Search results for: primary care clinic
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 8083

Search results for: primary care clinic

5443 The Experiences and Needs of Fathers’ of Children With Cancer in Coping With the Child's Illness

Authors: Karina Lõbus, Silver Muld, Kadri Kööp, Mare Tupits

Abstract:

Aim: The aim of the research is to describe the experiences and needs of fathers’ of children with cancer in coping with the child's disease. Background: Today, about 80% of children diagnosed with malignancy in developed countries survive. Despite the positive statistics, recovery is not always certain, treatment is often very intensive and long-term. Cancer is affecting an increasing number of the population, which is increasing the demand for quality care, but the nature of expected care is currently unclear. This topic is important for the development of professional practice, as nurses complain that their knowledge to deal with the relatives of a patient with a difficult diagnosis is limited and would therefore like additional information to deal with the situation. Design: Qualitative, empirical, descriptive research. Method: The data were collected through semi-structured interviews and analysed by inductive content analysis method. Interviews were conducted during Autumn 2020. 4 subjects participated in the research. Results and Conclusions: The thesis revealed that fathers had different experiences and needs in dealing with the child's illness. Fathers' experiences of coping with child's diseases encompassed experiences with information, social relationships, healthcare, changes in personal health and experiences regarding the child. Regarding information, the respondents pointed out bad experiences with the availability of information and the ability to convey the necessary information. Experiences regarding social relationships included experiences with relatives and strangers. Regarding healthcare, fathers mentioned experiences related to the child's health and healthcare professionals. In regards to personal health, fathers pointed out negative changes in their mental and physical health. In relation to the child, the subjects revealed experiences regarding changed values, way of life and raising the child. According to the research, fathers’ needs in relation to dealing with child's cancer included material, social, and spiritual needs. In regard to material needs, fathers pointed out the need for state assistance and the needs related to the surrounding environment. The needs concerning social belonging involved needs for a driving force and involvement in the treatment process. Regarding spiritual needs, fathers expressed mixed feelings towards the need for outside and professional help.

Keywords: father, coping, cancer, child, experience, need

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5442 Relationships between Motor Skills and Self-Perceived Athletic Competence in a Sample of Primary School Children

Authors: Cristina-Corina Bențea, Teodora-Mihaela Iconomescu, Laurențiu-Gabriel Talaghir, Claudiu Mereuță, Anamaria Berdilă

Abstract:

The study aims to examine the relationships between motor abilities, self-evaluation of athletic competence, and demographic characteristics in a sample of late-childhood participants. Defined as physical elements that enable the movements, motor skills are classified according to movement precision as gross and fine motor skills. Across their development, children enhance their ability to coordinate the limbs to produce different actions. In educational settings, they perform various instructional activities that involve the improvement of their athletic prowess and are taught how to strengthen their gross and fine motor abilities. Also, in relation to their activities, children tend to evaluate themselves differently across the various domains of their life. Starting from childhood, athletic competence is one of the area-specific evaluations of competence that refers to one’s ability to do well at sports, including outdoor games. Method: The sample consisted of fifty-eight primary school children, thirty girls, and twenty-eight boys, with ages between 8-10 years. The Bruininks-Oseretsky test of motor proficiency was used to assess both gross and fine motor skills in eight specific areas (fine motor precision, fine motor integration, manual dexterity, bilateral coordination, balance, running speed and agility, upper-limb coordination, strength). Athletic competence self-perceived was assessed with one of the six subscales of the Self-Perception Profile for Children. Results: Were examined both the relationships between each motor skills scale and subscales and between motor skills and general self-perceived athletic competence. Results indicated correlations between the athletic competence and four motor skills subscales depending on the gender and age of the children. The findings of the study were discussed related to the possibility to improve children's physical proficiency in educational settings according to the level of self-perceived athletic competence.

Keywords: gross motor skills, fine motor skills, athletic competence, self-evaluation, children, education

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5441 Chemical and Biomolecular Detection at a Polarizable Electrical Interface

Authors: Nicholas Mavrogiannis, Francesca Crivellari, Zachary Gagnon

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Development of low-cost, rapid, sensitive and portable biosensing systems are important for the detection and prevention of disease in developing countries, biowarfare/antiterrorism applications, environmental monitoring, point-of-care diagnostic testing and for basic biological research. Currently, the most established commercially available and widespread assays for portable point of care detection and disease testing are paper-based dipstick and lateral flow test strips. These paper-based devices are often small, cheap and simple to operate. The last three decades in particular have seen an emergence in these assays in diagnostic settings for detection of pregnancy, HIV/AIDS, blood glucose, Influenza, urinary protein, cardiovascular disease, respiratory infections and blood chemistries. Such assays are widely available largely because they are inexpensive, lightweight, and portable, are simple to operate, and a few platforms are capable of multiplexed detection for a small number of sample targets. However, there is a critical need for sensitive, quantitative and multiplexed detection capabilities for point-of-care diagnostics and for the detection and prevention of disease in the developing world that cannot be satisfied by current state-of-the-art paper-based assays. For example, applications including the detection of cardiac and cancer biomarkers and biothreat applications require sensitive multiplexed detection of analytes in the nM and pM range, and cannot currently be satisfied with current inexpensive portable platforms due to their lack of sensitivity, quantitative capabilities and often unreliable performance. In this talk, inexpensive label-free biomolecular detection at liquid interfaces using a newly discovered electrokinetic phenomenon known as fluidic dielectrophoresis (fDEP) is demonstrated. The electrokinetic approach involves exploiting the electrical mismatches between two aqueous liquid streams forced to flow side-by-side in a microfluidic T-channel. In this system, one fluid stream is engineered to have a higher conductivity relative to its neighbor which has a higher permittivity. When a “low” frequency (< 1 MHz) alternating current (AC) electrical field is applied normal to this fluidic electrical interface the fluid stream with high conductivity displaces into the low conductive stream. Conversely, when a “high” frequency (20MHz) AC electric field is applied, the high permittivity stream deflects across the microfluidic channel. There is, however, a critical frequency sensitive to the electrical differences between each fluid phase – the fDEP crossover frequency – between these two events where no fluid deflection is observed, and the interface remains fixed when exposed to an external field. To perform biomolecular detection, two streams flow side-by-side in a microfluidic T-channel: one fluid stream with an analyte of choice and an adjacent stream with a specific receptor to the chosen target. The two fluid streams merge and the fDEP crossover frequency is measured at different axial positions down the resulting liquid

Keywords: biodetection, fluidic dielectrophoresis, interfacial polarization, liquid interface

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5440 A Case of Mantle Cell Lymphoma Presenting With GI Symptoms and Noted to Have Extranodal Involvement of the Stomach and Colon on Presentation

Authors: Saba Amreen Syeda, Summaiah Asim, Syeda, Hafsa, Essam Quraishi

Abstract:

Mantle Cell Lymphoma (MCL) is a relatively uncommon type of lymphoma that comprises approximately 7 percent of non hodgkin's lymphomas (NHL), Classic MCL presents mostly in lymph nodes and occasionally in extranodal sites. About 26 % of MCL is present primarily in the Gastrointestinal tract. While both the upper GI tract and the lower GI tract could be involved, it is rare to present with concurrent upper and lower GI involvement with MCL. We present the case of a 51-year-old Asian Indian male that presented to our clinic with complaints of chronic diarrhea for the last one year, progressively worsening over the past three months. The Patient also reported black stool as well as bright red blood per rectum. Patient reported severe fatigue on minimal exertion. On a physical exam, the patient was noted to have matted lymphadenopathy in the neck. Patient was noted to be anemic with a hemoglobin to be 8 g/dl. Esophagogastroduodenoscopy and colonoscopy was performed. EGD showed a large 4 cm ulcer in the gastric antrum with thick heaped up edges. There was bleeding on contact. Colonoscopy showed a large 35 mm multilobulated polyp in the ascending colon, which was biopsied. The patient was also noted to have nodular proctitis in the mid rectum. This was localized and extended to about 5 cm. This area was biopsied as well. Biopsies from the stomach, colon, as well as the rectum, returned with findings of mantle cell lymphoma on pathology. Lymphoid cells in the biopsy were stained strongly positive for CD 20, cyclin D1, and CD 5. There was the absence of stain for CD 3 and CD 10. The IHC stain for CD 23 was negative. Biopsies from neck LAD were obtained and were also positive for MCL. The patient was referred to oncology for staging and treatment.

Keywords: mantle cell lymphoma, GI bleed, diarrhea, gastric ulcer, colon polyp

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5439 The Family, Tradition and Change in Africa: The Perspective of Postcolonial African Fiction

Authors: Ayobami Kehinde

Abstract:

The literary representations of the family, tradition and change in African literature offer an immense, and as yet little theorised area of literary scholarship. Therefore, this paper explores the nexus among the family, tradition and change in five purposively selected post-colonial African fiction: Chimamanda Adichie’s Purple Hibiscus, Wale Okediran’s Tenants of the House, J. M. Coetzee’s In the Heart of the Country, Tsitsi Dangrembga’s Nervous Condition and Meja Mwangi’s Striving for the Wind. The methodology centres on analysing, questioning, undermining and celebrating the family and its contemporary vicissitudes as depicted in the texts. This is with a view to exploring the postcolonial novel with references to concepts developed by major theorists in the field of postcolonial studies, including Frantz Fanon, Edward Said, Gayatri Spivak, Homi Bhabha, Kwame Appiah and Achille Mbembe. It is revealed that in spite of the fact that the family is a vital institution, the primary social unit in any community, an agent of acculturation and the first focus of development, independence and growth, the texts reflect a diversity of problems confronting the family unit in Africa. These include the multiple problems of disrupted family lives, enforced family separation, political and personal violence with the domestic environment. It is concluded that the post-colonial African novel is a quintessential weapon to analyse the continent, opening up to the reader the specific expressions and experiences of human lives and their wider contexts. Therefore, the post-colonial African novel is a primary socio-cultural indicator representing an immense variety of lived realities in the continent. The study, therefore, suggests a concerted concern with the preservation of traditional family structures and other related aspects, such as cultural values, spirituality, gender roles and mutual trust.

Keywords: family, African fiction, postcolonialism, African tradition, domestic dissonance

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5438 Cadmium Levels in Patients with Type 2 Diabetes Mellitus in Thasala Southern Thailand

Authors: Supabhorn Yimthiang, Wiyada Khanwian

Abstract:

Cadmium is a heavy metal that is important in the environment because it is highly toxic. The incidence and severity of type 2 diabetes mellitus are known to be associated with cadmium. The purpose of this study was to investigate the cadmium levels in patients with type 2 diabetes mellitus at diabetes mellitus clinic, Thasala hospital, Nakhon Si Thummarat, Thailand. The study population was composed of forty five subjects. Among them, twenty two were diabetic patients and twenty three were apparently healthy non-diabetic individual subjects. After an overnight fasting, blood and morning urine samples were collected from each subject to determine fasting blood sugar and cadmium levels in urine, respectively. Systolic and diastolic blood pressure values were measured by aneroid sphygmomanometer. Study approval was taken from the human subject ethics committee of Walailak University. Verbal and written informed consent was taken from all participants. In the study samples, there were 31.8% males and 68.2% females with mean age of 47+10.53 years. The geometric mean of urine cadmium was significantly higher in diabetic patients (1.015 + 0.79 µg/g creatinine) when compared with the healthy subjects (0.395 + 0.53 µg/g creatinine) (P<0.05). This result also showed that urine cadmium excretion in diabetic patients was higher than in healthy subjects by 2.6 times. Moreover, fasting blood sugar (153+47.86 μg/dl) and systolic blood pressure (183.26+17.15 mmHg) of diabetic patients was significantly different when compared with healthy subjects (79+5.38 μg/dl and 112.78+11.32 mmHg, respectively) (P<0.05). Meanwhile, the concentration of cadmium in urine showed positive correlation with fasting plasma glucose (r=0.616) and systolic blood pressure (r=0.487). This preliminary study showed that cadmium might play an important role in the development and pathogenesis of diabetes mellitus in general population. However, these findings require confirmation through additional epidemiological and biological research.

Keywords: blood pressure, cadmium, fasting blood sugar, type 2 diabetes mellitus

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5437 [Keynote Talk]: Let Us Move to Ethical Finance: A Case Study of Takaful

Authors: Syed Ahmed Salman

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Ethicality is essential in our daily activities, including personal and commercial activities. This is evidenced by referring to the historical development of the corporate governance and ethical guidelines. The first corporate governance guideline, i.e. Cadbury Report from U.K. focuses the responsibility of board members towards the shareholders only. Gradually, realising the need to take care of the society and community, stakeholders are now concerns of business entities. Consequently, later codes of corporate governance started extending the responsibility to the other stakeholders in addition to the shareholders. One prevailing corporate governance theory, i.e. stakeholder theory, has been widely used in the research to explore the effects of business entities on society. In addition, the Global Reporting Initiative (GRI) is the leading organisation which promotes social care from businesses for sustainable development. Conventionally, history shows that ethics is key to the long term success of businesses. Many organisations, societies, and regulators give full attention and consideration to ethics. Several countries have introduced ethical codes of conduct to direct trade activities. Similarly, Islam and other religions prohibit the practice of interest, uncertainty, and gambling because of its unethical nature. These prohibited practices are not at all good for the society, business, and any organisation especially as it is detrimental to the well-being of society. In order to avoid unethicality in the finance industry, Shari’ah scholars come out with the idea of Islamic finance which is free from the prohibited elements from the Islamic perspective. It can also be termed ethical finance. This paper highlights how Takaful as one of the Islamic finance products offers fair and just products to the contracting parties and the society. Takaful is framed based on ethical guidelines which are extracted from Shari’ah principles and divine sources such as the Quran and Sunnah. Takaful products have been widely offered all over the world, including in both Muslim and non-Muslim countries. It seems that it is gaining acceptance regardless of religion. This is evidence that Takaful is being accepted as an ethical financial product.

