Search results for: community health center

Authors: Molnar Catalina, Lexi Frankel, Amalia Ardeljan, Enoch Kim, Marissa Dallara, Omar Rashid

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Introduction: Clostridium difficile (C. diff) is a toxin-producing bacteria that can cause diarrhea and colitis. U.S. Center for Disease Control and Prevention revealed that C. difficile infection (CDI) has increased from 31 cases per 100,000 persons per year in 1996 to 61 per 100,000 in 2003. Approximately 500,000 cases per year occur in the United States. After exposure, the bacteria colonize the colon, where it adheres to the intestinal epithelium where it produces two toxins: TcdA and TcdB. TcdA affects the intestinal epithelium, causing fluid secretion, inflammation, and tissue necrosis, while TcdB acts as a cytotoxin purpose of this study was to evaluate the association between C diff infection and bronchial lung cancer development. Methods: Using ICD- 9 and ICD-10 codes, the data was provided by a Health Insurance Portability and Accountability Act (HIPAA) compliant national database to assess the patients infected with C diff as opposed to the non-infected patients. The Holy Cross Health, Fort Lauderdale, granted access to the database for the purpose of academic research. Patients were matched for age and Charlson Comorbidity Index (CCI). Standard statistical methods were used. Results: Bronchial lung cancer occurrence in the population not infected with C diff infection was 4741, as opposed to the population infected with C. diff, where 2039 cases of lung cancer were observed. The difference was statistically significant (p-value < 2.2x10^e-16), which reveals that C diff might be protective against bronchial lung cancer. The data was then matched by treatment to create to minimize the effect of treatment bias. Bronchial cancer incidence was 422 and 861 in infected vs. non-infected (p-value of < 2.2x10^e-16), which once more indicates that C diff infection could be beneficial in diminishing bronchial cancer development. Conclusion: This retrospective study conveys a statistical correlation between C diff infection and decreased incidence of lung bronchial cancer. Further studies are needed to comprehend the protective mechanisms of C. Diff infection on lung cancer.

Keywords: C. diff, lung cancer, protective, microbiology

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Authors: Emiko Suzuki

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Although fitness is defined as the body’s ability to respond to the demand of physical activity without undue fatigue in health science, in media oftentimes physical activity is presented as means to an attractive body rather than a fit and healthy one. Of all types of media, Instagram is becoming an increasingly persuasive source of information and advice on health and fitness, where individuals conceptualize what health and fitness mean for them. However, this user-generated and unregulated platform can be problematic, as it can communicate misleading information about health and fitness and possibly leading individuals to psychological problems such as eating disorders. In fact, previous research has shown that some messages that were posted with a tag that related to inspire others to do fitness, in fact, encouraged distancing the self from the internal needs of the body. For this reason, this present study aims to explore how health and fitness are communicated on Instagram by analyzing images and texts. A content analysis of images that were labeled with particular hashtags was performed, followed by a thematic analysis of texts from the same set of images. The result shows an interesting insight about messages about how health and fitness are communicated from companies through media, then digested and further shared among communities on Instagram. The study explores how the use of visual focused way of communicating health and fitness can lead to the dehumanization of human bodies.

Keywords: Instagram, fitness, dehumanization, body image, embodiment

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Authors: Cynthia Adlerstein-Grimberg, Andrea Bralic-Echeverría

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An extensive and controversial research debate discusses pedagogical documentation (PD) within early childhood education (ECE) as integral to ECE teachers' professional development. The literature converges in acknowledging that ICT integration in PD can be fundamental for children's and teachers' collaborative learning by making their processes visible and open to reflection. Controversial issues about PD emerge around ICT integration and the use of multimedia applications and platforms, displacing the physical experience involved in this pedagogical practice. Authors argue that online platforms make PD become a passive device to demonstrate accountability and performance. Furthermore, ICT integration would make educators inform children and families of pedagogical processes, positioning them more as consumers instead of involving them in collective thinking and pedagogical decision-making. This article analyses how pedagogical documentation mediated by a multimedia application (MAFApp) allows for the positive strengthening of an ECE pedagogical online community that thinks collectively about learning environments. In doing so, the paper shows how ICT integration supports ECE teachers' collective online thinking, enabling them to move from the controversial version of online PD, where they only act as informers of children's learning and assume a voyeuristic perspective, towards a collective online thinking that builds professional development and supports pedagogical decision-making about learning environments. This article answers How ECE teachers' pedagogical documentation evolves with ICT integration using the MAFApp multimedia application in a national ECE online community. From a posthumanist stance, this paper draws on an 18-month collaborative ethnographic immersion in Chile's unique public ECE online PD community. It develops a unique case study of an online ECE pedagogical community mediated by a multimedia application called MAFApp. This ECE online community includes 32 Chilean public kindergartens, 45 ECE teachers, and 72 assistants, who produced 534 pedagogical documentation. Fieldwork included 35 in-depth interviews, 13 discussion groups, and the constant comparison method for the PD coding. Findings show ICT integration in PD builds collective online thinking that evolves through four moments of growing complexity: 1) teachernalism of built environments, 2) onlookerism of children's anecdotes in learning environments; 3) storytelling of children's place-making, and 4) empowering pedagogies for co-creating learning environments. ICT integration through the MAFApp multimedia application enabled ECE teachers to build collective online thinking, making pedagogies of place visible and engaging children in co-constructing learning environments. This online PD is a continuous professional learning space for ECE teachers, empowering pedagogies of place. In conclusion, ICT integration into PD progressively empowers pedagogies of place in Chilean public ECE. Strengthening collective online thinking using the MAFApp multimedia application sharply contrasts with some recent PD research findings. ICT integration to PD enabled strong collective online thinking. Doing so makes PD operate as a place of professional development, pedagogical reflective encounters, and experimentation while inhabiting their own learning environments with children.

