Search results for: children care

Authors: F. Slaven, M. Uys, Y. Erasmus

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The South African National Mental Health Education Programme (SANMHEP) was a National Department of Health (NDoH) initiative to strengthen mental health services in South Africa in collaboration with the Foundation for Professional Development (FPD), SANOFI and the various provincial departments of health. The programme was implemented against the backdrop of a number of challenges in the management of mental health in the country related to staff shortages and infrastructure, the intersection of mental health with the growing burden of non-communicable diseases and various forms of violence, and challenges around substance abuse and its relationship with mental health. The Mental Health Care Act (No. 17 of 2002) prescribes that mental health should be integrated into general health services including primary, secondary and tertiary levels to improve access to services and reduce stigma associated with mental illness. In order for the provisions of the Act to become a reality, and for the journey of mental health patients through the system to improve, sufficient and skilled health care providers are critical. SANMHEP specifically targeted Medical Doctors and Professional Nurses working within the facilities that are listed to conduct 72-hour assessments, as well as District Hospitals. The aim of the programme was to improve the clinical diagnosis and management of mental disorders/conditions and the understanding of and compliance with the Mental Health Care Act and related Regulations and Guidelines in the care, treatment and rehabilitation of mental health care users. The course used a blended-learning approach and trained 1 120 health care providers through 36 workshops between February and November 2019. Of those trained, 689 (61.52%) were Professional Nurses, 337 (30.09%) were Medical Doctors, and 91 (8.13%) indicated their occupation as ‘other’ (of these more than half were psychologists). The pre- and post-evaluation of the face-to-face training sessions indicated a marked improvement in knowledge and confidence level scores (both clinical and legislative) in the care, treatment and rehabilitation of mental health care users by participants in all the training sessions. There was a marked improvement in the knowledge and confidence of participants in performing certain mental health activities (on average the ratings increased by 2.72; or 27%) and in managing certain mental health conditions (on average the ratings increased by 2.55; or 25%). The course also required that participants obtain 70% or higher in their formal assessments as part of the online component. The 337 participants who completed and passed the course scored 90% on average. This illustrates that when participants attempted and completed the course, they did very well. To further assess the effect of the course on the knowledge and behaviour of the trained mental health care practitioners a mixed-method outcome evaluation is currently underway consisting of a survey with participants three months after completion, follow-up interviews with participants, and key informant interviews with department of health officials and course facilitators. This will enable a more detailed assessment of the impact of the training on participants' perceived ability to manage and treat mental health patients.

Keywords: mental health, public health facilities, South Africa, training

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Authors: A. Gonzalez Aguna, J. M. Santamaria Garcia, J. L. Gomez Gonzalez, R. Barchino Plata, M. Fernandez Batalla, S. Herrero Jaen

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Background: Computer Science is a field that transcends other disciplines of knowledge because it allows to support all kinds of physical and mental tasks. Health centres have a greater number and complexity of technological devices and the population consume and demand services derived from technology. Also, nursing education plans have included competencies related to and, even, courses about new technologies are offered to health professionals. However, nurses still limit their performance to the use and evaluation of products previously built. Objective: Develop a teaching-learning methodology for acquiring skills on designing applications for care. Methodology: Blended learning teaching with a group of graduate nurses through official training within a Master's Degree. The study sample was selected by intentional sampling without exclusion criteria. The study covers from 2015 to 2017. The teaching sessions included a four-hour face-to-face class and between one and three tutorials. The assessment was carried out by written test consisting of the preparation of an IEEE 830 Standard Specification document where the subject chosen by the student had to be a problem in the area of care. Results: The sample is made up of 30 students: 10 men and 20 women. Nine students had a degree in nursing, 20 diploma in nursing and one had a degree in Computer Engineering. Two students had a degree in nursing specialty through residence and two in equivalent recognition by exceptional way. Except for the engineer, no subject had previously received training in this regard. All the sample enrolled in the course received the classroom teaching session, had access to the teaching material through a virtual area and maintained at least one tutoring. The maximum of tutorials were three with an hour in total. Among the material available for consultation was an example of a document drawn up based on the IEEE Standard with an issue not related to care. The test to measure competence was completed by the whole group and evaluated by a multidisciplinary teaching team of two computer engineers and two nurses. Engineers evaluated the correctness of the characteristics of the document and the degree of comprehension in the elaboration of the problem and solution elaborated nurses assessed the relevance of the chosen problem statement, the foundation, originality and correctness of the proposed solution and the validity of the application for clinical practice in care. The results were of an average grade of 8.1 over 10 points, a range between 6 and 10. The selected topic barely coincided among the students. Examples of care areas selected are care plans, family and community health, delivery care, administration and even robotics for care. Conclusion: The applied methodology of learning-teaching for the design of technologies demonstrates the success in the training of nursing professionals. The role of expert is essential to create applications that satisfy the needs of end users. Nursing has the possibility, the competence and the duty to participate in the process of construction of technological tools that are going to impact in care of people, family and community.

Keywords: care, learning, nursing, technology

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Authors: Vilma Zydziunaite, Monika Kelpsiene

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In early childhood and preschool education, play has an important role in learning and cognitive processes. In the context of a changing world, personal autonomy and the use of technology are becoming increasingly important for the development of a wide range of learner competencies. By integrating technology into learning environments, the educational reality is changed, promoting unusual learning experiences for children through play-based activities. Alongside this, teachers are challenged to develop encouragement and motivation strategies that empower children to act independently. The aim of the study was to reveal the changes in the roles and experiences of teachers in the application of AR technology for the enrichment of the learning process. A quantitative research approach was used to conduct the study. The data was collected through an electronic questionnaire. Participants: 319 teachers of 5-6-year-old children using AR technology tools in their educational process. Methods of data analysis: Cronbach alpha, descriptive statistical analysis, normal distribution analysis, correlation analysis, regression analysis (SPSS software). Results. The results of the study show a significant relationship between children's learning and the educational process modeled by the teacher. The strongest predictor of child learning was found to be related to the role of the educator. Other predictors, such as pedagogical strategies, the concept of AR technology, and areas of children's education, have no significant relationship with child learning. The role of the educator was found to be a strong determinant of the child's learning process. Conclusions. The greatest potential for integrating AR technology into the teaching-learning process is revealed in collaborative learning. Teachers identified that when integrating AR technology into the educational process, they encourage children to learn from each other, develop problem-solving skills, and create inclusive learning contexts. A significant relationship has emerged - how the changing role of the teacher relates to the child's learning style and the aspiration for personal leadership and responsibility for their learning. Teachers identified the following key roles: observer of the learning process, proactive moderator, and creator of the educational context. All these roles enable the learner to become an autonomous and active participant in the learning process. This provides a better understanding and explanation of why it becomes crucial to empower the learner to experiment, explore, discover, actively create, and foster collaborative learning in the design and implementation of the educational content, also for teachers to integrate AR technologies and the application of the principles of shared leadership. No statistically significant relationship was found between the understanding of the definition of AR technology and the teacher’s choice of role in the learning process. However, teachers reported that their understanding of the definition of AR technology influences their choice of role, which has an impact on children's learning.

