Search results for: children under five

Authors: Mohammad Naeem Lakanwall, Jamshid Abdul-Ghafar

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Background: Endocrinopathies are a commonly occurring entity, particularly those of the thyroid gland; however, there is a lack of scientific literature from Afghanistan, a country with very limited health care facilities and resources. To our best knowledge, this is the first study aimed to describe the frequency of occurrence and factors associated with thyroid dysfunction in the Afghan population. The aim of this study is to estimate the frequency and to identify factors associated with thyroid dysfunction among individuals coming to a tertiary care facility in Kabul, Afghanistan. Methods: A cross-sectional study was conducted from July to Sep 2018 at the Department of Clinical Pathology, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan. Blood samples were obtained, serum TSH levels were analyzed, and the patients were divided into three diagnostic categories according to their serum TSH concentrations: 1) hypothyroidism, 2) hyperthyroidism, 3) normal. Results: A total of 127 individuals were included in the final analysis. The majority of study participants (77%) were females. A large number of the participants (92%) did not have a family history of thyroid dysfunction. 74% of the participants in the study had normal TSH levels classified as normal thyroid function, (14%) had lower TSH levels, and (12%) higher TSH levels, classified as hyper and hypothyroid, respectively. Conclusions: The findings of the current study showed a high frequency of thyroid dysfunctions from a single center. Further large-scale studies are needed to find out the prevalence and document this entity for better health outcomes in the country.

Keywords: Afghanistan, factors, frequency, hypothyroid, hyperthyroid, thyroid, thyroid stimulating hormone

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Authors: A. Al-Wandi, A. Al-Ali, R. Dali, Y. Al-Karaghouli

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Background: Non-communicable diseases (NCDs) have become an alarming health problem across the globe. The risk of developing those diseases begins in childhood and develops gradually under the influence of risk factors including obesity, hypertension, dyslipidemia, cigarette smoking and decreased physical activity. Therefore, this study aims to determine the level of knowledge, attitudes, and practices of the risk factors of lifestyle induced chronic diseases (non-communicable diseases) among secondary school students in Sharjah city. Methods: Five hundred and ninety-one school children, from grades 10 to 12, formed the study sample, using the multistage stratified cluster sampling method. Four governmental schools were chosen, for each gender. Data was collected through a pretested, close-ended questionnaire consisting of five sections; demographics, physical activity, diet, smoking and sleeping patterns. Frequencies and descriptive statistics were used to analyze data through SPSS 23. Results: The data showed 64.6% of students had low knowledge of risk factors of non-communicable diseases. Concerning physical activity, 58.2 % were physically inactive and females being less active than males. More than 2/3 of students didn’t fulfill the recommended daily intake of fruits and vegetables (75.9%). 8% reported to be smokers with cigarettes being the most encountered tobacco product. Conclusion: Our study has demonstrated a low level of knowledge and practices yet, positive attitudes towards risk factors of chronic diseases. We recommend implementation of thorough awareness campaigns through public health education about the risk factors of non-communicable diseases.

Keywords: non-communicable diseases, physical activity, diet, knowledge, attitudes, practices, smoking

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Authors: Firjeeth C. Paramba, Vamanjore A. Naushad, Nishan K. Purayil, Osama H. Mohammed, Prem Chandra

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Background: Fever is a common problem in adults visiting the emergency department. Extensive studies have been done in children comparing the efficacy of various antipyretics. However, studies on the efficacy of antipyretic drugs in adults are very scarce. To the best of our knowledge, no controlled trial has been carried out comparing the antipyretic efficacy of paracetamol (oral and intravenous) and intramuscular diclofenac in adults. Methods: In this parallel-group, open-label trial, participants aged 14–75 years presenting with fever who had a temperature of more than 38.5°C were enrolled and treated. Participants were randomly allocated to receive treatment with 1,000 mg oral paracetamol (n=145), 1,000 mg intravenous paracetamol (n=139), or 75 mg intramuscular diclofenac (n=150). The primary outcome was degree of reduction in mean oral temperature at 90 minutes. The efficacy of diclofenac versus oral and intravenous paracetamol was assessed by superiority comparison. Analysis was done using intention to treat principles. Results: After 90 minutes, all three groups showed a significant reduction in mean temperature, with intramuscular diclofenac showing the greatest reduction (−1.44 ± 0.43, 95% confidence interval [CI] −1.4 to −2.5) and oral paracetamol the least (−1.08 ± 0.51, 95% CI −0.99 to −2.2). After 120 minutes, there was a significant difference observed in the mean change from baseline temperature between the three treatment groups (P, 0.0001). Significant changes in temperature were observed in favor of intramuscular diclofenac over oral and intravenous paracetamol at each time point from 60 minutes through 120 minutes inclusive. Conclusion: Both intramuscular diclofenac and intravenous paracetamol showed superior antipyretic activity than oral paracetamol. However, in view of its ease of administration, intramuscular diclofenac can be used as a first-choice antipyretic in febrile adults in the emergency department.

Keywords: antipyretic, intramuscular, intravenous, paracetamol, diclofenac, emergency department

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Authors: Sandipika Gupta

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Objective: Due to admirably low 30-day mortality rates for paediatric cardiac surgery, it is now pertinent to turn towards more intermediate-length outcomes such as morbidities closely associated with these surgeries. One such morbidity, major adverse events (MAE) comprises a group of adverse outcomes associated with paediatric cardiac surgery (e.g. cardiac arrest, major haemorrhage). Methods: This is a retrospective study that analysed the incidence and impact of MAE which was the primary outcome in the UK population. The data was collected in 5 centres between October 2015 and June 2017, amassing 3090 surgical episodes. The incidence and risk factors for MAE, were assessed through descriptive statistical analyses and multivariate logistic regression. The secondary outcomes of life status at 6 months and the length of hospital stay were also evaluated to understand the impact of MAE on patients. Results: Out of 3090 episodes, 134 (4.3%) had a postoperative MAE. The majority of the episodes were in: neonates (47%, P<0.001), high-risk cardiac diagnosis groups (20.1%, P<0.001), episodes with longer 5mes on the bypass (72.4%, P<0.001) and urgent surgeries (57.9%, P<0.001). Episodes reporting MAE also reported longer lengths of stay in hospital (29 days vs 9 days, P<0.001). Furthermore, patients experiencing MAE were at a higher risk of mortality at the 6-month life status check (mortality rates: 29.2% vs 2%, P<0.001).Conclusions: Key risk factors were identified. An important negative impact of MAE was found for patients. The identified risk factors could be used to profile and flag at-risk patients. Monitoring of MAE rates and closer investigation into the care pathway before and after individual MAEs in children’s heart units may lead to a reduction in these terrible events.

