Search results for: clinical advice services

Authors: Mohammad Ranjbar, Mohammad Bazyar, Blake Angell, Thomas Lung, Yibeltal Assefa

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Background: Current health insurance programs in Iran suffer from low enrolment and are not sufficient to attain the country to universal health coverage (UHC). We hypothesize that improving the enrollment rate and moving towards a more sustainable UHC can be achieved by improving the benefits package and providing new incentives. The objective of this study is to assess public preferences and willingness to pay (WTP) for social health insurance (SHI) in Iran. Methods: A discrete choice experiment (DCE) was conducted in 2021, using a self-administered questionnaire on 500 participants to estimate WTP and determine individual preferences for the SHI in Yazd, Iran. Respondents were presented with an eight-choice set and asked to select their preferred one. In each choice set, scenarios were described by eight attributes with varying levels. The conditional logit regression model was used to analyze the participants' preferences. Willingness to pay for each attribute was also calculated. Results: Most included attributes were significant predictors of the choice of a health insurance package. The maximum coverage of hospitalization costs in the private sector, ancillary services such as glasses, canes, etc., as well as coverage for hospitalization costs in the public sector and drug costs, were the most important determining factors for this choice. Coverage of preventive dental care did not significantly influence respondent choices. Estimating WTP showed that individuals are willing to pay more for higher financial protection, particularly against private sector costs; the WTP to increase the coverage of hospitalization costs in the private sector from 50% to 90% is estimated at 362,068 IR, Rials per month. Conclusion: This study identifies the key factors that the population value with regard to health insurance and the tradeoffs they are willing to make between them. Hospitalization, drugs, and ancillary services were the most important determining factors for their choice. The data suggest that additional resources coming into the Iranian health system might best be prioritized to cover hospitalization and drug costs and those associated with ancillary services.

Keywords: social health insurance, preferences, discrete choice experiment, willingness to pay

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Authors: Mai Ashraf Talaat

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Background: Vitamin C (ascorbic acid) is an essential nutrient for the development and repair of all body tissues. It can be obtained from a healthy diet or through supplementation. Due to its importance, vitamin C has become a mainstay in the treatment and prevention of many diseases and in maintaining immune, skin, bone and overall health. This review article aims to discuss the studies and case reports conducted to evaluate the effect of Vitamin C on oral health and the recent advances in oral medicine that involve the use of vitamin C. Data/Sources: The review was conducted for clinical studies, case reports and published literature in the English language that addresses this topic. An extensive search in the electronic databases of PubMed, PubMed Central, Web of Science, National Library of Medicine and ResearchGate was performed. Conclusion: Vitamin C is thought to treat periodontal diseases and gingival enlargement. It also affects biofilm formation and therefore, it helps in reducing caries incidence. Recently, vitamin C mesotherapy has been used to treat inflamed gingiva, bleeding gums and gingival hyperpigmentation. More research and randomized controlled trials are needed on this specific topic for more accurate judgment. Clinical significance: A minimally invasive approach - the usage of vitamin C in dental care could drastically reduce the need for surgical intervention.

Keywords: oral health, periodontology, vitamin C, Gingivitis

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Authors: Dmitry Yu. Korulkin, Raissa A. Muzychkina, Evgenii N. Kojaev

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In review the generalized data about biological activity of anthraquinone-containing plants and specimens on their basis is presented. Data of traditional medicine, results of bioscreening and clinical researches of specimens are analyzed.

Keywords: anthraquinones, physiologically active substances, phytopreparation, Ramon

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Authors: N. A. D. P. Niwunhella, W. G. R. C. K. Sirisena

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Appendicitis is one of the most encountered abdominal emergencies worldwide. Proper clinical diagnosis and appendicectomy with minimal post operative complications are therefore priorities. Aim of this study was to ascertain the overall management of acute appendicitis in Sri Lanka in special preference to delayed primary suturing of the surgical site, comparing other local and international treatment outcomes. Data were collected prospectively from 155 patients who underwent appendicectomy following clinical and radiological diagnosis with ultrasonography. Histological assessment was done for all the specimens. All perforated appendices were managed with delayed primary closure. Patients were followed up for 28 days to assess complications. Mean age of patient presentation was 27 years; mean pre-operative waiting time following admission was 24 hours; average hospital stay was 72 hours; accuracy of clinical diagnosis of appendicitis as confirmed by histology was 87.1%; post operative wound infection rate was 8.3%, and among them 5% had perforated appendices; 4 patients had post operative complications managed without re-opening. There was no fistula formation or mortality reported. Current study was compared with previously published data: a comparison on management of acute appendicitis in Sri Lanka vs. United Kingdom (UK). The diagnosis of current study was equally accurate, but post operative complications were significantly reduced - (current study-9.6%, compared Sri Lankan study-16.4%; compared UK study-14.1%). During the recent years, there has been an exponential rise in the use of Computerised Tomography (CT) imaging in the assessment of patients with acute appendicitis. Even though, the diagnostic accuracy without using CT, and treatment outcome of acute appendicitis in this study match other local studies as well as with data compared to UK. Therefore CT usage has not increased the diagnostic accuracy of acute appendicitis significantly. Especially, delayed primary closure may have reduced post operative wound infection rate for ruptured appendices, therefore suggest this approach for further evaluation as a safer and an effective practice in other hospitals worldwide as well.

Keywords: acute appendicitis, computerised tomography, diagnostic accuracy, delayed primary closure

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Authors: Negar Miri-Lavasani

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Background: Children with Attention-deficit/hyperactivity disorder (ADHD) show fine motor skills difficulties, and it is controversial whether this difficulty is based on problems in their fine motor skills or their executive function impairments. Objectives of Study: The Fine Motor and Executive Function assessment tool (FiM&EF) was developed to answer the question, ‘Do the fine motor skill deficits in children with ADHD come from their fine motor problems or is it caused by their executive function problems?’. This paper describes the development of a new assessment of Fine Motor and Executive Function (FiM &EF) needed by primary school students with ADHD aged 6-12 years with ADHD. Methods: A study on the content validity established through a survey of a panel of nine experts is explained in detail. Findings: Most the experts agreed such an assessment was needed and two items were deleted as a result of experts’ feedback. Relevance to Clinical Practice: Distinguishing the main reason of fine motor problem in these children could help the clinician for their therapy plans. Knowledge on the influence of executive functioning on fine motor ability in selected age children with ADHD would provide a clearer clinical picture of the fine motor capabilities and executive function for these children.

