Search results for: national health insurance program

Authors: Wisit Wichitkosoom

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Objective:The majority of the hisk-risk patients (ST-elevation myocardial infarction (STEMI), Acute cerebrovascular accident, Sepsis, Acute Traumatic patient ) are admitted to district or lacal hospitals (average 1-1.30 hr. from Udonthani general hospital, Northeastern province, Thailand) without proper facilities. The referral system was support to early care and early management at pre-hospital stage and prepare for the patient data to higher hospital. This study assessed the reduction in treatment delay achieved by pre-hospital diagnosis and referral directly to Udonthani General Hospital. Methods and results: Four district or local hospitals without proper facilities for treatment the very high-risk patient were serving the study region. Pre-hospital diagnoses were established with the simple technology such as LINE, SMS, telephone and Fax for concept of LEAN process and then the telemedicine, by ambulance monitoring (ECG, SpO2, BT, BP) in both real time and snapshot mode was administrated during the period of transfer for safety transfer concept (inter-hospital stage). The standard treatment for patients with STEMI, Intracranial injury and acute cerebrovascular accident were done. From 1 October 2012 to 30 September 2013, the 892 high-risk patients transported by ambulance and transferred to Udonthani general hospital were registered. Patients with STEMI diagnosed pre-hospitally and referred directly to the Udonthani general hospital with telemedicine closed monitor (n=248). The mortality rate decreased from 11.69% in 2011 to 6.92 in 2012. The 34 patients were arrested on the way and successful to CPR during transfer with the telemedicine consultation were 79.41%. Conclusion: The proper innovation could apply for health care system. The very high-risk patients must had the closed monitoring with two-way communication for the “safety transfer period”. It could modified to another high-risk group too.

Keywords: safety transfer, telemedicine, critical patients, medical and health sciences

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Authors: Felyppe Blum Goncalves, Juliana Sebastiany

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In line with Brazilian legislation on the inclusion of persons with disabilities in the world of work, known as the 'quota law' (Law 8213/91) and in accordance with the prerogatives of the United Nations Convention on Human Rights of people with disabilities, which was ratified by Brazil through Federal Decree No. 6.949 of August 25, 2009, the SESI National Department, through Working Groups, structured the product Affordable Industry. This methodology aims to prepare the industries for the adequate process of inclusion of people with disabilities, as well as the development of an organizational culture that values and respects human diversity. All industries in Brazil with 100 or more employees must comply with current legislation, but due to the lack of information and guidance on the subject, they end up having difficulties in this process. The methodology brings solutions for companies through the professional qualification of the disabled person, preparation of managers, training of human resources teams and employees. It also advocates the survey of the architectural accessibility of the factory and the identification of the possibilities of inclusion of people with disabilities, through the compatibility between work and job requirements, preserving safety, health, and quality of life.

Keywords: inclusion, app, disability, management

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Authors: Odewumi Olatunde, Adegun Sunday

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Linguistic diversity is seen to complicate attempts to build a stable and cohesive political community. Hence, the challenge of integration is enormous in a multi-ethno-lingual country like Nigeria. In the same vein, justification for minority language rights claims in relation to broader political theories of justice, freedom and democracy cannot be ignored. It is in the light of the fore-going that this paper explores Nigeria’s experiments at language policy and planning(LPP) and the long drawn agitations for self-determination and linguistic freedom by the minority ethnic groups in the polity which has been exacerbated by the National Policy on Education language provisions. The paper succinctly reviews Nigeria’s LPP efforts and its attendant theater of conflicts; explores international attempts at evolving normative principles of freedom and equality for language policy and finally evaluates the position of the Nigerian LPP in the light of evolving international conventions. On this premise, it is concluded that giving a conscientious and honest implementation of the Nigerian language provisions as assessed from their face validity, the nation’s efforts could be exonerated from running afoul of any known civilized values and best practices. It is, therefore, recommended that an effectual and consistent commitment to implementation driven by a renewed political will is what is required for the nation to succeed in this direction.

Keywords: integration, rights, challenge, conventions, policy

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Authors: Jonathan De Rothewelle

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A pandemic, such as that of COVID-19, can be a time of panic and stress; concerns about health supersede others such as work and leisure. With such concern comes the seeking of crucial information— information that, during a global health crisis, could mean the difference between life and death. Whether newspapers, cable news, or radio, media plays an important role in the transmission of medical information to the general public. Moreover, the news media in particular must uphold its obligation to the public to only disseminate factual, useful information. The circulation of misinformation, whether explicit or implicit, may profoundly impact global health. Using a discursive analytic framework founded in linguistics, the images and headlines of top coverage of COVID-19 from the most influential media outlets will be examined. Micro-analyses reveal what may be interpreted as evidence of sensationalism, which may be argued to a form of misinformation, and ultimately a departure from ethical media. Withdrawal from responsible reporting and publishing, expressly in times of epidemic, may cause further confusion and panic.

Keywords: public health, pandemic, public education, media

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Authors: Nithra Kitreerawutiwong, Sunsanee Mekrungrongwong, Artitaya Wongwonsin, Chakkraphan Phetphoom, Buaploy Phromjang

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Background: Thailand has implemented a district health system based on the concept of primary health care. Since 2014, Family Care Team (FCT) was launched to improve the quality of care through a multidisciplinary team include not only the health sector but also social sector work together. FCT classified into 3 levels: district, sub-district, and community. This system now consists of 66,353 teams, including 3,890 teams at district level, 12,237 teams at the sub-district level, and 50,326 teams at the community level. There is a report regarding assessment the situation and perception on FCT, however, relatively few examined the operationality of this policy. This study aimed to explore the perception of district manager on the process of the implementation of FCT policy and the factors associating to implement FCT in the district health system. Methods/Results: Forty in-depth interviews were performed: 5 of primary care manager at the provincial medical health office, 5 of community hospital director, 5 of district administrative health office, 10 of sub-district health promoting hospital, and 10 of local organization. Semi-structure interview guidelines were used in the discussions. The data was analyzed by thematic analysis. This policy was formulated based on the demographic change and epidemiology transition to serve a long term care for elderly. Facilitator factors are social capital in district health systems such as family health leader and multidisciplinary team. Barrier factors are communication to the frontline provider and local organization. The output of this policy in relation to the structure of FCT is well-defined. Unanticipated effects include training of FCT in community level. Conclusion: Early feedback from healthcare manager is valuable information for the improvement of FCT to function optimally. Moreover, in the long term, health outcome need to be evaluated.

