Search results for: long-term care services

Authors: Marwa Fady Abozed, Hemat Abd El Latif, Fathy Serry, Lotfi El Sayed

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The purpose of this study was to investigate the efficacy of intravenous nutrient(soluvit, vitalipid, aminoven infant, lipovenos) and bisolvon commonly used in neonatal intensive care units against biofilm cells of staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aerguinosa and klebseilla pneumonia as they are the most commonly isolated organisms and are biofilm producers. Also, the synergetic acticity of soluvit, heparin, bisolvon with antibiotics and its effect on minimum biofilm eradication concentration(MBEC) was tested. Intravenous nutrient and bromohexine are widely used in newborns. Numbers of viable cell count released from biofilm after treatment with intravenous nutrient and bromohexine were counted to compare the efficacy. The percentage of reduction in biofilm regrowth in case of using soluvit was 43-51% and 36-42 % for Gram positive and Gram negative respectively, on adding the vitalipid the percentage was 45-50 %and 37-41% for Gram positive and Gram negative respectively. While, in case of using bisolvon the percentage was 46-52% and 47-48% for Gram positive and Gram negative respectively. Adding lipovenos had a reduction percentage of 48-52% and 48-49% for Gram positive and Gram negative respectively. While, adding aminoven infant the percentage was 10-15% and 9-11% for Gram positive and Gram negative respectively. Adding soluvit, heparin and bisolvon to antibiotics had synergic effect. soluvit with ciprofloxacin has 8-16 times decrease than minimum biofilm eradication concentration (MBEC) for ciprofloxacin alone. While, by adding soluvit to vancomycin the MBEC reduced by 16 times than MBEC of vancomycin alone. In case of combination soluvit with cefotaxime, amikacin and gentamycin the reduction in MBEC was 16, 8 and 6-32 times respectively. The synergetic effect of adding heparin to ciprofloxacin, vancomycin, cefotaxime, amikacin and gentamicin was 2 times reduction with all except in case of gram negative the range of reduction was 0-2 with both gentamycin and ciprofloxacin. Bisolvon exihited synergetic effect with ciprofloxacin, vancomycin, cefotaxime, amikacin and gentamicin by 16, 32, 32, 8, 32-64 and 32 times decrease in MBEC respectively.

Keywords: biofilm, neonatal intensive care units, antibiofilm agents, intravenous nutrient

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Authors: Philippa Sambevski

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Breast cancer is the most common cancer diagnosed in Australian women. The incidence of breast cancer for Aboriginal and Torres Strait Islander (ATSI) women is lower than for non-indigenous women. However, the mortality rate for ATSI women is higher. The participation rate of ATSI women in BreastScreen Australia is below the general population. In this thematic literature review, the author collates viable strategies to increase breast screening rates among culturally and linguistically diverse individuals and provide culturally competent care. Barriers to accessing BreastScreen for ATSI women include language or communication limits, isolation, and a lack of culturally sensitive information. Culturally competent strategies require healthcare workers with an appropriate cultural and social background, clear messages, and the embedding of cultural respect within healthcare organisations. Cultural safety is determined by partnering with local indigenous groups, recognising the consumer experience, and allowing people to raise their concerns. The corresponding academic poster identifies strategies for healthcare workers to provide culturally competent care in a BreastScreen setting.

Keywords: breast screen, closing the gap, Australia, cultural safety, Aboriginal and Torres Strait Islander

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Authors: Hamood Al Kiyumi, Salim Al Huseini, Khalid Al Risi, Hassan Mirza, Amira Al Hosni, Sanjay Jaju, Asaad Al Habsi

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Objectives: The aim of this study was to assess the proportion of depressive symptoms along with demographic data in children diagnosed with epilepsy in a tertiary care institution in Oman. Methods: This cross-sectional study was conducted between June 2016 and August 2018. We have included 75 children with age group from five to 12 years old, attending epilepsy clinic at Sultan Qaboos University Hospital who were diagnosed with epilepsy and already on treatment. Patients were excluded if they have mental retardation. Validated Depression Scale for Children (CES-DC) questionnaire was utilized to assess the level of depressive symptoms among children. In addition, we have looked at associated factors including seizure status in the last three months, compliance with antiepileptic medications, type of epilepsy, and number of antiepileptic medications. Results: In this study, we found that depressive symptoms were present in 39 (52%) of patients. We also found that 96% of the patients were compliant to medications. In addition, seizure was present in the last three months in 48% of the sample studies. There was no statistically significant association between any of the studied variables and depression. Conclusions: Although depression is highly prevalent in children with epilepsy, this study did not find any significant association between the CES-DC scores and the studied factors.

