Search results for: psychological interventions

Authors: Boris Bajer, Andrea Havranova, Miroslav Vlcek, Richard Imrich, Adela Penesova

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Lifestyle interventions can prevent the deterioration of impaired glucose tolerance to manifest type 2 diabetes, and also prevent cardiovascular diseases, as it showed many studies (the Finnish Diabetes Prevention Study, Diabetes Prevention Program (DPP), . the China Da Qing Diabetes Prevention Study, etc.) Therefore the aim of our study was to compare the effect of intensified lifestyle intervention on cardiometabolic parameters. Methods: It is an ongoing randomized interventional clinical study (NCT02325804) focused on the reduction of body weight/fat. Intervention: hypocaloric diet (30% restriction of calories) and physical activity 150 minutes/week. Before and after 8 weeks of intervention all patients underwent complete medical examination (measurement of physical fitness, resting metabolic rate (RMR), body composition analysis, oral glucose tolerance test, parameters of lipid metabolism, and other cardiometabolic risk factors. Results: So far 39 patients finished the intervention. The average reduction of body weight was 6,8 + 4,9 kg (0-15 kg; p=0,0006), accompanied with significant reduction of body fat percentage (p ≤ 0,0001), amount of fat mass (p=0,03), waist circumference (p=0.02). Amount of lean mass and RMR remained unchanged. Heart rate (p=0,02), systolic and diastolic blood pressure was reduced (p=0,01 p=0,02 resp.) as well as insulin sensitivity was improved. Lipid parameters also changed - cholesterol, LDL decreased (p=0,05, p=0,04 resp.), while triglycerides showed tendency to decrease (p=0,055). Liver function improved, alanine aminotrasnferase (ALT) were reduced (p=0,01). Physical fitness significantly improved (as measure VO2 max (p=0,02). Conclusion: Results of our study are in line with previous results about the beneficial effect of intensive lifestyle changes on the reduction of cardiometabolic risk factors and improvement of liver function. Supported by grants APVV 15-0228; VEGA 2/0161/16

Keywords: obesity, weight loss, diet lipids, blood pressure, liver enzymes

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Authors: Klara Strecker

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During times of globalization, socioeconomic systems have become connected across the world through global supply chains. As a result, consumption and production locations have increasingly become spatially decoupled. This decoupling leads to complex entanglements of systems and sustainability challenges across distances -entanglements which can be conceptualized as telecouplings. Through telecouplings, people and environments across the world have become closely connected, bringing challenges as well as opportunities. Some argue that telecoupling dynamics started taking shape during times of colonization when resources were first traded across the world. An example of such a telecoupling is that of the rose. Every third rose sold in Europe is grown in Kenya and enters the European market through the Dutch flower auction system. Many Kenyan farms are Dutch-owned, closely entangling Kenya and the Netherlands through the trade of roses. Furthermore, the globalization of the flower industry and the resulting shift of production away from the Netherlands and towards Kenya has led to significant changes in the Dutch horticulture sector. However, the sustainability effects of this rose telecoupling is limited neither to the horticulture sector nor to the Netherlands and Kenya. Alongside the flow of roses between these countries come complex financial, knowledge-based, and regulatory flows. The rose telecoupling also creates spillover effects to other countries, such as Ethiopia, and other industries, such as Kenyan tourism. Therefore, telecoupling dynamics create complex entanglements that cut across sectors, environments, communities, and countries, which makes effectively governing and managing telecouplings and their sustainability implications challenging. Indeed, sustainability can no longer be studied in spatial and temporal isolation. This paper aims to map the rose telecoupling’s complex environmental and social interactions to identify points of tension guiding sustainability-targeted interventions. Mapping these interactions will provide a more holistic understanding of the sustainability challenges involved in the Dutch-Kenyan rose trade. This interdisciplinary telecoupling approach reframes and integrates interdisciplinary knowledge about the rose trade between the Netherlands, Kenya, and beyond.

Keywords: Dutch-Kenyan rose trade, globalization, socio-ecological system, sustainability, telecoupling

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Authors: Isa Shu’aibu, A. A. Mu’inat, F. U. Maigari, M. A. Mani

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Candida albicans is the common cause of both oral and vaginal candidiasis in humans. This candidiasis leads to a wide range of physical, psychological and even physiological problems in humans particularly pregnant women. Samples of endocervical and high vaginal swab were collected from 200 women attending Gombe Specialist Hospital and inoculated on Saboraud Dextrose Agar (SDA) incorporated with chloramphenicol to get rid of the unwanted bacterial contaminants. Gram staining technique and germ tube test were employed for the identification, as Candida albicans is positive for both. Gram positive samples were 70% (n=140) and were further subjected to germ tube test. The remaining 30% (n=60) were found to be Gram negative. 90% (n=126) of the Gram positive ones isolated were also found to be positive for germ tube test; confirming the presence of Candida albicans. Antifungal susceptibility testing revealed that members of Imidazole (Ketoconazole, Miconazole) and those of Triazoles (Fluconazole and Itraconazole) were found to be more effective at concentrations of 20, 50 and 100 µg/disc compared to Griseofulvin (Fulcin) with only 26.00 mm zone of inhibition at 100 µg/disc concentration.

Keywords: Candida albicans, candidiasis, endocervical, vaginal swab, antifungal susceptibility, imidazole, triazoles

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Authors: Vaishali Sharma

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The research is an attempt to hunt a scientific and objective method to transform Ajmer's traditional walled city into a living cultural heritage space, exploring urban management methods to elevate local economy and social space in relation to specific cultural-based initiatives. Ajmer is among the oldest and religiously diverse settlements in Rajasthan, that has seen superimposed developments through the eras. With numerous agencies operating towards the development of the town core of Ajmer, it becomes essential to structure development changes in tune with the transformations and the existing heritage. The study was radio-controlled by the subsequent analysis question: What is the way to overcome the genetic social and economic stress inside the communities and revive public life? In order to create necessary interventions at the neighbourhood level, fifteen neighbourhoods were identified. Each of those was analyzed relatively on three major dimensions: Heritage, Social and Local Economy. Each dimension was further broken down into multiple sub-aspects for an overall and exhaustive understanding. The average median values of the responses were used to develop a color-coded matrix to represent the scores in an exceedingly structured quantified manner, moreover, linking it to the spatial structure. Respondent perceptions on numerous dimensions were additionally recorded, so that the proposals are inclusive in nature. The goals are targeted at Ajmer's traditional walled towns, which will make it easier for the community to regulate the rapid transformations and commercialization occurring within the space. The study recommends the necessity for accrued support in methods and policies from the non-public sector, businesses as well as local stakeholders. An expansion, revitalization and maintenance of the major business and heritage corridors, for an increased local and visitor experience, can produce an impetus for promotion of the intangible heritage, to spur the local economic processes, conservation of heritage precincts and upward development.