Keywords: family care team, district health system, primary care, qualitative study

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Authors: Joanna Bajerska, Agata Chmurzyńska, Agata Muzsik, Patrycja Krzyżanowska, Klaudia Łochocka, Jarosław Walkowiak

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The Mediterranean diet (MED) is regarded as beneficial in the therapy of central obesity-associated metabolic abnormalities. However, in the traditional diet of the Central European countries, food items with positive nutritional profiles (rye bread, oats, buckwheat, herrings, linseed and rapeseed oil, berries, apples, plums, root vegetables etc.) are also used. We hypothesized that the Central European Diet (CED) may be comparatively effective in reducing symptoms of central obesity as MED. We tested the health effects of the CED, which is an environmentally friendly regional diet and the traditional MED diet in a group of postmenopausal centrally obese women. A total 58 with a mean age of 60 y (50-70y), body mass index (in kg/m(2)) of 33.4 (22.6-47.3), and waist circumference of 105 cm (87.5-137 cm) were randomly assigned to receive either the diet based on food items commonly used in Central Europe (the CED group; n = 29) or the Mediterranean diet (the MED group; n = 29) for 15 weeks. Body mass and body composition were measured with a Bod Pod (Cosmed, Italy). A non-elastic flexible measuring tape was used to measure waist circumference. Additionally, blood pressure, plasma lipid and glucose levels were assessed with the use of a biochemical analyzer. A total of 50 subjects [86% (CED 83%; MED 90%)] completed the intervention. A high dietary compliance for both described diets was achieved. The mean (±SEM) weight and waist circumference changes were -7.4 ± 0.7 kg; -8.3 ± 0.7 cm and -8.1 ± 0.5 kg; -7.1 ± 0.6 cm for the CED and MED groups, respectively. Moreover, there were no differences between the effectiveness of the diets used in terms of the influence on fat mass, blood pressure, and biochemical parameters. The preliminary data suggest that both described diets may be successfully used for improving central obesity-associated metabolic abnormalities. The project was financed by the National Science Centre awarded based on the number of decision DEC-013/09/B/NZ9/02365

Keywords: central european diet, central obesity, Mediterranean diet, metabolic abnormalities

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Authors: Kaoutar Chbihi, Aziza Menouni, Imane Berni, Tarik Abchouch, Samir El Jaafari

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The unpredictability and ambiguity of a pandemic, combined with the economic impact, sedentary lifestyle, and increased living cost, have the potential to seriously raise the risk of mental health issues among the population. Therefore, this study had the aim to assess the magnitude of mental health outcomes and risk factors among the general population in Morocco in times of the Covid-19 pandemic. This study consisted of a cross-sectional design and was survey-based and region-stratified by collecting demographic data and mental health measurements from 523 participants. The degree of depression, anxiety, and insomnia symptoms were assessed by using the 9-item Patient Health Questionnaire and the 7-items Generalized Anxiety Disorder. The survey was completed by 523 individuals. Results showed that 67.9% were women, and 58.6% were aged 18-30 years. 49% of participants reported depression issues, while 39.8% experienced anxiety. Being a married woman with children was associated with severe symptoms of depression and anxiety. Finally, our findings reported a significant mental health burden among the general population of Morocco, which needs to be tackled by specific co-created interventions and adapted strategies in order to prevent impacts on public health.

Keywords: anxiety, COVID-19, depression, mental health, Morocco, pandemic

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Authors: Agburuga Obi, Madumere Akuego Jane

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This paper explores the important role sports can play in the promotion of good health and prevention of diseases. Technological advancements in today’s world has come along with some difficulties to man. This is because work formally done by man has been taken over by machines, thus, man has become sedentary. This has created a lot of health problems to man such as cardiovascular diseases, diabetes, cancer, obesity, and osteoporosis. To nip this ugly situation in the bud, the following recommendations are made: specific measures should be taken to raise the awareness within the government, key sectors and the population of the diverse benefits or physical activity and sports and the risk and costs of inactivity, provision of equipment, facilities for sports and recreational activities in every community, participation in physical activities in sports if not on daily basis at least thrice a week.

Keywords: physical activities, sport, good health, prevention, diseases

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Authors: Jane Killough

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A podcast series was developed to support learning amongst first-year undergraduate mental health nursing students. Many first-year students do not have any clinical experience and find it difficult to engage with theory, which can present as cumbersome. Further, it can be challenging to relate abstract concepts to everyday mental health practice. Mental health professionals and service users from practice were interviewed on a range of core topics that are key to year one learning. The podcasts were made available, and students could access these recordings at their convenience to fit in with busy daily routines. The aim was to enable meaningful learning by providing access to those who have lived experience and who can, in effect, bring to life the theory being taught in university and essentially bridge the theory and practice gap while fostering working relationships between practice and academics. The student experience will be evaluated using a logic model.

