Search results for: community-based palliative care

Authors: Nina Kaufmans

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Traditional therapies, utilizing spoken narratives as a primary source of intervention, are proven to be limited in effectively treating post traumatic stress disorder. Following the effects of the global pandemic of COVID-19, an increasing number of mental health consumers are beginning to experience somatically-based distress in addition to existing mental health symptoms. Moreover, the aftermath of the rapid increase in demand for mental health services has caused significant burnout in mental health professionals. This paper explores the ramifications of recent changes and challenges in the mental health demands and subsequent response and its consequences for mental health workers. We will begin by investigating the neurobiological mechanisms involved in traumatic experiences, then discuss the premises for "bottom-up" or somatically oriented psychotherapy approaches, and finally offer clinical skills and interventions for clients diagnosed with post traumatic stress disorder. In addition, we will discuss how somatically-based psychotherapy interventions implemented in sessions may decrease burnout and improve the well-being of clinicians. We will discuss how the integration of somatically-based interventions into counseling would increase the effectiveness of mental health recovery and sustain remission while simultaneously providing opportunities for self-care for mental health professionals.

Keywords: somatic psychotherapy interventions, trauma counseling, preventing and treating burnout, adults with PTSD, bottom-up skills, the effectiveness of trauma treatment

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Authors: Inkyong Yi

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Acute kidney injury (AKI) in trauma patients is known to be associated with multiple factors, especially shock and consequent inadequate renal perfusion, yet its clinical presentation is little known in severe trauma patients. Our aim was to investigate the clinical presentation of acute kidney injury and its outcome in severe trauma patients at a level I trauma center. A total of 93 consecutive adult trauma patients with an injury severity score (ISS) of more than 15 were analyzed retrospectively from our Level I trauma center data base. Patients with direct renal injury were excluded. Patients were dichotomized into two groups, according to the presence of AKI. Various clinical parameters were compared between two groups, with Student’s T test and Mann-Whitney’s U test. The AKI group was further dichotomized into patients who recovered within seven days, and those who required more than 7days for recovery or those who did not recover at all. Various clinical parameters associated with outcome were further analyzed. Patients with AKI (n=33, 35%) presented with significantly higher age (61.4±17.3 vs. 45.4±17.3, p < 0.0001), incidence of comorbidities (hypertension; 51.5% vs. 13.3%, OR 6.906 95%CI 2.515-18.967, diabetes; 27.3% vs. 6.7%, OR 5.250, 95%CI 1.472-18.722), odds of head and neck trauma (69.7% vs. 41.7%, OR 3.220, 95%CI 1.306-7.942) and presence of shock during emergency room care (66.7% vs 21.7% OR 7.231, 95%CI, 2.798-18.687). Among AKI patients, patients who recovered within 1 week showed lower peak lactate (4.7mmol/L, 95%CI 2.9-6.5 vs 7.3mmol/L, 95%CI 5.0-9.6, p < 0.0287), lesser units of transfusion during first 24 hours (pRBC; 20.4unit, 95%CI 12.5-28.3 vs. 58.9unit, 95%CI 39.4-78.5, p=0.0003, FFP; 16.6unit, 95%CI 6.8-26.4 vs. 56.1unit, 95%CI 26.9-85.2, p=0.0027). In severe trauma patients, patients with AKI showed different clinical presentations and worse outcomes. Initial presence of shock and higher DIC profiles may be important risk factors for AKI in severe trauma patients. In patients with AKI, peak lactate level and amounts of transfusion are related to recovery.

Keywords: acute kidney injury, lactate, transfusion, trauma

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Authors: Richa Grover, Rahul Grover, V. Balaji Rao, Kavish Kejriwal

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Selection of suppliers is a crucial problem in the supply chain management. On top of that, sustainable supplier selection is the biggest challenge for the organizations. Environment protection and social problems have been of concern to society in recent years, and the traditional supplier selection does not consider about this factor; therefore, this research work focuses on introducing sustainable criteria into the structure of supplier selection criteria. Sustainable Supply Chain Management (SSCM) is the management and administration of material, information, and money flows, as well as coordination among business along the supply chain. All three dimensions - economic, environmental, and social - of sustainable development needs to be taken care of. Purpose of this research is to maximize supply chain profitability, maximize social wellbeing of supply chain and minimize environmental impacts. Problem statement is selection of suppliers in a sustainable supply chain network by ranking the suppliers against sustainable criteria identified. The aim of this research is twofold: To find out what are the sustainable parameters that can be applied to the supply chain, and to determine how these parameters can effectively be used in supplier selection. Multicriteria decision making tools will be used to rank both criteria and suppliers. AHP Analysis will be used to find out ratings for the criteria identified. It is a technique used for efficient decision making. TOPSIS will be used to find out rating for suppliers and then ranking them. TOPSIS is a MCDM problem solving method which is based on the principle that the chosen option should have the maximum distance from the negative ideal solution (NIS) and the minimum distance from the ideal solution.

Keywords: sustainable supply chain management, sustainable criteria, MCDM tools, AHP analysis, TOPSIS method

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Authors: Rachel Ashwell, Sally Millett

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Introduction: Adequate post-operative pain relief is a key priority in the delivery of caesarean sections. This improves patient experience, reduces morbidity and enables optimal mother-infant interaction. Recommendations outlined in the NICE guidelines for caesarean section (CS) include offering peri-operative intrathecal/epidural diamorphine and post-operative opioid analgesics; offering non-steroidal anti-inflammatory drugs (NSAIDs) unless contraindicated and taking hourly observations for 12 hours following intrathecal diamorphine. Method: This audit assessed the provision of post-CS analgesia in 29 women over a two-week period. Indicators used were the use of intrathecal/epidural opioids, use of post-operative opioids and NSAIDs, frequency of observations and patient satisfaction with pain management on post-operative days 1 and 2. Results: All women received intrathecal/epidural diamorphine, 97% were prescribed post-operative opioids and all were prescribed NSAIDs unless contraindicated. Hourly observations were not maintained for 12 hours following intrathecal diamorphine. 97% of women were satisfied with their pain management on post-operative day 1 whereas only 75% were satisfied on day 2. Discussion: This service meets the proposed standards for the provision of post-operative analgesia, achieving high levels of patient satisfaction 1 day after CS. However, patient satisfaction levels are significantly lower on post-operative day 2, which may be due to reduced frequency of observations. The lack of an official audit standard for patient satisfaction on postoperative day 2 may result in reduced incentive to prioritise pain management at this stage.