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Authors: Claire Stafford, Charles Golden, Daniel Amen, Kristen Willeumier

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The aim of this study is to investigate the effect of the administration of the Conners Continuous Performance Test (CPT-3) on cerebral blood flow (CBF) in adults with ADHD. The data for this study was derived from a large SPECT database. Participants in the ADHD group (n=81, Mage=37.97) were similar to those in the healthy control group (n=8503, Mage=41.86). All participants were assessed for cerebral blood flow levels before and after CPT-3 administration. Both age and gender were considered covariates. Multiple 2-by-2 ANCOVAs with repeated measures were conducted with sphericity assumed. The main effects of CPT-3 administration on CBF levels were significant in the left and right side of the frontal and occipital, and right temporal lobe. The main effects of ADHD diagnosis were significant in all brain areas assessed. The interaction between CPT-3 administration and ADHD diagnosis was significant in the left and right side of the limbic system, basal ganglia, the frontal lobe, and occipital lobe. Post hoc tests with a Bonferroni adjustment revealed that CBF levels increased following CPT-3 administration but less so in the ADHD group. Individuals had higher levels of CBF following the administration of CPT-3. Due to a significant interaction, we can infer that ADHD diagnosis changes the effect of CPT-3 administration on CBF levels. This is consistent with our hypothesis considering that CPT-3 is a test of sustained attention, a common challenge for children with ADHD. The aforementioned interaction was not found to be significant in the parietal lobe. This may be due to the nature of CPT- 3 which does not require an integration of sensory information.

Keywords: SPECT, ADHD, conners continuous performance test, cerebral blood flow

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Authors: Grace Modupe Adebo, Ayodeji Oluwamuyiwa Adedapo

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Women are key actors in ensuring food security in terms of food availability, food access, and food utilization in the developing economy, however, they suffer mostly during violent conflicts due to their feminist nature of rearing and caring for their children and relatives. The study was embarked upon to access the effects of violent conflicts posed by Boko Haram insurgency on women and food security in the Northeast of Nigeria. The study made use of secondary data. A time series data collected over a 22 years period were used. The data collected were subjected to descriptive statistics and t-test analysis. The findings of the study established a significant difference in food production (availability) before and after the Boko Haram insurgency at the 1% level of significance. The high level of Internally Displaced Person (IDP) with a high proportion of women depicts a very low level of food accessibility as the men and women has fled and uninhabited their place of abode for over a period of four to five years, thus diminishing their economic power, and the means of acquiring food which invariably endanger food stability and utilization. The study confirmed the abduction and changing roles of women as cooks, porters, spies, partners, and sex slaves to Boko Haram troop members, thus affecting their livelihoods and food security. The study recommends hands-on interventions by the governmental, non-governmental and international agencies to terminate the activities of Boko Haram in the area and restore the food production for enhanced food security.

Keywords: Boko Haram insurgency, food accessibility, food production, food utilization, women’s livelihoods

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Authors: Klara Smith-Etxeberria

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main goal of this study was to analyze the predictive ability of some variables associated with the parental divorce process alongside attachment history with parents on both, mother-child and father-child relationship quality. Our sample consisted of 173 undergraduate and vocational school students from the Autonomous Community of the Basque Country. All of them belonged to a divorced family. Results showed that adequate maternal strategies during the divorce process (e.g.: stable, continuous and positive role as a mother) was the variable with greater predictive ability on mother-child relationships quality. In addition, secure attachment history with mother also predicted positive mother-child relationships. On the other hand, father-child relationship quality was predicted by adequate paternal strategies during the divorce process, such as his stable, continuous and positive role as a father, along with not badmouthing the mother and promoting good mother-child relationships. Furthermore, paternal negative emotional state due to divorce was positively associated with father-child relationships quality, and both, history of attachment with mother and with father predicted father-child relationships quality. In conclusion, our data indicate that both, paternal and maternal strategies for children´s adequate adjustment during the divorce process influence on mother-child and father-child relationships quality. However, these results suggest that paternal strategies during the divorce process have a greater predictive ability on father-child relationships quality, whereas maternal positive strategies during divorce determine positive mother-child relationships among young adults.

Keywords: father-child relationships quality, mother-child relationships quality, parental divorce process, young adulthood

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Authors: Tatiana Pratt, Benyamin Hanasabzadeh, Panayiota Courelli

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The COVID-19 pandemic is one of the largest global public health issues of this current century. COVID-19 puts people diagnosed with obesity at higher risk of not only contracting the virus but also being hospitalized and dying, making this a vital time to implement obesity prevention programs. However, COVID-19 is predicted to rapidly increase the obesity rate in the United States due to the mandatory sedentary lifestyle the pandemic demands; this is especially harmful to adolescent-aged children because it creates lifelong unhealthy habits and behaviors. Adolescent obesity prevention programs have been rigorously implemented throughout the last century to help diminish the ever-increasing adolescent obesity rate. Since the pandemic kept adolescents inside and away from in-person school, many programs have now become ineffective due to their in-person participation. Examples of in-person participation programs include school lunch programs, OSNAP and New Moves. Therefore, online programs or remote intervention measures are now more essential. This leads to programs such as Time2bHealthy, HEALTH[e]TEEN, and SWITCH should be looked at with more vitality. Adolescents have intertwined their lives with technology and screen usage. Therefore, online and remote prevention programs will continue to play a large role in the post-pandemic era. This literature review will be reviewing past and current adolescent obesity prevention programs and their effectiveness with the new remote, sedentary lifestyle adolescents. Furthermore, it will suggest new ways to more productively decrease adolescent obesity rates by analyzing the harmful factors that COVID-19 introduced into their lifestyles.