Keywords: education, mental health nursing students, podcast, practice, undergraduate

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Authors: Umesh Kumar Singh, Chanchala Joshi

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With increasing dependency on IT infrastructure, the main objective of a system administrator is to maintain a stable and secure network, with ensuring that the network is robust enough against malicious network users like attackers and intruders. Security risk management provides a way to manage the growing threats to infrastructures or system. This paper proposes a framework for risk level estimation which uses vulnerability database National Institute of Standards and Technology (NIST) National Vulnerability Database (NVD) and the Common Vulnerability Scoring System (CVSS). The proposed framework measures the frequency of vulnerability exploitation; converges this measured frequency with standard CVSS score and estimates the security risk level which helps in automated and reasonable security management. In this paper equation for the Temporal score calculation with respect to availability of remediation plan is derived and further, frequency of exploitation is calculated with determined temporal score. The frequency of exploitation along with CVSS score is used to calculate the security risk level of the system. The proposed framework uses the CVSS vectors for risk level estimation and measures the security level of specific network environment, which assists system administrator for assessment of security risks and making decision related to mitigation of security risks.

Keywords: CVSS score, risk level, security measurement, vulnerability category

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Authors: Chonlawit Yuwajitaa, Suttipong Pruangkab

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Existing situation on labour use, health management and problems, and ancillary work done along with buffalo farming in Thailand was studied, There were 52 farms had been interviewed during August to September 2014. The study revealed that 100 percent of labor use was family labors themselves and all of farmers reared their buffaloes and grew rice simultaneously. The farmers valued veterinary service and advice as the most important problem (40.40%) and buffalo farming health problems was found 7.69% of dystocia, retain placenta and abortion. The major problem that should be taken into account was officials involved and buffalo farming should be continually promoted by government sectors to help solving economic problems as a whole.

Keywords: buffalo, labor use, health management, Thailand

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Authors: Eyup Dogan

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The number of research articles analyzing the integration properties of energy variables has rapidly increased in the energy literature for about a decade. The stochastic behaviors of energy variables are worth knowing due to several reasons. For instance, national policies to conserve or promote energy consumption, which should be taken as shocks to energy consumption, will have transitory effects in energy consumption if energy consumption is found to be stationary in one country. Furthermore, it is also important to know the order of integration to employ an appropriate econometric model. Despite being an important subject for applied energy (economics) and having a huge volume of studies, several known limitations still exist with the existing literature. For example, many of the studies use aggregate energy consumption and national level data. In addition, a huge part of the literature is either multi-country studies or solely focusing on the U.S. This is the first study in the literature that considers a form of energy consumption by sectors at sub-national level. This research study aims at investigating unit root properties of electricity consumption for 12 regions of Turkey by four sectors in addition to total electricity consumption for the purpose of filling the mentioned limits in the literature. In this regard, we analyze stationarity properties of 60 cases . Because the use of multiple unit root tests make the results robust and consistent, we apply Dickey-Fuller unit root test based on Generalized Least Squares regression (DFGLS), Phillips-Perron unit root test (PP) and Zivot-Andrews unit root test with one endogenous structural break (ZA). The main finding of this study is that electricity consumption is trend stationary in 7 cases according to DFGLS and PP, whereas it is stationary process in 12 cases when we take into account the structural change by applying ZA. Thus, shocks to electricity consumption have transitory effects in those cases; namely, agriculture in region 1, region 4 and region 7, industrial in region 5, region 8, region 9, region 10 and region 11, business in region 4, region 7 and region 9, total electricity consumption in region 11. Regarding policy implications, policies to decrease or stimulate the use of electricity have a long-run impact on electricity consumption in 80% of cases in Turkey given that 48 cases are non-stationary process. On the other hand, the past behavior of electricity consumption can be used to predict the future behavior of that in 12 cases only.

Keywords: unit root, electricity consumption, sectoral data, subnational data

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Authors: Nicole A. Alford

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The study of online graduate education started just 30 years ago, with the first online graduate program in the 1990s. Institutions are looking for ways to increase retention and support the needs of students with the rapid expansion of online higher education due to the global pandemic. Online education provides access and opportunities to those who otherwise would be unable to pursue an advanced degree for logistical reasons. Thus, the objective of the critical literature review is to survey current research of student experiences given the expanding role of online doctoral programs. The guiding research questions are: What are the personal, professional, and student life practices of graduate students who enrolled in a fully online university doctoral program or course? and How do graduate students who enrolled in a fully online doctoral program or course describe the factors that contributed to their continued study? The systematic literature review was conducted employing a variety of databases to locate articles using key Boolean terms and synonyms within three categories of the e-learning, doctoral education, and student perspectives. Inclusion criteria for the literature review consisted of empirical peer-reviewed studies with original data sources that focused on doctoral programs and courses within a fully online environment and centered around student experiences. A total of 16 articles were selected based on the inclusion criteria and systemically analyzed through coding using the Boote and Beile criteria. Major findings suggest that doctoral students face stressors related to social and emotional wellbeing in the online environment. A lack of social connection, isolation, and burnout were the main challenges experienced by students. Students found support from their colleagues, advisors, and faculty to persist. Communities and cohorts of online doctoral students were found to guard against these challenges. Moreover, in the methods section of the articles, there was a lack of specificity related to student demographics, general student information, and insufficient detail about the online doctoral program. Additionally, descriptions regarding the experiences of cohorts and communities in the online environment were vague and not easily replicable with the given details. This literature review reveals that doctoral students face social and emotional challenges related to isolation and the rigor of the academic process and lean on others for support to continue in their studies. Given the lack of current knowledge about online doctoral students, it proves to be a challenge to identify effective practices and create high-retention doctoral programs in online environments. The paucity of information combined with the dramatic transition to e-learning due to the global pandemic can provide a perfect storm for attrition in these programs. Several higher education institutions have transitioned graduate studies online, thus providing an opportunity for further exploration. Given the new necessity of online learning, this work provides insight into examining current practices in online doctoral programs that have moved to this modality during the pandemic. The significance of the literature review provides a springboard for research into online doctoral programs as the solution to continue advanced education amongst a global pandemic.