Keywords: cultural heritage, economic revitalization, neighbourhoods in walled cities, social space, tangible and intangible heritage

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Authors: Balkibekova Venera Serikpaevna

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Background: Autism Spectrum Disorder (ASD) poses significant challenges in both diagnosis and treatment. Existing therapeutic interventions often target specific symptoms, necessitating the exploration of alternative approaches. This study investigates the RITM (Rhythm Integration Tapping Music) developed by Balkibekova, aiming to create imitation, social engagement and a wide range of emotions through brain development. Methods: A randomized controlled trial was conducted with 100 participants diagnosed with ASD, aged 1 to 4 years. Participants were randomly assigned to either the RITM therapy group or a control group receiving standard care. The RITM therapy, rooted in tapping rhythm to music such as: marche on the drums, waltz on bells, lullaby on musical triangle, dancing on tambourine, polka on wooden spoons. Therapy sessions were conducted over a 3 year period, with assessments at baseline, midpoint, and post-intervention. Results: Preliminary analyses reveal promising outcomes in the RITM therapy group. Participants demonstrated significant improvements in social interactions, speech understanding, birth of speech, and adaptive behaviors compared to the control group. Careful examination of subgroup analyses provides insights into the differential effectiveness of the RITM approach across various ASD profiles. Conclusions: The findings suggest that RITM therapy, as developed by Balkibekova, holds promise as intervention for ASD. The integrative nature of the approach, addressing multiple domains simultaneously, may contribute to its efficacy. Further research is warranted to validate these preliminary results and explore the long-term impact of RITM therapy on individuals with ASD. This abstract presents a snapshot of the research, emphasizing the significance, methodology, key findings, and implications of the RITM therapy method for consideration in an autism conference.

Keywords: RITM therapy, tapping rhythm, autism, mirror neurons, bright emotions, social interactions, communications

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Authors: Aysheh Maslemani, Ruth Mayo, Greg Maio, Ariel Knafo-Noam

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Values are abstract ideals that serve as guiding principles in one's life. As inherently positive and desirable concepts, values are seen as motivators for actions and behaviors. However, research has largely ignored the possibility that values may elicit negative feelings despite being explicitly important to us. In the current study, we aim to examine this possibility. Four hundred participants over 18 years(M=41.6, SD=13.7, Female=178) from the UK completed a questionnaire in which they were asked to indicate their level of positive/negative feelings towards a comprehensive list of values and then report the importance of these values to them. The results support our argument by showing that people can have negative feelings towards their values and that people can feel both positive and negative emotions towards their values simultaneously, which means feeling ambivalence. We ran a mixed-effect model with ambivalence, value type, and their interaction as fixed effects, with by subject random intercept and by subject random slope for ambivalence. The results reveal that values that elicit less ambivalence predicted higher ratings for value importance. This research contributes to the field of values on multiple levels. Theoretically, it will uncover new insights about values, such as the existence of negative emotions towards them and the presence of ambivalence towards values. These findings may inspire future studies to explore the effects of ambivalence on people's well-being, behaviors, cognition, and their affect. We discuss the findings and consider their implications for understanding the social psychological mechanisms underpinning value ambivalence.

Keywords: emotion, social cognition, values., ambivalence

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Authors: Aysheh Maslemani, Ruth Mayo, Greg Maio, Ariel Knafo-Noam

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Values are abstract ideals that serve as guiding principles in one's life. As inherently positive and desirable concepts, values are seen as motivators for actions and behaviors. However, research has largely ignored the possibility that values may elicit negative feelings despite being explicitly important to us. In the current study we aim to examine this possibility. Four hundred participants over 18 years(M=41.6,SD=13.7,Female=178) from the UK completed a questionnaire in which they were asked to indicate their level of positive/negative feelings towards a comprehensive list of values and then report the importance of these values to them. The results support our argument by showing that people can have negative feelings towards their values and that people can feel both positive and negative emotions towards their values simultaneously, which means feeling ambivalence. We ran a mixed-effect model with ambivalence, value type, and their interaction as fixed effects, with by subject random intercept, and by subject random slope for ambivalence. The results reveal that values that elicit less ambivalence predicted higher ratings for value importance. This research contributes to the field of values on multiple levels. Theoretically, it will uncover new insights about values, such as the existence of negative emotions towards them, the presence of ambivalence towards values. These findings may inspire future studies to explore the effects of ambivalence on people's well-being, behaviors, cognition, and their affect. We discuss the findings and consider their implications for understanding the social psychological mechanisms underpinning value ambivalence.

Keywords: ambivalence, emotion, social cognition, values

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Authors: Samira Rabiei, Faezeh Askari, Reza Rastmanesh

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Objective: To evaluate the effects of nutrition education and adherence to a healthy diet on glycemic and lipidemic control in patients with T2DM. Material and Methods: A randomized controlled trial was conducted on 494 patients with T2DM, aged 14-87 years from both sexes who were selected by convenience sampling from referees to Aliebneabitaleb hospital in Ghom. The participants were divided into two 247 person groups by stratified randomization. Both groups received a diet adjusted based on ideal body weight, and the intervention group was additionally educated about healthy food choices regarding diabetes. Information on medications, psychological factors, diet and physical activity was obtained from questionnaires. Blood samples were collected to measure FBS, 2 hPG, HbA1c, cholesterol, and triglyceride. After 2 months, weight and biochemical parameters were measured again. Independent T-test, Mann-Whitney, Chi-square, and Wilcoxon were used as appropriate. Logistic regression was used to determine the odds ratio of abnormal glycemic and lipidemic control according to the intervention. Results: The mean weight, FBS, 2 hPG, cholesterol and triglyceride after intervention were significantly lower than before that (p < 0.05). Discussion: Nutrition education plus a weigh reducer diet is more effective on glycemic and lipidemic control than a weight reducer diet, alone.

Keywords: type 2 diabetes mellitus, nutrition education, glycemic control, lipid profile

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Authors: Lubisi L. V., Madumo M. B., Mudau N. P., Makhuvele L., Sibuyi M. M.