Keywords: Caesarean section, analgesia, postoperative care, patient satisfaction

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Authors: El Alia Boularas, H. Bekkar, H. Larachi, H. Rezk-kallah

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Introduction: Notwithstanding cosmetics are used in life every day, these products are not all innocuous and harmless, as they may contain ingredients responsible for allergic reactions and, possibly, for other health problems. Additionally, environmental pollution should be taken into account. Thus, it is time to investigate what is ‘hidden behind beauty’. Aims: 1.To investigate prevalence of 13 chemical ingredients in cosmetics being object of concern, which the Algerians use regularly. 2.To know the profile of questioned consumers and describe their opinion on cosmetics. Methods: The survey was carried out in year 2013 over a period of 3 months, among Algerian Internet users having an e-mail address or a Facebook account.The study investigated 13 chemical agents showing health and environmental problems, selected after analysis of the recent studies published on the subject, the lists of national and international regulatory references on chemical hazards, and querying the database Skin Deep presented by the Environmental Working Group. Results: 300 people distributed all over the Algerian territory participated in the survey, providing information about 731 cosmetics; 86% aged from 20 to 39 years, with a sex ratio=0,27. A percentage of 43% of the analyzed cosmetics contained at least one of the 13 toxic ingredients. The targeted ingredient that has been most frequently reported was ‘perfume’ followed by parabens and PEG.85% of the participants declared that cosmetics ‘can contain toxic substances’, 27% asserted that they verify regularly the list of ingredients when they buy cosmetics, 61% said that they try to avoid the toxic ingredients, among whom 24 % were more vigilant on the presence of parabens, 95% were in favour of the strengthening of the Algerian laws on cosmetics. Conclusion: The results of the survey provide the indication of a widespread presence of toxic chemical ingredients in personal care products that Algerians use daily.

Keywords: Algerians consumers, cosmetics, survey, toxic ingredients

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Authors: Ekroop Singh Sethi, Arshnoor Kaur, M. H. Bharath

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India is the fastest growing economy and a land of tradition, culture and realm of 19 % of the world’s children. Children are an essential part of any economy as its future GDP contributors and, therefore, it is the duty of a country to take care of its future wealth providers. Each country has its own way of child welfare. India is a developing country, has its own child welfare schemes in place, but the question is, are they really as effective as they seem? Are the schemes sufficient? And what about implementation? With 41% of the population below the age of 18, questions relating to child education and welfare require focus. Right to education is a significant act of the government of India that explains the roadmap of free and compulsory elementary education for children in India, making the India 135th country to bring education as right, involving proper support from the government to overcome the shadow of economic conditions and status which prevents children to learn and grow. But is right to education a children-centric movement? As faces the major problem of well-planned, practical curriculum and facilitators, as only 40% of grade 5 students could barely read the textbook of grade 2. Is the policy worthy of settling the child or still trapped in negative realities of the competitive environment of private VS government schools. From the steps to encouragement from the pupil's home to enlightening centers, the article focuses on level of execution, impact and difference in terms to contributing and enabling the children of India for a better tomorrow and a solution to multilayered problems of elementary education in India.

Keywords: growing economy, child welfare, right to education, elementary education, private vs government schools, pupil's home, enlightening centers, execution, impact

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Authors: Cecilia Amponsem-Boateng, Timothy Bonney Oppongx, Weidong Zhang, Jonathan Boakye Yiadom, Lianke Wang, Kwabena Acheampong, Godfrey Opolot

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In Ghana, the management of hypertension in primary health care is a cost-effective way of addressing premature deaths from vascular disorders that include hypertension. There is little or no evidence of large-scale studies on the prevalence, risk, and knowledge/awareness of hypertension in students aged 12–22 years in Ghana. In a cross-sectional study, blood pressure, anthropometric indices, and knowledge/awareness assessment of students at second-cycle schools were recorded from 2018 to 2020 in three regions of Ghana. Multistage cluster sampling was used in selecting regions and the schools. Prevalence of prehypertension and hypertension was categorized by the Joint National Committee 7, where appropriate, chi-square, scatter plots, and correlations were used in showing associations. A total of 3165 students comprising 1776 (56.1%) females and 1389 (43.9%) males participated in this study within three regions of Ghana. The minimum age was 12 years and the maximum age was 22 years. The mean age was 17.21 with standard deviation (SD: 1.59) years. A 95% confidence interval was set for estimations and a P value < 0.05 was set as significant. The prevalence rate of overall hypertension was 19.91% and elevated (prehypertension) was 26.07%. Risk indicators such as weight, BMI, waist circumference, physical activity, and form of the diet were positively correlated with hypertension. Among Ghanaian students currently in second-cycle educational institutions, 19.91% were hypertensive and 26.07% were prehypertensive. This may indicate a probable high prevalence of hypertension in the future adult population if measures are not taken to curb the associated risks.