Keywords: children with ADHD, executive function, fine motor, test

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Authors: Adrian J. Forca, Simeon J. Cainday III

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The Jordan Water District Interactive Billing and Accounting Information Systems is designed for Jordan Water District to uplift the efficiency and effectiveness of its services to its customers. It is designed to process computations of water bills in accurate and fast way through automating the manual process and ensures that correct rates and fees are applied. In addition to billing process, a mobile app will be integrated into it to support rapid and accurate water bill generation. An interactive feature will be incorporated to support electronic billing to customers who wish to receive water bills through the use of electronic mail. The system will also improve, organize and avoid data inaccuracy in accounting processes because data will be stored in a database which is designed logically correct through normalization. Furthermore, strict programming constraints will be plunged to validate account access privilege based on job function and data being stored and retrieved to ensure data security, reliability, and accuracy. The system will be able to cater the billing and accounting services of Jordan Water District resulting in setting forth the manual process and adapt to the modern technological innovations.

Keywords: accounting, bill, information system, interactive

Procedia PDF Downloads 251

Authors: Taha SamadSoltani, Peyman Rezaei Hachesu, Marjan GhaziSaeedi, Maryam Zolnoori

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Introduction: Data mining defined as a process to find patterns and relationships along data in the database to build predictive models. Application of data mining extended in vast sectors such as the healthcare services. Medical data mining aims to solve real-world problems in the diagnosis and treatment of diseases. This method applies various techniques and algorithms which have different accuracy and precision. The purpose of this study was to apply knowledge discovery and data mining techniques for the diagnosis of asthma based on patient symptoms and history. Method: Data mining includes several steps and decisions should be made by the user which starts by creation of an understanding of the scope and application of previous knowledge in this area and identifying KD process from the point of view of the stakeholders and finished by acting on discovered knowledge using knowledge conducting, integrating knowledge with other systems and knowledge documenting and reporting.in this study a stepwise methodology followed to achieve a logical outcome. Results: Sensitivity, Specifity and Accuracy of KNN, SVM, Naïve bayes, NN, Classification tree and CN2 algorithms and related similar studies was evaluated and ROC curves were plotted to show the performance of the system. Conclusion: The results show that we can accurately diagnose asthma, approximately ninety percent, based on the demographical and clinical data. The study also showed that the methods based on pattern discovery and data mining have a higher sensitivity compared to expert and knowledge-based systems. On the other hand, medical guidelines and evidence-based medicine should be base of diagnostics methods, therefore recommended to machine learning algorithms used in combination with knowledge-based algorithms.

Keywords: asthma, datamining, classification, machine learning

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Authors: Cengiz Demir, Recep Keşli, Gülşah Aşık

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Objective: This study was carried out with the purpose of defining by using the E test method and determining the antibiotic resistance profiles of Gram-negative anaerobic bacilli isolated from various clinical specimens obtained from patients with suspected anaerobic infections and referred to Medical Microbiology Laboratory of Afyon Kocatepe University, ANS Application and Research Hospital. Methods: Two hundred and seventy eight clinical specimens were examined for isolation of the anaerobic bacteria in Medical Microbiology Laboratory between the 1st November 2014 and 30th October 2015. Specimens were cultivated by using Scheadler agar that 5% defibrinated sheep blood added, and Scheadler broth. The isolated anaerobic Gram-negative bacilli were identified conventional methods and Vitek 2 (ANC ID Card, bioMerieux, France) cards. Antibiotic resistance rates against to penicillin G, clindamycin, cefoxitin, metronidazole, moxifloxacin, imipenem, meropenem, ertapenem and doripenem were determined with E-test method for each isolate. Results: Of the isolated twenty-eight anaerobic gram negative bacilli fourteen were identified as the B. fragilis group, 9 were Prevotella group, and 5 were Fusobacterium group. The highest resistance rate was found against penicillin (78.5%) and resistance rates against clindamycin and cefoxitin were found as 17.8% and 21.4%, respectively. Against to the; metronidazole, moxifloxacin, imipenem, meropenem, ertapenem and doripenem, no resistance was found. Conclusion: Since high rate resistance has been detected against to penicillin in the study penicillin should not be preferred in empirical treatment. Cefoxitin can be preferred in empirical treatment; however, carrying out the antibiotic sensitivity testing will be more proper and beneficial. No resistance was observed against carbapenem group antibiotics and metronidazole; so that reason, these antibiotics should be reserved for treatment of infectious caused by resistant strains in the future.

Keywords: anaerobic gram-negative bacilli, anaerobe, antibiotics and resistance profiles, e-test method

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Authors: Hamidreza Jahani, Zahra Salehzadeh, Ehsan Amini, Mohsen Tohidifar

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Calvarial Hyperostosis Syndrome (CHS) is a benign bone disease of the skull. It is a non-neoplastic and proliferative bone disease, and the main feature of the disease is progressive and asymmetrical bone involvement. CHS is mostly reported in young male and female bullmastiff dogs and less frequently in other breeds. The etiology of CHS is unknown. This is the first case report of CHS in Iran. A 3-month-old male Persian Mastiff was presented with chief complaints of multiple episodes of seizure, pacing, bizarre behavior, delayed growth, head pressing, and difficulty in opening the mouth. Central blindness and open fontanelles were observed in clinical examination. No abnormality was found in the complete blood count and routine blood biochemical tests. CT scan findings include cortical thickening of frontal and parietal bones and enlargement of the left retropharyngeal lymph node. For treatment, oral clindamycin for two weeks, prednisolone and phenobarbital for one month, respectively, were administrated, and the case showed improvement after a week and recovered after one month.

