental health is the medium through which he expresses his thoughts, so pay attention to it because it is an essential building block in the process of building the child's future personality, where it gives him a balance between feelings and mental thoughts, and since the family is the child's first guardian, it greatly affects his personality and psychological development. As the disturbed environment contributes to behavioral deviations and mental disorders, unlike the stable environment, which plays a major role in developing the child's abilities and forming his psychologically sound attitudes, this should not be forgotten about the role of the school, it is also the second social institution after the family and has a major impact on the child's mental health as it contributes It is important in forming the child's personality and developing his skills and achieving his healthy psychological development, by providing him with psychological care and helping him to solve his problems by using models that are valid for the behavior that is taught to him or that the teachers present in their daily behavior with him.

Keywords: psychological, behavioral problems, children, school education

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Authors: Sideri Katerina, Chanania Eleni

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The reasons why people remain unvaccinated, especially health workers, are complex. In Greece, 2 percent of health workers (around 7,000) remain unvaccinated, despite the fact that for this group of people vaccination against COVID-19 is mandatory. In April 2022, the Greek health minister repeated that unvaccinated health care workers will remain suspended from their jobs ‘for as long as the pandemic lasts,’ explaining that the suspension of the workers in question was ‘entirely their choice’ and that health professionals who do not believe in vaccines ‘do not believe in their own science.’ Although policy circles around the world often link vaccine hesitancy to ignorance of science or misinformation, various recently published qualitative studies show that vaccine hesitancy is the result of a combination of factors, which include distrust towards elites and the system of innovation and distrust towards government. In a similar spirit, some commentators warn that labeling hesitancy as “anti-science” is bad politics. In this paper, we worked within the tradition of STS taking the view that people draw upon personal associations to enact and express civic concern with an issue, the enactment of public concern involves the articulation of threats to actors’ way of life, personal values, relationships, lived experiences, broader societal values and institutional structures. To this effect, we have conducted 27 in depth interviews with unvaccinated Greek health workers and we are in the process of conducting 20 more interviews. We have so far found that rather than a question of believing in ‘facts’ vaccine hesitancy reflects deep distrust towards those charged with the making of decisions and pharmaceutical companies and that emotions (rather than rational thinking) play a crucial role in the formation of attitudes and the making of decisions. We need to dig deeper so as to understand the causes of distrust towards technical government and the ways in which public(s) conceive of and want to be part in the politics of innovation. We particularly address the question of the effectiveness of mandatory vaccination of health workers and whether such top-down regulatory measures further polarize society, to finally discuss alternative regulatory approaches and governance structures.

Keywords: vaccine hesitancy, innovation, trust in vaccines, sociology of vaccines, attitude drivers towards scientific information, governance

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Authors: Pankaj Dhiman, Simranjeet Kaur

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This research paper presents a comprehensive sentiment analysis of social media responses to videos on Facebook, YouTube, Twitter, and Instagram during the 2024 Indian general elections. The study focuses on the sentiment patterns of voters towards the National Democratic Alliance (NDA) and The Indian National Developmental Inclusive Alliance (INDIA) on these platforms. The analysis aims to understand the impact of social media on voter sentiment and its correlation with the election outcome. The study employed a mixed-methods approach, combining both quantitative and qualitative methods. With a total of 200 posts analysed during general election-2024 final phase, the sentiment analysis was conducted using natural language processing (NLP) techniques, including sentiment dictionaries and machine learning algorithms. The results show that NDA received significantly more positive sentiment responses across all platforms, with a positive sentiment score of 47% compared to INDIA's score of 38.98 %. The analysis also revealed that Twitter and YouTube were the most influential platforms in shaping voter sentiment, with 60% of the total sentiment score coming from these two platforms. The study's findings suggest that social media sentiment analysis can be a valuable tool for understanding voter sentiment and predicting election outcomes. The results also highlight the importance of social media in shaping public opinion and the need for political parties to engage effectively with voters on these platforms. The study's implications are significant, as they indicate that social media can be a key factor in determining the outcome of elections. The findings also underscore the need for political parties to develop effective social media strategies to engage with voters and shape public opinion.