Keywords: depression, children, epilepsy, Oman

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Authors: Julio Jesus Salazar, Max Jesus De Lama

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

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

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Authors: Tsung Chin Wu, Yu Chen Tsai, Rhay Hung Weng, Weir Sen Lin

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In recent years, nursing staff’s lower job satisfaction has led to higher turnover rates, and high turnover rates not only cause medical institution costs to increase but also the quality of medical care to decrease. From the perspective of internal marketing, institution staffs are internal customers, and institutions should focus and meet the needs of staff, so that staff will strive to meet the needs of external customers and provide them with the required care. However, few previous studies have investigated the impact of internal staff satisfaction on external customers. Therefore, this study aimed to conduct job satisfaction surveys on internal staff to investigate the relationship between job satisfaction and quality of medical care through statistical analysis of the study results. The related study results may serve as a reference for healthcare managers. This study was conducted using a questionnaire and the subjects were nursing staff from four hospitals. A total of 600 questionnaires were distributed and 577 valid questionnaires were returned with a response rate of 96.1%. After collecting the data, the reliability and validity of the study variables were confirmed by confirmatory factor analysis. The impact of internal marketing and job satisfaction on turnover intention of nursing staff was analyzed using descriptive analysis, one-way ANOVA, Pearson correlation analysis and multiple regression analysis. The study results showed that there was a significant difference between nursing staff’s job title and ‘professional participation’ and ‘shifts’. There was a significant difference between salary and ‘shifts’ and ‘turnover intention’, as well as between marriage and ‘remuneration’ and ‘turnover intention’. A significant difference was found between professional advancement and ‘professional growth’ and ‘type of leave’, as well as between division of service and ‘shifts’ and ‘turnover intention’. Pearson correlation analysis revealed a significant negative correlation between turnover intention and ‘internal marketing’, ‘interaction’, ‘professional participation’, ‘grasp of environment’, ‘remuneration’ and ‘shifts’, meaning that the higher the satisfaction, the lower the turnover intention. It is recommended that hospitals establish a comprehensive internal marketing mechanism to enhance staff satisfaction and in turn, reduce intention to resign, and the key to increasing job satisfaction is by establishing effective methods of internal communication.

Keywords: internal marketing, job satisfaction, turnover intention, nursing staff

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Authors: Mariana Branco, Nahida Sobrino, Cristina Neves, Márcia Santos, Afonso Granja, João Rosa Oliveira, Joana Costa, Luísa Castro Leite

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This case reports a COVID-19 infection in an unvaccinated adult man with no history of COVID-19 and no relevant clinical history besides anabolic steroid use, undergoing weaning with tamoxifen after a bodybuilding competition. The patient presented a 4cm cervical mass 3 weeks after COVID-19 infection in his cohabitants. He was otherwise asymptomatic and tested negative to multiple RT-PCR tests. Nevertheless, the IgG COVID-19 antibody was positive, suggesting the previous infection. This report raises a potential link between anabolic steroid use and atypical COVID-19 onset. Objectives: The goals of this paper are to raise a potential link between anabolic steroid use and atypical COVID-19 onset but also to report an uncommon case of COVID-19 infection with consecutive negative gold standard tests. Methodology: The authors used CARE guidelines for case report writing. Introduction: This case reports a COVID-19 infection case in an unvaccinated adult man, with multiple serial negative reverse transcription polymerase chain reaction (RT-PCR) test results, presenting with single cervical lymphadenopathy. Although the association between COVID-19 and lymphadenopathy is well established, there are no cases with this presentation, and consistently negative RT-PCR tests have been reported. Methodologies: The authors used CARE guidelines for case report writing. Case presentation: This case reports a 28-year-old Caucasian man with no previous history of COVID-19 infection or vaccination and no relevant clinical history besides anabolic steroid use undergoing weaning with tamoxifendue to participation in a bodybuilding competition. He visits his primary care physician because of a large (4 cm) cervical lump, present for 3 days prior to the consultation. There was a positive family history for COVID-19 infection 3 weeks prior to the visit, during which the patient cohabited with the infected family members. The patient never had any previous clinical manifestation of COVID-19 infection and, despite multiple consecutive RT-PCR testing, never tested positive. The patient was treated with an NSAID and a broad-spectrum antibiotic, with little to no effect. Imagiological testing was performed via a cervical ultrasound, followed by a needle biopsy for histologic analysis. Serologic testing for COVID-19 immunity was conducted, revealing a positive Anti-SARS-CoV-2 IgG (Spike S1) antibody, suggesting the previous infection, given the unvaccinated status of our patient Conclusion: In patients with a positive epidemiologic context and cervical lymphadenopathy, physicians should still consider COVID-19 infection as a differential diagnosis, despite negative PCR testing. This case also raises a potential link between anabolic steroid use and atypical COVID-19 onset, never before reported in scientific literature.