Keywords: calvarial hyperostosis, Persian Mastiff, frontal bone, seizure

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Authors: Marwa Elkalla, E. Ali Abdelfadil, Ali. Mohamed. M. Sami, Ali M. Abdel-Monem

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To assess the impact of the blood collection technique on clinical pathology markers and to establish reference intervals, a study was performed using normal, healthy C57BL/6 mice. Both sexes were employed, and they were randomly assigned to different groups depending on the phlebotomy technique used. The blood was drawn in one of four ways: intracardiac (IC), caudal vena cava (VC), caudal vena cava (VC) plus a peritoneal collection of any extravasated blood, or retroorbital phlebotomy (RO). Several serum biochemistries, such as a liver function test, a complete blood count with differentials, and a platelet count, were analysed from the blood and serum samples analysed. Red blood cell count, haemoglobin (p >0.002), hematocrit, alkaline phosphatase, albumin, total protein, and creatinine were all significantly greater in female mice. Platelet counts, specific white blood cell numbers (total, neutrophil, lymphocyte, and eosinophil counts), globulin, amylase, and the BUN/creatinine ratio were all greater in males. The VC approach seemed marginally superior to the IC approach for the characteristics under consideration and was linked to the least variation among both sexes. Transaminase levels showed the greatest variation between study groups. The aspartate aminotransferase (AST) values were linked with decreased fluctuation for the VC approach, but the alanine aminotransferase (ALT) values were similar between the IC and VC groups. There was a lot of diversity and range in transaminase levels between the MC and RO groups. We found that the RO approach, the only one tested that allowed for repeated sample collection, yielded acceptable ALT readings. The findings show that the test results are significantly affected by the phlebotomy technique and that the VC or IC techniques provide the most reliable data. When organising a study and comparing data to reference ranges, the ranges supplied here by collection method and sex can be utilised to determine the best approach to data collection. The authors suggest establishing norms based on the procedures used by each individual researcher in his or her own lab.

Keywords: clinical, pathology, blood, effect

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Authors: Rahbel Rahman, Rogério Meireles Pinto, Margareth Santos Zanchetta

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Background: Existing shortcomings of current health-service delivery include poor teamwork, competencies that do not address consumer needs, and episodic rather than continuous care. Brazil’s Sistema Único de Saúde (Unified Health System, UHS) is acknowledged worldwide as a model for delivering community-based care through Estratégia Saúde da Família (FHS; Family Health Strategy) interdisciplinary teams, comprised of Community Health Agents (in Portuguese, Agentes Comunitário de Saude, ACS), nurses, and physicians. FHS teams are mandated to collectively offer clinical care, disease prevention services, vector control, health surveillance and social services. Our study compares medical providers (nurses and physicians) and community-based providers (ACS) on their perceptions of work environment, professional skills, cognitive capacities and job context. Global health administrators and policy makers can leverage on similarities and differences across care providers to develop interprofessional training for community-based primary care. Methods: Cross-sectional data were collected from 168 ACS, 62 nurses and 32 physicians in Brazil. We compared providers’ demographic characteristics (age, race, and gender) and job context variables (caseload, work experience, work proximity to community, the length of commute, and familiarity with the community). Providers perceptions were compared to their work environment (work conditions and work resources), professional skills (consumer-input, interdisciplinary collaboration, efficacy of FHS teams, work-methods and decision-making autonomy), and cognitive capacities (knowledge and skills, skill variety, confidence and perseverance). Descriptive and bi-variate analysis, such as Pearson Chi-square and Analysis of Variance (ANOVA) F-tests, were performed to draw comparisons across providers. Results: Majority of participants were ACS (64%); 24% nurses; and 12% physicians. Majority of nurses and ACS identified as mixed races (ACS, n=85; nurses, n=27); most physicians identified as males (n=16; 52%), and white (n=18; 58%). Physicians were less likely to incorporate consumer-input and demonstrated greater decision-making autonomy than nurses and ACS. ACS reported the highest levels of knowledge and skills but the least confidence compared to nurses and physicians. ACS, nurses, and physicians were efficacious that FHS teams improved the quality of health in their catchment areas, though nurses tend to disagree that interdisciplinary collaboration facilitated their work. Conclusion: To our knowledge, there has been no study comparing key demographic and cognitive variables across ACS, nurses and physicians in the context of their work environment and professional training. We suggest that global health systems can leverage upon the diverse perspectives of providers to implement a community-based primary care model grounded in interprofessional training. Our study underscores the need for in-service trainings to instill reflective skills of providers, improve communication skills of medical providers and curative skills of ACS. Greater autonomy needs to be extended to community based providers to offer care integral to addressing consumer and community needs.

Keywords: global health systems, interdisciplinary health teams, community health agents, community-based care

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Authors: Zou Xuan, Liu Hongchen

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The ideal dentin desensitizing agent should not only have good biological safety, simple clinical operation mode, the superior treatment effect, but also should have a durable effect to resist the oral environmental temperature change and oral mechanical abrasion, so as to achieve a persistent desensitization effect. Also, when using desensitizing agent to prevent the post-operative hypersensitivity, we should not only prevent it from affecting crowns’ retention, but must understand its effects on bond strength of dentin adhesives. There are various of desensitizers and dentin adhesives in clinical treatment. They have different chemical or physical properties. Whether the use of desensitizing agent would affect the bond strength of dentin adhesives still need further research. In this in vitro study, we built the hypersensitive dentin model and post-operative dentin model, to evaluate the sealing effects and durability on exposed tubule by three different dentin desensitizers and to evaluate the sealing effects and the bond strength of dentin adhesives after using three different dentin desensitizers on post-operative dentin. The result of this study could provide some important references for clinical use of dentin desensitizing agent. 1. As to the three desensitizers, the hypersensitive dentin model was built to evaluate their sealing effects on exposed tubule by SEM observation and dentin permeability analysis. All of them could significantly reduce the dentin permeability. 2. Test specimens of three groups treated by desensitizers were subjected to aging treatment with 5000 times thermal cycling and toothbrush abrasion, and then dentin permeability was measured to evaluate the sealing durability of these three desensitizers on exposed tubule. The sealing durability of three groups were different. 3. The post-operative dentin model was built to evaluate the sealing effects of the three desensitizers on post-operative dentin by SEM and methylene blue. All of three desensitizers could reduce the dentin permeability significantly. 4. The influences of three desensitizers on the bonding efficiency of total-etch and self-etch adhesives were evaluated with the micro-tensile bond strength study and bond interface morphology observation. The dentin bond strength for Green or group was significantly lower than the other two groups (P<0.05).