Keywords: Indian Elections-2024, NDA, INDIA, sentiment analysis, social media, democracy

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Authors: Endalew Fufa Kufi

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Every married person aspires to be a parent regardless of the situation in which s/he lives. Such aspiration meets with reality when the destined parent is able to give adequate supports and services to his/her children, whether the latter are got by birth or through adoption. The adequacy of services parents provide their children is both enriched and tempted by the work on which they involve. On the one hand, parents need to work and earn a living in order to support their family. On the other hand, they must spend most of their time outside home to do the work, which shortens the time and might they spare to care for their children. Where the sufficiency of services parents owe their children could be ascertained by in terms of life skills, physical care and related provisions, the role of working fathers and mothers in providing such supports could be diverse across cultures and work traditions. Hence, this research deals with the investigation of working mothers’ parental practices, challenges they face in providing parental services and the implication for the future progress of the parents and their children. Target of the study will be Arsi University in Oromia Regional State of Ethiopia. Descriptive survey design in holding the research, and data for the research will be collected in the form of experiential self-report from 150 working mothers selected from the entire working women population of Colleges of Agriculture and Environmental Studies and College of Health Sciences through stratified random-sampling. Instruments of data collection will be closed and open-ended questionnaire. Complementary data will also be collected from purposively selected samples through semi-structured interview. Data for the research will be collected through questionnaire first and then through interview. Data analysis will also follow the same procedure. The collected data will systematically be organized and statistically and thematically analyzed in order to come up with indicative findings. The overarching thesis is that, working mothers in the study area bear a lot of responsibilities both at home and at work place which leave them very little time for parenting services. Unless due attention is given to the way they can spare time for their children, they are more likely to be tense between work-life and family care services, which tempt them in different directions.

Keywords: challenges, mothers, practices, university, working

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Authors: Yaara Shilo

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Early childhood education and care (ECEC)in Israel has undergone extensive reform and now requires daycare centers to meet internationally recognized professional standards. Since 1948, one of the aims of childcare facilities was to enable women’s participation in the workforce.A 1965 law grouped daycare centers for young children with facilities for the elderly and for disabled persons under the same authority. In the 1970’s, ECEC leaders sought to change childcare from proprietary to educational facilities. From 1976 deliberations in the Knesset regarding appropriate attribution of ECEC frameworks resulted in their being moved to various authorities that supported women’s employment: Ministries of Finance, Industry, and Commerce, as well as the Welfare Department. Prior to 2018, 75% of infants and toddlers in institutional care were in unlicensed and unsupervised settings. Legislative processes accompanied the conceptual change to an eventual appropriate attribution of ECEC frameworks. Position papers over the past two decades resulted in recommendations for standards conforming to OECD regulations. Simultaneous incidents of child abuse, some resulting in death, riveted public attention to the need for adequate government supervision, accelerating the legislative process. Appropriate care for very young children must center on quality interactions with caregivers, thus requiring adequate staff training. Finally, in 2018 a law was passed stipulating standards for staff training, proper facilities, child-adult ratios, and safety measures. The Ariav commission expanded training to caregivers for ages 0-3. Transfer of the ECEC to the Ministry of Education ensured establishment of basic training. Groundwork created by new legislation initiated professional development of EC educators for ages 0-3. This process should raise salaries and bolster the system’s ability to attract quality employees. In 2022 responsibility for ECEC ages 0-3 was transferred from the Ministry of Finance to the Ministry of Education, shifting emphasis from proprietary care to professional considerations focusing on wellbeing and early childhood education. The recent revolutionary changes in ECEC point to a new age in the care and education of Israel’s youngest citizens. Implementation of international standards, adequate training, and professionalization of the workforce focus on the child’s needs.

Keywords: policy, early childhood, care and education, daycare, development

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Authors: Dana Cassandra Winkler, Delia Leiding, Rene Bergs, Franziska Kaiser, Ramona Kirchhart, Ute Habel