Keywords: adolescent, obesity, overweight, COVID-19, preventative care, public health, public policy, obesity prevention programs, online programs

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Authors: Nipun Ansal

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People guard their beliefs and opinions with their lives. Beliefs that they’ve formed over a period of time, and can go to any lengths to defy, desist from, resist and negate any outward stimulus that has the potential to shake them. Cognitive dissonance is term used to describe it in theory. And every human being, in order to defend himself from cognitive dissonance applies 4 rings of defense viz. Selective Exposure, Selective Perception, Selective Attention, and Selective Retention. This paper is a discursive analysis on how the onslaught of social media, complete with its intrusive weaponry, has amorphized the external ring of defense: the selective exposure. The stimulus-response model of communication is one of the most inherent model that encompasses communication behaviours of children and elderly, individual and masses, humans and animals alike. The paper deliberates on how information bombardment through the uncontrollable channels of the social media, Facebook and Twitter in particular, have dismantled our outer sphere of exposure, leading users online to a state of constant dissonance, and thus feeding impulsive action-taking. It applies case study method citing an example to corroborate how knowledge generation has given in to the information overload and the effect it has on decision making. With stimulus increasing in number of encounters, opinion formation precedes knowledge because of the increased demand of participation and decrease in time for the information to permeate from the outer sphere of exposure to the sphere of retention, which of course, is through perception and attention. This paper discusses the challenge posed by this fleeting, stimulus rich, peer-dominated media on the traditional models of communication and meaning-generation.

Keywords: communication, discretion, exposure, social media, stimulus

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Authors: Sufia Ferdousi

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Child-friendly education (CFE) is very important for the children, especially the early year’s students, because it fosters the holistic development of a child. Teacher plays a key role in creating child-friendly education. This study intends to learn about child-friendly education in Bangladesh. The purpose of the study is to explore how CFE is being practiced in Bangladesh. The study attempted to fulfill the purpose through case study investigation. One school, named Nalanda, was selected for the study as it claims to run the school through CFE approach. The objective of the study was to identify, how this school is different from the other schools in Bangladesh, to explore overall teaching learning system like, curriculum, teaching strategies, assessments and to investigate the support system for Child Friendly Education provided to the teachers through training or mentoring. The nature of the case study was qualitative method to get maximum information from the students, parents, teachers and school authorities. The findings were based on 3 classroom observations, interviews with 1 teacher, 1 head teacher and 1 trainer, FGD with 10 students and 6 parents, were used to collect the data. It has been found that Nalanda is different than the other schools in Bangladesh in terms of, parents’ motivation about school curriculum, and sufficiency of teachers’ knowledge on joyful learning/child-friendly learning. The students took part in the extracurricular activities alongside the national curriculum. Teachers showed particular strength in the teaching learning strategies, using materials and assessment. And Nalanda gives strong support for teacher’s training. In conclusion, The Nalanda School in Dhaka was found appropriate for the requirements of Child-friendly education.

Keywords: child friendly education, overall teaching learning system, the requirements of child-friendly education, the alternative education approach

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Authors: Akbar Ali

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The aim of this study is to explore the academic performance of adolescents who are living with their single parents. Living with single parents is challenging experience especially when children are in adolescence phase. The core aim of study was to investigate how family environment, social status and parental support affect adolescents’ academic performance. This study is carried out in Punjab, Pakistan on adolescents who are experiencing the single family environment either my divorce or natural parental marital transition. Qualitative methodology was employed to evaluate the different aspects of aspects of academic performance. A sample of 40 students in-between age 14 to 18 years was selected from different institutions coming from different socio cultural backgrounds and having different family situations comprising different types of single family structure. Data was collected through semi structured interviews to explore the academics performance and family dynamics. Findings of the study indicated that adolescents living with single parents show poor academic performance due to lack of interest, absentees, poor social and economic support, less parental involvement. Students were showing less or no interest in extracurricular activities and less social interaction with fellows. Parental economic status , Parenting style, parental involvement and academic support are the key factors which directly academic outcomes. Research experience was challenging because students were reluctant to share family issues. Proper academic and counselling centre should be established to provide emotional and academic counselling for such students. Longitudinal research should be carried out to trace the academic outcomes and social adjustments.

Keywords: academic counselling, marital transitions, parenting style, parental involvement

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Authors: Anela Lupuwana

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The main objective of this paper is to develop an ethnobotanical survey that documents medicinal plants used to treat diarrhea among infants in the Eastern Cape province of South Africa. In South Africa’s pluralistic healthcare system, medicinal plants are an integral part of healing and treating an array of diseases. This is also the case in rural areas of South Africa, where healthcare facilities are hard to access. There is a lack of literature on the use of medicinal plants to cure ailments common to children, and this paper fills this gap. A total of 18 participants were interviewed using semi-structured interviews. A purposive approach was used to sample the study cohorts. A total of 28 medicinal plants representing 19 different families were recorded, with the family Asteraceae (11%) having the most medicinal plants. The remaining plants (82%) were distributed equally among the following families: Rubiaceae, Canellaceae, Aloaceae, Rutaceae, Thymeleaceae, Myrinaceae, Olinaceae, Iradeceae, Zingiberaceae, Capparaceae, Aizoaceae, Fabaceae, Geraniaceae, Cornaceae, Monimiaceae, Talinaceae, Chrysobalanaceae, and Icacinaceae. Oral administration was the most common mode of administration, with 82% of plants taken orally. Healing was proven to be holistic; it was more than just treating physical ailments as such; infants were protected from evil spirits that made them vulnerable to illnesses. There was also evidence of the assimilation of Dutch medicine and animal products into traditional healing methods. In order to mitigate the prevalence of disease and illness in South Africa, I recommend that diversity in healing practices should be acknowledged and appreciated.