Keywords: e-learning, experiences, higher education, literature review

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Authors: Oli Sophie Meredith, Jacquelyn Osborne, Sarah Verdon, Jane Frawley

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PROJECT OVERVIEW AND BACKGROUND: Over one million Australians are affected by ADHD at an economic and social cost of over $20 billion per annum. Despite health outcomes being significantly worse compared with men, women have historically been overlooked in ADHD diagnosis and treatment. While research suggests physical activity and other non-prescription options can help with ADHD symptoms, the frontline response to ADHD remains expensive stimulant medications that can have adverse side effects. By interviewing women with ADHD, this research will examine women’s self-directed approaches to managing symptoms, including alternatives to prescription medications. It will investigate barriers and affordances to potentially helpful approaches and identify any concerning strategies pursued in lieu of diagnosis. SIGNIFICANCE AND INNOVATION: Despite the economic and societal impact of ADHD on women, research investigating how women manage their symptoms is scant. This project is significant because although women’s ADHD symptoms are markedly different to those of men, mainstream treatment has been based on the experiences of men. Further, it is thought that in developing nuanced coping strategies, women may have masked their symptoms. Thus, this project will highlight strategies which women deem effective in ‘thriving’ rather than just ‘hiding’. By investigating the health service use, self-care and physical activity of women with ADHD, this research aligns with a priority research areas as identified by the November 2023 senate ADHD inquiry report. APPROACH AND METHODS: Semi-structured interviews will be conducted with up to 20 women with ADHD. Interviews will be conducted in person and online to capture experience across rural and metropolitan Australia. Participants will be recruited in partnership with the peak representative body, ADHD Australia. The research will use an intersectional framework, and data will be analysed thematically. This project is led by an interdisciplinary and cross-institutional team of women with ADHD. Reflexive interviewing skills will be employed to help interviewees feel more comfortable disclosing their experiences, especially where they share common ground ENGAGEMENT, IMPACT AND BENEFIT: This research will benefit women with ADHD by increasing knowledge of strategies and alternative treatments to prescription medications, reducing the social and economic burden of ADHD on Australia and on individuals. It will also benefit women by identifying risks involved with some self-directed approaches in lieu of medical advice. The project has an accessible impact plan to directly benefit end-users, which includes the development of a podcast and a PDF resource translating findings. The resources will reach a wide audience through ADHD Australia’s extensive national networks. We will collaborate with Charles Sturt’s Accessibility and Inclusion Division of Safety, Security and Well-being to create a targeted resource for students with ADHD.

Keywords: ADHD, women's health, self-directed strategies, health service use, physical activity, public health

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Authors: Calvin Odhiambo

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Depression among young adults is a common health problem and a growing public health concern. Of the young adult population, college students are particularly vulnerable to depression as they find themselves grappling with the stress and anxiety of college life while at the same navigating the demands of separation and independence from familial ties. To deal with the resultant mental health challenges affecting this population, most colleges offer counseling services to their student population. What is not known, however, is the extent to which students are aware of or even utilize such mental health services. Our study set out to assess the level of student awareness and utilization of counseling services and programs at a southeastern public university in the United States. Data were collected through self-administered questionnaires given to a convenience sample of 508 undergraduate students voluntarily recruited from 38 classes representing five colleges. Data analysis was done using the Statistical Package of Social Sciences (SPSS) version 25. Results showed that even though a majority of students were aware of the mental health services offered by the university, an overwhelming majority of these students did not utilize any of these services or participate in any mental health programs offered by the university. Significant gender and racial differences were observed. Reasons for the lack of awareness and utilization of mental health services are explored. Recommendations are made on how to increase student awareness and utilization of mental health services, and the implications of the findings are discussed. The findings of this study help to fill an academic lacuna on this issue and provides an important basis for developing policies to help mitigate the growing problem of depression and attendant mental health problems among undergraduate students.

Keywords: depression, counseling services, undergraduate college students, utilization of mental health services, perceptions and awareness

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Authors: S. J. Shahidzadeh Tabatabaei, A. M. Fattahi

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Modal analysis of an FGM plate composed of Al2O3 ceramic phase and 304 stainless steel metal phases was performed in this paper by ABAQUS software with the assumption that the behavior of material is elastic and mechanical properties (Young's modulus and density) are variable in the thickness direction of the plate. Therefore, a sub-program was written in FORTRAN programming language and was linked with ABAQUS software. For modal analysis, a finite element analysis was carried out similar to the model of other researchers and the accuracy of results was evaluated after comparing the results. Comparison of natural frequencies and mode shapes reflected the compatibility of results and optimal performance of the program written in FORTRAN as well as high accuracy of finite element model used in this research. After validation of the results, it was evaluated the effect of material (n parameter) on the natural frequency. In this regard, finite element analysis was carried out for different values of n and in simply supported mode. About the effect of n parameter that indicates the effect of material on the natural frequency, it was observed that the natural frequency decreased as n increased; because by increasing n, the share of ceramic phase on FGM plate has decreased and the share of steel phase has increased and this led to reducing stiffness of FGM plate and thereby reduce in the natural frequency. That is because the Young's modulus of Al2O3 ceramic is equal to 380 GPa and Young's modulus of SUS304 steel is 207 GPa.

Keywords: FGM plates, modal analysis, natural frequency, finite element method

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Authors: Robert E. Kenney, Efrain Antunez, Samuel Nodal, Ameer Malik, Richard B. Aguilar