Keywords: teacher, learner, augmented reality, collaboration, shared leadership, preschool education

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Authors: Tigist mamo, Beryl Oranga, Precious Mubanga

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High rates of child undernutrition in Ethiopia place children at significant risk, highlighting the need for low-cost, nutritious diets starting at six months of age. These diets should be diverse and rich in essential nutrients like proteins, vitamins, and minerals. However, many rural households participating in the Productive Safety Net Program (PSNP) struggle to afford fortified foods and often rely on low-protein, cereal-based diets, leading to micronutrient deficiencies. In addition, fasting practices further restrict the consumption of animal-source foods for 190 to 250 days each year, limiting dietary diversity even more. Addressing these challenges requires solutions beyond nutrition counseling, focusing on factors such as seasonality, food perishability, and safety to promote better health outcomes for children. The program's main objective is to empower caregivers with practical recipes for complementary feeding for children aged 6 to 23 months by enhancing meals with affordable ingredients like cereal, legumes, dried vegetables, and meat. The ongoing implementation research within the SPIR-II program is centered on developing a cost-effective mixed flour and exploring drying techniques to extend shelf life, ultimately addressing the delayed introduction of complementary foods and increasing nutrient-rich options in households. Saleswomen participating in the SPIR-II program have been empowered to produce easy-to-use local complementary flour and conduct door-to-door sales in their neighborhoods. Caregivers who have purchased and fed this flour to their children have reported significant improvements in their nutritional status. Additionally, SPIR-II is testing low-tech drying methods suitable for rural Ethiopian contexts to reduce food loss and promote the inclusion of nutrient-dense foods in children's diets. The paper will highlight the primary outcomes of these initiatives as they are being implemented.

Keywords: food preservation, easy-to-use mixed flour, complementary feeding, drying techniques

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Authors: Amina Sa'id Muhammad, Asmau Ishaq Alhassan, Beba Raymond, Fatima Bello

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Severe acute malnutrition (SAM) remains a major killer of children under five years of age. Nigeria has the second highest burden of stunted children in the world, with a national prevalence rate of 32 percent of children under five. An estimated 2 million children in Nigeria suffer from severe acute malnutrition (SAM), and 3.9% of children in northwest Nigeria suffer from SAM, which is significantly higher than the national average of 2.1%. Community-Based Management of Acute Malnutrition (CMAM) has proven to be an effective intervention in the treatment of SAM in children using Ready-to-Use Therapeutic Food (RUTF). Ready-to-use therapeutic food (RUTF) is a key component for the treatment of Severe Acute Malnutrition. It contains all the energy and nutrients required for rapid catch-up growth and used particularly in the treatment of children over 6 months of age with SAM without medical complications. However, almost all RUTFs are currently imported to Nigeria from other countries. Shortages of RUTF due to logistics (shipping costs, delays, donor fatigue etc) and funding issues present a threat to the achievement of the 2030 World Health Assembly (WHA) targets for reducing malnutrition in addition to 2030 SDGs 2 (Zero Hunger), 3 (Good Health and Wellbeing), 12 (Responsible Consumption and Production), and 17 (Partnerships for the Goals), thus undermining its effectiveness in combating malnutrition On the other hand, the availability of human and material resources that will aid local production of RUTF presents an opportunity to fill in the gap in regular RUTF supply. About one thousand Nigerian children die of malnutrition-related causes every day, reaching a total of 361,000 each year. Owing to the high burden of malnutrition in Nigeria, the local production of RUTF is a logical step, that will ensure increased availability, acceptability, access, and efficiency in supply, and at lower costs. Objective(s): The objectives of this study were therefore, to formulate RUTF from locally available resources and to determine its energy and nutrients composition, incommensurate with the standard/commercial RUTF. Methods: Three samples of RUTF were formulated using locally available resources (soya beans, wheat, rice, baobab, brown-sugar, date palm and soya oil); which were subjected to various analysis to determine their energy/proximate composition, vitamin and mineral contents and organoleptic properties were also determined using sensory evaluation. Results: The energy values of the three samples of locally produced RUTF were found to be in conformity with WHO recommendation of ≥ 500 kcal per 100g. The energy values of the three RUTF samples produced in the current study were found to be 563.08, 503.67 and 528.98 kcal respectively. Sample A, B and C had protein content of 13.56% 16.71% and 14.62% respectively, which were higher than that of commercial RUTF (10.9%). Conclusions/recommendations: The locally formulated RUTF samples had energy value of more than 500 kcal per 100g; with an appreciable amount of macro and micro nutrients. The appearance, taste, flavor and general acceptability of the formulated RUTF samples were also commendable.

Keywords: energy, malnutrition, nutrients, RUTF

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Authors: Ojochenemi J. Onubi, Debbi Marais, Lorna Aucott, Friday Okonofua, Amudha Poobalan

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Background: Obesity is a worldwide epidemic with major health and economic consequences. Pregnancy is a trigger point for the development of obesity, and maternal obesity is associated with significant adverse effects in the mother and child. Nigeria is experiencing a double burden of under- and over-nutrition with rising levels of obesity particularly in women. However, there is scarcity of data on maternal obesity in Nigeria and other African countries. Aims and Objectives: This project aimed at identifying crucial components of potential interventions for maternal obesity in Nigeria. The objectives were to assess the prevalence, effects, and distribution of maternal obesity; knowledge, attitude and practice (KAP) of pregnant women and maternal healthcare providers; and identify existing interventions for maternal obesity in Nigeria. Methodology: A systematic review and meta-analysis were initially conducted to appraise the existing literature on maternal obesity in Africa. Following this, a quantitative questionnaire survey of the KAP of pregnant women and a qualitative interview study of the KAP of Health Care Workers (HCW) were conducted in seven secondary and tertiary hospitals across Nigeria. Quantitative data was analysed using SPSS statistical software, while thematic analysis was conducted for qualitative data. Results: Twenty-nine studies included in the systematic review showed significant prevalence, socio-demographic associations, and adverse effects of maternal obesity on labour, maternal, and child outcomes in Africa. The questionnaire survey of 435 mothers revealed a maternal obesity prevalence of 17.9% among mothers who registered for antenatal care in the first trimester. The mothers received nutrition information from different sources and had insufficient knowledge of their own weight category or recommended Gestational Weight Gain (GWG), causes, complications, and safe ways to manage maternal obesity. However, majority of the mothers were of the opinion that excess GWG is avoided in pregnancy and some practiced weight management (diet and exercise) during pregnancy. For the qualitative study, four main themes were identified: ‘Concerns about obesity in pregnancy’, ‘Barriers to care for obese pregnant women’, ‘Practice of care for obese pregnant women’, and ‘Improving care for obese pregnant women’. HCW expressed concerns about rising levels of maternal obesity, lack of guidelines for the management of obese pregnant women and worries about unintended consequences of antenatal interventions. ‘Barriers’ included lack of contact with obese women before pregnancy, late registration for antenatal care, and perceived maternal barriers such as socio-cultural beliefs of mothers and poverty. ‘Practice’ included anticipatory care and screening for possible complications, general nutrition education during antenatal care and interdisciplinary care for mothers with complications. HCW offered suggestions on improving care for obese women including timing, type, and settings of interventions; and the need for involvement of other stake holders in caring for obese pregnant women. Conclusions: Culturally adaptable/sensitive interventions should be developed for the management of obese pregnant women in Africa. Education and training of mothers and health care workers, and provision of guidelines are some of the components of potential interventions in Nigeria.