Keywords: ethics, insurance, Islamic finance, religion and takaful

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5436 Role of Financial Institutions in Promoting Micro Service Enterprises with Special Reference to Hairdressing Salons

Authors: Gururaj Bhajantri

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Financial sector is the backbone of any economy and it plays a crucial role in the mobilisation and allocation of resources. One of the main objectives of financial sector is inclusive growth. The constituents of the financial sector are banks, and financial Institutions, which mobilise the resources from the surplus sector and channelize the same to the different needful sectors in the economy. Micro Small and the Medium Enterprises sector in India cover a wide range of economic activities. These enterprises are divided on the basis of investment on equipment. The micro enterprises are divided into manufacturing and services sector. Micro Service enterprises have investment limit up to ten lakhs on equipment. Hairdresser is one who not only cuts and shaves but also provides different types of hair cut, hairstyles, trimming, hair-dye, massage, manicure, pedicure, nail services, colouring, facial, makeup application, waxing, tanning and other beauty treatments etc., hairdressing salons provide these services with the help of equipment. They need investment on equipment not more than ten lakhs. Hence, they can be considered as Micro service enterprises. Hairdressing salons require more than Rs 2.50,000 to start a moderate salon. Moreover, hairdressers are unable to access the organised finance. Still these individuals access finance from money lenders with high rate of interest to lead life. The socio economic conditions of hairdressers are not known properly. Hence, the present study brings a light on the role of financial institutions in promoting hairdressing salons. The study also focuses the socio-economic background of individuals in hairdressings salons, problems faced by them. The present study is based on primary and secondary data. Primary data collected among hairdressing salons in Davangere city. Samples selected with the help of simple random sampling techniques. Collected data analysed and interpreted with the help of simple statistical tools.

Keywords: micro service enterprises, financial institutions, hairdressing salons, financial sector

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5435 Understanding Rural Teachers’ Perceived Intention of Using Play in ECCE Mathematics Classroom: Strength-Based Approach

Authors: Nyamela M. ‘Masekhohola, Khanare P. Fumane

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The Lesotho downward trend in mathematics attainment at all levels is compounded by the absence of innovative approaches to teaching and learning in Early Childhood. However, studies have shown that play pedagogy can be used to mitigate the challenges of mathematics education. Despite the benefits of play pedagogy to rural learners, its full potential has not been realized in early childhood care and education classrooms to improve children’s performance in mathematics because the adoption of play pedagogy depends on a strength-based approach. The study explores the potential of play pedagogy to improve mathematics education in early childhood care and education in Lesotho. Strength-based approach is known for its advocacy of recognizing and utilizing children’s strengths, capacities and interests. However, this approach and its promisingattributes is not well-known in Lesotho. In particular, little is known about the attributes of play pedagogy that are essential to improve mathematic education in ECCE programs in Lesotho. To identify such attributes and strengthen mathematics education, this systematic review examines evidence published on the strengths of play pedagogy that supports the teaching and learning of mathematics education in ECCE. The purpose of this review is, therefore, to identify and define the strengths of play pedagogy that supports mathematics education. Moreover, the study intends to understand the rural teachers’ perceived intention of using play in ECCE math classrooms through a strength-based approach. Eight key strengths were found (cues for reflection, edutainment, mathematics language development, creativity and imagination, cognitive promotion, exploration, classification, and skills development). This study is the first to identify and define the strength-based attributes of play pedagogy to improve the teaching and learning of mathematics in ECCE centers in Lesotho. The findings reveal which opportunities teachers find important for improving the teaching of mathematics as early as in ECCE programs. We conclude by discussing the implications of the literature for stimulating dialogues towards formulating strength-based approaches to teaching mathematics, as well as reflecting on the broader contributions of play pedagogy as an asset to improve mathematics in Lesotho and beyond.

Keywords: early childhood education, mathematics education, lesotho, play pedagogy, strength-based approach.

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5434 Formation of the Investment Portfolio of Intangible Assets with a Wide Pairwise Comparison Matrix Application

Authors: Gulnara Galeeva

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The Analytic Hierarchy Process is widely used in the economic and financial studies, including the formation of investment portfolios. In this study, a generalized method of obtaining a vector of priorities for the case with separate pairwise comparisons of the expert opinion being presented as a set of several equal evaluations on a ratio scale is examined. The author claims that this method allows solving an important and up-to-date problem of excluding vagueness and ambiguity of the expert opinion in the decision making theory. The study describes the authentic wide pairwise comparison matrix. Its application in the formation of the efficient investment portfolio of intangible assets of a small business enterprise with limited funding is considered. The proposed method has been successfully approbated on the practical example of a functioning dental clinic. The result of the study confirms that the wide pairwise comparison matrix can be used as a simple and reliable method for forming the enterprise investment policy. Moreover, a comparison between the method based on the wide pairwise comparison matrix and the classical analytic hierarchy process was conducted. The results of the comparative analysis confirm the correctness of the method based on the wide matrix. The application of a wide pairwise comparison matrix also allows to widely use the statistical methods of experimental data processing for obtaining the vector of priorities. A new method is available for simple users. Its application gives about the same accuracy result as that of the classical hierarchy process. Financial directors of small and medium business enterprises get an opportunity to solve the problem of companies’ investments without resorting to services of analytical agencies specializing in such studies.

Keywords: analytic hierarchy process, decision processes, investment portfolio, intangible assets

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5433 IT-Based Global Healthcare Delivery System: An Alternative Global Healthcare Delivery System

Authors: Arvind Aggarwal

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We have developed a comprehensive global healthcare delivery System based on information technology. It has medical consultation system where a virtual consultant can give medical consultation to the patients and Doctors at the digital medical centre after reviewing the patient’s EMR file consisting of patient’s history, investigations in the voice, images and data format. The system has the surgical operation system too, where a remote robotic consultant can conduct surgery at the robotic surgical centre. The instant speech and text translation is incorporated in the software where the patient’s speech and text (language) can be translated into the consultant’s language and vice versa. A consultant of any specialty (surgeon or Physician) based in any country can provide instant health care consultation, to any patient in any country without loss of time. Robotic surgeons based in any country in a tertiary care hospital can perform remote robotic surgery, through patient friendly telemedicine and tele-surgical centres. The patient EMR, financial data and data of all the consultants and robotic surgeons shall be stored in cloud. It is a complete comprehensive business model with healthcare medical and surgical delivery system. The whole system is self-financing and can be implemented in any country. The entire system uses paperless, filmless techniques. This eliminates the use of all consumables thereby reduces substantial cost which is incurred by consumables. The consultants receive virtual patients, in the form of EMR, thus the consultant saves time and expense to travel to the hospital to see the patients. The consultant gets electronic file ready for reporting & diagnosis. Hence time spent on the physical examination of the patient is saved, the consultant can, therefore, spend quality time in studying the EMR/virtual patient and give his instant advice. The time consumed per patient is reduced and therefore can see more number of patients, the cost of the consultation per patients is therefore reduced. The additional productivity of the consultants can be channelized to serve rural patients devoid of doctors.