Keywords: infants, traditional healers, primary care givers, traditional medicine

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Authors: Aisha M. Khairat

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Community education in the Arab Republic of Egypt is a model that provides education to remote, underprivileged villages and hamlets where children have no access to public education. The community education model is based on the philosophy of transforming individuals to reach their full potential and on instilling the seeds of empowerment and citizenship to induce societal transformation. This research aims at investigating the degree to which the leadership style and organizational culture of the Egyptian community schools demonstrates an empowering approach. Nile Valley NGO, an Egyptian Non-Governmental Organization (NGO) leading hundreds of Egyptian community schools was studied to investigate the perceptions of empowerment amongst its leadership. This in turn will have serious implications on the level of empowerment the communities managed by Nile Valley NGO are experiencing, and will serve as an indicator to the degree to which community schools are achieving their goals in transforming individuals and empowering communities and reforming Egyptian education – and not just a tool to reach literacy. This mixed-methods research utilized surveys and semi-structured interviews to capture the perceptions of empowerment in the views of a sample of 380 community schools facilitators (teachers) spanning 8 Egyptian governorates and Nile Valley NGO’s community education project team and leadership. The findings demonstrate interesting leadership approaches with traits from transformational and servant leadership theoretical models. The organizational culture at Nile Valley NGO reflects the universal dichotomy between market-oriented and humanitarian orientations. The perceptions of empowerment were positive, and several success stories were uncovered in spite of the many challenges faced on the national level and despite the scarcity or resources.

Keywords: community education, community schools in Egypt, empowerment, organizational culture, leadership

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Authors: Timothy Mossman

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The number of adolescent children accompanying their immigrant parents to Canada has steadily increased since the 1990s. Much of the applied linguistics literature on these so-called ‘Generation 1.5’ youth has focused on their deficiencies as academic writers in US Rhetoric and Composition and ESL contexts in higher education and the stigma of ESL in US K-12 contexts. However, the literature on Generation 1.5 students and identity in Canadian higher education is limited. This qualitative study investigates the processes of identity construction of three Generation 1.5 students studying at a university in Metro Vancouver to find out what types of identities and representations of self and other they make relevant, the meanings they attribute to their identities, and what motivates them to construct these identities. The study analyzes the accounts and experiences of the participants in interviews, focus groups, and texts and as ‘culture-in-action,’ positing that they constructed identities as social categories associated with the languages and social practices of their countries of birth, in liminal spaces among a continuum between Canada and their countries of birth, and a spectrum of related cultural representations. Ideas and beliefs associated with broader ‘macro’ social structures in Canadian society related to language, culture, legitimacy, immigration, power, distinction, and racism were shown to be transcended in and through their representations of themselves and others. Data suggest that moving to Canada caused participants to experience discontinuities between their cultures, languages, and social practices, and in some cases a conflicting sense of self. The study brings implications for finding ways to understand the complexity of immigrant students, avoid reifying and generalizing about them, and not see them as stuck-in-between or lacking.

Keywords: culture-in-action, generation 1.5, identity, membership categorization analysis

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Authors: Laura Lamas Abraira

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Large-scale Chinese immigration in Spain emerged in the 80's. Engaged in their own businesses or working for other Chinese migrants with long schedules, young couples had to choose between contracting or transnationalising the care labour as they were unable to combine productive and reproductive tasks. In most cases, they decided to transnationalize the care labour embodied on grandparents or children migratory paths. Either the grandparents go to Spain to take care of their grandchildren or the kids were left behind or sent to China after being born in Spain in order to be raised with their extended family members. Very little is known about how the people who have been raised in a transnational context relates their own experience and agency as care managers within the family care cycle. In order to fill this gap, this paper aims to inquire into these transnationally-reared Chinese young adults’ narratives about their own experience and expectations (past, present and future) by adopting care circulation and care cycle approach within life course framework. Drawing upon a qualitative study resulting from a multi-sited ethnography (Spain-China), we argue that young adults raised in transnational context build their narratives as a result of an otherness process related to their parents and an essentialization of their Chinese roots to use selectively among different contexts. In doing so, these family narratives constitute a part of their social identity that interact with other dimensions such as the ethnic one. We suggest when building their parent's otherness they also build their sameness among pairs, as members of the same club, marked by transnational care on a double time basis: the practices of their parents as wrong past, and their own as an amendable future.

Keywords: Chinese families, narratives, transnational care, young adults

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Authors: Inosha Bimali, Shambhu P. Adhikari, Sumana Baidya, Nishchal R. Shakya

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Background: An earthquake of 7.8 magnitudes with an epicenter in Gorkha on 25th April 2015 and second earthquake of 6.5 magnitudes with an epicenter at Sindhupalchwok on 12th May 2015 struck the beautiful country of Nepal, killing more than 8,500 people and over 18,500 individuals were left injured with various forms of disabilities. Objectives: To explore number, type and level of disability among post earthquake victims. A door to door physiotherapy rehabilitation program will be conducted at the community level as a continuation of this study. Methods: A survey was carried out in the catchment area of Bahunepati and Manekharka outreach centers of Sindhupalchowk district and Gaurishankar outreach center of Dolakha district of Dhulikhel Hospital. Physical disability was identified using a disability survey form given by Ministry of women, children and social welfare Nepal Government. World health organization disability assessment schedule-2 was used to identify the level of disability. Results: Twenty-nine person with disabilities at Bahunepati, four person with disabilities at Manekharkha and two person with disabilities at Gaurishankar and its catchment area were identified. Level of disability was an average of 56% with majority of survivors having upper extremities fractures followed by lower extremities fractures and miscellaneous injury. Few spinal cord injuries and head injuries were also identified. Conclusion: Though number of person with disabilities was found relatively less, disability level is high; hence an urgent need of physiotherapy rehabilitation is reflected to improve the quality of life of the affected people.