Keywords: Africa, maternal, obesity, pregnancy

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Authors: Fabio L. Vieira, Micaelle F. C. Lemos, Luciano C. Lemos, Rafaela S. Oliveira, Ian A. Cunha

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Brazil has some challenges ahead related to population oral health, most of them associated with the need of expanding into the local level its promotion and prevention activities, offer equal access to services and promote changes in the lifestyle of the population. The program implemented an oral health initiative in public schools in the city of Salvador, Bahia. The mission was to improve oral health among students on primary and secondary education, from 2 to 15 years old, using the school as a pathway to increase access to healthcare. The main actions consisted of a team's visit to the schools with educational sessions for dental cavity prevention and individual assessment. The program incorporated a clinical surveillance component through a dental evaluation of every student searching for dental disease and caries, standardization of the dentists’ team to reach uniform classification on the assessments, and the use of an online platform to register data directly from the schools. Sequentially, the students with caries were referred for free clinical treatment on the program’s Health Centre. The primary purpose of this study was to analyze the effects and outcomes of this school-based oral health program. The study sample was composed by data of a period of 3 years - 2015 to 2017 - from 13 public schools on the suburb of the city of Salvador with a total number of assessments of 9,278 on this period. From the data collected the prevalence of children with decay on permanent teeth was chosen as the most reliable indicator. The prevalence was calculated for each one of the 13 schools using the number of children with 1 or more dental caries on permanent teeth divided by the total number of students assessed for school each year. Then the percentage change per year was calculated for each school. Some schools presented a higher variation on the total number of assessments in one of the three years, so for these, the percentage change calculation was done using the two years with less variation. The results show that 10 of the 13 schools presented significative improvements for the indicator of caries in permanent teeth. The mean for the number of students with caries percentage reduction on the 13 schools was 26.8%, and the median was 32.2% caries in permanent teeth institution. The highest percentage of improvement reached a decrease of 65.6% on the indicator. Three schools presented a rise in caries prevalence (8.9, 18.9 and 37.2% increase) that, on an initial analysis, seems to be explained with the students’ cohort rotation among other schools, as well as absenteeism on the treatment. In conclusion, the program shows a relevant impact on the reduction of caries in permanent teeth among students and the need for the continuity and expansion of this integrated healthcare approach. It has also been evident the significative of the articulation between health and educational systems representing a fundamental approach to improve healthcare access for children especially in scenarios such as presented in Brazil.

Keywords: primary care, public health, oral health, school-based oral health, data management

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Authors: Davit Khachatryan, Shuo Xiang

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Numerous published studies on the use of prazosin in the treatment of PTSD-related sleep disturbances in adult population have resulted in updates to the recommendation for prazosin for nightmares that showed its strength of evidence elevated from C to B in the US Department of Veterans Affairs clinical practice guideline. In addition, the American Academy of Sleep Medicine clinical practice guideline gave prazosin a level-A recommendation for the treatment of PTSD-associated nightmares. The aim of this review is to summarize the available literature for prazosin use for nightmares and other sleep disturbances in children and adolescents with PTSD. Method: A comprehensive search for studies on prazosin use for sleep disturbances in child and adolescent population with PTSD has been performed. We looked at MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, Scopus, Web of Science, and Cochrane CENTRAL databases. Results: Compared to adult population with similar psychopathology, the available literature in child and adolescent population is scarce. Despite increased interest in prazosin in the management of PTSD, only six studies investigating this medication in children and adolescents have been published. Conclusion: A large randomized control trial on this topic is needed for more definite evidence on the efficacy and safety of prazosin in the treatment of nightmares in children and adolescents with PTSD.

Keywords: guidelines, prazosin, PTSD, sleep disturbance

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Authors: Md. Ashikur Rahman

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Optimal breastfeeding practice is essential to reducing childhood morbidity and mortality and helps to achieve Millennium Development Goal (MDG). A cross-sectional study was conducted in a rural area in Dhaka district to explore the barrier to optimal breastfeeding practices. The population of this study constitutes all nursing mothers having children aged 0-6 months, and they were selected purposively. The study adopted a structured and in-depth interview procedure consisting of open and closed-ended questions. Four hundred rural nursing mothers constituted the sample of the structured interview, while 15 were involved in the in-depth interview. Among the respondent's majority (67%) were in the age group 17-25 years, with a mean age of 24.44 years. Most (39.5%) of the mothers were housewives with a secondary level of education (46.5%). About 32% of mothers started breastfeeding within one hour after birth. But delayed initiation was reported in 31.5% of mothers, whereas 36.8% of mothers forgot the exact time of initiation of breastfeeding. The main reason not to practice colostrum was mothers tried to breastfeed, but there was no milk, stated 13.8% of mothers. In addition, about one-third (34.3%) of the respondents practiced pre-lacteal feeding, and among them, 12.8% introduced sugar with water. Reasons given by the mothers for bottle-feeding was that baby was not satisfied with breast milk only; 22.0% of mothers indicated this cause. The main influence to take formula milk by their mother and mothers-in-law was stated by 18.8% of mothers. Some mothers stated that major constraints to EBF were the perception of not having enough milk (25.5 %) and babies crying seems to be hungry (8.8%). One-third of the mothers (31.5%) felt uncomfortable during breastfeeding. Access to antenatal and postnatal counseling in the study area also was a key obstacle to optimal breastfeeding practices. In a qualitative survey, some mothers believed that there was no difference between breast milk and formula milk. Colostrum feeding, pre-lacteal feeding, early initiation of breastfeeding, and exclusive breastfeeding were strongly associated with family type, family member, birth order, religion, husbands' occupation, delivery attendants and delivery type, postnatal care, and health care facilities. To reduce the barriers to the successful practice of exclusive breastfeeding, there is a need for a grass-roots approach to educating and counseling nursing mothers with identifying factors influencing or discouraging the optimal practice.

Keywords: exclusive, breast feeding, practices, Bangladesh

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Authors: Alexis Winfield, Carly Sugar, Barbara Fenesi

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The COVID-19 pandemic uprooted regular routines forcing many children to learn from home, requiring many adults to work from home, and cutting families off from support outside the home. Public health restrictions associated with the pandemic caused widespread psychological distress, including depression and anxiety, increased fear, panic, and stress. These trends are particularly concerning for families raising neuroatypical children, such as those with Attention-Deficit Hyperactivity Disorder (ADHD), as these children are already more likely than their typically developing peers to experience comorbid mental health issues and to experience greater distress when required to stay indoors. Families with children who have ADHD are also at greater risk for experiencing heightened familial stress due to the challenges associated with managing ADHD behavioural symptoms, greater parental discord and divorce, and greater financial difficulties compared to other families. The current study engaged families comprised of at least one child diagnosed with ADHD to elucidate 1) the unique ways that the COVID-19 pandemic affected their mental health and 2) the specific barriers these families faced to maintaining optimal mental wellbeing. A total of 33 participants (15 parent-child dyads) engaged in virtual interviews. Content analysis revealed that the most frequently identified mental health effects for families were increased child anxiety and disconnectedness, as well as deteriorating parental mental health. The most frequently identified barriers to maintaining optimal mental well-being were lack of routine, lack of social interaction and social support, and uncertainty and fear. Findings underscore areas of need during times of large-scale social isolation, bring voice to the families of children with ADHD, and contribute to our understanding of the pandemic’s impact on the wellbeing of vulnerable families. This work contributes to a growing body of research aimed at creating safeguards to support mental wellbeing for vulnerable families during times of crisis.