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Background: Violence is a multidimensional phenomenon, affecting people of every age, socio-economic status and gender. Nevertheless, most studies primarily focus on men perpetrating women. Aim of the present study is to identify the likelihood of mental and somatic disorders and risk-taking behavior in male violence affected. In addition, the relationship between age of violence experience and the risk for health-related problems was analyzed. Method: On the basis of current evidence, a questionnaire was developed focusing on demographic background, health status, risk-taking behavior, and active and passive violence exposure. In total, 5221 males (Mean: 56,1 years, SD: 17,6) were consulted. To account for the time of violence experience in an efficient way, age clusters ‘0-12 years’, ‘13-20 years’, ‘21-35 years’, ‘36-65 years’ and ‘over 65 years’ were defined. A binary logistic regression was calculated to reveal differences in violence-affected and non-violence affected males regarding health and risk-taking factors. Males who experienced violence on a daily/ almost daily basis vs. males who reported violence occurrence once/ several times a month/ year were compared with respect to health factors and risk-taking behavior. Data of males, who indicated active and passive violence exposure, were analyzed by a chi²-analysis, to investigate a possible relation between the age of victimization and violence perpetration. Findings: Results imply that general violence experience, independent of active and passive violence exposure increases the likelihood in favor of somatic-, psychosomatic- and mental disorders as well as risk-taking behavior in males. Experiencing violence on a daily or almost daily basis in childhood and adolescence may serve as a predictor for increased health problems and risk-taking behavior. Furthermore, the violence experience and perpetration occur significantly within the same age cluster. This underlines the importance of a near-term intervention to minimize the risk, that victims become perpetrators later. Conclusion: The present study reveals predictors concerning health risk factors as well as risk-taking behavior in males with violence exposure. The results of this study may underscore the benefit of intervention and regular health care approaches in violence-affected males and underline the importance of acknowledging the overlap of violence experience and perpetration for further research.

Keywords: health disease, male, mental health, prevalence, risk-taking behavior, violence

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Authors: Merav Ben Natan, May Revach, Or Sade, Yaniv Yonay, Yaron Berkovich

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Background: The inclusion of nurse practitioners (NPs) specializing in orthopedics holds promise for enhancing the quality of care for orthopedic patients. Understanding patients’ perspectives on this role is crucial for evaluating the feasibility and acceptance of integrating NPs into orthopedic settings. This study aims to explore the receptiveness of orthopedic patients to treatment by orthopedic NPs and examines potential associations between patients’ willingness to engage with NPs, their familiarity with the NP role, perceptions of nursing, and satisfaction with orthopedic nursing care. Methods: This cross-sectional study involved patients admitted to an orthopedic department at a central Israeli hospital between January and February 2023. Data was collected using a validated questionnaire consisting of five sections, reviewed by content experts. Statistical analyses were conducted using SPSS and included descriptive statistics, independent samples t-tests, Pearson correlations, and linear regression. Results: Participants in the study showed a moderate willingness to receive treatment from orthopedic NPs, with more than two-thirds expressing strong openness. Patients were generally receptive to NPs performing various clinical tasks, though there was less enthusiasm for NPs’ involvement in medication management and preoperative evaluations. Positive attitudes towards nurses and familiarity with the NP role were significant predictors of patient receptiveness to NP treatment. Conclusion: Patient acceptance of orthopedic NPs varies across different aspects of care. While there is a general willingness to receive care from NPs, these nuanced preferences must be considered when implementing NPs in orthopedic settings. Awareness and positive perceptions of the NP role play crucial roles in shaping patients’ willingness to engage with NPs.

Keywords: orthopedic nurse practitioners, patient receptiveness, perceptions of nursing, clinical tasks

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Authors: Doctor Akanle Florence Foluso

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Access to health care and people’s ability to having a responsible, satisfying and safe sexual life is clearly a defined human right of people with hearing impairment and others with disabilities this paper looks at disability and sexuality: a human right approach to sexual and reproductive health of the hearing impaired adolescents in developing countries. This paper investigates the extent to which the hearing impaired has a satisfying, safe sexual life and whether their human right in regards to information education is violated. The study population consists of all hearing impaired adolescents and young adults aged 10-24 years who are currently enrolled in the primary and secondary schools in Nigeria. A sample of 389 hearing impaired adolescents was selected, an adapted version of the illustrative questionnaire for interview – survey by Johncleland was used to collect the data. A correlation of 0.80 was obtained at p<0.05 level of significance. Teachers in the schools of the deaf who used sign language were used in the administration of the questionnaire. The data generated were analyzed using Frequency Counts, Percentages, Means and Standard Deviation to give a Summary on responses on access to information, education, voluntary testing and counselling and other reproductive services. This is to investigate if the sexual and reproductive right violated or protected. Findings show that a gap exists in the level of knowledge of SRH services, voluntary counselling because more than half the respondents are not aware of these services in their community. Access to information, education and health services are rights denied the hearing impaired. So their SRH rights are violated.