Keywords: dentin, desensitizer, dentin permeability, thermal cycling, micro-tensile bond strength

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Authors: F. A. Thomas, M. Schrafl-Altermatt, R. Treier, S. Kaufmann

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Stroke is the main cause of adult disability. Especially upper limb function is affected in most patients. Recently, cooperative hand movements have been shown to be a promising type of upper limb training in stroke rehabilitation. In these movements, which are frequently found in activities of daily living (e.g. opening a bottle, winding up a blind), the force of one upper limb has to be equally counteracted by the other limb to successfully accomplish a task. The use of standardized and reliable clinical assessments is essential to evaluate the efficacy of therapy and the functional outcome of a patient. Many assessments for upper limb function or impairment are available. However, the evaluation of cooperative hand movement tasks are rarely included in those. Thus, the aim of this study was (i) to develop a novel clinical assessment (CASA - Cooperative Activity Stroke Assessment) for the evaluation of patients’ capacity to perform cooperative hand movements and (ii) to test its inter- and interrater reliability. Furthermore, CASA scores were compared to current gold standard assessments for upper extremity in stroke patients (i.e. Fugl-Meyer Assessment, Box & Blocks Test). The CASA consists of five cooperative activities of daily living including (1) opening a jar, (2) opening a bottle, (3) open and closing of a zip, (4) unscrew a nut and (5) opening a clipbox. Here, the goal is to accomplish the tasks as fast as possible. In addition to the quantitative rating (i.e. time) which is converted to a 7-point scale, also the quality of the movement is rated in a 4-point scale. To test the reliability of CASA, fifteen stroke subjects were tested within a week twice by the same two raters. Intra-and interrater reliability was calculated using the intraclass correlation coefficient (ICC) for total CASA score and single items. Furthermore, Pearson-correlation was used to compare the CASA scores to the scores of Fugl-Meyer upper limb assessment and the box and blocks test, which were assessed in every patient additionally to the CASA. ICC scores of the total CASA score indicated an excellent- and single items established a good to excellent inter- and interrater reliability. Furthermore, the CASA score was significantly correlated to the Fugl-Meyer and Box & Blocks score. The CASA provides a reliable assessment for cooperative hand movements which are crucial for many activities of daily living. Due to its non-costly setup, easy and fast implementation, we suggest it to be well suitable for clinical application. In conclusion, the CASA is a useful tool in assessing the functional status and therapy related recovery in cooperative hand movement capacity in stroke patients.

Keywords: activitites of daily living, clinical assessment, cooperative hand movements, reliability, stroke

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Authors: Madhavi-Priya Singh, Liam Lowe, Farouk Arnaout, Ludmilla Pillay, Giordan Perez, Luke Mischker, Steve Costa

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Introduction: An Emergency Department consultant identified the failure of medical students to complete the task of clerking a patient in its entirety. As six medical students on our first clinical placement, we recognised our own failure and endeavored to examine why this failure was consistent among all medical students that had been given this task, despite our best motivations as adult learners. Aim: Our aim is to understand and investigate the elements which impeded our ability to learn and perform as medical students in the clinical environment, with reference to the prescribed task. We also aim to generate a discussion around the delivery of medical education with potential solutions to these barriers. Methods: Six medical students gathered together to have a comprehensive reflective discussion to identify possible factors leading to the failure of the task. First, we thoroughly analysed the delivery of the instructions with reference to the literature to identify potential flaws. We then examined personal, social, ethical, and cultural factors which may have impacted our ability to complete the task in its entirety. Results: Through collation of our shared experiences, with support from discussion in the field of medical education and ethics, we identified two major areas that impacted our ability to complete the set task. First, we experienced an ethical conflict where we believed the inconvenience and potential harm inflicted on patients did not justify the positive impact the patient interaction would have on our medical learning. Second, we identified a lack of confidence stemming from multiple factors, including the conflict between preclinical and clinical learning, perceptions of perfectionism in the culture of medicine, and the influence of upward social comparison. Discussion: After discussions, we found that the various factors we identified exacerbated the fears and doubts we already had about our own abilities and that of the medical education system. This doubt led us to avoid completing certain aspects of the tasks that were prescribed and further reinforced our vulnerability and perceived incompetence. Exploration of philosophical theories identified the importance of the role of doubt in education. We propose the need for further discussion around incorporating both pedagogic and andragogic teaching styles in clinical medical education and the acceptance of doubt as a driver of our learning. Conclusion: Doubt will continue to permeate our thoughts and actions no matter what. The moral or psychological distress that arises from this is the key motivating factor for our avoidance of tasks. If we accept this doubt and education embraces this doubt, it will no longer linger in the shadows as a negative and restrictive emotion but fuel a brighter dialogue and positive learning experience, ultimately assisting us in achieving our full potential.

Keywords: ethics, medical student, doubt, medical education, faith

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Authors: Yonathan Audhitya Suthihono, Ratih Dyah Kusumastuti

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The radiology department in a tertiary referral hospital faces service operation challenges such as huge and various patient arrival, which can increase the probability of patient queuing. During the COVID-19 pandemic, it is mandatory to apply social distancing protocol in the radiology department. A strategy to prevent the accumulation of patients at one spot would be required. The aim of this study is to identify an alternative solution which can reduce the patient’s waiting time in radiology department. Discrete event simulation (DES) is used for this study by constructing several improvement scenarios with Arena simulation software. Statistical analysis is used to test the validity of the base case scenario model and to investigate the performance of the improvement scenarios. The result of this study shows that the selected scenario is able to reduce patient waiting time significantly, which leads to more efficient services in a radiology department, be able to serve patients more effectively, and thus increase patient satisfaction. The result of the simulation can be used by the hospital management to improve the operational performance of the radiology department.