Keywords: e-health, telemedicine, telecare, IT-based healthcare

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5432 Developing Effective Strategies to Reduce Hiv, Aids and Sexually Transmitted Infections, Nakuru, Kenya

Authors: Brian Bacia, Esther Githaiga, Teresia Kabucho, Paul Moses Ndegwa, Lucy Gichohi

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Purpose: The aim of the study is to ensure an appropriate mix of evidence-based prevention strategies geared towards the reduction of new HIV infections and the incidence of Sexually transmitted Illnesses Background: In Nakuru County, more than 90% of all HIV-infected patients are adults and on a single-dose medication-one pill that contains a combination of several different HIV drugs. Nakuru town has been identified as the hardest hit by HIV/Aids in the County according to the latest statistics from the County Aids and STI group, with a prevalence rate of 5.7 percent attributed to the high population and an active urban center. Method: 2 key studies were carried out to provide evidence for the effectiveness of antiretroviral therapy (ART) when used optimally on preventing sexual transmission of HIV. Discussions based on an examination, assessments of successes in planning, program implementation, and ultimate impact of prevention and treatment were undertaken involving health managers, health workers, community health workers, and people living with HIV/AIDS between February -August 2021. Questionnaires were carried out by a trained duo on ethical procedures at 15 HIV treatment clinics targeting patients on ARVs and caregivers on ARV prevention and treatment of pediatric HIV infection. Findings: Levels of AIDS awareness are extremely high. Advances in HIV treatment have led to an enhanced understanding of the virus, improved care of patients, and control of the spread of drug-resistant HIV. There has been a tremendous increase in the number of people living with HIV having access to life-long antiretroviral drugs (ARV), mostly on generic medicines. Healthcare facilities providing treatment are stressed challenging the administration of the drugs, which require a clinical setting. Women find it difficult to take a daily pill which reduces the effectiveness of the medicine. ART adherence can be strengthened largely through the use of innovative digital technology. The case management approach is useful in resource-limited settings. The county has made tremendous progress in mother-to-child transmission reduction through enhanced early antenatal care (ANC) attendance and mapping of pregnant women Recommendations: Treatment reduces the risk of transmission to the child during pregnancy, labor, and delivery. Promote research of medicines through patients and community engagement. Reduce the risk of transmission through breastfeeding. Enhance testing strategies and strengthen health systems for sustainable HIV service delivery. Need exists for improved antenatal care and delivery by skilled birth attendants. Develop a comprehensive maternal reproductive health policy covering equitability, efficient and effective delivery of services. Put in place referral systems.

Keywords: evidence-based prevention strategies, service delivery, human management, integrated approach

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5431 Professionals’ Learning from Casework in Child Protection: The View from Within

Authors: Jude Harrison

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Child protection is a complex and sensitive practice. The core responsibility is the care and protection of children and young people who have been subject to or who are at risk from abuse and neglect. The work involves investigating allegations of harm, preparing for and making representations to the legal system, and case planning and management across a continuum of complicated care interventions. Professionals’ learning for child protection practice is evident in a range of literature investigating multiple learning processes such as university preparation, student placements, professional supervision, training, and other post-qualifying professional development experiences at work. There is, however, very limited research into how caseworkers learn in and through their daily practice. Little is known, therefore, about how learning at work unfolds for caseworkers, the dimensions in which it can be understood or the ways in which it can be best facilitated and supported. Compounding this, much of the current child protection learning literature reflects an orthodox conception of learning as mentalistic and individualised, in which knowledge is typically understood as abstract theory or as technical skill or competency. This presentation outlines key findings from a PhD research study that explored learning at work for statutory child protection caseworkers from an alternative interpretation of learning using a practice theory approach. Practice theory offers an interpretation of learning as performative and grounded in situated experience. The findings of the study show that casework practice is both a mode and site of learning. The study was ethnographic in design based and followed 17 child protection caseworkers via in-depth interviews, observations and participant reflective journaling. Inductive and abductive analysis was used to organise and interpret the data and expand analysis, leading to themes. Key findings show learning to be a sociomaterial property of doing; the social ontological character of learning; and teleoaffectivity as a feature of learning. The findings contribute to theoretical and practical understandings of learning and practice in child protection, child welfare and the professional learning literature more broadly. The findings have potential to contribute to policy directions at state, territory and national levels to enhance child protection practice and systems.

Keywords: adiult learning, workplace learning, child welfare, sociomaterial, practice theory

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5430 Effects of Branched-Chain Amino Acid Supplementation on Sarcopenic Patients with Liver Cirrhosis

Authors: Deepak Nathiya1, Ramesh Roop Rai, Pratima Singh1, Preeti Raj1, Supriya Suman, Balvir Singh Tomar

Abstract:

Background: Sarcopenia is a catabolic state in liver cirrhosis (LC), accelerated with a breakdown of skeletal muscle to release amino acids which adversely affects survival, health-related quality of life, and response to any underlying disease. The primary objective of the study was to investigate the long-term effect of branched-chain amino acids (BCAA) supplementations on parameters associated with improved prognosis in sarcopenic patients with LC, as well as to evaluate its impact on cirrhotic-related events. Methods: We carried out a 24 week, single-center, randomized, open-label, controlled, two cohort parallel-group intervention trial comparing the efficacy of BCAA against lactoalbumin (L-ALB) on 106 sarcopenic liver cirrhotics. The BCAA (intervention) group was treated with 7.2 g BCAA per whereas, the lactoalbumin group was also given 6.3 g of L-Albumin. The primary outcome was to assess the impact of BCAA on parameters of sarcopenia: muscle mass, muscle strength, and physical performance. The secondary outcomes were to study combined survival and maintenance of liver function changes in laboratory and clinical markers in the duration of six months. Results: Treatment with BCAA leads to significant improvement in sarcopenic parameters: muscle strength, muscle function, and muscle mass. The total cirrhotic-related complications and cumulative event-free survival occurred fewer in the BCAA group than in the L-ALB group. Prognostic markers also improved significantly in the study. Conclusion: The current clinical trial demonstrated that long-term BCAAs supplementation improved sarcopenia and prognostic markers in patients with advanced liver cirrhosis.

Keywords: sarcopenia, liver cirrhosis, BCAA, quality of life

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5429 Technical Efficiency in Organic and Conventional Wheat Farms: Evidence from a Primary Survey from Two Districts of Ganga River Basin, India

Authors: S. P. Singh, Priya, Komal Sajwan

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With the increasing spread of organic farming in India, costs, returns, efficiency, and social and environmental sustainability of organic vis-a-vis conventional farming systems have become topics of interest among agriculture scientists, economists, and policy analysts. A study on technical efficiency estimation under these farming systems, particularly in the Ganga River Basin, where the promotion of organic farming is incentivized, can help to understand whether the inputs are utilized to their maximum possible level and what measures can be taken to improve the efficiency. This paper, therefore, analyses the technical efficiency of wheat farms operating under organic and conventional farming systems. The study is based on a primary survey of 600 farms (300 organic ad 300 conventional) conducted in 2021 in two districts located in the Middle Ganga River Basin, India. Technical, managerial, and scale efficiencies of individual farms are estimated by applying the data envelopment analysis (DEA) methodology. The per hectare value of wheat production is taken as an output variable, and values of seeds, human labour, machine cost, plant nutrients, farm yard manure (FYM), plant protection, and irrigation charges are considered input variables for estimating the farm-level efficiencies. The post-DEA analysis is conducted using the Tobit regression model to know the efficiency determining factors. The results show that technical efficiency is significantly higher in conventional than organic farming systems due to a higher gap in scale efficiency than managerial efficiency. Further, 9.8% conventional and only 1.0% organic farms are found operating at the most productive scale size (MPSS), and 99% organic and 81% conventional farms at IRS. Organic farms perform well in managerial efficiency, but their technical efficiency is lower than conventional farms, mainly due to their relatively lower scale size. The paper suggests that technical efficiency in organic wheat can be increased by upscaling the farm size by incentivizing group/collective farming in clusters.