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Background and Aims: Learners with disabilities can be integrated into mainstream schools, whereas there are those learners that are accommodated in special schools based on the support needs they require. These needs, among others, pertain to access to high-intensity therapeutic support by physiotherapists, occupational therapists, and speech therapists. However, access to physiotherapists in low- and middle-income countries is limited, and this creates a knowledge gap in identifying, to the best of our knowledge, best practice patterns aligned with physiotherapy at special schools. This gap compromises the quality of support to be rendered towards strengthening rehabilitation and optimising the participation of learners with disabilities in special schools. The aim of the scoping review was to map the evidence on practice patterns employed by physiotherapists at special schools for learners with disabilities. Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. Key terms regarding physiotherapy practice patterns for learners with disabilities at special schools were used to search the literature on the databases. Literature was sourced from Google Scholar, EBSCO, PEDro, PubMed, and Research Gate from 2013 to 2023. A total of 28 articles were initially retrieved and after a process of screening and exclusion, nine articles were included. All the researchers reviewed the articles for eligibility. Articles were initially screened based on the titles, followed by full text. Articles written in English or translated into English mentioned physical / physiotherapy interventions in special schools, both published and unpublished, were included. A qualitative data extraction template was developed and an inductive approach to thematic data analysis was used for included articles to see which themes emerged. Results: Three themes emerged after inductive thematic data analysis. 1. Collaboration with educators, parents, and therapists 2. Family Centred Approach 3. Telehealth. Conclusion: Collaboration is key in delivering therapeutic support to learners with disabilities at special schools. Physiotherapists need to be collaborators at the level of interprofessional and transprofessional. In addition, they need to explore technology to work remotely, especially when learners become absent physically from school.

Keywords: learners with disabilities, special school, physiotherapists, therapeutic support

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Authors: Kwizera Mireille, Kharesh Ahmed Al-Khadher

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This paper explores the critical issue of girls' and women's right to education, exploring the challenges they face in accessing and benefiting from quality education. Gender disparities in education have persisted globally, hindering social progress and sustainable development. The fundamental importance of education in empowering individuals and promoting gender equality is acknowledged, making it imperative to address the disparities that hinder girls' and women's educational opportunities. The paper discusses various factors contributing to these disparities, including cultural norms(common in third-world countries), socio-economic constraints, and systemic biases. Drawing on a wide range of scholarly sources, empirical studies, and reports from international organizations, this paper highlights the broader societal benefits of educating girls and women, ranging from improved health outcomes to enhanced economic development and greater social and political participation. The paper further outlines strategies and initiatives aimed at overcoming these challenges. These include policy interventions, community-based programs, and international collaborations that work towards eliminating gender-based discrimination in educational settings. The paper emphasizes the significance of not only ensuring access but also fostering an inclusive and safe learning environment that encourages girls and women to thrive academically and personally. By analyzing successful case studies and best practices from around the world, the paper offers insights into effective approaches that can be adopted to enhance girls' and women's right to education globally. Furthermore, it emphasizes the importance of raising awareness of girl's and women's education. In conclusion, this paper underscores the urgency of prioritizing and protecting the educational rights of girls and women's right to education as a fundamental human right and catalyst for gender equality. It calls for a concerted effort from governments, NGOs, educational institutions, and society as a whole to create an equitable and empowering educational landscape that contributes to gender equality and sustainable development.

Keywords: empowerment, gender equality, inclusive education, right to education

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Authors: Elżbieta Turska

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Introduction: One of the most difficult times in a person’s life is adolescence. The experiences in this period may shape the future life of this person to a large extent. This is the reason why many young people experience sadness, dejection, hopelessness, sense of worthlessness, as well as losing interest in various activities and social relationships, all of which are often classified as mood disorders. As many as 15-40% adolescents experience depressed moods and for most of them they resolve and are not carried into adulthood. However, (5-6%) of those affected by mood disorders develop the depressive syndrome and as many as (1-3%) develop full-blown clinical depression. Materials: A large questionnaire was given to 2508 students, aged 13–16 years old, and one of its parts was the Burns checklist, i.e. the standard test for identifying depressed mood. The questionnaire asked about many aspects of the student’s life, it included a total of 53 questions, most of which had subquestions. It is important to note that the data suffered from many problems, the most important of which were missing data and collinearity. Aim: In order to identify the correlates of mood disorders we built predictive models which were then trained and validated. Our aim was not to be able to predict which students suffer from mood disorders but rather to explore the factors influencing mood disorders. Methods: The problems with data described above practically excluded using all classical statistical methods. For this reason, we attempted to use the following Artificial Intelligence (AI) methods: classification trees with surrogate variables, random forests and xgboost. All analyses were carried out with the use of the mlr package for the R programming language. Resuts: The predictive model built by classification trees algorithm outperformed the other algorithms by a large margin. As a result, we were able to rank the variables (questions and subquestions from the questionnaire) from the most to least influential as far as protection against mood disorder is concerned. Thirteen out of twenty most important variables reflect the relationships with parents. This seems to be a really significant result both from the cognitive point of view and also from the practical point of view, i.e. as far as interventions to correct mood disorders are concerned.

Keywords: mood disorders, adolescents, family, artificial intelligence

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Authors: Sehmus Aslan, Sibel Karacaoglu, Cengiz Sevgin, Ummuhan Bas Aslan

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Objective: Anger expression style is an important moderator of the effects on the person and person’s environment. Anger and anger expression have become important constructs in identifying individuals at high risk for psychological difficulties. To our knowledge, there is no information about anger and anger expression of adolescents with visual impairment. The aim of this study was to compare anger and anger expression among adolescents with and without visual impairment. Methods: Thirty-eight adolescents with visual impairment (18 female, 20 male) and 44 adolescents without visual impairment (22 female, 24 male), in totally 84 adolescents aged between 12 to 15 years, participated in the study. Anger and anger expression of the participants assessed with The State-Trait Anger Scale (STAS). STAS, a self-report questionnaire, is designed to measure the experience and expression of anger. STAS has four subtitles including continuous anger, anger in, anger out and anger control. Reliability and validity of the STAS have been well established among adolescents. Mann-Whitney U Test was used for statistical analysis. Results: No significant differences were found in the scores of continuous anger and anger out between adolescents with and without visual impairment (p < 0.05). On the other hand, there were differences in scores of anger control and anger in between adolescents with and without visual impairment (p>0.05). The score of anger control in adolescents with visual impairment were higher compared with adolescents without visual impairment. Meanwhile, the adolescents with visual impairment had lower score for anger in compared with adolescents without visual impairment. Conclusions: The results of this study suggest that there is no difference in anger level among adolescents with and without visual impairment meanwhile there is difference in anger expression.