Keywords: early childhood education, ICT integration, multimedia application, online collective thinking, pedagogical documentation, professional development

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Authors: Ioannis Panagiotopoulos, Efstathios Kastritis, Anastasia Katinioti, Georgios Efthymiadis, Argyrios Doumas, Maria Koutelou

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Introduction: Transthyretin amyloidosis (ATTR) is a rare but serious infiltrative disease. Myocardial scintigraphy with DPD has emerged as the most effective, non-invasive, highly sensitive, and highly specific diagnostic method for cardiac ATTR amyloidosis. However, there are cases in which additional laboratory investigations reveal AL amyloidosis or other diseases despite a positive DPD scintigraphy. We describe the experience from the Onassis Cardiac Surgery Center and the monitoring center for infiltrative myocardial diseases of the cardiology clinic at AHEPA. Materials and Methods: All patients with clinical suspicion of cardiac or extracardiac amyloidosis undergo a myocardial scintigraphy scan with Tc-99m DPD. In this way, over 500 patients have been examined. Further diagnostic approach based on clinical and imaging findings includes laboratory investigation and invasive techniques (e.g., biopsy). Results: Out of 76 patients in total with positive myocardial scintigraphy Grade 2 or 3 according to the Perugini scale, 8 were proven to suffer from AL Amyloidosis during the investigation of paraproteinemia. Among these patients, 3 showed Grade 3 uptake, while the rest were graded as Grade 2, or 2 to 3. Additionally, one patient presented diffuse and unusual radiopharmaceutical uptake in soft tissues throughout the body without cardiac involvement. These findings raised suspicions, leading to the analysis of κ and λ light chains in the serum, as well as immunostaining of proteins in the serum and urine of these specific patients. The final diagnosis was AL amyloidosis. Conclusion: The value of DPD scintigraphy in the diagnosis of cardiac amyloidosis from transthyretin is undisputed. However, positive myocardial scintigraphy with DPD should not automatically lead to the diagnosis of ATTR amyloidosis. Laboratory differentiation between ATTR and AL amyloidosis is crucial, as both prognosis and therapeutic strategy are dramatically altered. Laboratory exclusion of paraproteinemia is a necessary and essential step in the diagnostic algorithm of ATTR amyloidosis for all positive myocardial scintigraphy with diphosphonate tracers since >20% of patients with Grade 3 and 2 uptake may conceal AL amyloidosis.

Keywords: AL amyloidosis, amyloidosis, ATTR, myocardial scintigraphy, Tc-99m DPD

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Authors: M. P. Sebastian

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Health for all is considered as a sign of well-being and inclusive growth. New healthcare technologies are contributing to the quality of human lives by promoting health education and awareness, leading to the prevention, early diagnosis and treatment of the symptoms of diseases. Healthcare technologies have now migrated from the medical and institutionalized settings to the home and everyday life. This paper explores these new technologies and investigates how they contribute to health education and awareness, promoting the objective of high-value health system for all. The methodology used for the research is literature review. The paper also discusses the opportunities and challenges with futuristic healthcare technologies. The combined advances in genomics medicine, wearables and the IoT with enhanced data collection in electronic health record (EHR) systems, environmental sensors, and mobile device applications can contribute in a big way to high-value health system for all. The promise by these technologies includes reduced total cost of healthcare, reduced incidence of medical diagnosis errors, and reduced treatment variability. The major barriers to adoption include concerns with security, privacy, and integrity of healthcare data, regulation and compliance issues, service reliability, interoperability and portability of data, and user friendliness and convenience of these technologies.

Keywords: big data, education, healthcare, information communication technologies (ICT), patients, technologies

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Authors: Charles St. Geste, Michael Neumann, Catherine Twohig

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Our primary aim is to examine farmer-centered participatory action learning as a tool to improve agricultural production, build resilience to climate shocks and, more broadly, advance community-driven solutions for sustainable development in rural communities across Haiti. For over six years, sixty plus farmers from Deslandes, Haiti, organized in three traditional work groups called konbits, have designed and tested low-input agroecology techniques as part of the Konbit Vanyan Kapab Pwoje Agroekoloji. The project utilizes a participatory action learning approach, emphasizing social inclusion, building on local knowledge, experiential learning, active farmer participation in trial design and evaluation, and cross-community sharing. Mixed methods were used to evaluate changes in knowledge and adoption of agroecology techniques, confidence in advancing agroecology locally, and innovation among Konbit Vanyan Kapab farmers. While skill and knowledge in application of agroecology techniques varied among individual farmers, a majority of farmers successfully adopted techniques outside of the trial farms. The use of agroecology techniques on trial and individual farms has doubled crop production in many cases. Farm income has also increased, and farmers report less damage to crops and property caused by extreme weather events. Furthermore, participatory action strategies have led to greater local self-determination and greater capacity for sustainable community development. With increased self-confidence and the knowledge and skills acquired from participating in the project, farmers prioritized sharing their successful techniques with other farmers and have developed a farmer-to-farmer training program that incorporates participatory action learning. Using adult education methods, farmers, trained as agroecology educators, are currently providing training in sustainable farming practices to farmers from five villages in three departments across Haiti. Konbit Vanyan Kapab farmers have also begun testing production of value-added food products, including a dried soup mix and tea. Key factors for success include: opportunities for farmers to actively participate in all phases of the project, group diversity, resources for application of agroecology techniques, focus on group processes and overcoming local barriers to inclusive decision-making.

Keywords: agroecology, participatory action learning, rural Haiti, sustainable community development

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Authors: Karim Hajjar, Luis Lillo, Diego Martinez, Manuel Hermosilla, Nicholas Risko

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Objectives: This study examines the relationship between universal health coverage (UCH) and the burden of emergency diseases at a global level. Methods: Data on Disability-Adjusted Life Years (DALYs) from emergency conditions were extracted from the Institute for Health Metrics and Evaluation (IHME) database for the years 2015 and 2019. Data on UHC, measured using two variables, 1) coverage of essential health services and 2) proportion of population spending more than 10% of household income on out-of-pocket health care expenditure, was extracted from the World Bank Database for years preceding our outcome of interest. Linear regression was performed, analyzing the effect of the UHC variables on the DALYs of emergency diseases, controlling for other variables. Results: A total of 133 countries were included. 44.4% of the analyzed countries had coverage of essential health services index of at least 70/100, and 35.3% had at least 10% of their population spend greater than 10% of their household income on healthcare. For every point increase in the coverage of essential health services index, there was a 13-point reduction in DALYs of emergency medical diseases (95% CI -16, -11). Conversely, for every percent decrease in the population with large household expenditure on healthcare, there was a 0.48 increase in DALYs of emergency medical diseases (95% CI -5.6, 4.7). Conclusions: After adjusting for multiple variables, an increase in coverage of essential health services was significantly associated with improvement in DALYs for emergency conditions. There was, however, no association between catastrophic health expenditure and DALYs.