Keywords: organic, conventional, technical efficiency, determinants, DEA, Tobit regression

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5428 Characterization of Chest Pain in Patients Consulting to the Emergency Department of a Health Institution High Level of Complexity during 2014-2015, Medellin, Colombia

Authors: Jorge Iván Bañol-Betancur, Lina María Martínez-Sánchez, María de los Ángeles Rodríguez-Gázquez, Estefanía Bahamonde-Olaya, Ana María Gutiérrez-Tamayo, Laura Isabel Jaramillo-Jaramillo, Camilo Ruiz-Mejía, Natalia Morales-Quintero

Abstract:

Acute chest pain is a distressing sensation between the diaphragm and the base of the neck and it represents a diagnostic challenge for any physician in the emergency department. Objective: To establish the main clinical and epidemiological characteristics of patients who present with chest pain to the emergency department in a private clinic from the city of Medellin, during 2014-2015. Methods: Cross-sectional retrospective observational study. Population and sample were patients who consulted for chest pain in the emergency department who met the eligibility criteria. The information was analyzed in SPSS program vr.21; qualitative variables were described through relative frequencies, and the quantitative through mean and standard deviation ‬or medians according to their distribution in the study population. Results: A total of 231 patients were evaluated, the mean age was 49.5 ± 19.9 years, 56.7% were females. The most frequent pathological antecedents were hypertension 35.5%, diabetes 10,8%, dyslipidemia 10.4% and coronary disease 5.2%. Regarding pain features, in 40.3% of the patients the pain began abruptly, in 38.2% it had a precordial location, for 20% of the cases physical activity acted as a trigger, and 60.6% was oppressive. Costochondritis was the most common cause of chest pain among patients with an established etiologic diagnosis, representing the 18.2%. Conclusions: Although the clinical features of pain reported coincide with the clinical presentation of an acute coronary syndrome, the most common cause of chest pain in study population was costochondritis instead, indicating that it is a differential diagnostic in the approach of patients with pain acute chest.

Keywords: acute coronary syndrome, chest pain, epidemiology, osteochondritis

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5427 Masstige and the New Luxury: An Exploratory Study on Cosmetic Brands Among Black African Woman

Authors: Melanie Girdharilall, Anjli Himraj, Shivan Bhagwandin, Marike Venter De Villiers

Abstract:

The allure of luxury has long been attractive, fashionable, mystifying, and complex. As globalisation and the popularity of social media continue to evolve, consumers are seeking status products. However, in emerging economies like South Africa, where 60% of the country lives in poverty, this desire is often far-fetched and out of reach to most of the consumers. As a result, luxury brands are introducing masstige products: products that are associated with luxury and status but within financial reach to the middle-class consumer. The biggest challenge that this industry faces is the lack of knowledge and expertise on black female’s hair composition and offering products that meet their intricate requirements. African consumers have unique hair types, and global brands often do not accommodate for the complex nature of their hair and their product needs. By gaining insight into this phenomenon, global cosmetic brands can benefit from brand expansion, product extensions, increased brand awareness, brand knowledge, and brand equity. The purpose of this study is to determine how cosmetic brands can leverage the concept of masstige products to cater to the needs of middle-income black African woman. This study explores the 18- to 35-year-old black female cohort, which comprises approximately 17% of the South African population. The black hair care industry in Africa is expected a 6% growth rate over the next 5 years. The study is grounded in Paul’s (2019) 3-phase model for masstige marketing. This model demonstrates that product, promotion, and place strategies play a significant role in masstige value creation and the impact of these strategies on the branding dimensions (brand trust, brand association, brand positioning, brand preference, etc.).More specifically, this theoretical framework encompasses nine stages, or dimensions, that are of critical importance to companies who plan to infiltrate the masstige market. In short, the most critical components to consider are the positioning of the product and its competitive advantage in comparison to competitors. Secondly, advertising appeals and use of celebrities, and lastly, distribution channels such as online or in-store while maintain the exclusivity of the brand. By means of an exploratory study, a qualitative approach was undertaken, and focus groups were conducted among black African woman. The focus groups were voice recorded, transcribed, and analysed using Atlas software. The main themes were identified and used to provide brands with insight and direction for developing a comprehensive marketing mix for effectively entering the masstige market. The findings of this study will provide marketing practitioners with in-depth insight into how to effectively position masstige brands in line with consumer needs. It will give direction to both existing and new brands aiming to enter this market, by giving a comprehensive marketing mix for targeting the growing black hair care industry in Africa.

Keywords: africa, masstige, cosmetics, hard care, black females

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5426 Isolation and Expansion of Human Periosteum-Derived Mesenchymal Stem Cells in Defined Serum-Free Culture Medium

Authors: Ainur Mukhambetova, Miras Karzhauov, Vyacheslav Ogay

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Introduction: Mesenchymal stem cells (MSCs) have the capacity to be differentiated into several cell lineages and are a promising source for cell therapy and tissue engineering. However, currently most MSCs culturing protocols use media supplemented with fetal bovine serum (FBS), which limits their application in clinic due to the possibility of zoonotic infections, contamination and immunological reactions. Consequently, formulating effective serum free culture medium becomes one of the important problems in contemporary cell biotechnology. Objectives: The aim of this study was to define an optimal serum-free medium for culturing of periosteum derived MSCs. Materials and methods: The MSCs were extracted from human periosteum and transferred to the culture flasks pretreated with CELLstart™. Immunophenotypic characterization, proliferation and in vitro differentiation of cells grown on STEM PRO® MSC SFM were compared to the cells cultured in the standard FBS containing media. Chromosome analysis and flow cytometry were also performed. Results: We have shown that cells were grown on STEM PRO® MSC SFM retained all the morphological, immunophenotypic (CD73, CD90, CD105, vimentin and Stro-1) and cell differentiation characteristics specific to MSCs. Chromosome analysis indicated no anomalies in the chromosome structure. Flow cytometry showed a high expression of cell adhesion molecules CD44 (98,8%), CD90 (97,4%), CD105 (99,1%). In addition, we have shown that cell is grown on STEM PRO® MSC SFM have higher proliferation capacity compared to cell expanded on standard FBS containing the medium. Conclusion: We have shown that STEM PRO® MSC SFM is optimal for culturing periosteum derived human MSCs which subsequently can be safely used in cell therapy.

Keywords: cell technologies, periosteum-derived MSCs, regenerative medicine, serum-free medium

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5425 Leisure Time Physical Activity during Pregnancy and the Associated Factors Based on Health Belief Model: A Cross Sectional Study

Authors: Xin Chen, Xiao Yang, Rongrong Han, Lu Chen, Lingling Gao

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Background: Leisure time physical activity (LTPA) benefits both pregnant women and their fetuses. The guidelines recommended that pregnant women should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week. The aim of this study was to investigate the rate of LTPA participation among Chinese pregnant women and to identify its predictors based on the health belief model. Methods: A cross-sectional study was conducted from June 2019 to September 2019 in Changchun, China. A total of 225 pregnant women aged 18 years or older with no severe physical or mental disease were recruited in the obstetric clinic. Self-administered questionnaires were used to collect data. LTPA was assessed by a pregnant physical activity questionnaire (PPAQ). A revised pregnancy physical activity health belief scale and social-demographic and perinatal characteristics factors were collected and used to predict LTPA participation. Data were analyzed using descriptive statistics and multivariate logistic regression. Results: The participants had a high level of perceived susceptibility, perceived severity, perceived benefits, and action clues, with mean item scores above 3.5. The predictors of LTPA in Chinese pregnant women were pre-pregnancy exercise habits [OR 3.236 (95% CI:1.632, 6.416)], perceived susceptibility score [OR 2.083 (95% CI:1.002, 4.331)], and perceived barriers score [OR 3.113 (95%CI:1.462, 6.626)]. Conclusions: The results of this study will lead to better identification of pregnant women who may not participate in LTPA. Healthcare professionals should be cognizant of issues that may affect LTPA participation among pregnant women, including pre-pregnancy exercise habits, perceived susceptibility, and perceived barriers.