Keywords: adolescent, anger, impaired, visual

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Authors: M. R. Bhuiyan, S. M. M. Hossain, M. Z. Islam

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Autism Spectrum Disorder (ASD) is the fastest growing serious developmental disorder characterized by social deficits, communicative difficulties, and repetitive behaviors. ASD is an emerging public health issue globally which is associated with huge financial burden to the family, community and the nation. The aim of this study was to assess the financial burden of family for the children with Autism spectrum Disorder. This cross-sectional study was carried out from July 2015 to June 2016 among 154 children with ASD to assess the financial burden of family. Data were collected by face-to-face interview with semi-structured questionnaire following systematic random sampling technique. Majority (73.4%) children were male and mean (±SD) age was 6.66 ± 2.97 years. Most (88.8%) of the children were from urban areas with average monthly family income Tk. 41785.71±23936.45. Average monthly direct cost of the children was Tk.17656.49 ± 9984.35, while indirect cost was Tk. 13462.90 ± 9713.54 and total treatment cost was Tk. 23076.62 ± 15341.09. Special education cost (Tk. 4871.00), cost of therapy (Tk. 4124.07) and travel cost (Tk. 3988.31) were the major types of direct cost, while loss of income (Tk.14570.18) was the chief indirect cost incurred by the families. The study found that majority (59.8%) of the children attended special schools were incurred Tk.20001-78700 as total treatment cost, which were statistically significant (p<0.001). Again, families with higher monthly family income incurred higher treatment cost (r=0.526, p<0.05). Difference between mean direct and indirect cost was found significant (t=4.190, df=61, p<0.001). According to the analysis of variance, mean difference of father’s educational status among direct cost (F=10.337, p<0.001) and total treatment cost (F=7.841, p<0.001), which were statistically significant. The study revealed that maximum children with ASD were under five years, three-fourth were male. According to monthly family income, maximum family were in middle class. The study recommends cost effective interventions and financial safety-net measures to reduce the financial burden of families for the children with ASD.

Keywords: autism spectrum disorder, financial burden, direct cost, indirect cost, special education

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Authors: Siwaporn Mahathamnuchock, Krit Phanpanya

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This survey study aims 1) to investigate the preparation of Mae Hong Son people for entering into the aging society 2) to study awareness of public health preparedness for the aging society of Mae Hong Son Province Administrative Organization. The samples used in this study were people aged 55-60 years in Mae Hong Province. Located at Khun Yuam Sub district, Khun Yuam District, Pang Ma Pha Sub district, Pang Ma Pha District, Thung Yao Sub district, Pai District, Mae ka Tuan Sub district, Sob Moei District, Mae Sariang Sub district, Mae Sariang District, Mae Tho Sub district, Mae La Noi District. And Huai Pha Sub district, Muang Mae Hong District. The data were collected from 1,088 people by Stratified sampling Method. The instrument used in this study were 36 items of questionnaire that contains three parts: 1) Sample’s general information 2) The Interview of Mae Hong Son people’s preparation before entering aging society. 3) The Interview about preparedness of health for the aging society of Mae Hong Son Province Administrative Organization. Then analyzed the data by using percentage and standard deviation. The research found that Mae Hong Son people are preparing for an aging society as followed; psychological, residence, physical health, careers and leisure time on a large scale with an average of 3.81 (SD=0.88), 3.66 (SD=0.99), 3.53(SD=1.04) and 3.51(SD=0.89), respectively. However finances and saving were prepared on moderate scale with an average of 2.84(SD=0.89) and in the awareness of public health preparedness for the aging society of Mae Hong Son Province Administrative Organization were moderate with an average of 2.99 (SD=1.07).

Keywords: aging society, preparedness, perception, Mae Hong Son province

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Authors: Hossein Nikandam Kermanshah, Babak Samavatian, Akbar Hemmati Sabet, Mohammad Ahmadpanah

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This is a quasi-experimental study that has been conducted in order to compare the effectiveness of social skills training and stress management training on self-esteem and aggression in first grade high school students. Forty-five people were selected from research community and were put randomly in there groups of social skills training, stress management training and control ones. Collecting data tools in this study was devise, self-esteem and AGQ aggression questionnaire. Self-esteem and aggression questionnaires has been conducted as the pre-test and post-test. Social skills training and stress management groups participated in eight 1.5 hour session in a week. But control group did not receive any therapy. For descriptive analysis of data, statistical indicators like mean, standard deviation were used, and in inferential statistics level multi variable covariance analysis have been used. The finding result show that group training social skills and stress management is significantly effective on the self-esteem and aggression, there is a meaningful difference between training social skills and stress management on self-esteem that the preference is with group social skills training, in the difference between group social skills training and stress management on aggression, the preference is with group stress management.

Keywords: social skill training, stress management training, self-esteem aggression, psychological sciences

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Authors: Kunkanit Sutamchai, Kate E. Rowlands

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Recent public ethical scandals in many organizations around the world have raised concern about organizational ethics, which have, in turn, made ethical behaviors and conducts on the part of leaders become more critical topics in organizational studies. However, current research on the benefits of mindfulness within the workplace contexts has predominantly focused on stress reduction and work performance enhancement, while the aspects of ethical behavior development have been far less investigated in mindfulness research in the organizational and management fields. Only recently has there been an emerging call for organizational researchers and practitioners to study mindfulness concepts and practices from the original Buddhist perspectives given that ethics is regarded as a foundation for Buddhist mindfulness. Yet little, if any, empirical research on the contributions of mindfulness practices to ethical leadership has been done in Eastern Buddhist contexts. Therefore, this study aims to explore the extent to which and how Buddhist-based mindfulness practices can influence organizational leaders’ ethical values and practices. On this basis, Thailand was selected as a context of study due to a predominantly Buddhist society and culture. Qualitative data were gathered through in-depth semi-structured interviews with twenty executive leaders from various private organizations in Thailand, who practice Buddhist-based mindfulness meditation regularly. The findings from this study shed light on the role Buddhist-based mindfulness practices can play in promoting ethical behavior among executive leaders in Thailand. The results also suggest that ethical values and practices influenced by Buddhist-based mindfulness practices are well aligned with the elements appeared in the inter-disciplinary and cross-cultural ethical leadership framework, namely: humane, justice, sustainability and responsibility, and moderation. This study concludes that the integration of ethical dimensions to mindfulness practices may provide promising opportunities for ethical leadership development, particularly in the context of Thailand. This could contribute significantly to the future development of both organizations and society at large. The study also suggests that mindfulness interventions in organizational contexts should place more explicit emphasis on ethics. This may be done by relating the ethical principles underlying Buddhist-based mindfulness to other ethical systems in different contexts and cultures where they can be aligned.