Keywords: emergency medicine, universal healthcare, global health, health economics

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Authors: M. S. Aparna, Pushparaj Shetty D.

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Nowadays social networking sites have become so popular that the producers or the sellers look for these sites as one of the best options to target the right audience to market their products. There are several tools available to monitor or analyze the social networks. Our task is to identify the right community web pages and find out the behavior analysis of the members by using these tools and formulate an appropriate strategy to market the products or services to achieve the set goals. The advertising becomes more effective when the information of the product/ services come from a known source. The strategy explores great buying influence in the audience on referral marketing. Our methodology proceeds with critical budget analysis and promotes viral influence propagation. In this context, we encompass the vital bits of budget evaluation such as the number of optimal seed nodes or primary influential users activated onset, an estimate coverage spread of nodes and maximum influence propagating distance from an initial seed to an end node. Our proposal for Buyer Prediction mathematical model arises from the urge to perform complex analysis when the probability density estimates of reliable factors are not known or difficult to calculate. Order Statistics and Buyer Prediction mapping function guarantee the selection of optimal influential users at each level. We exercise an efficient tactics of practicing community pages and user behavior to determine the product enthusiasts on social networks. Our approach is promising and should be an elementary choice when there is little or no prior knowledge on the distribution of potential buyers on social networks. In this strategy, product news propagates to influential users on or surrounding networks. By applying the same technique, a user can search friends who are capable to advise better or give referrals, if a product interests him.

Keywords: viral marketing, social network analysis, community web pages, buyer prediction, influence propagation, budget constraints

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Authors: Nikat Parveen, M. Ananthi

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Big data is one of the emerging technology, which collects the data from various sensors and those data will be used in many fields. Data retrieval is one of the major issue where there is a need to extract the exact data as per the need. In this paper, large amount of data set is processed by using the feature selection. Feature selection helps to choose the data which are actually needed to process and execute the task. The key value is the one which helps to point out exact data available in the storage space. Here the available data is streamed and R-Center is proposed to achieve this task.

Keywords: big data, key value, feature selection, retrieval, performance

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Authors: M. Aljumaan, F. Alkhadra, A. Aldajani, M. Alarfaj, A. Alawami, Y. Aljamaan

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Introduction: The internet has been widely available with 18 million users in Saudi Arabia alone. It was shown that 58% of Saudis are using the internet as a source of health-related information which may contribute to overcrowding of the Emergency Room (ER). Not many studies have been conducted to show the effect of online searching for health related information (HRI) and its role in influencing internet users to visit various health care facilities. So the main objective is to determine a correlation between HRI website use and health care facility visits in Saudi Arabia. Methodology: By conducting a cross sectional study and distributing a questionnaire, a total number of 1095 people were included in the study. Demographic data was collected as well as questions including the use of HRI websites, type of websites used, the reason behind the internet search, which health care facility it lead them to visit and whether seeking health information on the internet influenced their attitude towards visiting health care facilities. The survey was distributed using an internet survey applications. The data was then put on an excel sheet and analyzed with the help of a biostatician for making a correlation. Results: We found 91.4% of our population have used the internet for medical information using mainly General medical websites (77.8%), Forums (34.2%), Social Media (21.6%), and government websites (21.6%). We also found that 66.9% have used the internet for medical information to diagnose and treat their medical conditions on their own while 34.7% did so due to the inability to have a close referral and 29.5% due to their lack of time. Searching for health related information online caused 62.5% of people to visit health care facilities. Outpatient clinics were most visited at 77.9% followed by the ER (27.9%). The remaining 37.5% do not visit because using HRI websites reassure them of their condition. Conclusion: In conclusion, there may be a correlation between health information website use and health care facility visits. However, to avoid potentially inaccurate medical information, we believe doctors have an important role in educating their patients and the public on where to obtain the correct information & advertise the sites that are regulated by health care officials.

Keywords: ER visits, health related information, internet, medical websites

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Authors: Liong-Rung Liu, Yu-Hui Chiu, Wen-Han Chang

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Firearm injuries are high-energy injuries. The ballistic pathways could cause severe burns or chemical damages to vessels, musculoskeletal or other major organs. The high mortality rate is accompanied by complications such as sepsis. As laws prohibit gun possession, civilian gunshot wounds (GSW) are relatively rare in Taiwan. Our hospital, Mackay Memorial Hospital, located at the center of Taipei city is surrounded by nightclubs and red-light districts. Due to this unique location, our hospital becomes the first-line trauma center managing gunshot victims in Taiwan. To author’s best knowledge, there are few published research articles regarding this unique situation. We hereby analyze the distinct characteristics and length of stay (LOS) of GSW patients in the emergency room (ER) at Mackay Memorial Hospital. A 6-year retrospective analysis of 27 patients treated for GSW injuries from January 2012 to December 2017 was performed. The patients’ records were reviewed for the following analyses, 1) wound position and the correlated clinical presentations; 2) the LOS in ED of patients receiving emergency surgery for major organ or vascular injuries. We found males (96.3%) were injured by guns more often than females (3.7%) in all age groups. The most common injured site was in the extremities. With regards to the ER LOS, the average time were 72.2 ± 34.5 minutes for patients with triage I and 207.4 ± 143.9 minutes for patients with triage II. The ED LOS of patients whose ISS score were more than 15 was 59.9 ± 25.6 minutes, and 179.4 ± 119.8 minutes for patients whose ISS score were between 9 to 15, respectively. Among these 27 patients, 10 patients had emergency surgery and their average ED stay time was 104.5 ± 33.3 minutes. Even more, the average ED stay time could be shortened to 88.8 ± 32.3 minutes in the 5 patients with trauma team activation. In conclusion, trauma team activation in severe GSW patients indeed shortens the ED LOS and might initially improve the quality of patient care. This is the result of better trauma systems, including advances in care from emergency medical services and acute care surgical management.