Keywords: attention-deficit hyperactivity disorder, COVID-19, mental health, vulnerable families

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Authors: Lucky Farha, Martha L. Hall

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The current adaptive clothing brands are limited in numbers and specific categories. This study explores clothing challenges for children with Down syndrome and factors that influence their perception of adaptive clothing brands. Another aim of this study was to explore brands' challenges in the adaptive business and factors that influence their perceptions towards the adaptive market. In order to determine the market barriers affecting adaptive target market needs, the researcher applied Technology Acceptance Model. After interviewing and surveying parents/caregivers having children with Down syndrome and current adaptive brands, the results found education as the significant gap in the adaptive clothing market yet to be overcome. Based on the finding, several recommendations were suggested to improve the current barriers in the adaptive clothing market.

Keywords: adaptive fashion, disability, functional clothing, clothing needs assessment, down syndrome, clothing challenge

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Authors: Padam Pandey, Madhu Sudan Dhakal

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As a consequence of being a patrimonial society, most of the Nepalese women work inside the house and take care their children. Men are always regarded to be responsible for managing fund to fulfill the family requirement. Outgoing men of 25-35 for employment in foreign country is a common practice. In the absence of man, women aged of 20-45 have to be active in society. The responsibility of women is not only looking after inside the house but also leading the society. This study analysis gender aspect of household work and involvement in the society. This study shows that women are leading 56% different organizations in the society where 51% women spend more than 54% time in community development work. The involvement of man in the house work has significantly increased. The women leadership has succeeded to show the transparency in all the community development activities. It shows a model of social harmony, solidarity, and unity in the Sarankot Village Development Committee. Social behavior change towards women is a milestone of sustainable community development. This study recommends that the equal participation is essential to sustain community development.

Keywords: gender, women leadership, social harmony, unity sustainable development

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Authors: John Acire, Wilfred Lajul, Ogwang Tom

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Using a qualitative research technique, this study investigates the influence of Early Childhood Education (ECE) on learning outcomes in lower primary schools in Gulu City, Uganda. The study, which is based on Vygotsky's sociocultural theory of human learning, fills gaps in the current literature on the influence of ECE on learning outcomes. The aims of the study include analyzing the state of learning outcomes, investigating ECE practices, and determining the influence of these practices on learning outcomes in lower primary schools. The findings highlight the critical significance of ECE in promoting children's overall development. Nursery education helps children improve their handwriting, reading abilities, and general cognitive development. Children who have received nursery education have improved their abilities to handle pencils, form letters, and engage in social interactions, highlighting the significance of fine motor skills and socializing. Despite the good elements, difficulties in implementing ECE practices were found, such as differences in teaching styles, financial limits, and potential weariness due to prolonged school hours. The study suggests focused interventions to improve the effectiveness of ECE practices, ensure their connection with educational goals and maximize their influence on children's development. The study's findings show that respondents agree on the importance of nursery education in supporting holistic development, socialization, language competency, and conceptual comprehension. Challenges in nursery education, such as differences in teaching techniques and insufficient resources, highlight the need for comprehensive measures to address these challenges. Furthermore, parental engagement in home learning activities was revealed as an important factor affecting early education outcomes. Children who were engaged at home performed better in lower primary, emphasizing the value of a supportive family environment. Finally, the report suggests measures to enhance parental participation, changes in teaching methods through retraining, and age-appropriate enrolment. Future studies might concentrate on the involvement of parents, ECE policy practice, and the influence of ECE teachers on lower primary school learning results. These ideas are intended to help create a more favorable learning environment by encouraging holistic development and preparing children for success in succeeding academic levels.

Keywords: early childhood education, learning outcomes in lower primary schools, early childhood education practices, how ECE practices influence learning outcomes in lower primary schools

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Authors: Eric Lee G. Escobedo-Wu, Nidhi Rohatgi, Fouzel Dhebar

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It is challenging for patients to navigate through healthcare systems after-hours. This leads to delays in care, patient/provider dissatisfaction, inappropriate resource utilization, readmissions, and higher costs. It is important to provide patients and providers with effective clinical decision-making tools to allow seamless connectivity and coordinated care. In August 2015, patient-centric Stanford Health Care established Clinical Advice Services (CAS) to provide clinical decision support after-hours. CAS is founded on key Lean principles: Value stream mapping, empathy mapping, waste walk, takt time calculations, standard work, plan-do-check-act cycles, and active daily management. At CAS, Clinical Assistants take the initial call and manage all non-clinical calls (e.g., appointments, directions, general information). If the patient has a clinical symptom, the CAS nurses take the call and utilize standardized clinical algorithms to triage the patient to home, clinic, urgent care, emergency department, or 911. Nurses may also contact the on-call physician based on the clinical algorithm for further direction and consultation. Since August 2015, CAS has managed 228,990 calls from 26 clinical specialties. Reporting is built into the electronic health record for analysis and data collection. 65.3% of the after-hours calls are clinically related. Average clinical algorithm adherence rate has been 92%. An average of 9% of calls was escalated by CAS nurses to the physician on call. An average of 5% of patients was triaged to the Emergency Department by CAS. Key learnings indicate that a seamless connectivity vision, cascading, multidisciplinary ownership of the problem, and synergistic enterprise improvements have contributed to this success while striving for continuous improvement.

Keywords: after hours phone calls, clinical advice services, nurse triage, Stanford Health Care

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Authors: Wei-Chih Huang, Pei-Lung Chung, Ching-Heng Lin, Hsuan-Chia Yang, Der-Ming Liou

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Background: In-Hospital Cardiac Arrest (IHCA) threaten life of the inpatients, cause serious effect to patient safety, quality of inpatients care and hospital service. Health providers must identify the signs of IHCA early to avoid the occurrence of IHCA. This study will consider the potential association between early signs of IHCA and the essence of patient care provided by nurses and other professionals before an IHCA occurs. The aim of this study is to identify significant associations between nursing interventions and abnormal early evaluation results of IHCA that can assist health care providers in monitoring inpatients at risk of IHCA to increase opportunities of IHCA early detection and prevention. Materials and Methods: This study used one of the data mining techniques called association rules mining to compute associations between nursing interventions and abnormal early evaluation results of IHCA. The nursing interventions and abnormal early evaluation results of IHCA were considered to be co-occurring if nursing interventions were provided within 24 hours of last being observed in abnormal early evaluation results of IHCA. The rule based methods were utilized 23.6 million electronic medical records (EMR) from a medical center in Taipei, Taiwan. This dataset includes 733 concepts of nursing interventions that coded by clinical care classification (CCC) codes and 13 early evaluation results of IHCA with binary codes. The values of interestingness and lift were computed as Q values to measure the co-occurrence and associations’ strength between all in-hospital patient care measures and abnormal early evaluation results of IHCA. The associations were evaluated by comparing the results of Q values and verified by medical experts. Results and Conclusions: The results show that there are 4195 pairs of associations between nursing interventions and abnormal early evaluation results of IHCA with their Q values. The indication of positive association is 203 pairs with Q values greater than 5. Inpatients with high blood sugar level (hyperglycemia) have positive association with having heart rate lower than 50 beats per minute or higher than 120 beats per minute, Q value is 6.636. Inpatients with temporary pacemaker (TPM) have significant association with high risk of IHCA, Q value is 47.403. There is significant positive correlation between inpatients with hypovolemia and happened abnormal heart rhythms (arrhythmias), Q value is 127.49. The results of this study can help to prevent IHCA from occurring by making health care providers early recognition of inpatients at risk of IHCA, assist with monitoring patients for providing quality of care to patients, improve IHCA surveillance and quality of in-hospital care.