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Physician burnout has gained much attention during the COVID pandemic. After-hours workload, HCC coding, HEDIS metrics, and clinical documentation negatively impact career satisfaction. These and other influences have increased the rate of physicians leaving the workforce. In addition, roughly 1% of the entire physician workforce will be retiring earlier than expected based on pre-pandemic trends. The two Medical Specialties with the highest rates of burnout are Family Medicine and Primary Care. With a predicted shortage of primary care physicians looming, the need to address physician burnout is crucial. Commonly reported issues leading to clinician burnout are clerical documentation requirements, increased time working on Electronic Health Records (EHR) after hours, and a decrease in work-life balance. Clinicians experiencing burnout with physical and emotional exhaustion are at an increased likelihood of providing lower quality and less efficient patient care. This may include a lack of suitable clinical documentation, medication reconciliation, clinical assessment, and treatment plans. While the annual baseline turnover rates of physicians hover around 6-7%, the COVID pandemic profoundly disrupted the delivery of healthcare. A report found that 43% of physicians switched jobs during the initial two years of the COVID pandemic (2020 and 2021), tripling the expected average annual rate to 21.5 %/yr. During this same time, an average of 4% and 1.5% of physicians retired or left the workforce for a non-clinical career, respectively. The report notes that 35.2% made career changes for a better work-life balance and another 35% reported the reason as being unhappy with their administration’s response to the pandemic. A physician-led primary care-focused health organization, Cano Health (CH), based out of Florida, sought to preemptively address this problem by implementing several supportive measures. Working with >120 clinics and >280 PCPs from Miami to Tampa and Orlando, managing nearly 120,000 Medicare Advantage lives, CH implemented a number of changes to assist with the clinician’s workload. Supportive services such as after hour and home visits by APRNs, in-clinic care managers, and patient educators were implemented. In 2021, assistive Artificial Intelligence Software (AIS) was integrated into the EHR platform. This AIS converts free text within PDF files into a usable (copy-paste) format facilitating documentation. The software also systematically and chronologically organizes clinical data, including labs, medical records, consultations, diagnostic images, medications, etc., into an easy-to-use organ system or chronic disease state format. This reduced the excess time and documentation burden required to meet payor and CMS guidelines. A clinician Documentation Support team was employed to improve the billing/coding performance. The effects of these newly designed workflow interventions were measured via analysis of clinician turnover from CH’s hiring and termination reporting software. CH’s annualized average clinician turnover rate in 2020 and 2021 were 17.7% and 12.6%, respectively. This represents a 30% relative reduction in turnover rate compared to the reported national average of 21.5%. Retirement rates during both years were 0.1%, demonstrating a relative reduction of >95% compared to the national average (4%). This model successfully promoted the retention of clinicians in a Value-Based Care setting.

Keywords: clinician burnout, COVID-19, value-based care, burnout, clinician retirement

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Authors: Sachi Matsuoka

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This study aimed at implicating a current community health in South India focusing on a Vaidya, a non-codified traditional doctor, based on long-term field works. As the prevalence of colonic diseases is increasing in all over the world, it is needed to know the potential of non-codified medicines and how they can effectively take in a part in community health. Describing the people’s treatment seeking behaviours in a suburban village which is susceptible to modernization can give us a new insight for studying Indian medicines, that is included not only non-codified but also codified traditional ones, affected by global, national and local communities. Both qualitative and quantitative data were gathered via participatory fieldworks and open-ended interviews to a Vaidya and his 97 patients and 31 individuals who lived in a community near the Vaidya’s station. It was found that the community members seldom consulted the Vaidya while a number of patients outside the village (mainly from urban nearby area) daily visited the Vaidya. Thus, the role of the Vaidya as the community’ s primary health care provider had nearly disappeared. Nonetheless, the Vaidya was deeply respected as one of the community’ s leaders by its members because of the spiritual and financial support he provided to them. The reasons for choosing the Vaidya for the patients from urban area are characterized by several social factors of the patients such as their religious belief, seriousness, occupation and medical history. Meanwhile, not only the Vaidya but also other codified traditional medicines, e.g., Ayurveda, were less popular among the community members. It sounds paradoxical given that the traditional Indian medical system has been becoming popular as an alternative medicine in societies outside of India, such as in Europe. The community members who are less educated and engaged in religious activities in daily life preferred to allopathy, the biomedicine in Indian context. It is thus concluded that roles of non-codified medicine has changed depending on its cultural and social contexts, even though its medical system is not authorized by the government. Nowadays, traditional medical effectiveness is recognized as evidenced by scientific survey and the codified medical doctors treats diseases rather than people. However, this study implicated that people’s treatment seeking behaviors are likely based on the social context in which people live their lives even though evidenced based codified medicine is provided in their community.

Keywords: medical pluralism, non-codified medicine, south india, treatment-seeking behaviours

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Authors: Maria M. Calheiros, Carla Silva, Eunice Magalhães

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Professionals working in child protection services (CPS) need to have common and clear criteria to identify cases of maltreatment and to differentiate levels of severity in order to determine when CPS intervention is required, its nature and urgency, and, in most countries, the service that will be in charge of the case (community or specialized CPS). Actually, decision-making process is complex in CPS, and, for that reason, such criteria are particularly important for who significantly contribute to that decision-making in child maltreatment cases. The main objective of this presentation is to describe the Maltreatment Severity Assessment Questionnaire (MSQ), specifically designed to be used by professionals in the CPS, which adopts a multidimensional approach and uses a scale of severity within subtypes. Specifically, we aim to provide evidence of validity and reliability of this tool, in order to improve the quality and validity of assessment processes and, consequently, the decision making in CPS. The total sample was composed of 1000 children and/or adolescents (51.1% boys), aged between 0 and 18 years old (M = 9.47; DP = 4.51). All the participants were referred to official institutions of the children and youth protective system. Children and adolescents maltreatment (abuse, neglect experiences and sexual abuse) were assessed with 21 items of the Maltreatment Severity Questionnaire (MSQ), by professionals of CPS. Each item (sub-type) was composed of four descriptors of increasing severity. Professionals rated the level of severity, using a 4-point scale (1= minimally severe; 2= moderately severe; 3= highly severe; 4= extremely severe). The construct validity of the Maltreatment Severity Questionnaire was assessed with a holdout method, performing an Exploratory Factor Analysis (EFA) followed by a Confirmatory Factor Analysis (CFA). The final solution comprised 18 items organized in three factors 47.3% of variance explained. ‘Physical neglect’ (eight items) was defined by parental omissions concerning the insurance and monitoring of the child’s physical well-being and health, namely in terms of clothing, hygiene, housing conditions and contextual environmental security. ‘Physical and Psychological Abuse’ (four items) described abusive physical and psychological actions, namely, coercive/punitive disciplinary methods, physically violent methods or verbal interactions that offend and denigrate the child, with the potential to disrupt psychological attributes (e.g., self-esteem). ‘Psychological neglect’ (six items) involved omissions related to children emotional development, mental health monitoring, school attendance, development needs, as well as inappropriate relationship patterns with attachment figures. Results indicated a good reliability of all the factors. The assessment of child maltreatment cases with MSQ could have a set of practical and research implications: a) It is a valid and reliable multidimensional instrument to measure child maltreatment, b) It is an instrument integrating the co-occurrence of various types of maltreatment and a within-subtypes scale of severity; c) Specifically designed for professionals, it may assist them in decision-making processes; d) More than using case file reports to evaluate maltreatment experiences, researchers could guide more appropriately their research about determinants and consequences of maltreatment.