Keywords: COVID-19, cervical lymphadenopathy, anabolic steroids, primary care

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Authors: Madan Khadka, Dhruba Uprety, Rubina Rai

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Background and objective: In 2011, around 273,465 women died worldwide during pregnancy, childbirth or within 42 days after childbirth. Near-miss is recognized as the predictor of the level of care and maternal death. The objective of the study was to evaluate the associated risk factors of near-miss obstetric cases and maternal death. Material and Methods A Prospective Observational Study was done from August 1, 2014, to June 30, 2015, in Department of Obstetrics and Gynecology at BPKIHS hospital, tertiary care hospital in Eastern Nepal, Dharan. Case eligible by the 5-factor scoring system and WHO near miss criteria were evaluated. Risk factors included severe hemorrhage, hypertensive disorders, and a complication of abortion, ruptured uterus, medical/surgical condition and sepsis. Results: A total of 9,727 delivery were attended during the study period from August 2014 to June 2014. There were 6307 (71.5%) vaginal delivery and 2777(28.5%) caesarean section and 181 perinatal death with a total of 9,546 live birth. A total of 162 near miss was identified, and 16 maternal death occurred during the study. Maternal near miss rate of 16.6 per 1000 live birth, Women with life-threatening conditions (WLTC) of 172, Severe maternal outcome ratio of 18.64 per 1000 live birth, Maternal near-miss mortality ratio (MNM: 1 MD) 10.1:1, Mortality index (MI) of 8.98%. Risk factors were obstetric hemorrhage 27.8%, abortion/ectopic 27.2%, eclampsia 16%, medical/surgical condition 14.8%, sepsis 13.6%, severe preeclamsia 11.1%, ruptured uterus 3.1%, and molar pregnancy 1.9%. 19.75% were prim gravidae, with mean age 25.66 yrs, and cardiovascular and coagulation dysfunction as a major life threatening condition and sepsis (25%) was the major cause of mortality. Conclusion: Hemorrhage and hypertensive disorders are the leading causes of near miss event and sepsis as a leading cause of mortality. As near miss analysis indicates the quality of health care, it is worth presenting in national indices.

Keywords: abortion, eclampsia, hemorrhage, maternal mortility, near miss

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Authors: Tri Murti Tugiman, Awalyya Fasha

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

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

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Authors: Sohail Bawani, Kausar S. Khan, Rozina Karmaliani, Shehnaz Mir

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Action research (AR) is one of the types of health systems research (HSR), and participatory action research (PAR) is known for being effective in health systems strengthening (HSS). The current literature on PAR for HSS cites numerous examples and case studies that led to improve health services; build child health information system; increase knowledge and awareness of people about health problems, and identify pathways for institutional and policy change by engaging people in research. But examples of marginalized communities being agents of change in health governance are not common in health systems research (HSR). This approach to PAR is at the heart of Paolo Freire’s Social Transformation Theory and Critical Consciousness building, which was used to design a community-based PAR study in the Northern/mountainous areas of Pakistan. The purpose of the study was to understand the place and role of marginalized communities in strengthening existing health governance structure (health facility and village health committees and health boards) by taking marginalized communities as partners. Community meetings were carried out to identify who is living at the social, political, cultural and economic margins in 40 different villages. Participatory reflection and analysis (PRA) tools were used during the meeting to facilitate identification. Focus group discussions were conducted with marginalized groups using PRA tools and family ethnographies with marginalized families identified through group discussions. Findings of the study revealed that for the marginalized health systems constitute more than just delivery of health services, but it also embraces social determinants that surround systems and its governance. The paper argues that from Frerian perspective people’s participation should not only be limited to knowledge generation. People must be seen active users of the knowledge that they generate for achieving better health outcomes that they want to achieve in the time to come. PAR provides a pathway to the marginalized in playing a role in health governance. The study dissemination planned shall engage the marginalized in a dialogue with service providers so that together a role for the marginalized can be outlined.

Keywords: participatory action research, health systems, marginalized, health services

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Authors: Annika Kjallman Alm, Ove Hellzen, Malin Rising-Holmstrom

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Worldwide, the number of people who are living with dementia is increasing because of an aging population, which leads to increased financial and social costs, including reduced quality of life for people with dementia and their care partners. Most people who have dementia reside in the community. Aging in place could be described as having the health and social supports and services you need to live safely and independently in your home or your society for as long as you wish and are able. People with dementia are not different than people without dementia where they want to remain at home, if possible, with a sense of familiarity and engagement in typical everyday activities. So how do persons with dementia or cognitive decline see their possibilities to be socially involved and experience support? The aim of this study was to explore persons with cognitive decline's sense of involvement and support living in the ordinary dwelling. The study was approved by the Ethical Review Authority in Sweden prior to the interviews. Interviews were conducted with 20 persons living at home, either alone or in a relationship. The persons had perceived cognitive decline; some were under investigation or already had a diagnose of early dementia. Thematic analysis was used to identify, analyze, and report patterns within the data. Researchers extracted three main themes through participants’ interviews: a) Importance of social involvement with family and friends. b) Hindrances for social involvement. c) Struggling mentally with a new life situation. Results found that going to activity centers, staying involved, and meeting friends and family enhanced the sense of involvement and support. There were also hindrances to a sense of involvement and support as they struggled with the diagnose and the changes in daily life, such as physical problems, mental problems, or economic issues. The mental struggle of accepting the cognitive decline and the changes in daily life it brought was also an issue for some of the participants. A multidimensional support should be provided by the community to enable persons with cognitive decline to stay involved in family and community in the comfort of their own homes.