Keywords: in-hospital cardiac arrest, patient safety, nursing intervention, association rule mining

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Authors: Sony Subedi, Colleen Davison, Susan Bartels

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Objective: The aim of this study is to i) investigate the socio-demographics and living conditions of households in Haiti pre- and post 2010 earthquake, ii) determine the household prevalence of emotional and physical abuse in children (aged 2-14) after the earthquake, and iii) explore the association between earthquake-related loss and experience of emotional and physical child abuse in the household while considering potential confounding variables and the interactive effects of a number of social, economic, and demographic factors. Methods: A nationally representative sample of Haitian households from the 2005/6 and 2012 phases of the Demographic and Health Surveys (DHS) was used. Descriptive analysis was summarized using frequencies and measures of central tendency. Chi-squared and independent t-tests were used to compare data that was available pre-earthquake and post-earthquake. The association between experiences of earthquake-related loss and emotional and physical child abuse was assessed using log-binomial regression models. Results: Comparing pre-post-earthquake, noteworthy improvements were observed in the educational attainment of the household head (9.1% decrease in “no education” category) and in possession of the following household items: electricity, television, mobile-phone, and radio post-earthquake. Approximately 77.0% of children aged 2-14 experienced at least one form of physical abuse and 78.5% of children experienced at least one form of emotional abuse one month prior to the 2012 survey period. Analysis regarding the third objective (association between experiences of earthquake-related loss and emotional and physical child abuse) is in progress. Conclusions: The extremely high prevalence of emotional and physical child abuse in Haiti indicates an immediate need for improvements in the enforcement of existing policies and interventions aimed at decreasing child abuse in the household.

Keywords: Haiti earthquake, physical abuse, emotional abuse, natural disasters, children

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Authors: H. Booke, R. Nordmeier

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Sudden cardiac arrest is sometimes eye-witnessed by kids. Mostly, their (grand-)parents are affected by sudden cardiac arrest, putting these kids under enormous psychological pressure: Although they are more than desperate to help, they feel insecure and helpless and are afraid of causing harm rather than realizing their chance to help. Even years later, they may blame themselves for not having helped their beloved ones. However, the absolute majority of school children - at least in Germany - is not educated to provide first aid. Teaching young kids (5th grade) in basic life support thus may help to save lives while washing away the kids' fear from causing harm during cardio-pulmonary resuscitation. A teaching of circulatory and respiratory (patho-)physiology, followed by hands-on training of basic life support for every single child, was offered to each school in our district. The teaching was performed by anesthesiologists, and the program was called 'kids can save lives'. However, before enrollment in this program, the entire class must have had lessons in biology with a special focus on heart and circulation as well as lung and gas exchange. More than 1.000 kids were taught and trained in basic life support, giving them the knowledge and skills to provide basic life support. This may help to reduce the rate of failure to provide first aid. Therefore, educating young kids in basic life support may not only help to save lives, but it also may help to prevent any feelings of guilt because of not having helped in cases of eye-witnessed sudden cardiac arrest.

Keywords: teaching, children, basic life support, cardiac arrest, CPR

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Authors: Fatma Refaat Ahmed, Sally Mohamed Farghaly

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Context: Intensive care unit (ICU) nurses often face pressure and constraints in their work, leading to the rationing of care when demands exceed available time and resources. Observations suggest that ICU nurses are frequently distracted from their core nursing roles by non-core tasks. This study aims to provide evidence on ICU nurses' multitasking activities and explore the association between nurses' personal and clinical characteristics and their time allocation. Research Aim: The aim of this study is to quantify the time spent by ICU nurses on multitasking activities and investigate the relationship between their personal and clinical characteristics and time allocation. Methodology: A self-observation form utilizing the "Diary" recording method was used to record the number of tasks performed by ICU nurses and the time allocated to each task category. Nurses also reported on the distractions encountered during their nursing activities. A convenience sample of 60 ICU nurses participated in the study, with each nurse observed for one nursing shift (6 hours), amounting to a total of 360 hours. The study was conducted in two ICUs within a university teaching hospital in Alexandria, Egypt. Findings: The results showed that ICU nurses completed 2,730 direct patient-related tasks and 1,037 indirect tasks during the 360-hour observation period. Nurses spent an average of 33.65 minutes on ventilator care-related tasks, 14.88 minutes on tube care-related tasks, and 10.77 minutes on inpatient care-related tasks. Additionally, nurses spent an average of 17.70 minutes on indirect care tasks per hour. The study identified correlations between nursing time and nurses' personal and clinical characteristics. Theoretical Importance: This study contributes to the existing research on ICU nurses' multitasking activities and their relationship with personal and clinical characteristics. The findings shed light on the significant time spent by ICU nurses on direct care for mechanically ventilated patients and the distractions that require attention from ICU managers. Data Collection: Data were collected using self-observation forms completed by participating ICU nurses. The forms recorded the number of tasks performed, the time allocated to each task category, and any distractions encountered during nursing activities. Analysis Procedures: The collected data were analyzed to quantify the time spent on different tasks by ICU nurses. Correlations were also examined between nursing time and nurses' personal and clinical characteristics. Question Addressed: This study addressed the question of how ICU nurses allocate their time across multitasking activities and whether there is an association between nurses' personal and clinical characteristics and time allocation. Conclusion: The findings of this study emphasize the need for a lean evaluation of ICU nurses' activities to identify and address potential gaps in patient care and distractions. Implementing lean techniques can improve efficiency, safety, clinical outcomes, and satisfaction for both patients and nurses, ultimately enhancing the quality of care and organizational performance in the ICU setting.