Keywords: discrete event simulation, hospital management patient queuing model, radiology department services

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Authors: Sakib Hasn, Shahid Anwar

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This study highlights the vital importance of assessing the Simulator Sickness Questionnaire and presence measures as virtual reality (VR) incorporation into language teaching gains popularity. To address user discomfort, which prevents efficient learning in VR environments, the measurement of SSQ becomes crucial. Additionally, evaluating presence metrics is essential to determine the level of engagement and immersion, both crucial for rich language learning experiences. This paper designs a VR-based Chinese language application and proposes a thorough test technique aimed at systematically analyzing SSQ and presence measures. Subjective tests and data analysis were carried out to highlight the significance of addressing user discomfort in VR language education. The results of this study shed light on the difficulties posed by user discomfort in VR language learning and offer insightful advice on how to improve VR language learning applications. Furthermore, the outcome of the research explores ‘VR-based language education,’ ‘inclusive language learning platforms," and "cross-cultural communication,’ highlighting the potential for VR to facilitate language learning across diverse cultural backgrounds. Overall, the analysis results contribute to the enrichment of language learning experiences in the virtual realm and underscore the need for continued exploration and improvement in this field.

Keywords: virtual reality (VR), language education, simulator sickness questionnaire, presence metrics, VR-based Chinese language education

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Authors: Oscar Maina Irungu

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Background: Men who have sex with men (MSM) in Mtwapa Town, Kilifi County are at high risk of HIV infection. Probability sample surveys to determine HIV prevalence among MSM in Mtwapa are needed to inform prevention and care services. Methods: In 2013, a cross-sectional survey was conducted among MSM aged 18-24 years old, using respondent-driven sampling (RDS) in Mtwapa. Consenting MSM were tested for HIV (fingerstick rapid test). Population-based prevalence and 95 % confidence intervals (CI) were estimated using RDS Analysis Tool (RDSAT). Results: Among 274 MSM, the median age was 20 years (IQR: 19-23 years). Fifty percent of MSM reported not selling sex, while 13.2 % reported sex work as their “main occupation”, and another 28.4 % reported selling sex in the past two months (but not as their main occupation).Overall HIV prevalence was 19.2 % (CI: 12.2-23.6%). HIV prevalence was higher among MSM who reported sex work as their main occupation (28.3%,CI: 12.1-42.3%) or selling sex in the past two months (26.6 %, CI: 17.2-35.7 %),than among MSM who did not sell sex (11.6%,CI: 7.0-18.1%). Conclusion: HIV prevalence among MSM were high than among Kilifi’s general population aged 15-64 years (8.8%; 2010 KAIS) and highest in male sex workers. Health programs need to address concerns and modify services to meet needs of diverse subgroups of MSM. We recommend continued, periodic surveillance to monitor HIV prevalence among MSM in Mtwapa, and expansion to other areas in Kenya.

Keywords: power point, Kenya, homosexuality, sex

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Authors: Grygorii Kostromin, Vladyslav Povoroznyuk

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Chronic venous diseases (CVD) are one of the common, though controversial problems in medicine. It is generally accepted that this pathology predominantly occurs in women. The issue of excessive weight as a risk factor for CVD is still considered debatable. To the author's best knowledge, today in Ukraine, there are barely any studies that describe the relationship between CVD and obesity. Our study aims to determine the association between age, body composition, obesity and CVD in postmenopausal women. The study was conducted in D. F. Chebotarev Institute of Gerontology, National Academy of Medical Sciences of Ukraine. We have examined 96 postmenopausal women aged 46-85 years (mean age – 66.19 ± 0.96 years), who were divided into two groups depending on the presence of CVD. The women were examined by vascular surgeons. For the diagnosis of CVD, we used clinical, anatomic and pathophysiologic classifications. We also performed clinical, ultrasound and densitometry examinations. We found that the CVD frequency in postmenopausal women increased with age (from 72% in those aged 45-59 years to 84% in those aged 75-89 years). A significant correlation between the total fat mass and age was determined in postmenopausal women with CVD. We also observed a significant correlation between the lower extremities’ fat mass and age in both examined groups. A significant correlation between body mass index and age was determined only in postmenopausal women without CVD.

Keywords: chronic venous disease, risk factors, age, obesity, postmenopausal women

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Authors: Muhammad Kashif Fida

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In the bank, teller’s job (cash officer) is highly important and critical as at one end it requires soft and brisk customer services and on the other side, handling cash with integrity. It is always challenging for recruiters to hire competent and trustworthy tellers. According to author’s knowledge, there is no comprehensive test available that may provide assistance in recruitment in Pakistan. So there is a dire need of a psychometric battery that could provide support in recruitment of potential candidates for the teller’ position. So, the aim of the present study was to construct ABL-Teller Aptitude Test (ABL-TApT). Three major phases have been designed by following American Psychological Association’s guidelines. The first phase was qualitative, indicators of the test have been explored by content analysis of the a) teller’s job descriptions (n=3), b) interview with senior tellers (n=6) and c) interview with HR personals (n=4). Content analysis of above yielded three border constructs; i). Personality, ii). Integrity/honesty, iii). Professional Work Aptitude. Identified indicators operationalized and statements (k=170) were generated using verbatim. It was then forwarded to the five experts for review of content validity. They finalized 156 items. In the second phase; ABL-TApT (k=156) administered on 323 participants through a computer application. The overall reliability of the test shows significant alpha coefficient (α=.81). Reliability of subscales have also significant alpha coefficients. Confirmatory Factor Analysis (CFA) performed to estimate the construct validity, confirms four main factors comprising of eight personality traits (Confidence, Organized, Compliance, Goal-oriented, Persistent, Forecasting, Patience, Caution), one Integrity/honesty factor, four factors of professional work aptitude (basic numerical ability and perceptual accuracy of letters, numbers and signature) and two factors for customer services (customer services, emotional maturity). Values of GFI, AGFI, NNFI, CFI, RFI and RMSEA are in recommended range depicting significant model fit. In third phase concurrent validity evidences have been pursued. Personality and integrity part of this scale has significant correlations with ‘conscientiousness’ factor of NEO-PI-R, reflecting strong concurrent validity. Customer services and emotional maturity have significant correlations with ‘Bar-On EQI’ showing another evidence of strong concurrent validity. It is concluded that ABL-TAPT is significantly reliable and valid battery of tests, will assist in objective recruitment of tellers and help recruiters in finding a more suitable human resource.