Keywords: aging in place, cognitive decline, dementia, sense of involvement

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Authors: Qudsiya Baig

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Empathy yields an unparalleled therapeutic value within patient physician interactions. Medical research is inundated with evidence to support that a physician’s ability to empathise with patients leads to a greater willingness to report symptoms, an improvement in diagnostic accuracy and safety, and a better adherence and satisfaction with treatment plans. Furthermore, the Institute of Medicine states that empathy leads to a more patient-centred care, which is one of the six main goals of a 21st century health system. However, there is a paradox between the theoretical significance of empathy and its presence, or lack thereof, in clinical practice. Recent studies have reported that empathy declines amongst students and physicians over time. The three most impactful contributors to this decline are: (1) disagreements over the definitions of empathy making it difficult to implement it into practice (2) poor consideration or regulation of empathy leading to burnout and thus, abandonment altogether, and (3) the lack of diversity in the curriculum and the influence of medical culture, which prioritises science over patient experience, limiting some physicians from using ‘too much’ empathy in the fear of losing clinical objectivity. These issues were investigated by conducting a fully inductive thematic narrative analysis of patient narratives in the UK to evaluate the behaviours and attitudes that patients associate with empathy. The principal enquiries underpinning this study included uncovering the factors that affected experience of empathy within provider-patient interactions and to analyse their effects on patient care. This research contributes uniquely to this discourse by examining the phenomenon of empathy directly from patients’ experiences, which were systematically extracted from a repository of online patient narratives of care titled ‘CareOpinion UK’. Narrative analysis was specifically chosen as the methodology to examine narratives from a phenomenological lens to focus on the particularity and context of each story. By enquiring beyond the superficial who-whatwhere, the study of narratives prescribed meaning to illness by highlighting the everyday reality of patients who face the exigent life circumstances created by suffering, disability, and the threat of life. The following six themes were found to be the most impactful in influencing the experience of empathy: dismissive behaviours, judgmental attitudes, undermining patients’ pain or concerns, holistic care and failures and successes of communication or language. For each theme there were overarching themes relating to either a failure to understand the patient’s perspective or a success in taking a person-centred approach. An in-depth analysis revealed that a lack of empathy was greatly associated with an emotive-cognitive imbalance, which disengaged physicians with their patients’ emotions. This study hereby concludes that competent providers require a combination of knowledge, skills, and more importantly empathic attitudes to help create a context for effective care. The crucial elements of that context involve (a) identifying empathy clues within interactions to engage with patients’ situations, (b) attributing a perspective to the patient through perspective-taking and (c) adapting behaviour and communication according to patient’s individual needs. Empathy underpins that context, as does an appreciation of narrative, and the two are interrelated.

Keywords: empathy, narratives, person-centred, perspective, perspective-taking

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

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

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

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Authors: Sharadha G., Suresh Kanakkanavar

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Background: Placenta previa is a condition characterized by partial or complete implantation of the placenta in the lower uterine segment. It is one of the main causes of vaginal bleeding in the third trimester and a significant cause of maternal and perinatal morbidity and mortality. Materials and Methods: This is an observational study involving 130 patients diagnosed with placenta previa and satisfying inclusion criteria. The demographic data, clinical, surgical, and treatment, along with maternal and neonatal outcome parameters, were noted in proforma. Results: The incidence of placenta previa among scarred uterus was 1.32%, and in unscarred uterus was 0.67%. The mean age of the study population was 27.12±4.426years. High parity, high abortion rate, multigravida status, and less gestational age at delivery were commonly seen in scarred uterus compared to unscarred uterus. Complete placenta previa, anterior placental position, and adherent placenta were significantly associated with a scarred uterus compared to an unscarred uterus. The rate of caesarean hysterectomy was higher in the scarred uterus, along with statistical association to previous lower-segment caesarean sections. Intraoperative procedures like uterine artery ligation, bakri balloon insertion, and iliac artery ligation were higher in the scarred group. The maternal intensive care unit admission rate was higher in the scarred group and also showed its statistical association with previous lower segment caesarean section. Neonatal outcomes in terms of pre-term birth, still birth, neonatal intensive care unit admission, and neonatal death, though higher in the scarred group, did not differ statistically among the groups. Conclusion: Advancing maternal age, multiparity, prior uterine surgeries, and abortions are independent risk factors for placenta previa. Maternal morbidity is higher in the scarred uterus group compared to the unscarred group. Neonatal outcomes did not differ statistically among the groups. This knowledge would help the obstetricians to take measures to reduce the incidence of placenta previa and scarred uterus which would improve the fetomaternal outcome of placenta previa.