Keywords: Buddhism, ethical leadership, leadership development, mindfulness, Thailand, training

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Authors: Ndje Ndje Mireille

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The improvement in the physical aspects of hysterectomy has tended to make us forget the psychological burden of this operation for many women. African women closely associate fertility and femininity, and they fear that their desire will diminish, that they will be less desirable after having undergone a hysterectomy. Medicine may be tempted to trivialize this surgical intervention by relying on the evolution of current surgery that leaves little or no marks. It is possible to think that the uterus is useless for a nun who has decided to freely disregard her motherhood. We used the clinical research method for this study. Through a semi-directive interview guide, we collected the verbatims of an hysterectomized catholic nun. The verbatims were transcribed and analyzed with the thematic content analysis. This analysis shows that the medical reality does not always correspond to the subjective experience of women, for whom hysterectomy can imply strong symbolic damage. The uterus is not essential to life, but it is essential to give life, and this lack can reactivate a desire for motherhood. The experience of hysterectomy is unique for each woman in relation to her history. This operation will eliminate all hope of pregnancy; it will be felt as intimate mutilation and an attack on femininity, it will bring up concerns about sexuality. Even if a woman has past the age of having children, has gone through menopause, or has freely decided not to have children, she still find it difficult to accept this procedure. The lack of uterus make a woman feel useless.

Keywords: hysterectomy, symbolic damage, desire for motherhood, feminity, nun

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Authors: Tony Feng, Rea Thomson, Kathryn Greenslade, Ross Medine, Jennifer Easterbrook, Calum Arthur, Matilda Powell-bowns

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There are clear guidelines on taking group and screen samples (G&S) for elective arthroplasty and major trauma. However, there is limited guidance on blood grouping for other trauma patients. The purpose of this study was to review the level of blood grouping at a major trauma centre and validate a protocol that limits the expensive processing of G&S samples. After reviewing the national guidance on transfusion samples in orthopaedic patients, data was prospectively collected for all orthopaedic admissions in the Royal Infirmary of Edinburgh between January to February 2023. The cause of admission, number of G&S samples processed on arrival and need for red cells was collected using the hospital blood bank. A new protocol was devised based on a multidisciplinary meeting which limited the requirement for G&S samples only to presentations in “category X”, including neck-of-femur fractures (NOFs), pelvic fractures and major trauma. A re-audit was completed between April and May after departmental education and institution of this protocol. 759 patients were admitted under orthopaedics in the major trauma centre across two separate months. 47% of patients were admitted with presentations falling in category X (354/759) and patients in this category accounted for 88% (92/104) of those requiring post-operative red cell transfusions. Of these, 51% were attributed to NOFs (47/92). In the initial audit, 50% of trauma patients outwith category X had samples sent (116/230), estimated to cost £3800. Of these 230 patients, 3% required post-operative transfusions (7/230). In the re-audit, 23% of patients outwith category X had samples sent (40/173), estimated to cost £1400, of which 3% (5/173) required transfusions. None of the transfusions in these patients in either audit were related to their operation and the protocol achieved an estimated cost saving of £2400 over one month. This study highlights the importance of sending samples for patients with certain categories of orthopaedic trauma (category X) due to the high demand for post-operative transfusions. However, the absence of transfusion requirements in other presentations suggests over-testing. While implementation of the new protocol has markedly reduced over-testing, additional interventions are required to reduce this further.

Keywords: blood transfusion, quality improvement, orthopaedics, trauma

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Authors: Esabelle Lo Yan Yam, Pheak Chhoun, Sovannary Tuot, Emily Lancsar, Siyan Yi

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Persons living with HIV (PLHIV) need lifelong antiretroviral treatment (ART) to keep their viral load suppressed to an undetectable level, maintain a healthy immune system, and reduce the risk of transmitting HIV to others. However, many factors affect PLHIV's adherence to ART, including access to antiretrovirals (ARV), stigma, lack of social support, and the burden of seeking lifelong care. Community-based care has been shown to be instrumental in the experience of PLHIV in many countries, including Cambodia. In this study based in Cambodia, a community-based ART delivery (CAD) intervention involving community action workers (CAWs) who are PLHIVs was introduced. These workers collect pre-packaged ARVs from the ART clinics and dispense them to PLHIVs in the communities. The quasi-experimental study involved approximately 2000 stable PLHIV in the intervention arm and another 2000 PLHIV in the control arm (receiving usual care). A cost-effectiveness analysis is currently conducted to complement the clinical effectiveness of the CAD intervention on the care continuum and treatment outcomes for stable PLHIV, as well as the operational effectiveness in increasing the efficiency of the ART clinics and the health system. The analysis will consider health system and societal perspectives based on primary outcomes, including retention in care, viral load suppression, and adherence to ART. Additionally, a consultation with the National Centre for HIV/AIDS, Dermatology, and STD under the Cambodia Ministry of Health will be done to discuss the conduct of a budget impact analysis that can quantify the financial impact on the government's budget when adopting the CAD intervention at the provincial and national levels. The budget impact analysis will take into consideration various scaling-up scenarios for the interventions in the country. The research will assess the cost-effectiveness of the CAD intervention to support national stakeholders in Cambodia to make an informed decision on the adoption and scaling up of the intervention in Cambodia. The results are currently being analyzed and will be available at the time of the conference.