Keywords: gunshot, length of stay, trauma, mortality

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Authors: Lok Raj Joshi, Naveen Prakash Shah, Sharad Kumar Sharma, I. Ratna Bhattarai, Rajendra Basnet, Deepak Dahal, Bahagwan Maharjan, Seraphine Kaminsa

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Context: Tuberculosis (TB) is a significant health issue in Nepal, a country with a high burden of the disease. Despite efforts to control TB, there is still a gap in the notification of TB cases, which hinders effective control and treatment. This paper aims to address this notification gap and proposes strategies to improve TB control in Nepal. Research Aim: The aim of this research is to understand and address the tuberculosis notification gap in Nepal. The focus is on enhancing the healthcare system, involving the private sector and communities, raising awareness, and addressing social determinants to achieve sustainable TB control. Methodology: The research methodology involved a review of existing epidemiological data and research studies related to TB in Nepal. Additionally, consultation with an expert group from the TB control program in Nepal provided insights into the current state of TB control and challenges in addressing the notification gap. Findings: The findings reveal that only 55% of TB cases were reported in 2022, indicating a significant notification gap. Of the reported cases, only 32% and 19% were referred by the private sector and community, respectively. Furthermore, 20% of diagnosed cases were not treated in the initial phase. The estimated number of cases of multidrug-resistant TB (MDR TB) was 2,800, suggesting a low diagnosis rate. Among the diagnosed MDR TB cases, only 60% were receiving treatment. Additionally, it was observed that 20% of diagnosed MDR TB cases were from India and not enrolling in TB treatment in Nepal, indicating a high rate of defaulters. Theoretical Importance: The study highlights the importance of adopting a holistic strategy to address the notification gap in TB cases in Nepal. It emphasizes the need to enhance healthcare infrastructure, raise awareness, involve the private sector and local communities, establish effective methods to trace initial defaulters, implement TB interventions in border regions, and mitigate the social stigma associated with the disease. Data Collection and Analysis Procedures: Data for this study was collected through a review of existing epidemiological data and research studies. The data were then analyzed to identify patterns, trends, and gaps in TB case notification in Nepal.

Keywords: TB, tuberculosis, private sector, community, migrants, nepal

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Authors: Mahnoor Shoaib

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Sustainable development involves meeting present needs without compromising future generations’ capacity to meet their own while enhancing the quality of life through a healthy and safe environment. In the context of rapid urbanization and globalization, architects and planners bear the responsibility of designing residential buildings that are sustainable and conducive to quality living. Residential buildings serve as multifunctional spaces for personal and family life, making them essential for fostering healthy communities. Therefore, sustainable housing must address not only economic and environmental factors but also social, historical, and cultural dimensions to enhance residents' social lives. This research investigates the socio-cultural aspects of tall residential buildings in Karachi, Pakistan, a developing community characterized by rapid population growth and urbanization. A mixed-methods approach, including qualitative interviews and surveys, was employed to assess residents' perceptions of sustainability in tall buildings, focusing on socio-cultural design constraints and their impact on residential satisfaction. The study finds that socio-cultural elements, such as liveability, social cohesion, and spatial agency, significantly influence residents’ satisfaction with high-rise developments. Moreover, it highlights the need for contextual design solutions that integrate local cultural values into the architecture of tall buildings rather than imposing Western design principles. In conclusion, this research provides valuable insights for architects, designers, and urban planners, emphasizing the importance of understanding community needs and preferences in developing sustainable residential environments. By prioritizing socio-cultural sustainability, we can enhance the overall quality of life for residents in tall buildings, contributing to healthier and more vibrant communities.

Keywords: high-rise residential buildings, quality of life, social cohesion, socio-cultural sustainability

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Authors: Meenalochana Inguva

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The context: The Center for Preparatory study is one of the strongest and most vibrant academic teaching units of the Sultan Qaboos University (SQU). The Foundation Programme English Language (FPEL) is part of a larger foundation programme which was implemented at SQU in fall 2010. The programme has been designed to prepare the students who have been accepted to study in the university in order to achieve the required educational goals (the learning outcomes) that have been designed according to Oman Academic Standards and published by the Omani Authority for Academic Accreditation (OAAA) for the English language component. The curriculum: At the CPS, the English language curriculum is based on the learning outcomes drafted for each level. These learning outcomes guide the students in meeting what is expected of them by the end of each level. These six levels are progressive in nature and are seen as a continuum. The study: A periodic evaluation of language programmes is necessary to improve the quality of the programmes and to meet the set goals of the programmes. An evaluation may be carried out internally or externally depending on the purpose and context. A self-study programme was initiated at the beginning of spring semester 2015 with a team comprising a total of 11 members who worked with-in the assigned course areas (level and programme specific). Only areas specific to FPEL have been included in the study. The study was divided into smaller tasks and members focused on their assigned courses. The self-study primarily focused on analyzing the programme LOs, curriculum planning, materials used and their relevance against the GFP exit standards. The review team also reflected on the assessment methods and procedures followed to reflect on student learning. The team has paid attention to having standard criteria for assessment and transparency in procedures. A special attention was paid to the staging of LOs across levels to determine students’ language and study skills ability to cope with higher level courses. Findings: The findings showed that most of the LOs are met through the materials used for teaching. Students score low on objective tests and high on subjective tests. Motivated students take advantage of academic support activities others do not utilize the student support activities to their advantage. Reading should get more hours. In listening, the format of the listening materials in CT 2 does not match the test format. Some of the course materials need revision. For e.g. APA citation, referencing etc. No specific time is allotted for teaching grammar Conclusion: The findings resulted in taking actions in bridging gaps. It will also help the center to be better prepared for the external review of its FPEL curriculum. It will also provide a useful base to prepare for the self-study portfolio for GFP standards assessment and future audit.