Keywords: hypertension, second-cycle schools, Ghana, youth

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Authors: Feyza Gökce, Jochen Gensichen, Antonius Schneider, Karolina de Valerio, Gabriele Pitschel-Walz

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People with depressive symptoms often first consult a General Practitioner (GP) before making use of other treatment options. The present study shows the adaptation and evaluation of a psychoeducational program for patients with depressive symptoms that are treated by GPs in Bavaria, Germany. The adaptation of an existing psychoeducational program, that is used in inpatient psychiatric settings, was performed in exchange with experts (psychotherapists, general practitioners, and a patient representative). As a result, a program consisting of 4 psychoeducational sessions was developed, which is carried out in individual settings in GP practices by the practitioners themselves. This program will be compared to treatment as usual that patients with depression receive by GPs. Data is collected at 3 measurement points (baseline, 3-months-follow-up, 6-months-follow-up) using different questionnaires (BDI-II, D-Lit-R German, FERUS, PAM13-D, PHQ-9, GAD-7, PHQ-15, PC-PTSD-5). In addition to the change in depressive symptoms, changes in depression knowledge, self-efficacy, and patient activation will be analyzed, and the feasibility of the program and the subjective benefit for GPs and patients will be assessed. By now, 84 patients have been recruited by 20 cluster-randomized GP practices, with 73.5% of the participants being female and 26.5% being males. The average age was M= 50.1 (SD= 14.67) years. The change in depression symptoms over the 3-month period will be compared between the two study conditions by using a linear mixed model by the end of data collection (December 2023). The subjective benefit for the patients and GPs will be assessed via feedback questionnaires. Results will be presentable by the beginning of 2024 and will provide indications for further development and barriers to the implementation of such a program for GP practices.

Keywords: depression, general practice, psychoeducation, primary care

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Authors: Aayushi Dalal

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It is the mother who bears the child in her womb for 9 months. It is typically rooted in the Indian culture that it is solely the responsibility of women to take care of the children and as a result the gender roles are stereotyped. Instead of a 50-50 partnership in parenting the child, it is hackneyed that men take the responsibility of the bread earner while women nurture the children by staying at home. Thus, mothers are considered to be more psychologically connected to the children than fathers. But the current society is observing role dilution of parents which can create a gap in understanding from the organization’s perspective. This is the basis of the study. The emergence of women into the job market has forever changed how society views the traditional roles of fathers and mothers. Feminism and financial power has reformed the classic parenting model. This has given rise to a more open and flexible society consequently emphasizing the father's importance in the emotional well being of the child while also being capable caretakers and disciplinarians. This study focuses on analyzing the comparative differences of the father's role in the psychological development of the child in India and USA while taking into consideration the organization’s support towards them. A sample size of 150 fathers- 75 from India and 75 from USA was selected and a structured survey was carried out which had several open ended as well as closed ended questions probing to the issue. It was made sure that the environmental factors had as minimal effect as possible on the subjects. The findings of this research would materialize a framework for fathers to understand the magnitude of their role in their child's upbringing. This would not only ameliorate the "father-child" relationship but also make organization more sympathetic towards their employees.

Keywords: paternity, child development, psychology, gender role, organization policy

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Authors: Chukwunonso Igboamalu, Daprim Ogaji

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Background: With the limited number of trained health care providers in Nigeria, patent and proprietary medicine vendors (PPMVs) are inevitable and highly needed especially in the rural areas for the supply of drugs in treating minor illnesses. These vendors serve as a crucial link between the healthcare system and the community, aiding in the distribution of medications and healthcare information, particularly in areas with limited hospital infrastructure. Objectives: The study set to measure the participants’ knowledge, attitude and patient referral practice and any association of their characteristics with patient referral. Methodology: This cross-sectional descriptive survey was conducted among PPMVs in Obio-Akpor LGA of Rivers State. Data was collected using a self-administered structured questionnaire and analysed using SPSS version 25. Results: The study showed that 18.3% had adequate knowledge, 62.4% had moderate knowledge and 19.2% had poor knowledge. Attitude was moderate among 73.4% of the study participants with only 13% showing adequate attitude. In reporting their referral practice, 34% showed poor referral practice, 58% reported moderate practice and only 8% showed adequate practice. Conclusion: Various facilitators as well as barriers to patient referral were highlighted by the respondents. This study indicated that while attitude and practice were moderate among respondents, the percentage of PPMVs with the adequate knowledge of patient referral was high. To enhance the effectiveness of patient referrals, addressing barriers to referral and promoting education and training for PPMVs are critical steps forward.

Keywords: knowledge, attitude, practice, barriers, facilitators, patent medicine vendor, referral

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Authors: Songul Cinaroglu

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Regional planning in health has gained speed for developing countries in recent years. In Turkey, 89 different Public Hospital Unions (PHUs) were conducted based on provincial levels. In this study technical efficiencies of 89 PHUs were examined by using Data Envelopment Analysis (DEA) and machine learning techniques by dividing them into two clusters in terms of similarities of input and output indicators. Number of beds, physicians and nurses determined as input variables and number of outpatients, inpatients and surgical operations determined as output indicators. Before performing DEA, PHUs were grouped into two clusters. It is seen that the first cluster represents PHUs which have higher population, demand and service density than the others. The difference between clusters was statistically significant in terms of all study variables (p ˂ 0.001). After clustering, DEA was performed for general and for two clusters separately. It was found that 11% of PHUs were efficient in general, additionally 21% and 17% of them were efficient for the first and second clusters respectively. It is seen that PHUs, which are representing urban parts of the country and have higher population and service density, are more efficient than others. Random forest decision tree graph shows that number of inpatients is a determinative factor of efficiency of PHUs, which is a measure of service density. It is advisable for public health policy makers to use statistical learning methods in resource planning decisions to improve efficiency in health care.