Keywords: motion study, ICU nurse, lean, nursing time, multitasking activities

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Authors: Peggy M. Randon, Lisa Randon

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Introduction: The post-COVID-19 era has presented unique challenges for addressing complex mental health issues, particularly due to exacerbated stress, increased social isolation, and disrupted continuity of care. This article outlines relevant health disparities and policy implications within the context of the United States while maintaining international relevance. Methods: A comprehensive literature review (including studies, reports, and policy documents) was conducted to examine concerns related to childhood-onset schizophrenia and the impact on patients and their families. Qualitative and quantitative data were synthesized to provide insights into the complex etiology of schizophrenia, the effects of the pandemic, and the challenges faced by socioeconomically disadvantaged populations. Case studies were employed to illustrate real-world examples and areas requiring policy reform. Results: Early intervention in childhood is crucial for preventing or mitigating the long-term impact of complex psychotic disorders, particularly schizophrenia. A comprehensive understanding of the genetic, environmental, and physiological factors contributing to the development of schizophrenia is essential. The COVID-19 pandemic worsened symptoms and disrupted treatment for many adolescent patients with schizophrenia, emphasizing the need for adaptive interventions and the utilization of virtual platforms. Health disparities, including stigma, financial constraints, and language or cultural barriers, further limit access to care, especially for socioeconomically disadvantaged populations. Policy implications: Current US health policies inadequately support patients with schizophrenia. The limited availability of longitudinal care, insufficient resources for families, and stigmatization represent ongoing policy challenges. Addressing these issues necessitates increased research funding, improved access to affordable treatment plans, and cultural competency training for healthcare providers. Public awareness campaigns are crucial to promote knowledge, awareness, and acceptance of mental health disorders. Conclusion: The unique challenges faced by children and families in the US affected by schizophrenia and other psychotic disorders have yet to be adequately addressed on institutional and systemic levels. The relevance of findings to an international audience is emphasized by examining the complex factors contributing to the onset of psychotic disorders and their global policy implications. The broad impact of the COVID-19 pandemic on mental health underscores the need for adaptive interventions and global responses. Addressing policy challenges, improving access to care, and reducing the stigma associated with mental health disorders are crucial steps toward enhancing the lives of adolescents and young adults with schizophrenia and their family members. The implementation of virtual platforms can help overcome barriers and ensure equitable access to support and resources for all patients, enabling them to lead healthy and fulfilling lives.

Keywords: childhood, schizophrenia, policy, United, States, health, disparities

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Authors: Ann Dashwood

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Using Standard Australian English with confidence is a cultural expectation of parents of primary school aged children who want to engage effectively with their children’s teachers and school administration. That confidence in support of their children’s learning at school is seldom experienced by parents whose first language is not English. Sharing language with competence in an intercultural environment is the common denominator for meaningful communication and engagement to occur in a school community. Experience in relevant, interactive sessions is known to enhance engagement and participation. The purpose of this paper is to identify a pedagogy for parents otherwise isolated from daily use of functional Australian cultural language learned to engage effectively in their children’s learning at school. The outcomes measure parents’ intercultural engagement with classroom teachers and attention to the school’s administrative procedures using quantitative and qualitative methods. A principled communicative task-based language learning approach, combined with intercultural communication strategies provide the theoretical base for intensive English inquiry-based learning and engagement. The quantitative analysis examines data samples collected by classroom teachers and administrators and parents’ writing samples. Interviews and observations qualitatively inform the study. Currently, significant numbers of projects are active in community centers and schools to enhance English language knowledge of parents from Language Backgrounds Other Than English (LBOTE). The study is significant to explore the effects of an intensive English pedagogy with parents of varied English language backgrounds, by targeting inquiry-based language use for social interactions in the school and wider community, specific engagement and cultural interaction with teachers and school activities and procedures.

Keywords: engagement, intercultural communication, language teaching pedagogy, LBOTE, school community

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Authors: Asfa Hussain, Chee Tang, Mien Nguyen

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Introduction: The safe usage of medications is dependent on clear, well-documented prescribing. Medical drug charts should be regularly checked to ensure that they are fit for purpose. Aims: The purpose of this study was to evaluate whether the Isabel Hospice drug charts were effective or prone to medical errors. The aim was to create a comprehensive palliative care drug chart in line with medico-legal guidelines and to minimise drug administration and prescription errors. Methodology: 50 medical drug charts were audited from March to April 2020, to assess whether they complied with medico-legal guidelines, in a hospice within East of England. Meetings were held with the larger multi-disciplinary team (MDT), including the pharmacists, nursing staff and doctors, to raise awareness of the issue. A preliminary drug chart was created, using the input from the wider MDT. The chart was revised and trialled over 15 times, and each time feedback from the MDT was incorporated into the subsequent template. In the midst of the COVID-19 pandemic in September 2020, the finalised drug chart was trialled. 50 new palliative drug charts were re-audited, to evaluate the changes made. Results: Prescribing and administration errors were high prior to the implementation of the new chart. This improved significantly after introducing the new drug charts, therefore improving patient safety and care. The percentage of inadequately documented allergies went down from 66% to 20% and incorrect oxygen prescription from 40% to 16%. The prescription drug-drug interactions decreased by 30%. Conclusion: It is vital to have clear standardised drug charts, in line with medico-legal standards, to allow ease of prescription and administration of medications and ensure optimum patient-centred care. This closed loop audit demonstrated significant improvement in documentation and prevention of possible fatal drug errors and interactions.

Keywords: palliative care, drug chart, medication errors, drug-drug interactions, COVID-19, patient safety

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Authors: Neeraj Vij, Amber Brennan, Jenni Winters, Hadi Salehi, Hamy Temkit, Emily Andrisevic, Mohan V. Belthur

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Idiopathic clubfoot is a common lower extremity deformity with an incidence of 1:500. The Ponseti Method is well known as the gold standard of treatment. However, there is limited functional data demonstrating correction of the clubfoot after treatment with the Ponseti method. The purpose of this study was to study the clinical and functional outcomes after the Ponseti method with the Clubfoot Disease-Specific Instrument (CDS) and pedobarography. This IRB-approved prospective study included patients aged 3-18 who were treated for idiopathic clubfoot with the Ponseti method between January 2008 and December 2018. Age-matched controls were identified through siblings of clubfoot patients and other community members. Treatment details were collected through a chart review of the included patients. Laboratory assessment included a physical exam, gait analysis, and pedobarography. The Pediatric Outcomes Data Collection Instrument and the Clubfoot Disease-Specific Instrument were also obtained on clubfoot patients (CF). The Wilcoxson rank-sum test was used to study differences between the CF patients and the typically developing (TD) patients. Statistical significance was set at p < 0.05. There were a total of 37 enrolled patients in our study. 21 were priorly treated for CF and 16 were TD. 94% of the CF patients had bilateral involvement. The age at the start of treatment was 29 days, the average total number of casts was seven to eight, and the average total number of casts after Achilles tenotomy was one. The reoccurrence rate was 25%, tenotomy was required in 94% of patients, and ≥1 tenotomy was required in 25% of patients. There were no significant differences between step length, step width, stride length, force-time integral, maximum peak pressure, foot progression angles, stance phase time, single-limb support time, double limb support time, and gait cycle time between children treated with the Ponseti method and typically developing children. The average post-treatment Pirani and Dimeglio scores were 5.50±0.58 and 15.29±1.58, respectively. The average post-treatment PODCI subscores were: Upper Extremity: 90.28, Transfers: 94.6, Sports: 86.81, Pain: 86.20, Happiness: 89.52, Global: 88.6. The average post-treatment Clubfoot Disease-Specific Instrument scores subscores were: Satisfaction: 73.93, Function: 80.32, Overall: 78.41. The Ponseti Method has a very high success rate and remains to be the gold standard in the treatment of idiopathic clubfoot. Timely management leads to good outcomes and a low need for repeated Achilles tenotomy. Children treated with the Ponseti method demonstrate good functional outcomes as measured through pedobarography. Pedobarography may have clinical utility in studying congenital foot deformities. Objective measures for hours of brace wear could represent an improvement in clubfoot care.