Keywords: assessment, maltreatment, children and youth, decision-making

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Authors: Johanna Sagner, María José Sandoval

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At the early stages of adolescence, young people, regardless of a disability or not, start to establish closer friendship ties. Unlike previous developmental phases, these ties are rather reciprocal, more committed, and require more time. Friendship ties during adolescence allow the development of social and personal skills, specifically the skills to start constructing identity. In an inclusive context that incorporates young people with a disability, friendship among peers also takes place. Nonetheless, the relation is shaped, among others, by the alterity construction about the other with disability. Research about peers’ relation between young people with and without disability in an inclusive context has shown that the relation tends to become a helper-helpee relation, where those with a disability are seen as people in need. Prejudices about the others’ condition or distancing from the other because of his/hers disability are common. In this sense, the helper-helpee relation, as a non-reciprocal and protective relation, will not promote friendship between classmates, but a rather asymmetric alterity. Our research is an explorative case study that wants to know how the relation between peers is shaped within a different inclusive program, were also the integrated group has special educational needs. Therefore, we analyze from a qualitative and quantitative approach the data of an inverted inclusive program. This is a unique case of a special public school for visual disability in Germany that includes young people from a mainstream school who had learning difficulties. For the research, we analyze data from interviews, focal interviews and open-ended questions with an interpretative phenomenological analysis approach. The questionnaires include a five point Likert scale, for which we calculate the acceptance rate. The findings show that the alterity relation between pupils is less asymmetrical and represents a rather horizontal alterity. The helper-helpee relation is marked by exchange, since both groups have special educational needs and therefore, those with visual disability and those with learning difficulties help each other indistinctly. Friendship is more present among classmates. The horizontal alterity peers’ relation is influenced by a sort of tie, where none of the groups need more or less help than other groups. Both groups identify that they themselves and the other have special needs. The axiological axe of alterity is not of superiority or inferiority, recognizing each other’s differences and otherness. Another influential factor relates with the amount of time they spend together, since the program does not have a resource room or a teacher who teaches parallel lessons. Two probable causes for that rather equal peer relation might be the constellation of fewer pupils per classroom and the differentiated lessons taught by teachers with a special educational formation.

Keywords: alterity, disability, inverted inclusion, peers’ relation

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Authors: Daniel Suárez, Jesús Tomas, Sandra Sendra, Sandra Viciano-Tudela, Luis Felipe Calle, Javier Urios, Jaime Lloret

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Our study is to develop a tool for the mobile phone to an assessment of body damage or determination of the degree of disability. This is a field of action of legal medicine and insurance with obvious economic implications. Those people who have suffered an accident or bodily harm demand a quantification of it. The assessment of bodily harm or disability by the expert medical professional is not exempt from complexity. Sometimes it is difficult to quantify pain; other times, the doctor faces simulators or exaggerators, and on many occasions, it is difficult to remember the extensive tables of scales whose details are complex to remember and apply. We present a tool, as a mobile application, that allows entering the sociodemographic date of the patient as well as the characteristics of the accident suffered by the person. With these preliminary data and introducing bodily damage, an approximate calculation of the compensation that the injured party should receive can be made. One of the results of this study is that it allows calculating joint mobility angles without the need to use a goniometer.

Keywords: mobile tool, body damage, personal injury and disability, telemedicine

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Authors: Flavio Contrera, Paulo Cesar Gregorio

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Recent political developments and government control actions in the face of the COVID-19 pandemic draw attention to the contrast between the duties of government and the demands of democratic representation. Elected by mobilizing far-right issues, Trump and Bolsonaro moved away from the WHO guidelines but had to accommodate demands on the health and on the social protection system on the one hand and demands from the economic sector on the other. This study used the MARPOR Project method to assess the impact of the COVID-19 pandemic on the issue and ideological congruence between the electoral and governmental arena in both the Trump and Bolsonaro Administrations. Findings reveal issue congruence between arenas in "National Way of Life: Positive", "Law and Order," and "Technology and Infrastructure" for Donald Trump, and "Welfare State Expansion" for Bolsonaro. Ideological estimation results show that Trump and Bolsonaro positioned to the right in their presidential elections, initially moved to the center-right. However, welfare policies actions at high frequency during the COVID-19 pandemic moved the ideological estimations of both governments to the center-left, despite their denial rhetoric.

Keywords: congruence, COVID-19, Donald Trump, Jair Bolsonaro

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Authors: Sasiwan Tassana-iem, Sumattana Glangkarn

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Diabetic nephropathy is a major complication in diabetic patients whom as the glomerular filtration rate falls. The affects their quality of life and results in loss of money for kidney replacement therapy costs. There is an existing intervention, but the prevalence remains high, thus this research aims to study lessons learned in implementing programs to delay diabetic nephropathy management in primary health care. Method: The target settings are, 24 sub-district health promoting hospital in Sakon Nakhon province. Participants included the health care professionals, head of the sub-district health promoting hospital and the person responsible for managing diabetic nephropathy in each hospital (n= 50). There are 400 patients with diabetes mellitus in an area. Data were collected using questionnaires, patient records data, interviews and focus groups and analyzed by statistics and content analysis. Result: Reflection of participants that the interventions to delay diabetic nephropathy management in each area, the Ministry of Public Health has a policy to screen and manage this disease. The implementing programs aimed to provide health education, innovative teaching media used in communication to educate. Patients and caregivers had misunderstanding about the actual causes and prevention of this disease and how to apply knowledge suitable for daily life. Conclusion: The obstacles to the success of the implementing programs to delay diabetic nephropathy management in primary health care were most importantly, the patient needs self-care and should be evaluated for health literacy. This is crucial to promote health literacy; to access and understand health information as well to decide their health-related choices based on health information which will promote and maintain a good health. This preliminary research confirms that situation of diabetic nephropathy still exists. The results of this study will lead to the development of delay in diabetic nephropathy implementation among patients in the province studied.