Keywords: public hospital unions, efficiency, data envelopment analysis, random forest

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Authors: Emel Bayraktar, Gulengun Turk

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Introduction and Objective: Safe administration of medicines is one of the main responsibilities of nurses. Intramuscular drug administration is among the most common methods used by nurses among all drug applications. This study was carried out in order to determine determine the effect of education given on injection in ventrogluteal area on the level of knowledge of nurses on this subject. Methods: The sample of the study consisted of 20 nurses who agreed to participate in the study between 01 October and 31 December 2019. The research is a pretest-posttest comparative, quasi-experimental type pilot study. The nurses were given a 4-hour training prepared on injection into the ventrogluteal area. The training consisted of two hours of theoretical and two hours of laboratory practice. Before the training and 4 weeks after the training, a questionnaire form containing questions about their knowledge and practices regarding the injection of the ventrogluteal region was applied to the nurses. Results: The average age of the nurses is 26.55 ± 7.60, 35% (n = 7) of them are undergraduate and 30% (n = 6) of them work in intensive care units. Before the training, 35% (n = 7) of the nurses stated that the most frequently used intramuscular injection site was the ventrogluteal area, and 75% (n = 15) stated that the safest area was the rectus femoris muscle. After the training, 55% (n = 11) of the nurses stated that they most frequently used the ventrogluteal area and 100% (n = 20) of them stated that the ventrogluteal area was the safest area. The average score the nurses got from the premises before the training is 14.15 ± 6.63 (min = 0, max = 20), the total score is 184. The average score obtained after the training was determined as 18.69 ± 2.35 (min = 12, max = 20), and the total score was 243. Conclusion: As a result of the research, it was determined that the training given on the injection of ventrogluteal area increased the knowledge level of the nurses. It is recommended to organize in-service trainings for all nurses on the injection of ventrogluteal area.

Keywords: safe injection, knowledge level, nurse, intramuscular injection, ventrogluteal area

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Authors: Rachna Agarwal, R. Naveen, Darpan Thakre, Rohit Shahi, Maryam Abbasi, Upendra Rathore, Latika Gupta

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Aim: Retinal changes are the window to systemic vasculature. Therefore, we explored retinal changes in patients with idiopathic inflammatory myopathies (IIM) as a surrogate for vascular health. Methods: Adult and juvenile IIM patients visiting a tertiary care centre in 2021 satisfying the International Myositis Classification Criteria were enrolled for detailed ophthalmic examination in comparison with healthy controls (HC). Patients with conditions that precluded thorough posterior chamber examination were excluded. Scale variables are expressed as median (IQR). Multivariate analysis (binary logistic regression-BLR) was conducted, adjusting for age, gender, and comorbidities besides factors significant in univariate analysis. Results: 43 patients with IIM [31 females; age 36 (23-45) years; disease duration 5.5 (2-12) months] were enrolled for participation. DM (44%) was the most common diagnosis. IIM patients exhibited frequent attenuation of retinal vessels (32.6% vs. 4.3%, p <0.001), AV nicking (14% vs. 2.2%, p=0.053), and vascular tortuosity (18.6% vs. 2.2%, p=0.012), besides decreased visual acuity (53.5% vs. 10.9%, p<0.001) and immature cataracts (34.9% vs. 2.2%, p<0.001). Attenuation of vessels [OR 10.9 (1.7-71), p=0.004] emerged as significantly different from HC after adjusting for covariates in BLR. Notably, adults with IIM were more predisposed to retinal abnormalities [21 (57%) vs. 1 (16%), p=0.068], especially attenuation of vessels [14(38%) vs. 0(0), p=0.067] than jIIM. However, no difference was found in retinal features amongst the subtypes of adult IIM, nor did they correlate with MDAAT, MDI, or HAQ-DI. Conclusion: Retinal microvasculopathy and diminution of vision occur in nearly one-third to half of the patients with IIM. Microvasculopathy occurs across subtypes of IIM, and more so in adults, calling for further investigation as a surrogate for damage assessment and potentially even systemic vascular health.

Keywords: idiopathic inflammatory myopathies, vascular health, retinal microvasculopathy, arterial attenuation

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Authors: Deependra Prasad Sarraf, Gajendra Prasad Rauniar, Robin Maskey, Rajiv Maharjan, Ashish Shrestha, Ramayan Prasad Kushwaha

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Objectives: To assess the perception of faculties towards online teaching-learning activities conducted during the COVID-19 pandemic and to identify barriers and facilitators to conducting online teaching-learning activities in our context. Methods: A cross-sectional study was conducted among faculties at B. P. Koirala Institute of Health Sciences using a 26-item semi-structured questionnaire. A Google Form was prepared, and its link was sent to the faculties via email. Descriptive statistics were calculated, and findings were presented as tables and graphs. Results: Out of 158 faculties, the majority were male (66.46%), medical faculties (85.44%), and assistant professors (46.84%). Only 16 (10.13%) faculties had received formal training regarding preparing and/or delivering online teaching learning activities. Out of 158, 133 (84.18%) faculties faced technical and internet issues. The most common advantage and disadvantage of online teaching learning activities perceived by the faculties were ‘not limited to time or place’ (94.30%) and ‘lack of interaction with the students’ (82.28%), respectively. Majority (94.3%) of them had a positive perception towards online teaching-learning activities conducted during COVID-19 pandemic. Slow internet connection (91.77%) and frequent electricity interruption (82.91%) were the most common perceived barriers to online teaching-learning. Conclusions: Most of the faculties had a positive perception towards online teaching-learning activities. Academic leaders and stakeholders should provide uninterrupted internet and electricity connectivity, training on online teaching-learning platform, and timely technical support.

Keywords: COVID-19 pandemic, faculties, medical education, perception

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Authors: Awad Mohamed Elkhadir, Rajab M. Ben Yousef

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Background/Aim: Radiological technologists are medical professionals who perform diagnostic imaging tests such as X-rays, magnetic resonance imaging (MRI) scans, and computer tomography (CT) scans. Despite the recognition of image interpretation by British radiologists, it is still considered a problem in the Arab world. This study evaluates the perceptions of radiologists in the Middle East concerning the plain image interpretation of adults by radiologic technologist specialists. Methods: This is a cross-sectional study that follows a quantitative approach. A close-ended questionnaire was distributed among 103 participants who were radiologists by profession from various hospitals in Saudi Arabia and Sudan. The gathered data was then analyzed through Statistical Package for Social Sciences (SPSS). Results: The results showed that 29% recognized the Radiologic Technologist Specialist (RTS) role of writing image reports, while 61% did not. A total of 38% of participants believed that RTS image interpretation would help diagnose unreported radiographs. 47% of the sample responded that the workload and stress on radiologists would reduce by allowing reporting for RTS, while 37% did not. Lastly, 43% believe that image interpretation by RTS can be introduced into the Middle East in the future. Conclusion: The study's findings reveal that the combination of image reporting and radiography improves the care of the patients. The study's outcomes also show that the burden of the medical practitioners reduces due to image reporting of the radiographers. Further researches need to be conducted in the Arab World to obtain and measure the associated factors of the desired criteria.