Keywords: sexual right diability, family planning, pregnancy, diability

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Authors: Benjamin J. Kuo, Silvia D. Vaca, Joao Ricardo Nickenig Vissoci, Catherine A. Staton, Linda Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Lydia Nanjula, Christine Muhumuza, Henry E. Rice, Gerald A. Grant, Michael M. Haglund

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Background: Traumatic Brain Injury (TBI) is disproportionally concentrated in low- and middle-income countries (LMICs), with the odds of dying from TBI in Uganda more than 4 times higher than in high income countries (HICs). The disparities in the injury incidence and outcome between LMICs and resource-rich settings have led to increased health outcomes research for TBIs and their associated risk factors in LMICs. While there have been increasing TBI studies in LMICs over the last decade, there is still a need for more robust prospective registries. In Uganda, a trauma registry implemented in 2004 at the Mulago National Referral Hospital (MNRH) showed that RTI is the major contributor (60%) of overall mortality in the casualty department. While the prior registry provides information on injury incidence and burden, it’s limited in scope and doesn’t follow patients longitudinally throughout their hospital stay nor does it focus specifically on TBIs. And although these retrospective analyses are helpful for benchmarking TBI outcomes, they make it hard to identify specific quality improvement initiatives. The relationship among epidemiology, patient risk factors, clinical care, and TBI outcomes are still relatively unknown at MNRH. Objective: The objectives of this study are to describe the processes of care and determine risk factors predictive of poor outcomes for TBI patients presenting to a single tertiary hospital in Uganda. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Research Electronic Data Capture (REDCap) was used to systematically collect variables spanning 8 categories. Univariate and multivariate analysis were conducted to determine significant predictors of mortality. Results: 563 TBI patients were enrolled from 1 June – 30 November 2016. 102 patients (18%) received surgery, 29 patients (5.1%) intended for surgery failed to receive it, and 251 patients (45%) received non-operative management. Overall mortality was 9.6%, which ranged from 4.7% for mild and moderate TBI to 55% for severe TBI patients with GCS 3-5. Within each TBI severity category, mortality differed by management pathway. Variables predictive of mortality were TBI severity, more than one intracranial bleed, failure to receive surgery, high dependency unit admission, ventilator support outside of surgery, and hospital arrival delayed by more than 4 hours. Conclusions: The overall mortality rate of 9.6% in Uganda for TBI is high, and likely underestimates the true TBI mortality. Furthermore, the wide-ranging mortality (3-82%), high ICU fatality, and negative impact of care delays suggest shortcomings with the current triaging practices. Lack of surgical intervention when needed was highly predictive of mortality in TBI patients. Further research into the determinants of surgical interventions, quality of step-up care, and prolonged care delays are needed to better understand the complex interplay of variables that affect patient outcome. These insights guide the development of future interventions and resource allocation to improve patient outcomes.

Keywords: care continuum, global neurosurgery, Kampala Uganda, LMIC, Mulago, prospective registry, traumatic brain injury

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Authors: Rukiye Pinar Boluktas

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According to 2015 statistics, in Turkey, 46% of older people live alone in their homes, 55% have poor health perceptions, 18% face poverty, and 43% are unhappy. Prevalence of depression is between 14% and 20%. In 2013, rate of suicide was 6.5. However, the most of older people prefer to live in their community although they are lonely, they face poverty, and face limitations as a result of chronic diseases and disabilities. Community based care for older people is also encouraged by Ministry of Health as it is more cost-effective. Music therapy is a simple, effective, safe, and nonpharmacologic intervention that may be used to decrease depression and to improve cognition, and health related quality of life (HRQOL). In Turkish culture, music is typically described as ‘food for soul’. This study aimed to investigate the effect of Turkish classical music songs in 32 community dwelling older people. Participants were received interventions two or three times per week, 50-60 min per session, for 8 weeks at a day health center. Each intervention session started listening music for 15-20 min to get remember songs, then followed singing songs as a group. Participants were assessed at baseline (week 0), and two follow-up at month 1 and month 2. Compared to baseline, at two follow-up, we observed that cognition improved, depression decreased, and SF-36 scores, including 8 domains and two summary scores increased. We conclude that an intervention comprising listening and singing Turkish classical music improve cognition, depression and HRQOL in older people.

Keywords: cognitive function, depression, elderly, quality of life, Turkish classical music

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