Keywords: community, disability, Nepal earthquake, physiotherapy

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Authors: Lisa Winstead, Penny Congcong Wang

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This two-year multiple case study of eight Spanish-English speaking teachers explores bilingual-bicultural Latino teachers’ lived experiences as English Language Learners and, more recently, as adult teachers who work with English Language Learners in mainstream schools. Research questions explored include: How do bilingual-bicultural teachers perceive their native language use and sense of self within society from childhood to adulthood? Correspondingly, what are bilingual teachers’ perceptions of how their own language learning experience might affect teaching students of similar linguistic and cultural backgrounds? This study took place in an urban area in the Pacific Southwest of the United States. Participants were K-8 teachers and enrolled in a Spanish-English bilingual authorization program. Data were collected from journals, focus group interviews, field notes, and class artifacts. Within case and cross-case analysis revealed that the participants were shamed about their language use as children which contributed to their primary language loss. They similarly reported how experiences of mainstream educator and administrator language shaming invalidated their ability to provide support for Latino heritage ELLs, despite their bilingual-bicultural expertise. However, participants reported that counter-narratives from the bilingual authorization program, parents, community and church organizations, and cultural responsive teachers were effective in promoting their language retention, pride, and feelings of well-being.

Keywords: teacher education, bilingual education, English language learners, emergent bilinguals, social justice, language shame, language loss, translanguaging

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Authors: Devendra Gupta, Sushilk K. Agarwal, Amit Kesari, P. K. Singh

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Objectives: Pediatric patients often may experience persistent respiratory failure that requires tracheostomy placement in Pediatric ICU. We have designed a technique of tracheostomy in pediatric patients with S-shaped incision on the tracheal wall with higher success rate and lower complication rate. Technique: Following general anesthesia and positioning of the patient, the trachea was exposed in midline by a vertical skin incision. In order to make S-shaped tracheostoma, second tracheal ring was identified. The conventional vertical incision was made in second tracheal ring and then extended at both its ends laterally in the inter-cartilaginous space parallel to the tracheal cartilage in the opposite direction to make the incision S-shaped. The trachea was dilated with tracheal dilator and appropriate size of tracheostomy tube was then placed into the trachea. Results: S-shaped tracheostomy was performed in 20 children with mean age of 6.25 years (age range is 2-7) requiring tracheostomy placement. The tracheostomy tubes were successfully placed in all the patients in single attempt. There was no incidence of significant intra-operative bleeding, subcutaneous emphysema, vocal cord palsy or pneumothorax. Two patients developed pneumonia and expired within a year. However, there was no incidence of tracheo-esophageal fistula, suprastomal collapse or difficulty in decannulation on one year of follow up related to our technique. One patient developed late trachietis managed conservatively. Conclusion: S-shaped tracheoplasty was associated with high success rate, reduced risk of the early and late complications in pediatric patients requiring tracheostomy.

Keywords: peatrics, tracheostomy, ICU, tracheostoma

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Authors: Arezoo Fallahi

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Introduction: Exposure to second-hand smoke is an important global health problem and threatens the health of people, especially children and women. The aim of this study was to determine the effect of education based on the Health Belief Model on preventive behaviors of exposure to secondhand smoke in women. Materials and Methods: This experimental study was performed in 2023in Sanandaj, west of Iran. Seventy-four people were selected by simple random sampling and divided into an intervention group (37 people) and a control group (37 people). Data collection tools included demographic characteristics and a second-hand smoke exposure questionnaire based on the Health Beliefs Model. The training in the intervention group was conducted in three one-hour sessions in the comprehensive health service centers in the form of lectures, pamphlets, and group discussions. Data were analyzed using SPSS software version 21 and statistical tests such as correlation, paired t-test, and independent t-test. Results: The intervention and control groups were homogeneous before education. They were similar in terms of mean scores of the Health Belief Model. However, after an educational intervention, some of the scores increased, including the mean perceived sensitivity score (from 17.62±2.86 to 19.75±1.23), perceived severity score (28.40±4.45 to 31.64±2), perceived benefits score (27.27±4.89 to 31.94±2.17), practice score (32.64±4.68 to 36.91±2.32) perceived barriers from 26.62±5.16 to 31.29±3.34, guide for external action (from 17.70±3.99 to 22/89 ±1.67), guide for internal action from (16.59±2.95 to 1.03±18.75), and self-efficacy (from 19.83 ±3.99 to 23.37±1.43) (P <0.05). Conclusion: The educational intervention designed based on the Health Belief Model in women was effective in performing preventive behaviors against exposure to secondhand smoke.

Keywords: women, health behaviour, smoke, belive

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Authors: Claude Takenga, Rolf-Dietrich Berndt, Erling Si, Markus Diem, Guohui Qiao, Melanie Gau, Michael Brandstoetter, Martin Kampel, Michael Dworzak

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In patients with acute lymphoblastic leukaemia (ALL), treatment response is increasingly evaluated with minimal residual disease (MRD) analyses. Flow Cytometry (FCM) is a fast and sensitive method to detect MRD. However, the interpretation of these multi-parametric data requires intensive operator training and experience. This paper presents a pipeline-software, as a ready-to-use FCM-based MRD-assessment tool for the daily clinical practice for patients with ALL. The new tool increases accuracy in assessment of FCM-MRD in samples which are difficult to analyse by conventional operator-based gating since computer-aided analysis potentially has a superior resolution due to utilization of the whole multi-parametric FCM-data space at once instead of step-wise, two-dimensional plot-based visualization. The system developed as a telemedical network reduces the work-load and lab-costs, staff-time needed for training, continuous quality control, operator-based data interpretation. It allows dissemination of automated FCM-MRD analysis to medical centres which have no established expertise for the benefit of an even larger community of diseased children worldwide. We established a telemedical network system for analysis and clinical follow-up and treatment monitoring of Leukaemia. The system is scalable and adapted to link several centres and laboratories worldwide.