Keywords: Arab world, image interpretation, radiographer, radiologist, Saudi Arabia, Sudan

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Authors: Rana Alkattan

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Aim: This study aims to identify and analyze the factors predicting the professional clinical competency among newly recruited registered nurses. In addition, it aims to explore factors significantly correlated with high and low professional clinical competency score. Method: A descriptive analytical is applied in this study, cross-sectional which conducted between June 2012 and June 2013 at King Abdulaziz University Hospital, as one of the largest governmental university tertiary Hospital in Saudi Arabia. A survey questionnaire was designed to collect data. And then, data were analyzed using the SPSS. Results: A total of the 86 nurses provided valid responses. 69 were female and 17 were male. The majority of the participants in this study were married, from the Philippines, between 20-29 years old. The majority had certified university bachelor’s degree in nursing, as well as had prior experience in nursing between 1 to 5 years. There are two categories emerged from the data, which significantly correlated with nurses' professional competence and development. The first was the newly employed registered nurses demographic characteristic (correlation coefficients 0.154 to 0.470, P < 0.05), while the second was the list of studied environmental factors except 'job rotation factor' (correlation coefficients 0.122 to 0.540, P < 0.01). However, nurses' attitude including motivation and confidence were not associated with nurse's professional competency. Conclusion: that nurses' professional competence development is a process affected by certain personal demographic and environmental factors which will enable newly graduates nurses to provide safe effective patients' care and maintain their career responsibilities.

Keywords: clinical, competence, development nurses professional, registered

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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.

Keywords:

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Authors: B. O. Diyaolu, E. A. Okebanjo

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Children in today’s world need attention and care even with their physique as obesity is also at the increased. Several factors can be responsible for obesity in children and adequate attention is paramount in other not to accommodate it into adolescent period. This study investigated perceived determinants of obesity among primary school pupils in Eti Osa Local Government area of Lagos State. Descriptive survey research design was used and population was all obese pupils in Eti Osa Local Government Area of Lagos State. 92 pupils were selected from randomly picked 12 primary schools while purposive sampling technique was used to pick primary 4-6 pupils. With the aid of body mass index (BMI) and age percentile chart the obese pupils were selected. The instrument for the study was a self-developed and structured questionnaire on perceived determinant of obesity. The questionnaire was divided into three sections. The Cronbach’s Alpha reliability coefficient of 0.74 was obtained. The hypotheses were tested at 0.05 significant levels. The completed questionnaire was collated coded and analyzed using descriptive statistics of frequency counts and percentage and inferential statistics of chi-square (X²). Findings of this study revealed that physical activities and parental influences were determinant of obesity. Physical activity is essential in reducing the rate of obesity in Eti Osa Local Government Area both at home and within the school environment. Primary schools need to create more playing ground for pupils to exercise themselves. Parents need to cater for their children diet ensuring not just the quantity but the quality as well.

Keywords: feeding pattern, obese pupils, parental influence, physical activities

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Authors: Karin Schoenpflug, Christine M. Klapeer

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In a large study for the Vienna City Council’s Antidiscrimination unit (WASt) an interdisciplinary team (in the fields of economics, sociology and political science) working with urban economics, critical citizenship studies, the sociology of work & inequality and urban political/human geography conducted an online survey asking LGBTIs (lesbians, gays, bisexuals, transgender and intersex people) in Vienna detailed questions on their quality-of-life, happiness and well-being. 3.161 persons responded and provided us with a rich data set concerning: 1) Labor market structures, discrimination, working conditions and employment practices (economic citizenship); 2) access to health care, welfare, education and safety in public spaces (social citizenship); 3) political participation as well as access to legal institutions (political citizenship). All those fields are important dimensions in regards to “full” citizenship and the well-being of the LGBTI population, but are also constitutive for the inclusion of sexual and gender minorities into the city population(s) of Vienna. Our data also allows us to map the sexual geography of Vienna as LGBTI communities are more likely to live in certain districts; some places are considered safe(r) and “friendlier”. In this way our work helps to fill a research gap connecting (urban) spaces and sexuality, and it produces new data and insights on the quality-of-life of this subpopulation. Our findings allow for urban (policy) planning and limiting violence and discrimination and improving the collective wellbeing and social cohesion.

Keywords: urban sexual geographies, LGBTI, socio-economic status, Vienna, sitizenship status

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Authors: Supannika Klangphukhiew, Roongnapa Srichana, Rina Patramanon

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Cortisol has been used as a well-known commercial stress biomarker. A homeostasis response to psychological stress is indicated by an increased level of cortisol produced in hypothalamus-pituitary-adrenal (HPA) axis. Chronic psychological stress contributing to the high level of cortisol relates to several health problems. In this study, the cortisol biosensor was fabricated that mimicked the natural receptors. The artificial antibodies were prepared using molecular imprinted polymer technique that can imitate the performance of natural anti-cortisol antibody with high stability. Cortisol-molecular imprinted polymer (cortisol-MIP) was obtained using the multi-step swelling and polymerization protocol with cortisol as a target molecule combining methacrylic acid:acrylamide (2:1) with bisacryloyl-1,2-dihydroxy-1,2-ethylenediamine and ethylenedioxy-N-methylamphetamine as cross-linkers. Cortisol-MIP was integrated to the sensor. It was coated on the disposable screen-printed carbon electrode (SPCE) for portable electrochemical analysis. The physical properties of Cortisol-MIP were characterized by means of electron microscope techniques. The binding characteristics were evaluated via covalent patterns changing in FTIR spectra which were related to voltammetry response. The performance of cortisol-MIP modified SPCE was investigated in terms of detection range, high selectivity with a detection limit of 1.28 ng/ml. The disposable cortisol biosensor represented an application of MIP technique to recognize steroids according to their structures with feasibility and cost-effectiveness that can be developed to use in point-of-care.