Keywords: diabetic nephropathy, chronic kidney disease, primary health care, implementation

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Authors: Ankit Shah, R. K. Shrivastava

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Flood and drought are two main features of hydrology which affect the human life. Floods are natural disasters which cause millions of rupees’ worth of damage each year in India and the whole world. Flood causes destruction in form of life and property. An accurate estimate of the flood damage potential is a key element to an effective, nationwide flood damage abatement program. Also, the increase in demand of water due to increase in population, industrial and agricultural growth, has let us know that though being a renewable resource it cannot be taken for granted. We have to optimize the use of water according to circumstances and conditions and need to harness it which can be done by construction of hydraulic structures. For their safe and proper functioning of hydraulic structures, we need to predict the flood magnitude and its impact. Hydraulic structures play a key role in harnessing and optimization of flood water which in turn results in safe and maximum use of water available. Mainly hydraulic structures are constructed on ungauged sites. There are two methods by which we can estimate flood viz. generation of Unit Hydrographs and Flood Frequency Analysis. In this study, Regional Flood Frequency Analysis has been employed. There are many methods for estimating the ‘Regional Flood Frequency Analysis’ viz. Index Flood Method. National Environmental and Research Council (NERC Methods), Multiple Regression Method, etc. However, none of the methods can be considered universal for every situation and location. The Narmada basin is located in Central India. It is drained by most of the tributaries, most of which are ungauged. Therefore it is very difficult to estimate flood on these tributaries and in the main river. As mentioned above Artificial Neural Network (ANN)s and Multiple Regression Method is used for determination of Regional flood Frequency. The annual peak flood data of 20 sites gauging sites of Narmada Basin is used in the present study to determine the Regional Flood relationships. Homogeneity of the considered sites is determined by using the Index Flood Method. Flood relationships obtained by both the methods are compared with each other, and it is found that ANN is more reliable than Multiple Regression Method for the present study area.

Keywords: artificial neural network, index flood method, multi layer perceptrons, multiple regression, Narmada basin, regional flood frequency

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Authors: Reinzo Vittorio B. Cardenas, Heather Venice L. Abogado, Andrea Therese V. Afable, Rhea D. Avillanoza, Marie Abegail P. Ayagan, Catherine D. Bantayan

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As the Internet provides fast and reliable health-related information, the tendency to self-diagnose increases to further understand medical jargon in a diagnosis with a physician and decreases costly consultation fees. The study aimed to explore and understand the factors affecting online health-seeking behaviors in middle-income class adults in Metro Manila. The study was conducted from March to April of 2021 with a sample size of 200 individuals aged 20 to 49 years old. The study was delivered via an online survey that used a questionnaire adapted from the research of Lee et al. (2015). Specifically, the survey consisted of three sections: assessing web-based health-seeking behaviors, consultation with health professionals, and participants' hesitancy to consult with physicians, which used a mix of a 5-point Likert-type scale with multiple responses and multiple-choice options. The results showed that the age and educational attainment of the respondents had a negative effect while presenting a positive effect of socio-economic status on health-seeking behavior. Lastly, there was a significant effect of participant’s hesitancy for professional consultation on their health-seeking behavior. The results gleaned from the study indicated that various individual and socio-economic factors might significantly affect one’s health-seeking behaviors. Although hesitancy had a significant effect on the spectrum of health-seeking behaviors, this does not imply that certain factors are specifically related to an individual’s tendency to seek health information. This information instead becomes essential in understanding the patient-physician relationship and giving patients a more holistic treatment.

Keywords: health-seeking behavior, health information, Internet, physician consultation

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Authors: John Hardy, Paul Lushenko

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he twenty-first century international security order has been fraught with challenges to the credibility and stability of the post-Cold War status quo. Although the American-led international system has rarely been threatened directly by dissatisfied states, an underlying challenge to the international security order has emerged in the form of a slow-burning abnegation of small but significant aspects of the status quo. Meanwhile, those security challenges which have threatened to destabilize order in the international system have not clearly belonged to the traditional notions of diplomacy and armed conflict. Instead, the main antagonists have been both states and non-state actors, the issues have crossed national and international boundaries, and contestation has occurred in a ‘gray zone’ between peace and war. Gray zone conflicts are not easily categorized as military operations, national security policies or political strategies, because they often include elements of diplomacy, military operations, and statecraft in complex combinations. This study applies three approaches to conceptualizing the gray zone in which many contemporary conflicts take place. The first approach frames gray zone conflicts as a form of coercive diplomacy, in which armed force is used to add credibility and commitment to political threats. The second approach frames gray zone conflicts as a form of discrete military operation, in which armed force is used sparingly and is limited to a specific issue. The third approach frames gray zones conflicts as a form of proxy war, in which armed force is used by or through third parties, rather than directly between belligerents. The study finds that each approach to conceptualizing the gray zone accounts for only a narrow range of issues which fall within the gap between traditional notions of peace and war. However, in combination, all three approaches are useful in explicating the gray zone and understanding the character of contemporary security challenges which defy simple categorization. These findings suggest that coercive diplomacy, discrete military operations, and proxy warfare provide three overlapping lenses for conceptualizing the gray zone and for understanding the gray zone conflicts which threaten international security in the early twenty-first century.