Keywords: data security, flow cytometry, leukaemia, telematics platform, telemedicine

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Authors: O. H. Gebril, N. A. Meguid

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Background: Iron had been a focus of interest recently as a main exaggerating factor for oxidative stresses in the central nervous system and a link to various neurological disorders is suspected. Many studies with various techniques showed evidence of disturbed iron-related proteins in the cell in human and animal models of neurodegenerative disorders. Also, linkage to significant pathological changes had been evidenced e.g. apoptosis and cell signaling. On the other hand, the role of iron in neurodevelopmental disorders is still unclear. With increasing prevalence of autism worldwide, some changes in iron parameters and its stores were documented in many studies. This study includes Haemochromatosis HFE gene polymorphisms (p.H63D and p.C282Y) and ferroportin gene (SLC40A1) Q248H polymorphism in autism and control children. Materials and Methods: Whole genome DNA was extracted; p.H63D and p.C282Y genotyping was studied using specific sequence amplification followed by restriction enzyme digestion on a sample of autism patients (25 cases) and twenty controls. Results: The p.H63D is seen more than the C282Y among both autism and control samples, with no significant association of p.H63D or p.C282Y polymorphism and autism was revealed. Also, no association with Q248H polymorphism was evidenced. Conclusion: The study results do not prove the role of cellular iron genes polymorphisms as risk factors for neurodevelopmental disorders, and in turn highlights the specificity of cellular iron related pathways in neurodegeneration. These results demand further gene expression studies to elucidate the main pathophysiological pathways that are disturbed in autism and other neurodevelopmental disorders.

Keywords: iron, neurodevelopmental, oxidative stress, haemohromatosis, ferroportin, genes

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Authors: Martina Dickson, Lilly Tennant

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The young Emirati female university students of today are the first generation of women in the UAE for whom higher education as become not only a possibility, but almost an expectation. Young women in the UAE today make up around 77% of students in higher education institutes in the country. However, the societal expectations placed upon these women in terms of early marriage, child-bearing and rearing are similar to those placed upon their mothers and grandmothers in a time where women were not expected to go to university. A large proportion of female university students in the UAE are mothers of young children, or become mothers whilst at the university. This creates a challenging situation for young student mothers, where two weeks’ maternity leave is typical across institutions. The context of this study is in one such institution in the UAE. We have employed a mixed method approach to gathering interview data from twenty mothers, and survey data from over one hundred mothers. The main findings indicate that mothers have strong desires for their institution to support them more, for example by the provision of nursery facilities and resting areas for new mothers, and giving them greater flexibility over course selections and schedules including the provision of online learning. However, the majority felt supported on a personal level by their tutors. The major challenges which they identified in returning to college after only two weeks’ leave included the inevitable health and lack of sleep issues when caring for a newborn, struggling to catch up with missed college work and handling their course load. We also explored the women's’ home support systems which were provided from a variety of extended family, spouses and paid domestic help.

Keywords: student mothers, challenges, supports, United Arab Emirates

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Authors: Adel Ben Mohamed

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The widespread use of the English language around the world has pushed many countries to consider such a language as a top priority in their educational system. One of these countries is the Sultanate of Oman. In this frame, the Omani government has allocated huge budgets as well as resources in order to implement the English language in its education system. The importance of English is prevalent in Oman. This is clearly noticeable through remarkable signs. For instance, most of the official documents in Oman are in both Arabic (the mother tongue) or English. In addition to that, there is a mushroom of English language institutes all over the country. In 2020, there are over fourteen English language institutes and centers in Oman (esl base, 2020). Moreover, these days most of the Omani parents are sending their children for tuition to learn the English language. Hence, it is apparent that the Sultanate of Oman is giving a great value to the importance of English in attaining various goals. However, in the world of work, what is more, important today is fluency rather than accuracy. Therefore, many people go for communication English rather than technical English. For example, Oman Daily Observer newspaper published a job advertisement of a sale assistant on 23rd of November 2020, recommended that speaking very well English is a must to be hired for the position (Oman Observer, 2020). In line with this and because of the great importance of the English language in Oman, the ministry of higher education has placed much emphasis on this official foreign language. Therefore, in the Omani educational system, all post -secondary students must sit for one year in one of the higher education institutions as a General Foundation Programmes (GFP) prior to moving to their respective majors in diploma level. Accordingly, the implementation of any teaching approach is determined by different factors: some are directly linked to teachers while others are related to organizational variables.

Keywords: teaching approaches, communicative, ability, investigating

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Authors: Nicoleta Simona Vedeanu, Rares Stiufiuc, Dana Alina Magdas

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A detailed knowledge of the teeth structure is mandatory to understand and explain the defects and the dental pathology, but especially to take a correct decision regarding dental prophylaxis and treatment. The present work is an alternative study to the traditional investigation methods used in dentistry, a study based on the use of modern, sensitive physical methods to investigate human enamel and dentin. For the present study, several teeth collected from patients of different ages were used for structural and dietary investigation. The samples were investigated by Raman spectroscopy for the molecular structure analysis of dentin and enamel, atomic force microscopy (AFM) to view the dental topography at the micrometric size and mass spectrometry for isotopic ratios as a fingerprint of patients’ personal diet. The obtained Raman spectra and their interpretation are in good correlation with the literature and may give medical information by comparing affected dental structures with healthy ones. AFM technique gave us the possibility to study in details the dentin and enamel surface to collect information about dental hardness or dental structural changes. δ¹³C values obtained for the studied samples can be classified in C4 category specific to young people and children diet (sweets, cereals, juices, pastry). The methods used in this attempt furnished important information about dentin and enamel structure and dietary habits and each of the three proposed methods can be extended at a larger level in the study of the teeth structure.