Keywords: Cambodia, community intervention, economic evaluation, global health, HIV/AIDs, implementation research

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Authors: Nami Matsumoto

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This study explores the experiences of cross-linguistic medical encounters by patients, and their views of receiving language support therein, with a particular focus on Japanese-English cases. The aim of this study is to investigate the reason for the frequent use of a spouse as a communication mediator from a Japanese perspective, through a comparison with that of English speakers. This study conducts an empirical qualitative analysis of the accounts of informants. A total of 31 informants who have experienced Japanese-English cross-linguistic medical encounters were recruited in Australia and Japan for semi-structured in-depth interviews. A breakdown of informants is 15 English speakers and 16 Japanese speakers. In order to obtain a further insight into collected data, additional interviews were held with 4 Australian doctors who are familiar with using interpreters. This study was approved by the Australian National University Human Research Ethics Committee, and written consent to participate in this study was obtained from all participants. The interviews lasted up to over one hour. They were audio-recorded and subsequently transcribed by the author. Japanese transcriptions were translated into English by the author. An analysis of interview data found that patients value relationship in communication. Particularly, Japanese informants, who have an English-speaking spouse, value trust-based communication interventions by their spouse, regardless of the language proficiency of the spouse. In Australia, health care interpreters are required to abide by the national code of ethics for interpreters. The Code defines the role of an interpreter exclusively to be language rendition and enshrines the tenets of accuracy, confidentiality and professional role boundaries. However, the analysis found that an interpreter who strictly complies with the Code sometimes fails to render the real intentions of the patient and their doctor. Findings from the study suggest that an interpreter should not be detached from the context and should be more engaged in the needs of patients. Their needs are not always communicated by an interpreter when they simply follow a professional code of ethics. The concept of relationship-centred care should be incorporated in the professional practice of health care interpreters.

Keywords: health care, Japanese-English medical encounters, language barriers, trust

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Authors: Heena Akbar, Winnie Niumata, Danielle Gallegos

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

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

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Authors: Neetika Mahajan, Awanish Shukla

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Entrepreneurship is key a driver to economic development. It opens opportunities for business startups and has potential to expand employment opportunities for many. Entrepreneurship gives ‘Purpose thriving’ approach towards society with new technologies and zeal to develop and compete in the market. There are many more advantages of entrepreneurship like freedom to scope of work and independence in setting own goals. Women contribute to nearly 50 percent of India’s population, constitute nearly 10 percent of a total number of entrepreneurs in India. Women are found to be better risk calculators, more ambitious and less prone to self-confidence. However, It is a hard fact that life has not been easy for women aspiring professional success. Gender parity is the biggest threat faced by female aspirant seeking new businesses. More challenges like socio-cultural barriers, insufficient financial assistance, etc. have been faced by the women of our country. To uplift the status of women in the society, a number of initiatives have been taken up by the Government of India. Initiatives like National Mission for Empowerment of Women by (Ministry of Women And Child Development) and SKILL INDIA aim to increase the technical skills and knowledge of women for tapping employment opportunities and self-confidence. Trade Related Entrepreneurship Assistance and Development (TREAD) Scheme and Mahila Coir Yojana are proposed by the Ministry of MSMEs aiming to facilitate employment opportunities for women and entrepreneurship development. This paper will aim to bring out the gaps and barriers, which are still resisting the potential women come upfront and start a new business irrespective of a number of initiatives being put by government of India. The aim is also to identify focus areas where further intervention is required and proposing suitable interventions. The methodology to take forward this research will include primary and secondary data collection from on ground survey to track various kind of challenges faced by aspirant women entrepreneurs. Insight will be put towards initiations by the government of India towards women empowerment and assistance to entrepreneurship. Scientific quantitative tools will be used to analyze collected information. The final output of the research shall focus on achieving the respective aims and objectives.

Keywords: women entrepreneurship, government programs and schemes, key challenges, economic development

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Authors: Håkon Riiber

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This paper explores the extent to which Russian ‘Active Measures’ play a role in contemporary Russian foreign policy and in what way the legacy of the Soviet Union is still apparent in these practices. The analysis draws on a set of case studies from the 21st century to examine these aspects, showing which ‘Active Measures’ features are old and which are new in the post-Cold War era. The paper highlights that the topic has gained significant academic and political interest in recent years, largely due to the aggressive posture of the Russian Federation on the world stage, exemplified through interventions in Estonia, Georgia, and Ukraine and interference in several democratic elections in the West. However, the paper argues that the long-term impact of these measures may have unintended implications for Russia. While Russia is unlikely to stop using Active Measures, increased awareness of the exploitation of weaknesses, institutions, or other targets may lead to greater security measures and an ability to identify and defend against these activities. The paper contends that Soviet-style ‘Active Measures’ from the Cold War era have been modernized and are now utilized to create an advantageous atmosphere for further exploitation to support contemporary Russian foreign policy. It offers three key points to support this argument: the reenergized legacy of the Cold War era, the use of ‘Active Measures’ in a number of cases in the 21st century, and the applicability of AM to the Russian approach to foreign policy. The analysis reveals that while this is not a new Russian phenomenon, it is still oversimplified and inaccurately understood by the West, which may result in a decreased ability to defend against these activities and limit the unwarranted escalation of the ongoing security situation between the West and Russia. The paper concludes that the legacy of Soviet-era Active Measures continues to influence Russian foreign policy, and modern technological advances have only made them more applicable to the current political climate. Overall, this paper sheds light on the important issue of Russian ‘Active Measures’ and the role they play in contemporary Russian foreign policy. It emphasizes the need for increased awareness, understanding, and security measures to defend against these activities and prevent further escalation of the security situation between the West and Russia.

Keywords: Russian espionage, active measures, disinformation, Russian intelligence

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Authors: Florian Tille, Heide Weishaar, Bernhard Gibis, Susanne Schnitzer

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Introduction: The quality of patient-doctor communication and of written health information is central to organizational health literacy (HL). Whether patients understand their doctors’ explanations and textual material on health, however, is understudied. This study identifies the overall levels of patient understanding of health information and its associations with patients’ social characteristics in outpatient health care in Germany. Materials & Methods: This analysis draws on data collected via a 2017 national health survey with a sample of 6,105 adults. Quality of communication was measured for consultations with general practitioners (GPs) and specialists (SPs) via the Ask Me 3 program questions, and through a question on written health material. Correlations with social characteristics were explored employing bivariate and multivariate logistic regression analyses. Results: Over 90% of all respondents reported that they had understood their doctors’ explanations during the last consultation. Failed understanding was strongly correlated with patients’ very poor health (Odds Ratio [OR]: 5.19; 95% confidence interval [CI]: 2.23–12.10; ref. excellent/very good health), current health problem (OR: 6.54, CI: 1.70–25.12; ref. preventive examination) and age 65 years and above (OR: 2.97, CI: 1.10–8.00; ref. 18 to 34 years). Fewer patients answered they understood written material well (86.7% for las visit at GP, 89.7% at SP). Understanding written material poorly was highly associated with basic education (OR: 4.20, CI: 2.76–6.39; ref. higher education) and 65 years old and above (OR: 2.66, CI: 1.43–4.96). Discussion: Overall ratings of oral patient-doctor communication and written communication of health information are high. Yet, a considerable share of patients reports not-understanding their doctors and poor understanding of the written health-related material. Interventions that can contribute to improving organizational HL in outpatient care in Germany include HL training for doctors, reducing system barriers to easily-accessible health information for patients and combining oral and written health communication means. Conclusion: This work adds to the study of organizational HL in Germany. To increase patient understanding of health-relevant information and thereby possibly reduce health disparities, meeting the communication needs especially of persons in different age groups, with basic education and in very poor health is suggested.