Keywords: gray zone, international security, military operations, national security, strategy

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Authors: Chung Gun Lee

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Objectives: Certain life change events were shown to have strong effects on physical activity-related behavior, but more research is needed to investigate the longer-term effects of different life change events on physical activity-related behaviors. The purpose of this study is to examine the effect of experiencing physically or non-physically forced sexual activity on sports participation from adolescence to young adulthood. Methods: This study used the National Longitudinal Study of Adolescent Health (Add Health) data. Group-based trajectory modeling was utilized to examine the effect of experiencing sexual assault on trajectories of sports participation from adolescence to young adulthood. Results: Male participants were divided into three trajectory groups (i.e., Low-stable, High-decreasing, and High-stable) and female participants were divided into two trajectory groups (i.e., Low-stable and High-decreasing). The main finding of this study is that women who experienced non-physically forced sexual activity significantly decreases sports participation throughout the trajectory in ‘High-decreasing group.’ The effect of non-physically forced sexual activity on women’s sports participation was considerably weakened and became insignificant after including psychological depression in the model as a potential mediator. Discussion: Special attention should be paid to sport participation among women victims of non-physically forced sexual activity. Further studies are needed to examine other potential mediators in addition to psychological depression when examining the effect of non-physically forced sexual activity on sport participation in women.

Keywords: adolescent, group-based trajectory modeling, sexual assault, young adult

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Authors: Mehmet Erdem Uzun, Hande Şirin, Amela Kojic Ateş, Utku Beyazıt, Aynur Bütün Ayhan

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The aim of this study was to examine the health literacy of parents with children diagnosed with ADHD. The study group consisted of 394 parents with children diagnosed with ADHD who applied to the child and adolescent psychiatry outpatient clinic of a public hospital in Bursa, Turkey. 339 mothers and 52 fathers participated in the study. The parents were administered a questionnaire prepared by the researchers in addition to the European Health Literacy Scale-Short Form. Prior to the onset of the analyses, a normality test was performed, and it was determined that the data did not show normal distribution. In this regard, Mann-Whitney U and Kruskal Wallis tests were employed in the analyses. According to the results obtained, it was determined that the health literacy of the mothers (x2=21.015, p<.001) and fathers (x2=7.462, p<.05) differed according to their education levels; that is, the health literacy level of parents who graduated from primary school was lower than the other parents. In addition, it was determined that the level of health literacy differed according to the income level of the family (x2=14.308, p<.05), and the health literacy level of the parents in the low-income group was lower than the other parents. On the other hand, it was seen that the health literacy levels of mothers and fathers did not differ according to the variables of age, whether they had social security, whether the child diagnosed with ADHD was taking medication, and if so, how long the child had been taking medication; age and gender of the child; whether there were other individuals diagnosed with ADHD in the family, and whether the child or parents had a chronic disease (p>.05). The results obtained were discussed in the light of the literature findings.

Keywords: health literacy, parents, children, ADHD

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Authors: Michael Scott, Phil Jarrell

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Digitalization seems to be everywhere these days. So if one was to digitalize Functional Safety, what would that require: • Ability to directly use data from intelligent P&IDs / process design in a PHA / LOPA • Ability to directly use data from intelligent P&IDs in the SIS Design to support SIL Verification Calculations, SRS, C&Es, Functional Test Plans • Ability to create Unit Operation / SIF Libraries to radically reduce engineering manhours while ensuring consistency and improving quality of SIS designs • Ability to link data directly from a PHA / LOPA to SIS Designs • Ability to leverage reliability models and SRS details from SIS Designs to automatically program the Safety PLC • Ability to leverage SIS Test Plans to automatically create Safety PLC application logic Test Plans for a virtual FAT • Ability to tie real-time data from Process Historians / CMMS to assumptions in the PHA / LOPA and SIS Designs to generate leading indicators on protection layer health • Ability to flag SIS bad actors for proactive corrective actions prior to a near miss or loss of containment event What if I told you all of this was available today? This paper will highlight how the digital revolution has revolutionized the way Safety Instrumented Systems are designed, configured, operated and maintained.

Keywords: IEC 61511, safety instrumented systems, functional safety, digitalization, IIoT

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Authors: Bambang Heliyanto, Rully Dyah Purwati, Hasnam, Fadjry Djufry

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Jatropha curcas L., a drought tolerant and monoecious perennial shrub, has received attention worldwide during the past decade. Realizing the facts, the Indonesian government has decided to option for Jatropha and palm oil for in country biofuel production. To support the program development of high yielding jatropha varieties is necessary. This paper reviews Jatropha improvement program in Indonesia using mass selection and hybrid development. To start with, at the end of 2005, in-country germplasm collection was mobilized to Lampung and Nusa Tenggara Barat (NTB) provinces and successfully collected 15 provenances/sub-provenances which serves as a base population for selection. A significant improvement has been achieved through a simple recurrent breeding selection during 2006 to 2007. Seed yield productivity increased more than double, from 0.36 to 0.97 ton dry seed per hectare during the first selection cycle (IP-1), and then increased to 2.2 ton per hectare during the second cycles (IP-2) in Lampung provenance. Similar result was also observed in NTB provenance. Seed yield productivity increased from 0.43 ton to 1 ton dry seed per hectare in the first cycle (IP-1), and then 1.9 ton in the second cycle (IP-2). In 2008, the population IP-3 resulted from the third cycle of selection have been identified which were capable of producing 2.2 to 2.4 ton seed yield per hectare. To improve the seed yield per hectare, jatropha hybrid varieties was developed involving superior provenances. As a result a Jatropha Energy Terbarukan (JET) variety-2 was released in 2017 with seed yield potential of 2.6 ton per hectare. The use of this high yielding genotypes for biofuel is discussed.

Keywords: Jatropha curcas, provenance, biofuel, improve population, hybrid

Procedia PDF Downloads 171