Keywords: concurrent validity, construct validity, content validity, reliability, teller aptitude test, objective recruitment

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Authors: Maide Yesilyurt, Saide Faydalı

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Patients experience pain at different intensities in postoperative. The diagnosis of the pain, the assessment and the success of the treatment and care make the measurement of this finding compulsory. The aim of the study is to determine the evaluation differences numeric pain scales. The descriptive study was conducted with 360 patients with in postoperative. The data were obtained from questionnaires related to six numeric pain scales most preferred in clinical use, and a face-to-face interview technique was used by the researcher. Regarding to numeric pain scale, questions include forth positive and one negative statement. In evaluating the data; chi-square and Pearson correlation tests were used. For the study, the patients’ informed consents, the institution and the ethics committee received permission. In this study, patients' ages are between 18-80, 95.8% of the patients were not informed about pain assessment. Patients evaluated the 5-item numeric scale as the easy, can be answered quickly, accurate, and appropriate for clinical use and the 101 items numeric scale as complex than other scales. Regarding to numeric pain scales with positive statements between age, marital status, educational status, previous surgery, having chronic disease and getting information about pain assessment significant difference has been detected. All numeric pain scales are correlated to each other. As a result, it was determined that as the items in the numerical scales decreased, the patients were able to perceive the scales better, and the items in the scales increased, the patients were in trouble to understand.

Keywords: numeric pain scales, nurse, pain assessment, patient

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Authors: Aparecida De Fatima Dutra, Freddie Avant, Wilma Cordova

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People living with HIV/AIDS (PLWHA) have benefited from advances in treatment. Medical costs are a challenge for some, but the real challenge is the stigma and discrimination PLWHA continue to face, even though the disease has festered for the last four decades. Few studies regarding stigma and discrimination give voice to those affected by these practices. This study provides a voice to PLWHA in Brazil and in the US as to how they perceive stigma and discrimination, as well as services they access. The methodology of this study was designed based on phenomenological research, which is a research that aims to identify what individuals facing the same situation have to share about their experiences. Qualitative research using in- depth interviews was used in order to gather participants’ perceptions about services they access, and stigma and discrimination they experience as PLWHA (hypothesis). The target population was a minority group of 13 Afro-descendant men, mean age of 48.3, residents in East Texas, United States and Salvador, Brazil. Our findings indicate that in both countries, overall, participants have reasonable access to medication and qualified services, except for some specialties, such as dentistry. With regard to stigma and discrimination the majority of participants have not disclosed their diagnosis. They state they prefer not to disclose for fear of being ostracized and rejected. Participants who did reveal their status indicate that stigma and discrimination is a daily occurrence. These experiences tend to occur within their own families, neighborhoods, and in public health agencies where HIV/AIDS is not the focus. Participants who did offer suggestions for social change indicated they would have to reveal their status even if it means being stigmatized and discriminated against. Other factors contributing to this discrimination include skin color and poverty. This study concludes that even after decades since the spread of this epidemic, nothing has changed regarding stigma and discrimination towards PLWHA. Lack of awareness, empathy and education continue to be a major challenge, not only at a local level but across the globe. In conclusion, as documented in previous studies while stigma and discrimination towards this population prevail, negative attitudes will continue to jeopardize all individuals from receiving equal access to prevention, treatment and care. It is crucial to face stigma and discrimination not only as individual experiences, but as social practices that violate and restrict human rights and that as a result, reinforce inequality and social exclusion. Policies should be at the forefront to eliminate the stigma and discrimination PLWHA experience. Health professionals and societies must take a stand in order to promote mindfulness about the negative effect of oppression towards individuals living with HIV/AIDS and the potential global impact of these practices.

Keywords: discrimination, HIV/AIDS, human rights, stigma

Procedia PDF Downloads 335

Authors: E. V. Fakhrutdinova, Y. S. Kolesnikova, E. A. Karasik, V. M. Zagidullina

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Poverty as the social and economic phenomenon exists in any society and represents a many-sided problem. In this sense it is universal and for many centuries serves as a research objects for scientists. Special attention to a problem of poverty in Russia is caused, first of all, by the critical growth of inequality and by scales of expansion of poverty, considerable decrease in the level and quality of life of the population, decrease in availability of education during the period of reforming. The expansion of poverty on the working members of society, youth, which has to provide reproduction of the population is alarming. As poverty is the reason of weakening of national security of the country, degradation of the population, decline in the quality of the human capital, complication of a demographic situation, strengthening of social contradictions in society, so far as the reduction of poverty, so, the increase in production. Poverty: the characteristic of an economic situation of the individual or social group at which they can't satisfy certain minimum requirements necessary for life, preservations of working capacity and reproduction. Poverty became one of the critical factors expelling people from the system of the institutional interactions reducing social space in which their relations were building breaking their social identity. Complication of the problem of poverty in modern society happened due to penetration of the related relations into many spheres of life. It is known that negative consequences of poverty display not only at the personal level of the poor person, but also at the level of interpersonal social interactions, decline in the quality and level of development of the human capital, and also at social and economic system in general. We conducted a research on the influence of education on the change of poverty level of the population. We consider education as a resource for an increase of the income and social mobility. Dependence of the income of the population on the level of education, availability of education (level of education and quality of education) on the level of income of families is found. Differentiation of quality and number of educational services for children depending on the level of the income of families is revealed. Influence of a factor of poverty on the availability of education is also studied. We consider expenses on education as the limiter of access to education. We consider education as a factor of fixation and aggravation of a property inequality. In the solution of problems of poverty the defining condition is the state regulation of social and economic development by means of creation of the effective institutional environment. The state has to develop measures for an increase of availability of various services to all categories of citizens, in particular services of health care and education, especially for poor citizens enters. The special attention regarding an increase of availability of education services has to be paid to creation of system of social elevators.