Keywords: pregnancy, health belief model., leisure time physical activity, factors

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5424 Quality Culture Framework Proposal for Libyan Industrial Companies

Authors: Mostafa Ahmed Shokshok

Abstract:

Libyan industrial companies face many challenges in today's competitive market. Quality management culture approaches is one of these challenges which may furnish the road to the Libyan industrial companies to effectively empower their employees and improve their ability to respond to the international competition. The primary objective of this paper is to design a practical approach to guide Libyan industrial companies toward successful quality culture implementation.

Keywords: TQM, quality culture, Libyan manufacturing industries, quality framework

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5423 Effectiveness of Breathing Training Program on Quality of Life and Depression Among Hemodialysis Patients: Quasi‐Experimental Study

Authors: Hayfa Almutary, Noof Eid Al Shammari

Abstract:

Aim: The management of depression in patients undergoing hemodialysis remains challenging. The aim of this study was to evaluate the effectiveness of a breathing training program on quality of life and depression among patients on hemodialysis. Design: A one-group pretest-posttest quasi-experimental design was used. Methods: Data were collected from hemodialysis units at three dialysis centers. Initial baseline data were collected, and a breathing training program was implemented. The breathing training program included three types of breathing exercises. The impact of the intervention on outcomes was measured using both the Kidney Disease Quality of Life Short Version and the Beck Depression Inventory-Second Edition from the same participants. The participants were asked to perform the breathing training program three times a day for 30 days. Results: The mean age of the patients was 52.1 (SD:15.0), with nearly two-thirds of them being male (63.4%). Participants who were undergoing hemodialysis for 1–4 years constituted the largest number of the sample (46.3%), and 17.1% of participants had visited a psychiatric clinic 1-3 times. The results show that the breathing training program improved overall quality of life and reduced symptoms and problems. In addition, a significant decrease in the overall depression score was observed after implementing the intervention. Conclusions: The breathing training program is a non-pharmacological intervention that has proven visible effectiveness in hemodialysis. This study demonstrated that using breathing exercises reduced depression levels and improved quality of life. The integration of this intervention in dialysis units to manage psychological issues will offer a simple, safe, easy, and inexpensive intervention. Future research should compare the effectiveness of various breathing exercises in hemodialysis patients using longitudinal studies. Impact: As a safety precaution, nurses should initially use non-pharmacological interventions, such as a breathing training program, to treat depression in those undergoing hemodialysis.

Keywords: breathing training program, depression, exercise, quality of life, hemodialysis

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5422 Application of Transportation Models for Analysing Future Intercity and Intracity Travel Patterns in Kuwait

Authors: Srikanth Pandurangi, Basheer Mohammed, Nezar Al Sayegh

Abstract:

In order to meet the increasing demand for housing care for Kuwaiti citizens, the government authorities in Kuwait are undertaking a series of projects in the form of new large cities, outside the current urban area. Al Mutlaa City located to the north-west of the Kuwait Metropolitan Area is one such project out of the 15 planned new cities. The city accommodates a wide variety of residential developments, employment opportunities, commercial, recreational, health care and institutional uses. This paper examines the application of comprehensive transportation demand modeling works undertaken in VISUM platform to understand the future intracity and intercity travel distribution patterns in Kuwait. The scope of models developed varied in levels of detail: strategic model update, sub-area models representing future demand of Al Mutlaa City, sub-area models built to estimate the demand in the residential neighborhoods of the city. This paper aims at offering model update framework that facilitates easy integration between sub-area models and strategic national models for unified traffic forecasts. This paper presents the transportation demand modeling results utilized in informing the planning of multi-modal transportation system for Al Mutlaa City. This paper also presents the household survey data collection efforts undertaken using GPS devices (first time in Kuwait) and notebook computer based digital survey forms for interviewing representative sample of citizens and residents. The survey results formed the basis of estimating trip generation rates and trip distribution coefficients used in the strategic base year model calibration and validation process.

Keywords: innovative methods in transportation data collection, integrated public transportation system, traffic forecasts, transportation modeling, travel behavior

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5421 Enhancing Oral Pre-Exposure Prophylaxis Uptake and Continuation among Adolescent Girls and Young Women in Busia District East Central Uganda

Authors: Jameson Mirimu, Edward Mawejje, Ibra Twinomujuni

Abstract:

Introduction: Adolescent girls and young women (AGYW) are a vulnerable category whose risk of acquiring HIV is 20 times compared to the general population accounting for 25% of the new infections. Despite proven scientific evidence of preventing HIV acquisition, Oral Pre-Exposure Prophylaxis (PreP) is less used as one of the biomedical interventions among the AGYW. By 2020, only 31000-32000 of the targeted 90,000 persons in Uganda enrolled on Oral PreP LPHS-EC project employed a combination of Expanded Peer Outreach Approach (EPOA) and Effective client follow-up to increase PreP initiation (PrEP_NEW) and continuation for more than three months (PrEP_CT). Method: Quantitatively, data from National Key population Combination tracker retrospectively analyzed by M&E, focused group discussion with AGYWs and Health care workers to identify barriers. Barriers found; hesitancy of AGYW, misconceptions about Oral PrEP, inadequate knowledge and skills in handling adolescent and Data quality issues. To address the mentioned barriers, youth friendly corners initiated in study sites, identified PrEP Champions among the AGYW, oral PrEP dialogues, group Antenatal counselling, CQI Projects initiated, weekly perfomance meetings to track performance. Results: Routine program data review PrEP_NEW and PrEP_CT increased from 5% (4/80) and 4% (2/54), respectively, in July 2022 to 90% (72/80) and 79% (43/54) respectively for PrEP_NEW and PrEP_CT at the end of March 2023. Lessons Learnt: Demystifying misconception about oral Prep through provision of adequate information by involving health care workers through skills enhancement, CQI projects are critical intervention. Conclusion: With improved safe spaces, skills enhancement of health workers, stakeholders’ engagement through Oral Prep dialogues is critical in improving PreP uptake and continuity among the AGYWS.