Keywords: placenta previa, scarred uterus, unscarred uterus, adherent placenta

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Authors: Manuel Branco

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

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

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Authors: Richard Ssempala, Francis Kintu, Christine K. Tashobya

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Funding for health remains a key constraint facing many developing countries, Uganda inclusive. Uganda’s health sector budget to the national budgetary allocation has stagnated between 8.2% to 10% over the years. Using data collected from different government documents, we sought to establish the implications of the budget allocation over the period (FY2010/11-2018/19) on health services delivery in Uganda to inform policymakers specifically Members of Parliament who are critical in making sectorial allocation on the steps they can adapt to change the terrain of health financing in Uganda. Findings revealed that the contribution of public funding to the health sector is low (15.7%) with private sources (42.6%) and donors contributing much more, with the bulk of private funds, are out of pocket. The study further revealed that low budget allocation had been manifested in inadequate and poorly motivated health workers, essential drug stock-outs that ultimately contribute to poor access to services, catastrophic health expenditures, and high morbidity rates. We recommend for a substantial and sustained increase in the government health budget, optimizing the available resources by addressing wastages, prioritizing health promotion, prevention and finally, institutionalizing the National Health Insurance Scheme.

Keywords: budget allocations, universal health coverage, health service delivery, Uganda

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Authors: Nepton Kiani

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Dental decay is one of the most common chronic diseases worldwide and imposes significant costs annually on people and healthcare systems. Addressing this issue is among the important programs of the World Health Organization in the field of oral and dental disease prevention and health promotion. In this context, oral and dental health in vulnerable groups, especially pregnant women, is of greater importance due to the health maintenance of the mother and fetus. The aim of this study is to investigate the DMFT index and various factors affecting it in order to identify different factors influencing the process of dental decay and to take an effective step in reducing the progression of this disease, control, and prevention. In this cross-sectional descriptive study, 120 pregnant women attending Nepton Policlinica clinic in Malaga, Spain, were evaluated for the DMFT index and oral and dental hygiene. In this regard, interviews, precise observations, and data collection were used. Subsequently, data analysis was performed using SPSS software and employing correlation tests, Kruskal-Wallis, and Mann-Whitney tests. The DMFT index for pregnant women in three age groups 22-26, 27- 31, and 32-36 years was respectively 2.8, 4.5, and 5.6. The results of logistic regression analysis showed that demographic variables (age, education, job, economic status) and the frequency of brushing and flossing lead to preventive behavior up to 49.58 percent (P<0.05). Generally, the results indicated that oral and dental care during pregnancy is poor. Only a small number of pregnant women regularly used toothbrush and dental floss or visited the dentist regularly. On the other hand, poor performance in adopting oral and dental care was more observed in pregnant women with lower economic and educational status. The present study showed that raising the level of awareness and education on oral and dental health in pregnant women is essential. In this field, it is necessary to focus on conducting educational-care courses at the level of healthcare centers for midwives, healthcare personnel, and at the community level for families, to prevent and perform dental treatments before the pregnancy period

Keywords: Malaga, oral and dental health, pregnant women, Spain

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Authors: Florence Matsveru

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The 21st-century church in Africa is faced with a myriad of challenges, which need attention. One of those challenges is pastoral ministry to congregants in high positions. This paper is based on a Ph.D. study entitled, ‘Wellbeing and work performance of Christians in managerial positions: A Namibian case study’ conducted between 2015 and 2018. The study was conducted with 32 purposively selected Christians working in managerial positions in Ohangwena Region, Namibia. The study employed a mixed-methods approach, i.e., both qualitative (to get participants’ feelings and perceptions) and quantitative (to get proportions of the experiences and perceptions). The research process involved a questionnaire survey and interviews. The study revealed that Christians in managerial positions have both common and unique experiences in three spheres: the workplace, the family and the church. The experiences lead to physical, emotional, psychological, social and spiritual needs. The findings also showed that some of the expectations placed upon Christians in managerial positions in the church may be unrealistic, while at the same time this group of congregants want to use their work experiences for the benefit of the church. A worrying finding was that pastors are generally not well-trained for ministry to congregants in high positions. Since these were perceptions of the participants (some of whom were also pastors), the researcher went further to do a short internet survey of the curricula of a number of theological colleges in Southern Africa. This survey did not show any ‘manager-sensitive’ modules in the surveyed colleges. Theological education for pastors, especially in African theological institutions, seems to ignore the unique needs of congregants in high positions. This paper argues that the needs of Christians in high positions should be considered in pastoral care and that theological education is key in equipping pastors with the necessary knowledge and skills. This paper is, therefore, a call to theological institutions to include ministry to people in high positions in their curricula. Pastors who are already beyond theological school may find it helpful to attend or hold workshops that focus on congregants in high positions so that this kind of 'sheep' will find good pasture in the church. A paper of this nature helps to strengthen pastoral ministry and to enhance the relevance of theological education.