Keywords: stress biomarker, cortisol, molecular imprinted polymer, screen-printed carbon electrode

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Authors: David J. Foran, Nhan Do, Samuel Ajjarapu, Wenjin Chen, Tahsin Kurc, Joel H. Saltz

Abstract:

The large-scale data and computational requirements of investigators throughout the clinical and research communities demand an informatics infrastructure that supports both existing and new investigative and translational projects in a robust, secure environment. In some subspecialties of medicine and research, the capacity to generate data has outpaced the methods and technology used to aggregate, organize, access, and reliably retrieve this information. Leading health care centers now recognize the utility of establishing an enterprise-wide, clinical data warehouse. The primary benefits that can be realized through such efforts include cost savings, efficient tracking of outcomes, advanced clinical decision support, improved prognostic accuracy, and more reliable clinical trials matching. The overarching objective of the work presented here is the development and implementation of a flexible Intelligent Retrieval and Interrogation System (IRIS) that exploits the combined use of computational imaging, genomics, and data-mining capabilities to facilitate clinical assessments and translational research in oncology. The proposed System includes a multi-modal, Clinical & Research Data Warehouse (CRDW) that is tightly integrated with a suite of computational and machine-learning tools to provide insight into the underlying tumor characteristics that are not be apparent by human inspection alone. A key distinguishing feature of the System is a configurable Extract, Transform and Load (ETL) interface that enables it to adapt to different clinical and research data environments. This project is motivated by the growing emphasis on establishing Learning Health Systems in which cyclical hypothesis generation and evidence evaluation become integral to improving the quality of patient care. To facilitate iterative prototyping and optimization of the algorithms and workflows for the System, the team has already implemented a fully functional Warehouse that can reliably aggregate information originating from multiple data sources including EHR’s, Clinical Trial Management Systems, Tumor Registries, Biospecimen Repositories, Radiology PAC systems, Digital Pathology archives, Unstructured Clinical Documents, and Next Generation Sequencing services. The System enables physicians to systematically mine and review the molecular, genomic, image-based, and correlated clinical information about patient tumors individually or as part of large cohorts to identify patterns that may influence treatment decisions and outcomes. The CRDW core system has facilitated peer-reviewed publications and funded projects, including an NIH-sponsored collaboration to enhance the cancer registries in Georgia, Kentucky, New Jersey, and New York, with machine-learning based classifications and quantitative pathomics, feature sets. The CRDW has also resulted in a collaboration with the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) at the U.S. Department of Veterans Affairs to develop algorithms and workflows to automate the analysis of lung adenocarcinoma. Those studies showed that combining computational nuclear signatures with traditional WHO criteria through the use of deep convolutional neural networks (CNNs) led to improved discrimination among tumor growth patterns. The team has also leveraged the Warehouse to support studies to investigate the potential of utilizing a combination of genomic and computational imaging signatures to characterize prostate cancer. The results of those studies show that integrating image biomarkers with genomic pathway scores is more strongly correlated with disease recurrence than using standard clinical markers.

Keywords: clinical data warehouse, decision support, data-mining, intelligent databases, machine-learning.

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Authors: Quoc Hung Le Pham

Abstract:

Human beings are motivated to satisfy the physiological needs and psychological needs. In the fundamental needs, bodily excretion is the most basic one, while physiological excretion refers to the final products produced in the process of discharging the body. This physiological process is a common human phenomenon. For instance, bodily secretion is totally natural, but people of various nationalities through the times avoid saying it directly. Terms like ‘shit’ are often negatively regarded as dirty, smelly and vulgar; it will lead people to negative thinking. In fact, it is in the psychology of human beings to avoid such unsightly terms. Especially in social situations where you have to take care of your image, and you have to release. The best way to solve this is to approach the use of euphemism. People prefer to say it as ‘answering nature's call’ or ‘to pass a motion’ instead. Chinese and Vietnamese nations are referring to use euphemisms to replace bodily secretions, so this research will take this phenomenon as the object aims to explore the similarities and dissimilarities between two languages euphemism. The basic of the niche of this paper is human physiological phenomenon excretion. As the preliminary results show, in expressing bodily secretions the deeply impacting factor is language and cultural factors. On language factor terms, two languages are using assonance to replace human nature discharge, whilst the dissimilarities are metonymy, loan word and personification. On culture factor terms, the convergences are metonymy and application of the semantically-contrary-word-euphemism, whilst the difference is Chinese euphemism using allusion but Vietnamese euphemism does not.

Keywords: cultural factors, euphemism, human needs, language factors

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Authors: Lucy Ampaw-Asiedu, Terri R. Norton

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In the wake of recent disasters happening around the world such as earthquake in Italy (January, 2017); hurricanes in the United States (US) (September 2016 and September 2017); and compounding disasters in Haiti (September 2010 and September 2016); to our best knowledge, never has the world seen the need to work on preemptive rather than reactionary measures to salvage this situation than now. Tornadoes are natural hazards that mostly affect mid-western and central states in the US. Tornadoes, like all natural hazards such as hurricanes, earthquakes, floods and others, are very destructive and result in massive destruction to homes, cause billions of dollars in damage and claims many lives. Healthcare facilities in general are vulnerable to disasters, and therefore, the safety of patients, health workers and those who come in to seek shelter should be a priority. The focus of this study is to assess disaster management measures instituted by healthcare facilities. Thus, the sole aim of the study is to examine the vulnerabilities and the design of safe spaces in healthcare facilities in Central US. Objectives that guide the study are to primarily identify the impacts of tornadoes in hospitals and to assess the structural design or specifications of safe spaces. St. John’s Regional Medical Center, now Mercy Hospital in Joplin, is used as a case study. Preliminary results show that the lateral base shear of the proposed design to be 684.24 ton (1508.49kip) for the safe space. Findings from this work will be used to make recommendations about the design of safe spaces for health care facilities in Central US.