Keywords: prep, uptake, continuation, AGYW

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5420 Placenta A Classical Caesarean Section with Peripartum Hysterectomy at 27+3 Weeks Gestation For Placnta Accreta

Authors: Huda Abdelrhman Osman Ahmed, Paul Feyi Waboso

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Introduction: Placenta accreta spectrum (PAS) disorders present a significant challenge in obstetric management due to the high risk of hemorrhage and potential complications at delivery. This case describes a 27+3 weeks gestation in a patient with placenta accreta managed with classical cesarean section and peripartum hysterectomy. Case Description: AGravida 4P3 patient presented at 27+3 weeks gestation with painless, unprovoked vaginal bleeding and an estimated blood loss (EBL) of 300 mL. At the 20+5 week anomaly scan, a placenta previa was identified anterior, covering the os anterior uterus and containing lacunae with signs of myometrial thinning. At a 24+1 week scan conducted at a tertiary center, further imaging indicated placenta increta with invasion into the myometrium and potential areas of placenta percreta. The patient’s past obstetric history included three previous cesarean sections, with no significant medical or surgical history. Social history revealed heavy smoking but no alcohol use. No drug allergies were reported. Given the risks associated with PAS, a management plan was formulated, including an MRI at a later stage and cesarean delivery with a possible hysterectomy between 34-36 weeks. However, at 27+3 weeks, the patient experienced another episode of vaginal bleeding EBL 500 ml, necessitating immediate intervention. Management: As the patient was unstable, she was not transferred to the tertiary center. Completed and informed consent was obtained. MDT planning-group and cross-matching 4 units, uterotonics. Tranexamic acid blood products, cryo, cell salvage, 2 obstetric consultants and an anesthetic consultant, blood bank aware and hematologist. HDU bed and ITU availability. This study assisted in performing a classical Caesarean section, Where the urologist inserted JJ ureteric stents. Following this, we also assisted in a total abdominal hysterectomy with the conservation of ovaries. 4 units RBC and 1 unit FFP were transfused. The total blood loss was 2.3 L. Outcome: The procedure successfully achieved hemostasis, and the neonate was delivered with subsequent transfer to a neonatal intensive care unit for management. The patient’s postoperative course was monitored closely with no immediate complications. Discussion: This case highlights the complexity and urgency in managing placenta accreta spectrum disorders, particularly with the added challenges posed by remote location and limited tertiary support. The need for rapid decision-making and interdisciplinary coordination is emphasized in such high-risk obstetric cases. The case also underscores the potential for surgical intervention and the importance of family involvement in emergent care decisions. Conclusion: Placenta accreta spectrum disorders demand meticulous planning and timely intervention. This case contributes to understanding PAS management at earlier gestational ages and provides insights into the challenges posed by access to tertiary care, especially in urgent situations.

Keywords: Accreta, Hysterectomy, 3MDT, prematurity

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5419 Prevalence and Correlates of Complementary and Alternative Medicine Use among Diabetic Patients in Lebanon: A Cross-Sectional Study

Authors: Farah Naja, Mohamad Alameddine

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Background: The difficulty of compliance to therapeutic and lifestyle management of type 2 diabetes mellitus (T2DM) encourages patients to use complementary and alternative medicine (CAM) therapies. Little is known about the prevalence and mode of CAM use among diabetics in the Eastern Mediterranean Region in general and Lebanon in particular. Objective: To assess the prevalence and modes of CAM use among patients with T2DM residing in Beirut, Lebanon. Methods: A cross-sectional survey of T2DM patients was conducted on patients recruited from two major referral centers - a public hospital and a private academic medical center in Beirut. In a face-to-face interview, participants completed a survey questionnaire comprised of three sections: socio-demographic, diabetes characteristics and types and modes of CAM use. Descriptive statistics, univariate and multivariate logistic regression analyses were utilized to assess the prevalence, mode and correlates of CAM use in the study population. The main outcome in this study (CAM use) was defined as using CAM at least once since diagnosis with T2DM. Results: A total of 333 T2DM patients completed the survey (response rate: 94.6%). Prevalence of CAM use in the study population was 38%, 95% CI (33.1-43.5). After adjustment, CAM use was significantly associated with a “married” status, a longer duration of T2DM, the presence of disease complications, and a positive family history of the disease. Folk foods and herbs were the most commonly used CAM followed by natural health products. One in five patients used CAM as an alternative to conventional treatment. Only 7 % of CAM users disclosed the CAM use to their treating physician. Health care practitioners were the least cited (7%) as influencing the choice of CAM among users. Conclusion: The use of CAM therapies among T2DM patients in Lebanon is prevalent. Decision makers and care providers must fully understand the potential risks and benefits of CAM therapies to appropriately advise their patients. Attention must be dedicated to educating T2DM patients on the importance of disclosing CAM use to their physicians especially patients with a family history of diabetes, and those using conventional therapy for a long time.

Keywords: nutritional supplements, type 2 diabetes mellitus, complementary and alternative medicine (CAM), conventional therapy

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5418 Beliefs, Attitudes, and Understanding of Childhood Cancer Among White and Latino Parents in the Phoenix Metropolitan Area: A Comparative Study

Authors: Florence Awde

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In 2023, it was expected 350 parents in Arizona would have a child receive a cancer diagnosis (Welcome Arizona Cancer Foundation For Children, n.d.). The news of a child’s diagnosis with cancer can be overwhelming and confusing, especially for those lucky enough to lack a personal tie to the disease that takes approximately 1800 children’s lives each year in the United States (Deegan et al., n.d.). A parent’s beliefs, attitudes, and understandings surrounding cancer are vital for medical staff to provide adequate and culturally competent care for each patient, especially across cultural and ethnic lines in regions housing multicultural populations. Arizona's cultural/linguistic mosaic houses many White and Latino populations and English and Spanish speakers. Variations in insurance coverage, from those insured through public insurance programs (e.g., Medicaid) or private insurance plans (e.g., employee-sponsored insurance) versus those uninsured, also factor into health-seeking attitudes and behaviors. To further understand parental attitudes, understandings, and beliefs towards childhood cancer, 22 parents (11 of Latino ethnicity, 11 of White ethnicity) were interviewed on these facets of childhood cancer, despite 21 of the 22 never having a child receive a cancer diagnosis. The exploration of these perceptions across ethnic lines revealed a higher report of fear-orientated beliefs amongst Latino parents--hypothesized to be rooted in the starkly contrasting lack of belief in the possibility of recovering for children with cancer, compared to their white counterparts who displayed more optimism in the recovery process. Further, this study’s results lay the foundation for future scholarship to explore avenues of information dispersal to Latino parents that correct misconceptions of health outcomes and enable earlier intervention to be possible, ultimately correlating to better health and treatment outcomes by increasing parental health literacy rates for childhood cancer in the Phoenix Metropolitan.

Keywords: Childhood Cancer, Parental Beliefs, Parental Attitudes, Parental Understandings, Phoenix Metropolitan, Culturally Competent Care, Health Disparities, Health Inequities

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5417 Frailty Patterns in the US and Implications for Long-Term Care

Authors: Joelle Fong

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Older persons are at greatest risk of becoming frail. As survival to the age of 80 and beyond continues to increase, the health and frailty of older Americans has garnered much recent attention among policy makers and healthcare administrators. This paper examines patterns in old-age frailty within a multistate actuarial model that characterizes the stochastic process of biological ageing. Using aggregate population-level U.S. mortality data, we implement a stochastic aging model to examine cohort trends and gender differences in frailty distributions for older Americans born 1865 – 1894. The stochastic ageing model, which draws from the fields of actuarial science and gerontology, is well-established in the literature. The implications for public health insurance programs are also discussed. Our results suggest that, on average, women tend to be frailer than men at older ages and reveal useful insights about the magnitude of the male-female differential at critical age points. Specifically, we note that the frailty statuses of males and females are actually quite comparable from ages 65 to 80. Beyond age 80, however, the frailty levels start to diverge considerably implying that women are moving quicker into worse states of health than men. Tracking average frailty by gender over 30 successive birth cohorts, we also find that frailty levels for both genders follow a distinct peak-and-trough pattern. For instance, frailty among 85-year old American survivors increased in years 1954-1963, decreased in years 1964-1971, and again started to increase in years 1972-1979. A number of factors may have accounted for these cohort differences including differences in cohort life histories, differences in disease prevalence, differences in lifestyle and behavior, differential access to medical advances, as well as changes in environmental risk factors over time. We conclude with a discussion on the implications of our findings on spending for long-term care programs within the broader health insurance system.