Keywords: curriculum planning, learning outcomes, reflections, self-evaluation

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Authors: Bimal Raj Regmi, Cassandra Star

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Climate change adaptation is now the priority of many Least Developed Countries (LDCs). The country governments in LDCs are designing institutional and financing architecture to implement adaptation programmes. Nepal has introduced the concept of Local Adaptation Plan of Action (LAPA) to facilitate adaptation at the local level. However, there is lack of clarity and ambiguity on whether or not LAPA can be effective means to reach to the most vulnerable. This research paper aims to generate evidences to assess the applicability and significance of LAPA. The study used a case study approach and relied on data gathered from field studies carried out in Pyuthan and Nawalparasi district of Nepal. The findings show that LAPA has potentials to link the community based adaptation with national adaptation initiatives and thus act as middle range approach to adaptation planning. However, the current scale of LAPA and its approaches to planning and delivery are constraints by socio-economic and governance barriers. This research paper argue that the in order to address the constraints a more flexible and co-management approach to LAPA is needed.

Keywords: community based adaptation, local adaptation, co-management, climate change

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Authors: Ivan M. Taremwa, Scholastic Ashaba, Harriet O. Adrama, Carlrona Ayebazibwe, Daniel Omoding, Imelda Kemeza, Jane Yatuha, Thadeus Turuho, Noni E. MacDonald, Robert Hilliard

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Background: The burden of malaria in Uganda remains unacceptably high, especially among children and pregnant women. To prevent malaria related complications, household possession and use of Insecticide Treated mosquito Nets (ITNs) has become a common practice in the country. Despite the availability of ITNs, the number of malaria cases has not gone down. We sought to explore knowledge, attitude, and behaviour towards the use of ITNs as a nightly malaria prevention strategy among pregnant women and children under five years of age in rural southwest Uganda. Materials and Methods: This was a community based, descriptive cross-sectional study, in which households with children under 5 years, and/or pregnant women were enrolled. We used a structured questionnaire to collect data on participants’ understanding of the causes, signs and symptoms of malaria; use of ITNs to prevent malaria; attitudes and behaviours towards the use of ITNs. We also conducted key informant interviews (KIIs) to get in-depth understanding of responses from the participants. We analysed quantitative data using STATA version 12. Qualitative findings from the KIIs were transcribed and translated, and manually analysed using thematic content analysis. Results: Of the 369 households enrolled, 98.6% (N=363) households had children under five. Most participants (41.2%, N=152) were in the 21-30 years of age category (mean age; 32.2). 98.6% (N=362) of the respondents considered ITNs a key malaria prevention strategy. The ITN possession rate was 84.0% (N=310), of these, 67.0% (N=205) consistently used them. 39% of the respondents did not have a positive attitude towards ITNs, as they considered more the perceived effects of ITNs. Conclusions: Although 84.0% of the respondents possessed ITNs, many were not consistently using them. There is need to engage all stakeholders (including cultural leaders, community health workers, religious leaders and the government) in the malaria prevention campaigns using ITNs through: a) government’s concerted effort to ensure universal access of good quality ITNs, b) end-user directed education to correct false beliefs and misinformation, c) telling the ITN success stories to improve on the usage.

Keywords: ITNs use, malaria, pregnant women, rural Uganda

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Authors: Murat İskender Aktaş, Selma Söyük

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The aim of this work is to specify the levels of organizational cynicism health workers. Organizational cynicism concept is evaluated in three sub-branches and these are cognitive, affective, and behavioral. The main objective of the work is to answer the questions about the relationship of demographic characteristics like sub-branches of cynicism and age, marital status, education level, total working hours, occupational groups and income levels. As works in our country are analyzed, there have been studies about cynicism in health and other sectors. However, there were no master’s thesis or organizational cynicism research found about the public health professionals. This is why the aim was chosen as to specify the levels of organizational cynicism of public health professionals. The average of the answers of the health workers to the questions about cynicism levels are 2.86. As organizational cynicism is evaluated according to the sub-branches, cognitive subscale average score is 3.21 affective subscale average score is 2.68 and behavioral subscale average score is counted as 2.67. As the results are analyzed, it is seen that the behavioral subscale has the highest average. This shows that the workers are often criticizing the internal complaints and organizational information with their friends out of the organization.

Keywords: cynicism, organizational cynicism, health care workers

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Authors: Eda Yakit Ak, Ergül Aslan

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The study was conducted using the quasi-experimental design to determine the influence of the nursing support program prepared according to the Health Belief Model on reproductive health behaviors of orthopedically disabled women in the physical therapy and rehabilitation clinic at a university hospital between August 2019-October, 2020. The research sample included 50 women (35 in the control group and 15 in the experimental group with orthopedic disability). A 3-week nursing support program was applied to the experimental group of women. To collect the data, Introductory Information Form and Scale for Determining the Protective Attitudes of Married Women towards Reproductive Health (SDPAMW) were applied. The evaluation was made with a follow-up form for four months. In the first evaluation, the total SDPAMW scores were 119.93±20.59 for the experimental group and 122.20±16.71 for the control group. In the final evaluation, the total SDPAMW scores were 144.27±11.95 for the experimental group and 118.00±16.43 for the control group. The difference between the groups regarding the first and final evaluations for the total SDPAMW scores was statistically significant (p<0.01). In the experimental group, between the first and final evaluations regarding the sub-dimensions of SDPAMW, an increase was found in the behavior of seeing the doctor on reproductive health issues, protection from reproductive organ and breast cancer, general health behaviors to protect reproductive health, and protection from genital tract infections (p<0.05). Consequently, the nursing support program based on the Health Belief Model applied to orthopedically disabled women positively affected reproductive health behaviors.

Keywords: orthopedically disabled, woman, reproductive health, nursing support program, health belief model

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Authors: Lateefat Amao, Misagh Faezipour

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Implementing electronic health records (EHR) in healthcare is a pivotal transition aimed at digitizing and optimizing patient health information management. The expectations associated with this transition are high, even towards other health information systems (HIS) and health technology. This multifaceted process involves careful planning and execution to improve the quality and efficiency of patient care, especially as healthcare technology is a sensitive niche. Key considerations include a thorough needs assessment, judicious vendor selection, robust infrastructure development, and training and adaptation of healthcare professionals. Comprehensive training programs, data migration from legacy systems and models, interoperability, as well as security and regulatory compliance are imperative for healthcare staff to navigate EHR systems adeptly. The purpose of this work is to offer a comprehensive review of the literature on EHR implementation. It explores the impact of this health technology on health practices, highlights challenges and barriers to its successful utility, and offers practical strategies that can impact its success in healthcare. This paper provides a thorough review of studies on the adoption of EHRs, emphasizing the wide range of experiences and results connected to EHR use in the medical field, especially across different types of healthcare organizations.