Keywords: poverty, education, human capital, quality of life

Procedia PDF Downloads 323

Authors: Salma Ainine, Colin Ritchie, Tracey McFee

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Background: The societal impact of antibiotic resistance is a major public health concern. The increase in the incidence of resistant bacteria can ultimately be fatal. Objective: To analyse the appropriateness of antibiotic prescribing in Dundee Dental Hospital, ultimately improving the safety and quality of patient care. Methods: Two examiners independently cross-checked approximately fifty consecutive prescriptions, and corresponding patient case notes, for three data collection cycles between August 2014–September 2015. The Scottish Dental Clinical Effectiveness Program (SDCEP) Drug Prescribing for Dentistry guidelines was the standard utilised. The criteria: clinical justification, regime justification, and review arrangements was measured, and compared to the standard. Results: Cycle one revealed 42% of antibiotic prescriptions were appropriate. Interventions included: multiple staff meetings, an introduction of a checklist attached to the prescription pack, and production of patient leaflets explaining indications for antibiotics. Cycle two and three revealed 44%, and 30% compliance, respectively. Conclusion: The results of the audit have yet to meet target standards set out in prescribing guidelines. However, steps are being taken and change has occurred on a cultural level.

Keywords: antibiotic resistance, antibiotic stewardship, dental infection, hygiene standards

Procedia PDF Downloads 225

Authors: Maarja Karbus, Elsbet Lippmaa, Kadri Kööp, Mare Tupits

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Aim: The aim is to describe the experiences and needs of mothers of children with cancer in coping with the child's illness. Background: Cancer affects different life areas. Especially if it is a child, in this case the whole family is involved. Loved ones are mentally affected, there are limitations, and life changes need to be made to make the whole treatment regimen and recovery as comfortable as possible. Also, the whole process is expensive and time consuming. The research is part of a larger project that covers the experiences and needs of parents of children with chronic illness and coping strategies related to the child's illness. Design: Qualitative, empirical, descriptive research. Method: Semi-structured interviews were used to collect data and inductive content analysis was used to analyze the data. The interviews were conducted in the autumn of 2020, 5 respondents participated in the research. Results and Conclusions: The research revealed that the mothers' experiences of coping with a child's disease included health-related experiences, material aspects, changes in lifestyle, support systems and contact with professionals. Regarding the organizational and material aspects of life, the subjects presented experiences with economic problems, adaptation of changes in lifestyle, access to information and changes in the treatment process. With regard to health, the respondents identified experiences with the mother's physical and mental health and experiences with the health of an ill child. The experience of different support systems was related to the support of family, friends, acquaintances, various organizations and specialists. Experiences with specialist support included experiences with family relationships and positive and negatiive experiences with staff. The mothers' needs in dealing with the child's disease included the mother's emotional needs, the support of other family members, and the need for various support systems and services. The needs of coping with the child were the need for understanding, support, confidence, the need to be strong and courageous, the need to ignore one's own needs, and the need for personal time and rest. The needs of other family members included the needs of an ill child and the need to pay attention to other children in the family. The needs of different supporters and services were related to different helpers and different services.

Keywords: cancer, mother, coping, child, need, experience, illness

Procedia PDF Downloads 150

Authors: Sujayeva V. A., Karpova I. S., Koslataya O. V., Kolyadko M. G., Russkikh I. I., Vankovich E. A.

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Objective: The goal of this study is to develop a method for the prevention of the progression of heart failure (HF) in patients with post-infarction cardiosclerosis who have suffered coronavirus infection. Methods: 135 patients with post-infarction cardiosclerosis were divided into 2 groups: Group I - patients who had suffered COVID-19 - 85 people, and Group II - patients who had not suffered COVID-19 - 50 people. Patients of group I, depending on the level of N-terminal fragment of natriuretic peptide (NTproBNP), were divided into 2 subgroups - subgroup A - with HF - 40 people, subgroup B - without HF - 45 people. All patients underwent a clinical examination, echocardiography, electrocardiotopography in 60 leads, computed angiography of the coronary arteries, heart magnetic resonance imaging, NTproBNP. Results: In the post-Covid period, in patients with post-infarction cardiosclerosis, remodeling of the left ventricle and right parts of the heart, deterioration of the systolic-diastolic function of both ventricles, increased pressure in the pulmonary artery, progression of coronary artery atherosclerosis, and an increase in the size of myocardial fibrosis were revealed. The consequence of these changes was the progression of heart failure. The developed method of medical prevention made it possible to improve the clinical course of coronary artery disease and prevent the progression of chronic heart failure in patients with post-infarction cardiosclerosis. Conclusions: In patients with post-infarction cardiosclerosis who initially had HF, after 1 year, according to laboratory and instrumental data, a slight decrease in its severity was revealed. In patients with post-infarction cardiosclerosis who did not have HF before COVID-19, HF developed 1 year after the coronavirus disease, which may be due to the identified process of myocardial fibrosis, which dictates the need to prevent the development of HF in patients with post-infarction cardiosclerosis, even those who did not initially have HF. The proposed method of medical prevention made it possible to improve the clinical course of coronary artery disease in patients with post-infarction cardiosclerosis after COVID-19, both in persons with and without HF, when included in the study. A method of medical prevention in people with post-infarction cardiosclerosis after COVID-19 infection, including spironolactone, loop diuretics, empagliflozin, sacubitril/valsartan, helped prevent the progression of HF.