Keywords: actuarial modeling, cohort analysis, frail elderly, health

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5416 Typification and Determination of Antibiotic Resistance Rates of Stenotrophomonas Maltophilia Strains Isolated from Intensive Care Unit Patients in a University Practice and Research Hospital

Authors: Recep Kesli, Gulsah Asik, Cengiz Demir, Onur Turkyilmaz

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Objective: Stenotrophomonas maltophilia (S. maltophilia) has recently emerged as an important nosocomial microorganism. Treatment of invasive infections caused by this organism is problematic because this microorganism is usually resistant to a wide range of commonly used antimicrobials. We aimed to evaluate clinical isolates of S. maltophilia in respect to sampling sites and antimicrobial resistant. Method: During a two years period (October 2013 and September 2015) eighteen samples collected from the intensive care unit (ICU) patients hospitalized in Afyon Kocatepe University, ANS Practice and Research Hospital. Identification of the bacteria was determined by conventional methods and automated identification system-VITEK 2 (bio-Mérieux, Marcy l’toile, France). Antibacterial resistance tests were performed by Kirby Bauer disc (Oxoid, England) diffusion method following the recommendations of CLSI. Results: Eighteen S. maltophilia strains were identified as the causative agents of different infections. The main type of infection was lower respiratory tract infection (83,4 %); three patients (16,6 %) had bloodstream infection. While, none of the 18 S. maltophilia strains were found to be resistant against to trimethoprim sulfametaxasole (TMP-SXT) and levofloxacine, eight strains 66.6 % were found to be resistant against ceftazidim. Conclusion: The isolation of S.maltophilia starains resistant to TMP-SXT is vital. In order to prevent or minimize infections due to S. maltophilia such precuations should be utilized: Avoidance of inappropriate antibiotic use, prolonged implementation of foreign devices, reinforcement of hand hygiene practices and the application of appropriate infection control practices. Microbiology laboratories also may play important roles in controlling S. maltophilia infections by monitoring the prevalence, continuously, the provision of local antibiotic resistance paterns data and the performance of synergistic studies also may help to guide appropirate antimicrobial therapy choices.

Keywords: Stenotrophomonas maltophilia, trimethoprim-sulfamethoxazole, antimicrobial resistance, Stenotrophomonas spp.

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5415 Indoor and Outdoor Health Risk Factors as a Result of Smoke Emission in Developing Countries: a Case of Nigeria

Authors: Beatrice Adeoye

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Background: One of the health challenges developing countries face is air pollution from indoor and outdoor activities. Smoke as a result of cooking, burning wastes and power generators litter the air space on a continual basis due to poverty and governance challenges. The short and long term implications of these actions are enormous and studies have attributed smoke as one of the leading preventable risk factors contributing to global burden of respiratory infections. Design/Methods: The issue at hand therefore includes an exploration of the existing policy frameworks regarding smoke, adherence to international conventions and practices, and more importantly the activities of the government in addressing these issues. Aside this, an understanding of the implications of smoke on peoples’ health and well-being also become crucial. Consequently, this article seeks to interrogate the effect of smoke on the health and well-being of Nigerians and the activities of the policy makers in addressing these challenges. Results (Main Argument): This study reviewed both primary and secondary data on poverty, smoke emission and attendant health risks coupled with existing policies on smoke and air pollution in the country. For instance, over 69% of Nigerians are poor, ranking third in the world; 2.9 billion people live in homes using wood, coal or dung as their primary cooking fuel; equally, 50.6% of Nigerians has no access to regular electricity supply. Further, sustainable policy regarding smoke emission is lacking in the country. This work further submitted that continued low standard of living as a result of governance challenges coupled with a lack of sustainable policy have aggravated the health risks related to smoke in the country. Conclusions: The implication on the health of the children, mothers and vulnerable groups for the future of the country is enormous and may continue if not addressed. Urgent attention therefore needs to be focused on this area considering what this portends for the nation now and in the future.

Keywords: air pollution, indoor, outdoor, respiratory infections

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5414 Fractional, Component and Morphological Composition of Ambient Air Dust in the Areas of Mining Industry

Authors: S.V. Kleyn, S.Yu. Zagorodnov, А.А. Kokoulina

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Technogenic emissions of the mining and processing complex are characterized by a high content of chemical components and solid dust particles. However, each industrial enterprise and the surrounding area have features that require refinement and parameterization. Numerous studies have shown the negative impact of fine dust PM10 and PM2.5 on the health, as well as the possibility of toxic components absorption, including heavy metals by dust particles. The target of the study was the quantitative assessment of the fractional and particle size composition of ambient air dust in the area of impact by primary magnesium production complex. Also, we tried to describe the morphology features of dust particles. Study methods. To identify the dust emission sources, the analysis of the production process has been carried out. The particulate composition of the emissions was measured using laser particle analyzer Microtrac S3500 (covered range of particle size is 20 nm to 2000 km). Particle morphology and the component composition were established by electron microscopy by scanning microscope of high resolution (magnification rate - 5 to 300 000 times) with X-ray fluorescence device S3400N ‘HITACHI’. The chemical composition was identified by X-ray analysis of the samples using an X-ray diffractometer XRD-700 ‘Shimadzu’. Determination of the dust pollution level was carried out using model calculations of emissions in the atmosphere dispersion. The calculations were verified by instrumental studies. Results of the study. The results demonstrated that the dust emissions of different technical processes are heterogeneous and fractional structure is complicated. The percentage of particle sizes up to 2.5 micrometres inclusive was ranged from 0.00 to 56.70%; particle sizes less than 10 microns inclusive – 0.00 - 85.60%; particle sizes greater than 10 microns - 14.40% -100.00%. During microscopy, the presence of nanoscale size particles has been detected. Studied dust particles are round, irregular, cubic and integral shapes. The composition of the dust includes magnesium, sodium, potassium, calcium, iron, chlorine. On the base of obtained results, it was performed the model calculations of dust emissions dispersion and establishment of the areas of fine dust РМ 10 and РМ 2.5 distribution. It was found that the dust emissions of fine powder fractions PM10 and PM2.5 are dispersed over large distances and beyond the border of the industrial site of the enterprise. The population living near the enterprise is exposed to the risk of diseases associated with dust exposure. Data are transferred to the economic entity to make decisions on the measures to minimize the risks. Exposure and risks indicators on the health are used to provide named patient health and preventive care to the citizens living in the area of negative impact of the facility.

Keywords: dust emissions, еxposure assessment, PM 10, PM 2.5

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