Keywords: healthcare, electronic health records, EHR implementation, patient care, interoperability

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Authors: Celeste De Kock, Bruce Anderson, Corneile Minnaar

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Geographic variation in the floral morphology of a flower species has often been assumed to result from co-variation in the availability of regionally-specific functional pollinator types, giving rise to plant ecotypes that are adapted to the morphology of the main pollinator types in that area. Wachendorfia paniculata is a geographically variable enantiostylous (handed) flower with preliminary observations suggesting that differences in pollinator community composition might be driving differences in the degree of herkogamy (spatial separation of the stigma and anthers on the same flower) across its geographic range. This study aimed to determine if pollinator-related variables such as visitation rate and pollinator type could explain differences in floral morphology seen in different populations. To assess pollinator community compositions, pollinator visitation rates, and the degree of herkogamy and flower size, flowers from 13 populations were observed and measured across the Western Cape, South Africa. Multiple regression analyses indicated that pollinator-related variables had no significant effect on the degree of herkogamy between sites. However, the degree of herkogamy was strongly negatively associated with the time of measurement. It remains possible that pollinators have had an effect on the development of herkogamy throughout the evolutionary timeline of different W. paniculata populations, but not necessarily to the fine-scale degree, as was predicted for this study. Annual fluctuations in pollinator community composition, paired with recent disturbances such as urbanization and the overabundance of artificially introduced honeybee hives, might also result in the signal of pollinator adaptation getting lost. Surprisingly, differences in herkogamy between populations could largely be explained by the time of day at which flowers were measured, suggesting a significant narrowing of the distance between reproductive parts throughout the day. We propose that this floral movement could possibly be an adaptation to ensure pollination if pollinator visitation to a flower was not sufficient earlier in the day, and will be explored in subsequent studies.

Keywords: enantiostyly, floral movement, geographic variation, ecotypes

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Authors: Emeshaw Damtew Zebene, Edom Seife, Hagos Tesfay, Gurja Belay

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Background: cancer incidence and mortality has grown rapidly throughout the world. Aging of the population, urbanization, physical inactivity, economic growth followed by smoking and drinking contributed a lot for the increased incidence of cancer all over the globe. Objective: the aim of this study was to assess a one-year trend of cancer patients who underwent curative/radical radiotherapy at radiotherapy center, Tikur Anbessa specialized hospital, Ethiopia. Methodology: We performed a prospective descriptive study of cancer patients treated with LINAC at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia, from April 2021- March 2022. A standardized questionnaire was used to collect sociodemographic and clinical characteristics of the patients. Descriptive statistics and chi-square results were generated using SPSS version 24. The level of significance was obtained at 0.05. Results: Sixty-four (64) curative/radical patients-44 females and 20 males were analyzed. Majority, 27(42.2%), of the patients age range from 45 to 64, and 45(70%) of them were urban residents where a group of higher gynecologic cancer was observed.78% of the patients were with locally advanced cancer, and 54(84.4%) of them had no awareness about cancer. Generally, head & neck cancer were found the most prevalent cancer 20(31.3%), and the leading cause of cancer among women was cervical cancer 17(38.6%), where about half 7(15.9%) of them were HIV positive. Conclusion: Our finding revealed that most of curative/radical patients presented at a locally advanced stage of the disease. Hence, maintaining the already available teletherapy machines and installing additional radiotherapy centers may help in treating the patients at the early stage of the disease. Since almost all of our study participants did not have information about cancer, awareness raising mechanisms should be done. Additionally, understanding differences in cancer incidence between urban and rural is important. Key words: Cancer, Curative/radical, Radiotherapy, Tikur Anbessa Specialized Hospital

Keywords: cancer, curative/radical, radiotherapy, tkur anbessa specialized hospital

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Authors: Nyasha Agnes Gurira, Patrick Ngulube

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Heritage as an asset can be used to achieve cultural and socio-economic development through its careful use as a tourist attraction. Cultural heritage sites, especially those listed as World Heritage sites generate a lot of revenue through their use as tourist attractions. According to article 5(a) of the World Heritage Convention, World Heritage Sites (WHS) must serve a function in the life of the communities. This is further stressed by the International Council on Monuments and Sites (ICOMOS) charter on cultural heritage tourism which recognizes the positive effects of tourism on cultural heritage and underlines that domestic and international tourism is among the foremost vehicles for cultural exchange, conservation should thus provide for responsible and well-managed opportunities for local communities. The inclusion of communities in the world heritage agenda identifies them as the owners of the heritage and partners in the management planning process. This reiterates the need to empower communities and enable them to participate in the decisions which relate to the use of their heritage divorcing from the ideals of viewing communities as beneficiaries from the heritage resource. It recognizes community ownership rights to cultural heritage an element enshrined in Zimbabwe’ national constitution. Through the use of contingency valuation approaches, by assessing the Willingness to pay for visitors at the site the research determined the tourism use value of Great Zimbabwe (WHS). It assessed the extent to which the communities at Great Zimbabwe (WHS) have been developed through the tourism use of the WHS. Findings show that the current management mechanism in place regards communities as stakeholders in the management of the WHS, their ownership and property rights are not fully recognized. They receive indirect benefits from the tourism use of the WHS. This paper calls for a shift in management approach where community ownership rights are fully recognized and more inclusive approaches are adopted to ensure that the goal of sustainable development is achieved. Pro-poor benefits of tourism are key to enhancing the livelihoods of communities and can only be achieved if their rights are recognized and respected.

Keywords: communities, cultural heritage tourism, development, property ownership rights, pro-poor benefits, sustainability, world heritage site

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Authors: Rakesh Namdeti

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The liquid waste-wastewater- is essentially the water supply of the community after it has been used in a variety of applications. In recent years, heavy metal concentrations, besides other pollutants, have increased to reach dangerous levels for the living environment in many regions. Among the heavy metals, Lead has the most damaging effects on human health. It can enter the human body through the uptake of food (65%), water (20%), and air (15%). In this background, certain low-cost and easily available biosorbent was used and reported in this study. The scope of the present study is to remove Lead from its aqueous solution using Olea EuropaeaResin as biosorbent. The results showed that the biosorption capacity of Olea EuropaeaResin biosorbent was more for Lead removal. The Langmuir, Freundlich, Tempkin, and Dubinin-Radushkevich (D-R) models were used to describe the biosorption equilibrium of Lead Olea EuropaeaResin biosorbent, and the biosorption followed the Langmuir isotherm. The kinetic models showed that the pseudo-second-order rate expression was found to represent well the biosorption data for the biosorbent.