Keywords: Christian managers, theological curricula, pastoral care, African

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Authors: Shamsuddeen Muhammad Ahmad

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

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

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Authors: Sahar Shams

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Coeliac disease (CD) is a widely reported disease particularly in countries with predominant Caucasian populations. It presents with many signs and symptoms including iron deficiency (ID) and iron deficiency anaemia/anaemia (IDA/A). The exact association between ID, IDA/A and CD and how accurate these signs are in diagnosing CD is not fully known. This systematic review was conducted to investigate the accuracy of both ID & IDA/A as a diagnostic indicator for CD and whether it warrants point of care testing. A systematic review was performed looking at studies published in MEDLINE, Embase, Cochrane Library, and Web of Science. QUADAS-2 tool was used to assess risk of bias in each study. ROC curve and forest plots were generated as part of the meta-analysis after data extraction. 16 studies were identified in total, 13 of which were IDA/A studies and 3 ID studies. The prevalence of CD regardless of diagnostic indicator was assumed as 1%. The QUADAS-2 tool indicated most of studies as having high risk of bias. The PPV for CD was higher in those with ID than for those with IDA/A. Meta-analysis showed the overall odds of having CD is 5 times higher in individuals with ID & IDA/A. The ROC curve showed that there is definitely an association between both diagnostic indicators and CD, the association is not a particularly strong one due to great heterogeneity between studies. Whilst an association between IDA/A & ID and coeliac disease was evident, the results were not deemed significant enough to prompt coeliac disease testing in those with IDA/A & ID.

Keywords: anemia, iron deficiency anemia, coeliac disease, point of care testing

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Authors: Enkelejda Shkurti, Diamant Shtiza

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Background: Health-related quality of life (HRQoL) is a significant consequence in health care. The objective of our study was to recognize features related to lower HRQoL scores in children with anorectal malformation (ARM) and Hirschsprung disease (HD). Methods: Children younger than 18 years, with HD or ARM, that were assessed at our private clinic in Tirana, Albania, from December 2018 to October 2019, were acknowledged. The outcomes of broad questionnaires concerning diagnosis, symptoms, and preceding health/surgical history and authenticated tools to measure urinary status, stooling grade, and HRQoL were appraised. Results: In patients aged 0-6 years, vomiting and abdominal enlargement were allied with a substantial decrease in total HRQoL scores. In children > 6 years of age, vomiting, abdominal swelling, and abdominal discomfort were also linked to a considerably lower HRQoL. The main indicator of lower HRQoL scores on regression tree analysis in all age clusters was the occurrence of psychosomatic, behavioral, or progressive comorbidity. Conclusion: Children with both HD or ARM that have a psychosomatic, behavioral, or growing problem experience considerably lower HRQoL than patients deprived of such problems, proposing that establishment of behavioral/growing sustenance as part of the care of these patients may have a considerable influence on their HRQoL.

Keywords: anorectal malformation, Hirsch Sprung disease, quality of life, Albania

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Authors: Aneena Suresh, C. S. Sidharth

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

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

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Authors: Rose Chapman Rodriguez

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Problem: Evidence-based practice (EBP) attributes are significantly associated with EBP implementation science, which improves patient care outcomes. Nurses influence EBP, yet little is known of the specific EBP attributes of pediatric nurses in their clinical sub-specialties. Aim: This study aims to investigate the relationship between nursing academic degree, years of experience, and clinical specialty, with mean survey scores on EBP belief, organizational culture, and implementation scales across all levels of nursing in a Children’s Hospital. Methods: A convenience sample of nurses (n=185) participated in a descriptive, cross-sectional, correlational study in May 2023. The electronic surveys comprised 11 demographic questions and nine survey items from the short-version EBP Beliefs Scale (Cronbach α = 0.81), Organizational Culture and Readiness Scale for System-wide Integration Scale (Cronbach α = 0.87), and EBP Implementation Scale (Cronbach α = 0.89). Findings: EBP belief scores were notably higher in nurses working in neonatology (m=4.33), critical care (m=4.47), and among nurse leaders (m=4.50). There was a statistically significant difference in EBP organizational culture among nurse leaders (m = 3.95, p=0.039) compared to clinical nurses (m = 3.34) and advanced practice nurses (m = 3.34). EBP implementation was favorable in neonatology (m=4.20), acute care (m=4.05), and nurse leaders (m=4.33). No significant difference or correlation was found in EBP belief, organizational culture, or implementation mean scores related to nurses' age, academic nursing degree, or years of experience in our cohort (EBP beliefs (r = -.06, p = .400), organizational readiness (r = .02, p = .770), and implementation scales (r = .01, p = .867). Conclusions: This study identified nurse’s EBP attributes in a Children’s Hospital using key variables studied in EBP social cognitive theory and learning theory. Magnet status, shared governance structure, specialty certification, and nurse leaders play a significant role in favorable EBP culture and implementation. Nurses’ unit level ‘group culture’ may vary depending on the EBP attributes and collaborative efforts of local teams. Opportunities for mentoring were identified, which may continue to enhance EBP implementation science across all nursing roles in our pediatric organization.