Keywords: AFM, dentine, enamel, Raman spectroscopy

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Authors: Ellen Lagast, Melissa Ceuterick, Mark Leys

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Although adolescence is a stressful period with an increased risk for mental illnesses such as anxiety and depression, little in-depth knowledge is available on the determinants of the use of psychotropic drugs (BZD/SSRIs) and the effects. A qualitative research with adolescents in Flanders was performed. Based on indepth interviews, the interviewees indicate feelings of ambiguity towards their medication use because on the one hand the medication helps to manage their mental vulnerability and disrupted lives, but on the other hand they experience a loss of control of their self and their environment. Undesired side-effects and stigma led to a negative pharmaceutical self. The interviewed youngsters also express dissatisfaction about the prescription behavior with regard to psychotropic drugs of their general practitioner (GP). They wished to have received more information about alternative non-pharmaceutical treatment options. Notwithstanding these comments, the majority of the interviewees maintained trust in their GP to act in their best interest. This paper will relate the prescription behavior in primary care to the organization of mental health care to better understand the “phamaceuticalization” and medicalization of mental health problems in Belgium. Belgium implemented fundamental mental health care reforms to collaborate, to integrate care and to optimize continuity of care. Children and adolescents still are confronted with long waiting lists to access (non-medicalized) mental health services. This access to mental health care partly explains general practitioners’ prescription behavior of psychotropics. Moreover, multidisciplinary practices have not pervaded primary health care yet. Medicalization and pharmaceuticalization of mental health vulnerabilities of youth are both a structural and cultural problem.

Keywords: adolescents, antidepressants, benzodiazepines, mental health system, psychotropic drugs

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Authors: Jamil Ahmed, Li P. Wong, Yan P. Chua

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The United Nation's sustainable development goals include the target to ensure access to water and sanitation for all; however, very few studies have assessed school-based drinking water in Pakistan. The purpose of this study was to characterize water quality in primary schools of Pakistan and to characterize how recent WASH interventions were associated with school water quality. We conducted a representative cross-sectional study of primary schools in the Sindh province of Pakistan. We used structured observations and structured interviews to ascertain the school’s WASH conditions. Our primary exposures of interest were the implementation of previous WASH interventions in the school and the water source type. Outcomes of interest included water quality (measured by various chemical and microbiological indicators) and water availability at the school’s primary drinking water source. We used log-binomial regression to characterize how WASH exposures were associated with water quality outcomes. We collected data from 256 schools. Groundwater was the primary drinking water source at most schools (87%). Water testing showed that 14% of the school’s water had arsenic above the WHO recommendations, and over 50% of the water samples exceeded recommendations for both lead and cadmium. A majority of the water sources (52%) had fecal coliform contamination. None of the schools had nitrate contamination (0%), and few had fluoride contamination (5%). Regression results indicated that having a recent WASH intervention at the school was not associated with either arsenic contamination (prevalence ratio=0.97; 95% CI: 0.46-2.1) or with fecal coliform contamination (PR=0.88; 95% CI: 0.67-1.17). Our assessment unveiled several water quality gaps that exist, including high heavy metal and fecal contamination. Our findings will help various stakeholders to take suitable action to improve water quality in Pakistani schools.

Keywords: WASH interventions, water quality, primary school children, heavy metals

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Authors: Bonnie Pollak

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As the world continues to suffer grievous injuries, future generations will suffer from trauma that was inflicted on innocent victims. Trauma can result from refugees fleeing their homes, exposure to warfare, loss of loved ones, and lack of shelter and basic necessities. The Holocaust continues to cause pain even though WWII ended nearly 80 years ago. One cannot forget the inhumane treatment and murder of relatives. The pain and trauma may continue for generations. The purpose of the Final Solution was to eliminate Jews in totality. Though Hitler’s plan was not successful, he managed to cause trauma that will continue with no end date in sight. “The Effects of Trauma and Secondary Trauma,” Trauma can cause life-long challenges, eating disorders, cardiovascular disease, cancer, sleeping difficulties, fear of going outside, guilt, separation problems, and epigenetic changes. Secondary Trauma, witnessing a loved one in danger or hearing about the danger, can cause similar symptoms as seen in primary trauma. The transmission of trauma was demonstrated in children of Holocaust survivors and in communities where oppression was commonplace. We are witnessing a repeat of widescale death and horrific injuries today in Ukraine and in other parts of the world, where concern for pain and trauma is not acknowledged by perpetrators. Lessons from the Holocaust can be applied to help others who have been traumatized by widescale terrorism resulting in death of loved ones, loss of home and shelter, food and other life-sustaining measures. The world must help victims by providing basic necessities but also by using trauma-informed care, focusing on strength and resilience, and helping individuals to feel pride in their identity.

Keywords: transmission of intergenerational trauma, impact on religious beliefs and practices, 2nd generation, identity

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Authors: Humaira Maheen, Elizabeth Hoban, Catherine Bennette