Keywords: novel biosorbent, central composite design, Lead, isotherms, kinetics

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Authors: Parul Suraia, Harshit Sosan Lakra

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Indigenous communities represent some of the most marginalized populations globally, with India labeled as tribals, experiencing particularly pronounced marginalization and a concerning decline in their numbers. These communities often inhabit geographically challenging regions characterized by low population densities, posing significant challenges to providing essential infrastructure services. Jharkhand, a Schedule 5 state, is infamous for its low-level health status due to disparities in access to health care. The primary objective of this study is to investigate the spatial inequalities in healthcare accessibility among tribal populations within the state and pinpoint critical areas requiring immediate attention. Health indicators were selected based on the tribal perspective and association of Sustainable Goal 3 (Good Health and Wellbeing) with other SDGs. Focused group discussions in which tribal people and tribal experts were done in order to finalize the indicators. Employing Principal Component Analysis, two essential indices were constructed: the Tribal Health Index (THI) and the Tribal Health Intervention Index (THII). Index values were calculated based on the district-wise secondary data for Jharkhand. The bivariate spatial association technique, Moran’s I was used to assess the spatial pattern of the variables to determine if there is any clustering (positive spatial autocorrelation) or dispersion (negative spatial autocorrelation) of values across Jharkhand. The results helped in facilitating targeting policy interventions in deprived areas of Jharkhand.

Keywords: tribal health, health spatial disparities, health status, Jharkhand

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Authors: Raj Chandran, Saul Datwyler, Jaime Marino, Daniel West, Karla Grasso, Adam Buss, Hina Syed, Zina Al Sahouri, Jennifer Yen, Krista Caudle, Beth McQuiston

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The Alinity i TBI test is Therapeutic Goods Administration (TGA) registered and is a panel of in vitro diagnostic chemiluminescent microparticle immunoassays for the measurement of glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) in plasma and serum. The Alinity i TBI performance was evaluated in a multi-center pivotal study to demonstrate the capability to assist in determining the need for a CT scan of the head in adult subjects (age 18+) presenting with suspected mild TBI (traumatic brain injury) with a Glasgow Coma Scale score of 13 to 15. TBI has been recognized as an important cause of death and disability and is a growing public health problem. An estimated 69 million people globally experience a TBI annually1. Blood-based biomarkers such as glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) have shown utility to predict acute traumatic intracranial injury on head CT scans after TBI. A pivotal study using prospectively collected archived (frozen) plasma specimens was conducted to establish the clinical performance of the TBI test on the Alinity i system. The specimens were originally collected in a prospective, multi-center clinical study. Testing of the specimens was performed at three clinical sites in the United States. Performance characteristics such as detection limits, imprecision, linearity, measuring interval, expected values, and interferences were established following Clinical and Laboratory Standards Institute (CLSI) guidance. Of the 1899 mild TBI subjects, 120 had positive head CT scan results; 116 of the 120 specimens had a positive TBI interpretation (Sensitivity 96.7%; 95% CI: 91.7%, 98.7%). Of the 1779 subjects with negative CT scan results, 713 had a negative TBI interpretation (Specificity 40.1%; 95% CI: 37.8, 42.4). The negative predictive value (NPV) of the test was 99.4% (713/717, 95% CI: 98.6%, 99.8%). The analytical measuring interval (AMI) extends from the limit of quantitation (LoQ) to the upper LoQ and is determined by the range that demonstrates acceptable performance for linearity, imprecision, and bias. The AMI is 6.1 to 42,000 pg/mL for GFAP and 26.3 to 25,000 pg/mL for UCH-L1. Overall, within-laboratory imprecision (20 day) ranged from 3.7 to 5.9% CV for GFAP and 3.0 to 6.0% CV for UCH-L1, when including lot and instrument variances. The Alinity i TBI clinical performance results demonstrated high sensitivity and high NPV, supporting the utility to assist in determining the need for a head CT scan in subjects presenting to the emergency department with suspected mild TBI. The GFAP and UCH-L1 assays show robust analytical performance across a broad concentration range of GFAP and UCH-L1 and may serve as a valuable tool to help evaluate TBI patients across the spectrum of mild to severe injury.

Keywords: biomarker, diagnostic, neurology, TBI

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Authors: Katarzyna Wyka, Dana Sylvan, JoAnn Difede

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Background and significance: The following disaster, population-based screening programs are routinely established to assess physical and psychological consequences of exposure. These data sets are highly skewed as only a small percentage of trauma-exposed individuals develop health issues. Commonly used statistical methodology in post-disaster mental health generally involves population-averaged models. Such models aim to capture the overall response to the disaster and its aftermath; however, they may not be sensitive enough to accommodate population heterogeneity in symptomatology, such as post-traumatic stress or depressive symptoms. Methods: We use an archival longitudinal data set from Weill-Cornell 9/11 Mental Health Screening Program established following the World Trade Center (WTC) terrorist attacks in New York in 2001. Participants are rescue and recovery workers who participated in the site cleanup and restoration (n=2960). The main outcome is the post-traumatic stress symptoms (PTSD) severity score assessed via clinician interviews (CAPS). For a detailed understanding of response to the disaster and its aftermath, we are adapting quantile regression methodology with particular focus on predictors of extreme distress and resilience to trauma. Results: The response variable was defined as the quantile of the CAPS score for each individual under two different scenarios specifying the unconditional quantiles based on: 1) clinically meaningful CAPS cutoff values and 2) CAPS distribution in the population. We present graphical summaries of the differential effects. For instance, we found that the effect of the WTC exposures, namely seeing bodies and feeling that life was in danger during rescue/recovery work was associated with very high PTSD symptoms. A similar effect was apparent in individuals with prior psychiatric history. Differential effects were also present for age and education level of the individuals. Conclusion: We evaluate the utility of quantile regression in disaster research in contrast to the commonly used population-averaged models. We focused on assessing the distribution of risk factors for post-traumatic stress symptoms across quantiles. This innovative approach provides a comprehensive understanding of the relationship between dependent and independent variables and could be used for developing tailored training programs and response plans for different vulnerability groups.