Keywords: health survey, organizational health literacy, patient-doctor communication, social characteristics, outpatient care, Ask Me 3

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Authors: Kougioumtzis Konstantin, Rylander Pär, Karlsteen Magnus

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Ball skills as a subset of fundamental motor skills are predictors for performance in sports. Currently, most tools evaluate ball skills utilizing subjective ratings. The aim of this study was to examine the psychometric properties of a newly developed instrument to objectively measure ball handling skills (BHS-test) utilizing digital instrument. Participants were a convenience sample of 213 adolescents (age M = 17.1 years, SD =3.6; 55% females, 45% males) recruited from upper secondary schools and invited to a sports hall for the assessment. The 8-item instrument incorporated both accuracy-based ball skill tests and repetitive-performance tests with a ball. Testers counted performance manually in the four tests (one throwing and three juggling tasks). Furthermore, assessment was technologically enhanced in the other four tests utilizing a ball machine, a Kinect camera and balls with motion sensors (one balancing and three rolling tasks). 3D printing technology was used to construct equipment, while all results were administered digitally with smart phones/tablets, computers and a specially constructed application to send data to a server. The instrument was deemed reliable (α = .77) and principal component analysis was used in a random subset (53 of the participants). Furthermore, latent variable modeling was employed to confirm the structure with the remaining subset (160 of the participants). The analysis showed good factorial-related validity with one factor explaining 57.90 % of the total variance. Four loadings were larger than .80, two more exceeded .76 and the other two were .65 and .49. The one factor solution was confirmed by a first order model with one general factor and an excellent fit between model and data (χ² = 16.12, DF = 20; RMSEA = .00, CI90 .00–.05; CFI = 1.00; SRMR = .02). The loadings on the general factor ranged between .65 and .83. Our findings indicate good reliability and construct validity for the BHS-test. To develop the instrument further, more studies are needed with various age-groups, e.g. children. We suggest using the BHS-test for diagnostic or assessment purpose for talent development and sports participation interventions that focus on ball games.

Keywords: ball-handling skills, ball-handling ability, technologically-enhanced measurements, assessment

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Authors: Adriana De Serio, Donato Forenza

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Aims. In this experimental research the Authors present the methodological plan “Musictherapy and Gardentherapy” that they created interconnected with the garden landscape ecosystems and aimed at PsychoPhysical Disability (MusGarPPhyD). In the context of the environmental education aimed at spreading the landscape culture and its values, it’s necessary to develop a solid perception of the environment sustainability to implement a multidimensional approach that pays attention to the conservation and enhancement of gardens and natural environments. The result is an improvement in the life quality also in compliance with the objectives of the European Agenda 2030. The MusGarPPhyD can help professionals such as musictherapists and environmental and landscape researchers strengthen subjects' motivation to learn to deal with the psychophysical discomfort associated with disability and to cope with the distress and the psychological fragility and the loneliness and the social seclusion and to promote productive social relationships. Materials and Methods. The MusGarPPhyD was implemented in multiple spaces. The musictherapy treatments took place first inside residential therapeutic centres and then in the garden landscape ecosystem. Patients: twenty, set in two groups. Weekly-sessions (50’) for three months. Methodological phases: - Phase P1. MusicTherapy treatments for each group in the indoor spaces. - Phase P2. MusicTherapy sessions inside the gardens. After each Phase, P1 and P2: - a Questionnaire for each patient (ten items / liking-indices) was administrated at t0 time, during the treatment and at tn time at the end of the treatment. - Monitoring of patients' behavioral responses through assessment scales, matrix, table and graph system. MusicTherapy methodology: pazient Sonorous-Musical Anamnesis, Musictherapy Assessment Document, Observation Protocols, Bodily-Environmental-Rhythmical-Sonorous-Vocal-Energy production first indoors and then outside, sonorous-musical instruments and edible instruments made by the Author/musictherapist with some foods; Administration of Patient-Environment-Music Index at time to and tn, to estimate the patient’s behavior evolution, Musictherapeutic Advancement Index. Results. The MusGarPPhyD can strengthen the individual sense of identity and improve the psychophysical skills and the resilience to face and to overcome the difficulties caused by the congenital /acquired disability. The multi-sensory perceptions deriving from contact with the plants in the gardens improve the psychological well-being and regulate the physiological parameters such as blood pressure, cardiac and respiratory rhythm, reducing the cholesterol levels. The secretions of the peptide hormones endorphins and the endogenous opioids enkephalins increase and bring a state of patient’s tranquillity and a better mood. The subjects showed a preference for musictherapy treatments within a setting made up of gardens and peculiar landscape systems. This resulted in greater health benefits. Conclusions. The MusGarPPhyD contributes to reduce psychophysical tensions, anxiety, depression and stress, facilitating the connections between the cerebral hemispheres, thus also improving intellectual performances, self-confidence, motor skills and social interactions. Therefore it is necessary to design hospitals, rehabilitation centers, nursing homes, surrounded by gardens. Ecosystems of natural and urban parks and gardens create fascinating skyline and mosaics of landscapes rich in beauty and biodiversity. The MusGarPPhyD is useful for the health management promoting patient’s psychophysical activation, better mood/affective-tone and relastionships and contributing significantly to improving the life quality.