Keywords: evidence-based practice, peditrics, nursing roles, implementation

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Authors: Eetedal Alanjem, Majedah Alnajem

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

Keywords: innovation, entrepreneurship, creativity, organisational development

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

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

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

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Authors: Ibrahim A. Alkali

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There is no reservation on the outstanding contribution of patient families in restoration of hospitalised patients, hence their consideration as essential component of hospital ward regimen. The psychological and emotional support a patient requires has been found to be solely provided by the patient’s family. However, consideration of their presence as one of the major functional requirements of an inpatient setting design have always been a source of disquiet, especially in developing countries where policies, norms and protocols of healthcare administration have no consideration for the patients’ family. This have been a major challenge to the hospital ward facilities, a concern for the hospital administration and patient management. The study therefore is aimed at obtaining a consensus opinion on the best approach for family integration in the design of an inpatient setting.  A one day visioning charrette involving Architects, Nurses, Medical Doctors, Healthcare assistants and representatives from the Patient families was conducted with the aim of arriving at a consensus opinion on practical design approach for sustainable family integration. Patient’s family are found to be decisive character of hospital ward regimen that cannot be undermined. However, several challenges that impede family integration were identified and subsequently a recommendation for an ideal approach. This will serve as a guide to both architects and hospital management in implementing much desired Patient and Family Centred Care.

Keywords: patient's family, inpatient setting, care giving, integration

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Authors: S. Tavuyanago

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

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

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Authors: Ryota Sugino, Satoshi Mizoguchi, Koji Kimita, Keiichi Muramatsu, Tatsunori Matsui, Yoshiki Shimomura

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Improving added value and productivity of services entails improving both value-in-exchange and value-in-use. Value-in-use is realized by value co-creation, where providers and receivers create value together. In higher education services, value-in-use comes from learners achieving learning outcomes (e.g., knowledge and skills) that are consistent with their learning goals. To enhance the learning outcomes of a learner, it is necessary to enhance and utilize the abilities of the teacher along with the abilities of the learner. To do this, however, the learner and the teacher need to build a consensus about their respective roles. Teachers need to provide effective learning content; learners need to choose the appropriate learning strategies by using the learning content through consensus building. This makes consensus building an important factor in value co-creation. However, methods to build a consensus about their respective roles may not be clearly established, making such consensus difficult. In this paper, we propose some strategies for consensus building between a teacher and a learner in value co-creation. We focus on a teacher and learner co-design and propose an analysis method to clarify a collaborative design process to realize value co-creation. We then analyze some counseling data obtained from a university class. This counseling aimed to build a consensus for value-in-use, learning outcomes, and learning strategies between the teacher and the learner.

Keywords: consensus building, value co-creation, higher education, learning service

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Authors: Mokgadi Malatji, Tebogo Mothiba, Rambelani Malema

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Absenteeism is a global problem in the working force and this is no exception in the nursing profession. A lot of attention has been drawn to factors that contribute to absenteeism however little attention has been placed on the effects of absenteeism on the remaining workers/nurses being left behind in the workplace by their colleagues. Nurses absent themselves leaving behind their colleagues to do their work. Nurses who are committed to their work often find themselves working under strenuous conditions due to inadequate staff. These may lead to poor patient care provision, nurses feeling overworked and sick due to the increased workload. The purpose of this study was to investigate the effects of absenteeism on nurses that remained at work at Mankweng Hospital in the Capricorn District, Limpopo Province. A descriptive cross-sectional quantitative research design was conducted to determine if there were any effects of absenteeism on nurses remaining at work. Data collection was done using structured questionnaires. The respondents (n=107), consisted of different categories of registered nurses (professional nurses (n=43), auxiliary nurses (n=40) and staff nurses (n=24)) who participated in this study. The findings indicated that most nurses (76, 6%) are demotivated and they struggle with completion of duties when their colleagues are absent. Patient care that nurses provided when their colleagues were absent was of poor quality as set standards and principles were not adhered to. Individualized patient care was not being implemented due to absenteeism. This simply implies that routine work is being done to cover basic duties. Most nurses (74, 8%) believed that favoritism and lack of appreciation of nurse’s skills and capabilities are being displayed by managers and that this contributes to absenteeism. Nurses who are loyal sacrifice their time and work overtime for absent colleagues and this led to fatigue and stress. From the study findings, it is recommended that nurses be trained frequently to upgrade their studies to motivate them to work. The government can provide this training to improve their skills as this will motivate nurses to work harder and be committed to their work. Training can be offered after a stipulated period. For example, after every five years, a nurse can be provided with a new skill. Team building events must be encouraged for the whole hospital to motivate staff. In conclusion, the study revealed that absenteeism poses detrimental effects on nurses, the hospital and patients. More and more nurses end up changing workplace due to these effects.