Keywords: disaster management, safe spaces, structural design, tornado, vulnerability

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Authors: Jo, Eui Chang, Shin, Heekang, Mun, A. Young , Kim, Hong Kyu

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Regarding change on population and family structure in Korea after the 1980s, there has been a rapid change of low fertility, graying and increase of single household that cannot be found in any other parts of the world. With the result of total population residence by the National Statistical Office, Korea will hold 52,160,065 people in 2030 and reduction is predicted and from 2025 people above the age of 65 will take 20% of the total population, which means the entry of a super aging society. Also, average number in a family will be 2.71 in 2015 and decrease to 2.33 in 2035. On the other hand, proportion of single and two person household will be 53.7% in 2015 and it will increase up to 68.4% in 2035. Old population will increase greatly, single and two person household will take 2/3 of the total households. Delphi research was processed in 3 steps on 40 professionals about the importance and changing factors of residential environment of apartment followed by the change of population structure. For interior plan, space variety, variability, safety, convenient installation, eco-friendly installation, and IT installation were important factors for construction plan, plan on aged and single households, convenient installation, safety installation, eco-friendly installation for subdivision plan, education/child care facility, parks/gymnasium facility, community facility, and accessibility of transportation were predicted as important factors.

Keywords: change of population structure, super-graying, change of residential environment of apartment, single household, interior plan, construction plan, subdivision plan, Delphi research

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Authors: Vladyslav Povoroznyuk, Tetiana Orlуk, Nataliia Dzerovych

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Introduction: Back pain is an extremely common health care problem worldwide. Many studies show a link between an obesity and risk of lower back pain. The aim is to study correlation and peculiarities of vertebral pain in women of different age depending on their anthropometric indicators. Materials: 1886 women aged 25-89 years were examined. The patients were divided into groups according to age (25-44, 45-59, 60-74, 75-89 years old) and body mass index (BMI: to 18.4 kg/m2 (underweight), 18.5-24.9 kg/m2 (normal), 25-30 kg/m2 (overweight) and more than 30.1 kg/m2 (obese). Methods: The presence and intensity of pain was evaluated in the thoracic and lumbar spine using a visual analogue scale (VAS). BMI is calculated by the standard formula based on body weight and height measurements. Statistical analysis was performed using parametric and nonparametric methods. Significant changes were considered as p <0.05. Results: The intensity of pain in the thoracic spine was significantly higher in the underweight women in the age groups of 25-44 years (p = 0.04) and 60-74 years (p=0.005). The intensity of pain in the lumbar spine was significantly higher in the women of 45-59 years (p = 0.001) and 60-74 years (p = 0.0003) with obesity. In the women of 45-74 years BMI was significantly positively correlated with the level of pain in the lumbar spine. Obesity significantly increases the relative risk of pain in the lumbar region (RR=0.07 (95% CI: 1.03-1.12; p=0.002)), while underweight significantly increases the risk of pain in the thoracic region (RR=1.21 (95% CI: 1.00-1.46; p=0.05)). Conclusion: In women, vertebral pain syndrome may be related to the anthropometric characteristics (e.g., BMI). Underweight may indirectly influence the development of pain in the thoracic spine and increase the risk of pain in this part by 1.21 times. Obesity influences the development of pain in the lumbar spine increasing the risk by 1.07 times.

Keywords: body mass index, age, pain in thoracic and lumbar spine, women

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Authors: Lakmali Anthony, Madeline Gillies

Abstract:

Purpose: Decreasing mortality has led to increased focus on patient-reported outcomes such as quality of life (QoL) in breast cancer. Breast cancer patients often have decreased QoL even after treatment is complete. This systematic review of the literature aims to identify psychosocial factors associated with decreased QoL in post-treatment breast cancer patients. Methodology: This systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The search was conducted in MEDLINE, EMBASE, and PsychINFO using MeSH headings. The two authors screened studies for relevance and extracted data. Results: Seventeen studies were identified, including 3,150 total participants (mean = 197) with a mean age of 51.9 years. There was substantial heterogeneity in measures of QoL. The most common was the European Organisation for Research and Treatment of Cancer QLQ-C30 (n=7, 41.1%). Most studies (n=12, 70.5%) found that emotional distress correlated with poor QoL, while 3 found no significant association. The most common measure of emotional distress was the Hospital Anxiety and Depression Scale (n=12, 70.5%). Other psychosocial factors associated with QoL were unmet needs, problematic social support, and negative affect. Clinicopathologic determinants included mastectomy without reconstruction, stage IV disease, and adjuvant chemotherapy. Conclusion: This systematic review provides a summary of the psychosocial determinants of poor QoL in post-treatment breast cancer patients, as well as the most commonly reported measures of these. An understanding of these potentially modifiable determinants of poor outcome is pivotal to the provision of quality, patient-centred care in surgical oncology.

Keywords: breast cancer, quality of life, psychosocial determinants, cancer surgery

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Authors: Priyanka Dixit

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Reproductive health problem is an important public health issue in most of the developing countries like India. It is a common problem in India for women in the reproductive age group to suffer from reproductive illnesses and not seek care. Existing literatures tell us very little about the several dimensions of reproductive morbidity. In addition the general perception says, metros have better medical infrastructure, so its residents should lead a healthier life. However some of the studies reveal a very different picture. Therefore, the present study is conducted with the specific objectives to find out the prevalence of reproductive health problem and treatment seeking behavior of currently married women in four metro cities in India namely; Mumbai, Delhi, Chennai and Kolkata. In addition, this paper also examines the effect of socio-economic and demographic factors on self-reported reproductive health problems. Bi-variate and multivariate regression have been applied to achieve the proposed objectives. Study is based on National Family Health Survey 2015-16 data. The analysis shows that the prevalence of any reproductive health problem among women is the highest in Mumbai followed by Delhi, Chennai, and Kolkata. A bulk of women in all four metro cities has reported abdominal pain, itching and burning sensation as the major problems while urinating. However, in spite of the high prevalence of reproductive health problems, a huge proportion of such women in all these cities do not seek any advice or treatment for these problems. This study also investigates determinants that affect the prevalence of reproductive health problem to policy makers plan for proper interventions for improving women’s reproductive health.