Keywords: functional outcomes, pediatric deformity, patient-reported outcomes, talipes equinovarus

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Authors: Tsu-Yun Chiu, Tsung-Hsueh Lu, Tain-Junn Cheng

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Background: Traditional chronic disease management did not pay attention to effects of geographic factors on the compliance of treatment regime, which resulted in geographic inequality in outcomes of chronic disease management. This study aims to examine the geographic distribution and clustering of quality indicators of diabetes care. Method: We first extracted address, demographic information and quality of care indicators (number of visits, complications, prescription and laboratory records) of patients with diabetes for 2014 from medical information system in a medical center in Tainan City, Taiwan, and the patients’ addresses were transformed into district- and village-level data. We then compared the differences of geographic distribution and clustering of quality of care indicators between districts and villages. Despite the descriptive results, rate ratios and 95% confidence intervals (CI) were estimated for indices of care in order to compare the quality of diabetes care among different areas. Results: A total of 23,588 patients with diabetes were extracted from the hospital data system; whereas 12,716 patients’ information and medical records were included to the following analysis. More than half of the subjects in this study were male and between 60-79 years old. Furthermore, the quality of diabetes care did indeed vary by geographical levels. Thru the smaller level, we could point out clustered areas more specifically. Fuguo Village (of Yongkang District) and Zhiyi Village (of Sinhua District) were found to be “hotspots” for nephropathy and cerebrovascular disease; while Wangliau Village and Erwang Village (of Yongkang District) would be “coldspots” for lowest proportion of ≥80% compliance to blood lipids examination. On the other hand, Yuping Village (in Anping District) was the area with the lowest proportion of ≥80% compliance to all laboratory examination. Conclusion: In spite of examining the geographic distribution, calculating rate ratios and their 95% CI could also be a useful and consistent method to test the association. This information is useful for health planners, diabetes case managers and other affiliate practitioners to organize care resources to the areas most needed.

Keywords: catchment area of healthcare, chronic disease management, Geographic information system, quality of diabetes care

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Authors: Mustafa Metin Donma, Orkide Donma

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Obesity in children particularly draws attention because it may threaten the individual’s future life due to many chronic diseases it may lead to. Most of these diseases, including obesity itself altogether are related to inflammation. For this reason, inflammation-related parameters gain importance. Within this context, complete blood cell counts, ratios or indices derived from these counts have recently found some platform to be used as inflammatory markers. So far, mostly adipokines were investigated within the field of obesity. The liver is at the center of the metabolic pathways network. Metabolic inflammation is closely associated with cellular dysfunction. In this study, hematologic inflammatory markers and two major hepatokines, cytokines produced predominantly by the liver, fibroblast growth factor-21 (FGF-21) and fetuin A were investigated in pediatric obesity. Two groups were constituted from seventy-six obese children based on World Health Organization criteria. Group 1 was composed of children whose age- and sex-adjusted body mass index (BMI) percentiles were between 95 and 99. Group 2 consists of children who are above the 99ᵗʰ percentile. The first and the latter groups were defined as obese (OB) and morbid obese (MO). Anthropometric measurements of the children were performed. Informed consent forms and the approval of the institutional ethics committee were obtained. Blood cell counts and ratios were determined by an automated hematology analyzer. The related ratios and indexes were calculated. Statistical evaluation of the data was performed by the SPSS program. There was no statistically significant difference in terms of neutrophil-to lymphocyte ratio, monocyte-to-high density lipoprotein cholesterol ratio and the platelet-to-lymphocyte ratio between the groups. Mean platelet volume and platelet distribution width values were decreased (p<0.05), total platelet count, red cell distribution width (RDW) and systemic immune inflammation index values were increased (p<0.01) in MO group. Both hepatokines were increased in the same group; however, increases were not statistically significant. In this group, also a strong correlation was calculated between FGF-21 and RDW when controlled by age, hematocrit, iron and ferritin (r=0.425; p<0.01). In conclusion, the association between RDW, a hematologic inflammatory marker, and FGF-21, an inflammation-related hepatokine, found in MO group is an important finding discriminating between OB and MO children. This association is even more powerful when controlled by age and iron-related parameters.

Keywords: childhood obesity, fetuin A , fibroblast growth factor-21, hematologic markers, red cell distribution width

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Authors: Zengmin Tian, Bin Lv, Rui Hui, Yupeng Liu, Chuan Wang, Qing Liu, Hongyu Li, Yan Qi, Li Song

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Objective Robot was used for replacement of the frame in recent years. The paper is to investigate the safety and effectiveness of frameless stereotactic surgery in the treatment of children with cerebral palsy. Methods Clinical data of 425 children with spastic cerebral palsy were retrospectively analyzed. The patients were treated with robot-assistant frameless stereotactic surgery of nuclear mass destruction. The motor function was evaluated by gross motor function measure-88 (GMFM-88) before the operation, 1 week and 3 months after the operation respectively. The statistical analysis was performed. Results The postoperative CT showed that the destruction area covered the predetermined target in all the patients. Minimal bleeding of puncture channel occurred in 2 patient, and mild fever in 3 cases. Otherwise, there was no severe surgical complication occurred. The GMFM-88 scores were 49.1±22.5 before the operation, 52.8±24.2 and 64.2±21.4 at the time of 1 week and 3 months after the operation, respectively. There was statistical difference between before and after the operation (P<0.01). After 3 months, the total effective rate was 98.1%, and the average improvement rate of motor function was 24.3% . Conclusion Replaced the traditional frame, the robot-assistant frameless stereotactic surgery is safe and reliable for children with spastic cerebral palsy, which has positive significance in improving patients’ motor function.

Keywords: cerebral palsy, robotics, stereotactic techniques, frameless operation

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Authors: Stefano Federici, Alessandro Lepri, Antonella Carrera

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Kessler and McKenna in the seventies, and recently Federici and Lepri investigated how an individual attributes gender to a person. By administering nudes of human figures, the scholars have found that the penis more than the vagina and the male sexual characteristics more than the female ones are significantly more salient in the gender attribution process. Federici and Lepri suggested that the asymmetrical salience of sexual characteristics is attributable to evolved decision-making processes for the solution of gender attribution problems to avoid the greatest danger of an (angry) adult male. The present study has observed the behaviour of 60 children, aged between 3 and 6 years, and their parents verifying whether the child gender attribution mechanisms are permeable to cultural stereotypes. The participating children were asked to make a male or a female on a tablet by combining 12 human physical characteristics (long hair, short hair, wide hips, narrow hips, breasts, flat chest, body hair, hairless body, penis, vagina, male face, and female face) and four cloths (male t-shirt, female t-shirt, pants, and skirt) by superimposing one or more of them on a sexually neutral manikin. On the tablet was installed an App, created by authors, to replicate the Kessler and McKenna and Federici and Lepri previous studies. One of the parents of each of the participating children was asked to make a male or a female using the same apparatus used by children. In addition, the participating parents were asked to complete a test, as proposed by Federici and Lepri in their previous study, to compare adult and child processes of gender attribution. The results suggested that children are affected both by evolved mechanisms as adults were (e.g., taking less time to make a male than a female, using the penis more often than the vagina), and by cultural modeling of parental and environmental gender stereotypes (e.g., the genitals were often covered with pants in case the delivery was to make a male and a skirt in the case was to make a female).