Keywords: musictherapy, gardentherapy, disability, life quality

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Authors: Ava Simone Arteaga

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This research explores the portrayal of drug use in U.K. digital news media, a topic of critical importance due to its influence on addiction treatment, recovery efforts, and public perceptions. Substance use disorder (SUD) as one of the most stigmatized health conditions globally, with media representations playing a crucial role in shaping societal attitudes. Despite the impact of media portrayals, there has been no comprehensive analysis of drug-related representations in U.K. digital news media for over thirteen years. This study aims to fill this gap by analyzing contemporary digital news depictions of drug use, focusing on how these portrayals influence public perception and contribute to stigma. This research will examine tabloid, national, and regional East Midlands press sites to understand current trends in drug-related reporting. The study will build on previous research, such as the 2010 UKDPC study, which revealed that drug users were often vilified, and that coverage was predominantly focused on criminal justice rather than recovery. Given the rise in drug-related deaths in the U.K. and the exacerbation of the drug crisis post-Brexit, this analysis is timely and crucial. The findings are expected to reveal how digital media continues to perpetuate stigma and misinformation about drug use. By comparing these findings with U.S. studies, the research will contribute to a better understanding of cross-cultural differences in drug-related media representations and inform policy discussions. The U.K. Government's ten-year plan to combat illegal drugs, which emphasizes reducing stigma, will benefit from this research by highlighting the need for improved media representations. Additionally, the study will engage with recent U.K. and international research on media stigma towards SUD to provide a broader context and comparative perspective. Ultimately, this study aims to drive changes in media reporting and contribute to the development of more effective public policies and interventions. By addressing current gaps in research and providing evidence-based recommendations, this work seeks to support the U.K. Government’s objectives and improve the media’s role in addressing drug-related issues.

Keywords: addiction, UK news media, media representations, depiction of drug use

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Authors: Tania Camarillo Contreras, Yana Kuchirko

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Women’s sexuality, despite it being a core part of human functioning, has historically been stigmatized, silenced, and regulated and silenced across many cultures. The regulation of women’s bodies and desires has often been accomplished via gender ideologies and norms that ascribe power to men over women. Within Latino communities, gender ideologies like marianismo provide scripts by which women are expected to adhere submissiveness, purity, and putting others’ needs before their own. Prior work on sexuality-related topics among Latinas has almost exclusively examined the roles of risky behavior, partner violence, and gender roles on psychological and health outcomes. it know little about positive aspects of Latinas’ sexuality, such as their perspectives on sexual excitation and inhibition. Moreover, we know little about Latina’s sexuality in relation to marianismo. In this study, it ask the following questions (1) What are Latina’s perspectives on sexual excitation/inhibition? Do they vary by demographic variables (e.g., education, religiosity); (2) Does endorsement of marianismo among Latina women predict their perspectives on sexual excitation/sexual inhibition? and (3) Does endorsement of double standard (mediator variable) mediate the relation between marianismo (Independent) and sexual excitation/sexual inhibition? The results of this study shed light on effects of culturally specific gender ideologies like marianismo on women’s sexualities and have implications for culturally informed and gender-affirming policies seeking to better support Latinas’ sexual health.

Keywords: cultural beliefs, latinas, marianismo, sexuality, sexual inhibition

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Authors: Ahmed A. Abd El Rahim, Andrew Anis Fakhrey Mosaad

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Background: An important psychological issue that has an impact on both mental and physical function is anxiety disorders. The general consensus is that aerobic exercise and physical activity are good for lowering anxiety and mood. Purpose: This study's goal was to look into how patients with anxiety disorders responded to aerobic exercise. Subjects: Anxiety disorders were identified in 30 individuals from the psychiatric hospital at Sohag University who were chosen based on inclusive criteria and had ages ranging from 25 to 45. Methods: Patients were split into two equal groups at random: For four weeks, three sessions per week, fifteen patients in group A (the study group), seven men and eight women, underwent medication therapy and aerobic exercise. Age (28.4 ± 2.11 years), weight (72.5 ± 10.06 kg), height (164.8 ± 9.64 cm), and BMI (26.65 ± 2.68 kg/m2) were all mean SD values. And in Group B (Control Group), only medication therapy was administered to 15 patients (9 males and 6 females). Age (29.6 ± 3.68), weight (75 ± 7.07 kg), height (166.9 ± 6.75) cm, and BMI (26.87 ± 1.11) kg/m2 were the mean SD values. Before and after the treatment, the Hamilton Anxiety Scale was used to gauge the patient's degree of anxiety. Results: Within the two groups, there were significant differences both before and after the treatment. Following therapy, there was a significant difference between the two groups; the study group displayed better improvement on the Hamilton Anxiety Scale. Conclusion: Patients with anxiety problems can benefit from aerobic activities and antianxiety drugs as effective treatments for lowering anxiety levels.

Keywords: aerobic exercises, anxiety disorders, antianxiety medications, Hamilton anxiety scale

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Authors: Noorulain Khalid, Unsaar Hayat, Muhammad Chaudhary, Christos Iosifidis, Felipe Dhawahir-Scala, Fiona Carley

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Dry eye disease (DED) is a common condition seen in the emergency eye department (EED) at Manchester Royal Eye Hospital (MREH). However, there is variability in the prescription of lubricating eye drops among different healthcare providers. The aim of this study was to develop an up-to-date, standardized algorithm for the prescription of lubricating eye drops in the EED at MREH based on international and national guidelines. The study also aimed to assess the impact of implementing the guideline on the rate of inappropriate lubricant prescriptions. Primarily, the impact was to be assessed in the form of the appropriateness of prescriptions for patients’ DED. The impact was secondary to be assessed through analysis of the cost to the hospital. Data from 845 patients who attended the EED over a 3-month period were analyzed, and 157 patients met the inclusion and exclusion criteria. After conducting a review of the literature and collaborating with the corneal team, an algorithm for the prescription of lubricants in the EED was developed. Three plan-do-study-act (PDSA) cycles were conducted, with interventions such as emails, posters, in-person reminders, and education for incoming trainees. The appropriateness of prescriptions was evaluated against the guidelines. Data were collected from patient records and analyzed using statistical methods. The appropriateness of prescriptions was assessed by comparing them to the guidelines and by clinical correlation with a specialized registrar. The study found a substantial improvement in the number of appropriate prescriptions, with an increase from 55% to 93% over the three PDSA cycles. There was additionally a 51% reduction in expenditure on lubricant prescriptions, resulting in cost savings for the hospital (approximate saving of £50/week). Theoretical importance: Appropriate prescription of lubricating eye drops improves disease management for patients and reduces costs for the hospital. The development and implementation of a standardized guideline facilitate the achievement of these goals. Conclusion: This study highlights the inconsistent management of DED in the EED and the potential lack of training in this area for healthcare providers. The implementation of a standardized, easy-to-follow guideline for lubricating eye drops can help to improve disease management while also resulting in cost savings for the hospital.

Keywords: lubrication, dry eye disease, guideline, prescription

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