Keywords: reproductive health, India, national family health survey-4, city

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Authors: Ayeshmanthe Rathnayake, Ashutosh Hardikar

Abstract:

Introduction: Lung cancer is the most common cause of cancer death in Australia, with more than 13000 cases per year. Until now, there has been a major deficiency of national comprehensive thoracic surgery data. The thoracic workload for surgeons as well as caseload per unit, is highly variable, with some centres performing less than 15 cases per annum, thus raising concerns about optimal care at low-volume sites. This is an attempt to review the outcomes of lung cancer surgery in Tasmania. Method: The objective of this study is to determine the surgical outcomes of lung cancer surgery at Royal Hobart Hospital (RHH) with the primary outcome of surgical mortality. Four hundred fifty-one cases were analysed retrospectively from 2010 to May 2022. Results: A total of 451 patients underwent thoracic surgery with a primary diagnosis of lung cancer. The primary outcome of 30-day mortality was <0.5%. The mean age was 65.3 years, with male predominance and a 4.2% prevalence of Indigenous Australians. The mean LOS was 7.5 days. The surgical approach was either VATS (50.3%) or Thoracotomy (49.7%), with a trend towards the former in recent years with an increase in the proportion of VATS from 18.2% to 51% (p<0.05) in complex resections since 2019. A corresponding reduction in conversion rate to open was observed (18% vs. 5.5%), and there were no deaths within this subgroup. Lung resections were divided into lobectomy (55.4%), wedge resection (36.8%), segmentectomy (2.9%) and pneumonectomy (4.9%). The RHH demonstrates good surgical outcomes for lung cancer and provides a sustainable service for Tasmania. Conclusion: This retrospective study reports the surgical outcomes of lung cancer surgery at the Royal Hobart Hospital, thereby providing insight into the surgical management of lung cancer in the state thus far. The state has been slow to catch up on the minimally invasive program, but the overall results have been comparable to most peers.

Keywords: lung cancer, thoracic surgery, lung resection, surgical outcomes

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Authors: Moses Aron, Elias Mwakilama, Jimmy Namangale

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Spending more time on long queues for a basic service remains a common challenge to most developing countries, including Malawi. For health sector in particular, Out-Patient Department (OPD) experiences long queues. This puts the lives of patients at risk. However, using queuing analysis to under the nature of the problems and efficiency of service systems, such problems can be abated. Based on a kind of service, literature proposes different possible queuing models. However, unlike using generalized assumed models proposed by literature, use of real time case study data can help in deeper understanding the particular problem model and how such a model can vary from one day to the other and also from each case to another. As such, this study uses data obtained from one urban HC for BP, Pediatric and General OPD cases to investigate an average queuing time for patients within the system. It seeks to highlight the proper queuing model by investigating the kind of distributions functions over patient’s arrival time, inter-arrival time, waiting time and service time. Comparable with the standard set values by WHO, the study found that patients at this HC spend more waiting times than service times. On model investigation, different days presented different models ranging from an assumed M/M/1, M/M/2 to M/Er/2. As such, through sensitivity analysis, in general, a commonly assumed M/M/1 model failed to fit the data but rather an M/Er/2 demonstrated to fit well. An M/Er/3 model seemed to be good in terms of measuring resource utilization, proposing a need to increase medical personnel at this HC. However, an M/Er/4 showed to cause more idleness of human resources.

Keywords: health care, out-patient department, queuing model, sensitivity analysis

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Authors: Wanutchaya Duanginta, Napaporn Apiratmateekul, Tippawan Sangkaew, Sunaree Wekinhirun, Kunchit Kongros, Wanvisa Treebuphachatsakul

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Thailand has a tropical climate with an average outdoor ambient air temperature of over 30°C, which can exceed manufacturer recommendations for the storage of glucose test strips. This study monitored temperature and humidity at actual sites of five sub-district health promoting hospitals (HPH) in Phitsanulok Province for the storage of glucose test strips in refrigerated conditions. Five calibrated data loggers were placed at the actual sites for glucose test strip storage at five HPHs for 8 weeks between April and June. For the stress test, two lot numbers of glucose test strips, each with two glucose meters, were kept in a plastic box with desiccants and placed in a refrigerator with the temperature calibrated to 4°C and at room temperature (RT). Temperature and humidity in the refrigerator and at RT were measured every hour for 30 days. The mean temperature for storing test strips at the five HPHs ranged from 29°C to 33°C, and three of the five HPHs (60%) had a mean temperature above 30°C. The refrigerator temperatures were 3.8 ± 2.0°C (2.0°C to 6.5°C), and relative humidity was 51 ± 2% (42 to 54%). The maximum of blood glucose testing by glucose meters when the test strips were stored in a refrigerator were not significantly different (p > 0.05) from unstressed test strips for both glucose meters using amperometry-GDH-PQQ and amperometry-GDH-FAD principles. Opening the test strip vial daily resulted in higher variation than when refrigerated after a single-use. However, the variations were still within an acceptable range. This study concludes that glucose tested strips can be stored in plastic boxes in a refrigerator if it is well-controlled for temperature and humidity. Storage of glucose-tested strips in the refrigerator during hot and humid weather may be useful for HPHs with limited air conditioners.

Keywords: environmental stressed test, thermal stressed test, quality control, point-of-care testing

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