Keywords: elderly, myocardial infarction, COVID-19, prevention

Procedia PDF Downloads 24

Authors: Mona K. Fehling, Jakob Unger, Dietmar J. Hecker, Bernhard Schick, Joerg Lohscheller

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Voice disorders origin from disturbances of the vibration patterns of the two vocal folds located within the human larynx. Consequently, the visual examination of vocal fold vibrations is an integral part within the clinical diagnostic process. For an objective analysis of the vocal fold vibration patterns, the two-dimensional vocal fold dynamics are captured during sustained phonation using an endoscopic high-speed camera. In this work, we present an approach allowing a fully automatic analysis of the high-speed video data including a computerized classification of healthy and pathological voices. The approach bases on a wavelet-based analysis of so-called phonovibrograms (PVG), which are extracted from the high-speed videos and comprise the entire two-dimensional vibration pattern of each vocal fold individually. Using a principal component analysis (PCA) strategy a low-dimensional feature set is computed from each phonovibrogram. From the PCA-space clinically relevant measures can be derived that quantify objectively vibration abnormalities. In the first part of the work it will be shown that, using a machine learning approach, the derived measures are suitable to distinguish automatically between healthy and pathological voices. Within the approach the formation of the PCA-space and consequently the extracted quantitative measures depend on the clinical data, which were used to compute the principle components. Therefore, in the second part of the work we proposed a strategy to achieve a normalization of the PCA-space by registering the PCA-space to a coordinate system using a set of synthetically generated vibration patterns. The results show that owing to the normalization step potential ambiguousness of the parameter space can be eliminated. The normalization further allows a direct comparison of research results, which bases on PCA-spaces obtained from different clinical subjects.

Keywords: Wavelet-based analysis, Multiscale product, normalization, computer assisted classification, high-speed laryngoscopy, vocal fold analysis, phonovibrogram

Procedia PDF Downloads 265

Authors: Sushil K. Sharma, Jeff Zhang, Saeed Tabar

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Worldwide, several governments are utilizing the Internet of Things (IoT) and other information and communication technologies (ICTs) to create smart city infrastructures to improve both the quality of government services and citizen welfare. Over 700 cities from around the world have already started implementing their smart city projects. Smart City utilizes the network of connected things, or the Internet of Things (IoT), that interconnects devices and various components across city infrastructure, making them work together seamlessly to enhance the quality, performance, and interactivity of urban services, optimize resources, and reduce costs. Without developing smart cities, the accelerating growth of cities, and their disproportionate consumption of physical and social resources are unsustainable. In 2016, the Indian Government released a list of 100 cities with the intention of kick-starting the process of developing them into 'smart cities’ as part of the Smart Cities Mission. This study reports the progress and challenges of Smart City projects in India. The data were collected through the city/state government websites, media reports, and focus group discussions/interviews. The preliminary results indicate that smart city projects are not only behind in their implementation and scope but also lacks the sincerity for its implementation.

Keywords: smart city, smart government, Internet of Things, digital government

Procedia PDF Downloads 182

Authors: Rachita Lal

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Solar energy is a clean energy source. Because it is readily available in India and has many potential decentralized uses, urban local authorities may use it in various ways to manage the energy needs in the territory under their control. Apart from these and other services for which people pay a substantial number of money, urban local councils play a crucial role in administering essential services like water supply, street lighting, and health care. ULBs may contribute considerably to the transition to solar energy, both for their benefit and simultaneously for several additional direct and indirect advantages at multiple levels. The research primarily focuses on using clean energy management to reduce urban areas' reliance on traditional (electricity) energy. A technique for estimating the rooftop solar power potential using GIS (Geographical Information System) is described. Given that the combustion of fossil fuels produces 75% of India's power, meeting the country's energy needs through renewable energy sources is a step toward sustainable development and combating climate change. The study will further help in categorization, phasing, and understanding the demand and supply and thus calculating the cumulative benefits. The main objectives are to study the consumption of conventional energy in the study area and to identify the potential areas where solar photovoltaic intervention can be installed.

Keywords: solar energy, GIS, clean energy management, sustainable development

Procedia PDF Downloads 88

Authors: Sandip Tambare, Revati Ghadge

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Alcohol withdrawal syndrome continue to be concerning health issue worldwide in alcoholics. Many current option for treating alcohol withdrawal signs are habit forming causing dependency of sedatives. The divine science of Ayurveda recommends Nasya for improvement of alcohol withdrawal signs. As per the latest reports 1/3 of the Indian population is using alcohol in an unhealthy manner, the complication being wide and varied among which, the Alcohol Withdrawal Syndrome is the dominant one. The presentation varies from mild sleep loss or anxiety to delirium. Ayurveda has given utmost in the context of Madatyaya(Alcoholism). Various protocols based on the identification of the status of tridoshas are explained which includes sodhana, samana and satwavachaya chikitsa. Various medications are being used, with appreciated effects in the clinical practice. As per reports, the panchakarma procedure nasya seems highly effective, in managing of the alcohol withdrawal syndrome. Nasya with Ksheerabala Taila is given for 7 days in the condition of Alcohol Withdrawal syndrome and it was the non Randomized trial with 30 subjects satisfying the DSM V criteria for alcohol withdrawl and the assessment was done using the Clinical Institute Withdrawal Assessment for Alcohol Scale revised (CIWA-Ar). Conclusion: Among the symptoms which were studied after the interventions, it was found that there was high significant response in almost all the symptoms in the given subjects. The eternal science of Ayurveda is able to answer the existing problem of alcohol and its abuse in the society.

Keywords: nasya, alcohol withdrawal, madatyaya, ksheerabala taila

Procedia PDF Downloads 139

Authors: Chryssa Thermolia, Ekaterini S. Bei, Stelios Sotiriadis, Kostas Stravoskoufos, Euripides G. M. Petrakis

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Moving into a new era of healthcare, new tools and devices are developed to extend and improve health services, such as remote patient monitoring and risk prevention. In this concept, Internet of Things (IoT) and Cloud Computing present great advantages by providing remote and efficient services, as well as cooperation between patients, clinicians, researchers and other health professionals. This paper focuses on patients suffering from bipolar disorder, a brain disorder that belongs to a group of conditions called effective disorders, which is characterized by great mood swings.We exploit the advantages of Semantic Web and Cloud Technologies to develop a patient monitoring system to support clinicians. Based on intelligently filtering of evidence-knowledge and individual-specific information we aim to provide treatment notifications and recommended function tests at appropriate times or concluding into alerts for serious mood changes and patient’s non-response to treatment. We propose an architecture, as the back-end part of a cloud platform for IoT, intertwining intelligence devices with patients’ daily routine and clinicians’ support.

Keywords: bipolar disorder, intelligent systems patient monitoring, semantic web technologies, healthcare

Procedia PDF Downloads 509