Keywords: biological sex, cognitive biases, cultural modeling, gender attribution, evolved decision-making processes

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Authors: Szu-Yi Chang, Jiin-Ru Rong

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This paper discussed a case involving a young female patient with schizophrenia. The patient's condition was deteriorating, and she was becoming increasingly reliant on her family to take care of her, and as her father did not understand the illness well and was afraid that others will learn about the presence of a mentally ill individual in their family, he and the patient's mother were thus unable to cope with the patient's deteriorating condition, which in turn caused her to suffer from a lack of self-confidence and low self-esteem. The patient received nursing care from July 26th to October 25th, 2017, during which counseling, family visits, and phone interviews were carried out, and her condition was monitored. By referring to the practical ability indicators for community psychiatric mental health nursing that were developed by the psychiatric mental health nurses' association of the Republic of China, defining categories such as 'self-construction,' 'self-management,' 'disease management,' and 'family nursing,' and incorporating indicators for empowerment and various skills into the steps and strategies used for nursing care, we will able to help the patient to construct her own identity, raise her self-esteem, improve her ability to independently perform activities of daily living, strengthen her disease management ability, and gradually build up her life management skills. The patient's family was also encouraged to communicate more among themselves, so as to align them with the nursing care objectives of improving the patient's ability to adapt to community life and her disease. The results indicated that the patient was able to maintain her mental stability within her community. By implementing effective self-management and maintaining a routine life, the patient was able to continue her active participation in community work and rehabilitation activities. Improvements were also achieved with respect to family role issues by establishing mutual understanding among the patient's family members and gaining their support. It is recommended that mental health nurses can leverage their community mental health nursing skills and the related strategies to promote adaptation to community life among mental life patients.

Keywords: community psychiatric mental health nursing, family nursing, schizophrenia, self-management

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Authors: Maria Lopez-Ibarra, Ana Velazquez-Wong, Lucelli Yañez-Gutierrez, Maria Araujo-Solis, Fabio Salamanca-Gomez, Alfonso Mendez-Tenorio, Haydeé Rosas-Vargas

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Congenital heart diseases (CHD) are the most common congenital abnormalities. These conditions can occur as both an element of distinct chromosomal malformation syndromes or as non-syndromic forms. Their etiology is not fully understood. Genetic variants such copy number variants have been associated with CHD. The aim of our study was to analyze these genomic variants in peripheral blood from Mexican children diagnosed with non-syndromic CHD. We included 16 children with atrial and ventricular septal defects and 5 healthy subjects without heart malformations as controls. To exclude the most common heart disease-associated syndrome alteration, we performed a fluorescence in situ hybridization test to identify the 22q11.2, responsible for congenital heart abnormalities associated with Di-George Syndrome. Then, a microarray based comparative genomic hybridization was used to identify global copy number variants. The identification of copy number variants resulted from the comparison and analysis between our results and data from main genetic variation databases. We identified copy number variants gain in three chromosomes regions from pediatric patients, 4q13.2 (31.25%), 9q34.3 (25%) and 20q13.33 (50%), where several genes associated with cellular, biosynthetic, and metabolic processes are located, UGT2B15, UGT2B17, SNAPC4, SDCCAG3, PMPCA, INPP6E, C9orf163, NOTCH1, C20orf166, and SLCO4A1. In addition, after a hierarchical cluster analysis based on the fluorescence intensity ratios from the comparative genomic hybridization, two congenital heart disease groups were generated corresponding to children with atrial or ventricular septal defects. Further analysis with a larger sample size is needed to corroborate these copy number variants as possible biomarkers to differentiate between heart abnormalities. Interestingly, the 20q13.33 gain was present in 50% of children with these CHD which could suggest that alterations in both coding and non-coding elements within this chromosomal region may play an important role in distinct heart conditions.

Keywords: aCGH, bioinformatics, congenital heart diseases, copy number variants, fluorescence in situ hybridization

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Authors: Andrea Zielke-Nadkarni

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Pain management is a question of quality of life and an indicator for nursing quality. Chronic pain which is predominant in oncology and palliative nursing situations is perceived today as a multifactorial, individual emotional experience with specific characteristics including the sociocultural dimension when dealing with migrant patients. This dimension of chronic pain is of major importance in professional nursing of migrant patients in hospices or palliative care units. Objectives of the study are: 1. To find out more about the sociocultural views on pain and nursing care, on customs and nursing practices connected with pain of both Turkish Muslim and German Christian women, 2. To improve individual and family oriented nursing practice with view to sociocultural needs of patients in severe pain in palliative care. In a qualitative-explorative comparative study 4 groups of women, Turkish Muslims immigrants (4 from the first generation, 5 from the second generation) and German Christian women of two generations (5 of each age group) of the same age groups as the Turkish women and with similar educational backgrounds were interviewed (semistructured ethnographic interviews using Spradley, 1979) on their perceptions and experiences of pain and nursing care within their families. For both target groups the presentation will demonstrate the following results in detail: Utterance of pain as well as “private” and “public” pain vary within different societies and cultures. Permitted forms of pain utterance are learned in childhood and determine attitudes and expectations in adulthood. Language, especially when metaphors and symbols are used, plays a major role for misunderstandings. The sociocultural context of illness may include specific beliefs that are important to the patients and yet seem more than far-fetched from a biomedical perspective. Pain can be an influential factor in family relationships where respect or hierarchies do not allow the direct utterance of individual needs. Specific resources are often, although not exclusively, linked to religious convictions and are significantly helpful in reducing pain. The discussion will evaluate the results of the study with view to the relevant literature and present nursing interventions and instruments beyond medication that are helpful when dealing with patients from various socio-cultural backgrounds in painful end-oflife situations.

Keywords: pain management, migrants, sociocultural context, palliative care

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Authors: Shahad Alkhalifah, Jonh Wright

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Autism spectrum disorder (ASD) is a pervasive developmental disorder associated, for 42% to 88% of people with ASD, with sensory processing disorders. Sensory processing disorders (SPD) impact daily functioning, and it is, therefore, essential to be able to diagnose them accurately. Currently, however, there is no assessment tool available for the Saudi Arabia (SA) population that would cover a wider enough age range. Therefore, this study aimed to assess the psychometric properties of the Sensory Processing Measure Preschool-Home Form (SPM-P) when used in English, with a population of English-speaking Saudi participants. This was chosen due to time limitations and the urgency in providing practitioners with appropriate tools. Using a convenience sampling approach group of caregivers of typically developing (TD) children and a group of caregivers for children with ASD were recruited (N = 40 and N = 16, respectively), and completed the SPM-P Home Form. Participants were also invited to complete it again after two weeks for test-retest reliability, and respectively, nine and five agreed. Reliability analyses suggested some issues with a few items when used in the Saudi culture, and, along with interscale correlations, it highlighted concerns with the factor structure. However, it was also found that the SPM-P Home has good criterion-based validity, and it is, therefore, suggested that it can be used until a tool is developed through translation and cultural adaptation. It is also suggested that the current factor structure of SPM-P Home is reassessed using a large sample.

Keywords: autism, sensory, assessment, reliability, sensory processing dysfunction, preschool, validity

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