Keywords: absenteeism, effects, nurses, remaining at work

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Authors: F. DelGaudio, H. Gill

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Resuscitation during cardiopulmonary (CPA) arrest is dynamic, high stress, high acuity situation, which can easily lead to communication breakdown, and errors. The care of these high acuity patients has also been shown to increase physiologic stress and task saturation of providers, which can negatively impact the care being provided. These difficulties are further complicated during a global pandemic and pose a significant safety risk to bedside providers. Nurse-led codes are a relatively new concept that may be a potential solution for alleviating some of these difficulties. An experienced nurse who has completed advanced cardiac life support (ACLS), and additional training, assumed the responsibility of directing the mechanics of the appropriate ACLS algorithm. This was done in conjunction with a physician who also acted as a physician leader. The additional nurse-led code training included a multi-disciplinary in situ simulation of a CPA on a suspected COVID-19 patient. During the CPA, the nurse leader’s responsibilities include: ensuring adequate compression depth and rate, minimizing interruptions in chest compressions, the timing of rhythm/pulse checks, and appropriate medication administration. In addition, the nurse leader also functions as a last line safety check for appropriate personal protective equipment and limiting exposure of staff. The use of nurse-led codes for CPA has shown to decrease the cognitive overload and task saturation for the physician, as well as limiting the number of staff being exposed to a potentially infectious patient. The real-world application has allowed physicians to perform and oversee high-risk procedures such as intubation, line placement, and point of care ultrasound, without sacrificing the integrity of the resuscitation. Nurse-led codes have also given the physician the bandwidth to review pertinent medical history, advanced directives, determine reversible causes, and have the end of life conversations with family. While there is a paucity of research on the effectiveness of nurse-led codes, there are many potentially significant benefits. In addition to its value during a pandemic, it may also be beneficial during complex circumstances such as extracorporeal cardiopulmonary resuscitation.

Keywords: cardiopulmonary arrest, COVID-19, nurse-led code, task saturation

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Authors: B. Mack, K. Tampe-Mai, E. Diesch

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Findings of an ongoing discrete choice study of future transport mode choice will be presented. Many urban centers face the triple challenge of having to cope with ever increasing traffic congestion, environmental pollution, and greenhouse gas emission brought about by private car use. In principle, private car use may be diminished by extending public transport systems like bus lines, trams, tubes, and trains. However, there are limits to increasing the (perceived) spatial and temporal flexibility and reducing peak-time crowding of classical public transport systems. An emerging new type of system, publicly or privately operated on-demand shuttle bus services, seem suitable to ameliorate the situation. A fleet of on-demand shuttle busses operates without fixed stops and schedules. It may be deployed efficiently in that each bus picks up passengers whose itineraries may be combined into an optimized route. Crowding may be minimized by limiting the number of seats and the inter-seat distance for each bus. The study is conducted as a discrete choice experiment. The choice between private car, public transport, and shuttle service is registered as a function of several push and pull factors (financial costs, travel time, walking distances, mobility tax/congestion charge, and waiting time/parking space search time). After the completion of the discrete choice items, the study participant is asked to rate the three modes of transport with regard to the pull factors of comfort, safety, privacy, and opportunity to engage in activities like reading or surfing the internet. These ratings are entered as additional predictors into the discrete choice experiment regression model. The study is conducted in the region of Stuttgart in southern Germany. N=1000 participants are being recruited. Participants are between 18 and 69 years of age, hold a driver’s license, and live in the city or the surrounding region of Stuttgart. In the discrete choice experiment, participants are asked to assume they lived within the Stuttgart region, but outside of the city, and were planning the journey from their apartment to their place of work, training, or education during the peak traffic time in the morning. Then, for each item of the discrete choice experiment, they are asked to choose between the transport modes of private car, public transport, and on-demand shuttle in the light of particular values of the push and pull factors studied. The study will provide valuable information on the potential of switching from private car use to the use of on-demand shuttles, but also on the less desirable potential of switching from public transport to on-demand shuttle services. Furthermore, information will be provided on the modulation of these switching potentials by pull and push factors.

Keywords: determinants of travel mode choice, on-demand shuttle services, private car use, public transport

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