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Background: Globally, role of Community Health Workers (CHW) as front line disaster health work force is underutilized. Developing countries which are at risk of natural disasters or humanitarian emergencies should lay down effective strategies especially to ensure adequate access to maternity care during crisis situation by using CHW as they are local, trained, and most of them possess a good relationship with the community. The Minimum Initial Service Package (MISP) is a set of universal guidelines that addresses women’s reproductive health needs during the first phase of an emergency. According to the MISP, pregnant women should have access to a skilled birth attendant and adequate transportation arrangements so they can access a maternity care facility. Pakistan is one of the few countries which has been severely affected by a number of natural disaster as well as humanitarian emergencies in last decade. Pakistan has a young and structured National Disaster Management System in place, where District Authorities play a vital role in disaster management. The District Health Department develops the contingency health plan for an emergency situation and implements it under the existing district health human resources (health workers and medical staff at the health facility) and infrastructure (health care facilities). Methods: A mixed methods study was conducted in rural villages of Sindh adjacent to the river Indus, and included in-depth interviews with 15 women who gave birth during the floods, structured interviews with 668 women who were pregnant during 2010-2014, and in-depth interviews with 25 community health workers (CHW) and 30 key informants. Results: Women said that giving birth in the relief camps during the floods was one of the most challenging times of their life. The district health department didn’t make transportation arrangement for labouring women from relief camp to the nearest health care facility. As a result 91.2% women gave birth in temporary shelters with the help of a traditional birth attendant (Dai) with no clean physical space available to birth. Of the 332 women who were pregnant at the time of the floods, 26 had adverse birth outcomes; 10 had miscarriages, 14 had stillbirths and there were four neonatal deaths. Conclusion: The district health department was not able to provide access to adequate maternity care during according to the international standard during the floods in 2011. We propose a model where CHWs will be used as frontline maternity care providers during any emergency or disaster situations in Pakistan. A separate "birthing station" should be mandatory in all district relief camps, managed by CHWs. Community midwives (CMW) would and the Lady Health Workers (LHW) would provide antenatal and postnatal care alongside, vaccination for pregnant women, neonates and children under five. There must be an ambulance facility for emergency obstetric cases and all district health facilities should have at least two medical staff identified and trained for emergency obstetric management. The District Health Department must provide clean birthing kits and regular and emergency contraceptives in the relief camps. Methods: A mixed methods study was conducted in rural villages of Sindh adjacent to the river Indus, and included in-depth interviews with 15 women who gave birth during the floods, structured interviews with 668 women who were pregnant during 2010-2014, and in-depth interviews with 25 community health workers (CHW) and 30 key informants. Results: Women said that giving birth in the relief camps during the floods was one of the most challenging times of their life. Nearly 91.2% women gave birth in temporary shelters with the help of a traditional birth attendant (Dai) with no clean physical space available to birth, and the health camp was mostly accessed by men and always overcrowded. There was no obstetric trained medical staff in the health camps or transportation provided to take women with complications to the nearest health facility. The rate of adverse outcome following disaster was 22.2% (95% CI: 8.62% – 42.2%) amongst 27 women who did not evacuate as compare to 7.91% (95% CI: 5.03% – 11.8%) among 278 women who lived in relief camp study participants. There were 27 women who evacuated on pre-flood warning and had 0% rate of adverse outcome. Conclusion: We propose a model where CHWs will be used as frontline maternity care providers during any emergency or disaster situations in Pakistan. A separate "birthing station" should be mandatory in all district relief camps, managed by CHWs. Community midwives (CMW) would and the Lady Health Workers (LHW) would provide antenatal and postnatal care alongside, vaccination for pregnant women, neonates and children under five. There must be an ambulance facility for emergency obstetric cases and all district health facilities should have at least two medical staff identified and trained for emergency obstetric management. The District Health Department must provide clean birthing kits and regular and emergency contraceptives in the relief camps.

Keywords: natural disaster, maternity care model, rural, Pakistan, community health workers

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Authors: Dinko Vuleta, Dejan Madić, Goran Sporiš, Nebojša Trajković

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The aim of this study was to determine the effects of gymnastics program in school on skill-related fitness in early adolescent students. The study involved 58 adolescent students (12.82±0.54 years; Height 156.81±8.16 cm; 53.46±12.31 kg) from primary school divided into two groups, following the randomization. The gymnastic group was involved in a 12 week of gymnastics classes, while the control group only participated in usual PE classes which consisted of multi-sport activities. The variables were selected within the several fitness batteries, measuring coordination (polygon backwards), upper and lower body strength standing long jump and medicine ball throw), speed (20 m sprint) and agility (4x10 test). Pre-test to post-test values showed significant improvements in all tested variables (p<0.05), except for the 4x10m test, where there were no significant improvements in neither of the groups (p>0.05). Significant interactions of time by group were observed for coordination, sprint speed, standing long jump and medicine ball throw (p<0.05). The results showed significant increase in skill-related fitness of the participants in the gymnastic group compared to the control group. Therefore, participation in gymnastics must be recommended as a positive foundational activity for school-aged children, from early childhood to adulthood. Additionally, the results can provide useful information in optimizing the training loads of pupils involved in gymnastic training throughout PE classes.

Keywords: effects, PE classes, physical fitness, training

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Authors: Aikaterini Tavoulari

Abstract:

This research aims to address the types of repetitive behaviours (RBs) observed by adults in children with vision impairment (VI) or autism spectrum disorder (ASD), the explanations the adults employ to interpret these behaviours, and the impact RBs have on the child, the caregiver, the professional and society. The underlying reason for this is an attempt to discover any potential differences between two different disabilities in a comparative fashion. The study is based on the interpretivism paradigm and follows a qualitative approach. A comparative case study design based on the ecological systems theory (EST) is adopted. Thirty-five caregivers and accredited professionals were recruited (17 for the VI group, out of whom 8 were caregivers and 9 were professionals, and 18 for the ASD group, out of whom 9 were caregivers and 9 were professionals). Following the completion of a pilot study, all participants were interviewed regarding one specific child – their own child/student – via semi-structured interviews. During the interviews, the researcher used a research diary as a methodological tool and video elicitation as a facilitation tool. A cross-case analysis was conducted, and data were analysed according to the method of thematic analysis. A link has been indicated between VI and ASD, which concerns perceptions about the socially constructed manner in which an RB is perceived. ASD is perceived by the participants as a disability with challenging characteristics, such as an RB. The ASD group perceived RB as linked to ableism, social stigmatisation, and taboo, in contrast to VI, where the existence of RB seems to be a consequence of sensory loss. Bi-directionality of EST seems to have been lost completely, and the macrosystem seems to drive the interactions between the ecological systems.

Keywords: ableism, social stigma, disability, repetitive behaviour, vision impairment, autism spectrum disorder, perceptions

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