Keywords: disaster workers, post traumatic stress, PTSD, quantile regression

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Authors: Alejandra Letelier, Anja Heilmann, Richard G. Watt, Stephen Jivraj, Georgios Tsakos

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Background: Socioeconomic position (SEP) influences adult health. People who experienced material disadvantages in childhood or adulthood tend to have higher adult disease levels than their peers from more advantaged backgrounds. Even so, life is a dynamic process and contains a series of transitions that could lead people through different socioeconomic paths. Research on social mobility takes this into account by adopting a trajectory approach, thereby providing a long-term view of the effect of SEP on health. Aim: The aim of this research examines the effects of intergenerational social mobility on adult general health, oral health and functioning in a population aged 50 and over in England. Methods: This study is based on the secondary analysis of data from the English Longitudinal Study of Ageing (ELSA). Using cross-sectional data, nine social trajectories were created based on parental and adult occupational socio-economic position. Regression models were used to estimate the associations between social trajectories and the following outcomes: adult self-rated health, self-rated oral health, oral health related quality of life, total tooth loss and grip strength; while controlling for socio-economic background and health related behaviours. Results: Associations with adult SEP were generally stronger than with childhood SEP, suggesting a stronger influence of proximal rather than distal SEP on health and oral health. Compared to the stable high group, being in the low SEP groups in childhood and adulthood was associated with poorer health and oral health for all examined outcome measures. For adult self-rated health and edentulousness, graded associations with social mobility trajectories were observed. Conclusion: Intergenerational social mobility was associated with self-rated health and total tooth loss. Compared to only those who remained in a low SEP group over time reported worse self-rated oral health and oral health related quality of life, and had lower grip strength measurements. Potential limitations in relation to data quality will be discussed.

Keywords: social determinants of oral health, social mobility, socioeconomic position and oral health, older adults oral health

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Authors: Nitu Marilena Cristina

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Decentralization of the education system is an educational policy option necessary from the perspective of democratizing internal life and streamlining service administration public. The experience of recent years has shown that decisions taken at central level do not to take into account all situations and especially all the specific needs and interests of the various institutions and individuals. A democratic society implies that the decision-making process is brought closer to the place of application, allowing citizens to take part in the decision-making that affects them directly or indirectly. Essentially decentralization of pre-university education is the transfer of authority, responsibility and resources in decision-making and general management, and financially to the educational units and the local community. This creates a frame of an effective collaboration between school and community. Modern theories on the leadership of education advocate the adoption of decentralization measures and participatory strategies. Numerous countries confronted with the educational impasse has appealed to these strategies. Reforming projects have begun application diversified and nuanced social decentralization models according to the specific social and educational situation. Analysis of legal provisions and measures adopted in the framework of the reform process indicates that, at least formally, decentralization is the solution chosen.

Keywords: decentralization, educational, management, reforming

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Authors: Helga Martins, Idália Matias

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Background:Multiple sclerosis is a chronic inflammatory autoimmune demyelinating disease that affects young adults. Multiple sclerosis is a chronic disease in which the patient needs to self-manage the disease and the therapeutic regimen. Consequently, the promotion of health literacy assumes a relevant role for the accessibility, understanding, and use of information in order to promote and maintain the health of patients with multiple sclerosis. Aim: To determine the impact of lower health literacy in the self-management of patients with a multiple sclerosis. Methods: Literature review based on a search on the following electronic databases: CINAHLand MEDLINE; comprising all results published between September 2016 and September 2021. The search strategy was: (“Self-management [MeSH]” AND “Multiple sclerosis[MeSH]”AND “Health literacy[MeSH]”). The inclusion criteria were: original papers reporting about multiple sclerosis patients; participants with age above 18 years old, written in English, Spanish, French, or Portuguese. Two independent reviewers have done the screening and analysis of the results. 38 citations were identified, and after duplicates removal, a total of 25 results were screened; 14 were included after the application of the inclusion criteria. Results: The lower health literacy in the self-management of patients with a multiple sclerosis is related toless healthy choices, riskier health behavior, poor health outcomes, decreased of adhering to the therapeutic regimen after discharge, less self-management of chronic illness, and increased the time of hospitalization. Conclusion: Inadequate levels of health literacy contribute to poor health outcomes, unsuccessful self-management of chronic illness, and inadequate adherence to the therapeutic regimen. Therefore, health literacy is important for health policy and the healthcare services, as it can be understood as a mediator of self-management of multiple sclerosis disease.

Keywords: health literacy, multiple sclerosis, review, self-management

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Authors: Marilena Ianculescu, Adriana Alexandru

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Internet of Health Things (IoHT) has already proved to be a persuasive means to support a proper assessment of the living conditions by collecting a huge variety of data. For a customized health management of a senior patient, IoHT provides the capacity to build a dynamic solution for sustaining the shift inside the patient-physician relationship by allowing a real-time and continuous remote monitoring of the health status, well-being, safety and activities of the senior, especially in a non-clinical environment. Thus, is created a win-win solution in which both the patient and the physician enhance their involvement and shared decision-making, with significant outcomes. Health monitoring systems in smart environments are becoming a viable alternative to traditional healthcare solutions. The ongoing “Non-invasive monitoring and health assessment of the elderly in a smart environment (RO-SmartAgeing)” project aims to demonstrate that the existence of complete and accurate information is critical for assessing the health condition of the seniors, improving wellbeing and quality of life in relation to health. The researches performed inside the project aim to highlight how the management of IoHT devices connected to the RO-SmartAgeing platform in a secure way by using a role-based access control system, can allow the physicians to provide health services at a high level of efficiency and accessibility, which were previously only available in hospitals. The project aims to identify deficient aspects in the provision of health services tailored to a senior patient’s specificity and to offer a more comprehensive perspective of proactive and preventive medical acts.

Keywords: health management, internet of health things, remote monitoring, senior patient

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