Search results for: health triangle

Authors: Hyunsik Park

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Objective: To provide information of charged nursing care facility for helping to establish geriatric health care policy, and to figure out which factors would be the main determinants for the choice of it. Method: 46 males and 53 females, and the same number of their caregivers admitted into the charged nursing care facility were recruited for intensive interview including personal information, disease information, and economic, familial, marital and emotional statuses. This is a cross-sectional study and we analyzed the data qualitatively. Results: Patients had 3.2 diseases and a hospitalization for 2.3 years on average. They were consists of 46 singles (46.9%), 8 unmarried (8.2%), 5 divorced (5.1%) and 32 married (32.7%). More than two third (70.1%) were supported by their eldest son or daughter. Mostly, the family caregivers decided to admit into the facilities by the doctor’s recommendation (68.4%). When they made a choice for a facility, most of them (42.9%) considered environmental and sanitary conditions. According to their expectation for management in nursing care facility, most caregivers (59.2%) wanted simple-staying for the duration, but most patients (61.3%) expected to be home after taking comprehensive rehabilitation. Three-quarter of the caregivers would agree to use nursing care facilities in the future, if they would be the same situation. Conclusion: Life style and environment are rapidly changing. In the near future, we need lots of the charged nursing care facilities for the old, thus this study can be the good reference for the preparing upcoming aged and super-aged society.

Keywords: nursing care facility, aged society, qualitative analysis, health

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Authors: Franz Zirena Vilca, Nestor Cahui Galarza, Walter Alejandro Zamalloa Cuba, Edith Tello Palma, Teofilo Donaires Flores, Valdemar Luiz Tornisielo

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The production of rainbow trout in the Lake Titicaca represents an important economic activity for Peru. The city of Puno is responsible for 83% of this production, so the use of antibiotics within the aquaculture system is not alien to this reality. Meanwhile, the waters of Lake Titicaca represent an important source for the supply of drinking water for 80% of the population of the Puno city. In this paper, twelve antibiotics for veterinary use were monitored in water samples during two seasons: dry (July 2015) and rainy (February 2016), water samples from trout production systems, near the water catching point in the lake and drinking water in the city house of Puno were considered. The samples were analyzed using liquid chromatography coupled to mass spectrometry and solid online phase extraction (On-line SPE-LC-MS/MS), all samples analyzed showed concentrations of Ciprofloxacin up to 65.2 ng L⁻¹ at the rainy season. On the other hand, 63% of water samples from the dry season and 36 % from the rainy season showed Chlortetracycline up to 8.7 and 6.1 ng L⁻¹, respectively. The presence of residues of veterinary antibiotics in drinking water means a serious health risk for 80% of the population of Puno since all these people are supplied from this source.

Keywords: chromatography, DNA damage, environmental risk, water pollution

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Authors: Christina Tafadzwa

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Global HIV and AIDS trends show that Sub-Saharan Africa is the hardest-hit region, and women are disproportionately affected and infected by HIV. The trend is conspicuous in South Africa, where adolescent girls and young women (AGYW), female university students included, bear the burden of HIV infection. Although the female condom (FC) is the only female-oriented HIV and AIDS technology that provides dual protection against unwanted pregnancy and HIV, its uptake and use remain erratic, especially among the youth and young women in institutions of higher learning. This paper explores empirical evidence from the University of Venda (UniVen), which is in the rural areas of Limpopo Province in South Africa, and also among higher learning institutions experiencing low uptake and use of the FC. A phenomenological approach consisting of in-depth interviews was utilized to collect data from a total of 20 female university students at UniVen who were purposively sampled based on their participation in HIV and AIDS dialogues and campaigns conducted on campus. The findings that were analysed thematically revealed that notions of rurality and sociocultural beliefs surrounding women's sexual and reproductive health are key structural factors that influence the low use and uptake of the FC at the rural university. The evidence thus far revealed that female students are discouraged from collecting or initiating FC because of cultural dictates or prescripts which place the responsibility to collect and initiate condom use on men. Hence the inference that UniVen female students' realities are compounded by notions of rurality and society's patriarchal nature that intersect and limit women's autonomy in matters of sex. Guided by the women empowerment theory, this paper argues that such practices take away UniVen female students' agency to decide on their sexual and reproductive health. The normalisation of socio-cultural and harmful gender practices is also a retrogression in the women's health agenda. The paper recommends a holistic approach that engages traditional and community leaders, particularly men, to unlearn and uproot harmful gender norms and patriarchal elements that hinder the promotion and use of the FC.

Keywords: female condom, UniVen, socio-cultural factors, female students, HIV and AIDS

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Authors: Christine Marie Cocchiola

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This study assesses the relationship between coercive control and subjugation. Coercive control is the foundation of most domestic violence and a serious public health problem, having significant legal and social justice ramifications. Beyond the physical, it oftentimes is preceded by or motivated by a need for control. Subjugation, as a personality trait and a maladaptive schema, leads individuals to minimize their own needs or wants and, thereby, often to a loss of autonomy, a dismissal of what one might know to be true. This includes a dismissal of the trademarks of an abusive relationship. Subjugation may contribute to a person engaging in or remaining in a coercively controlling relationship. One hundred fifty-four female survivors of domestic violence participated in this study, assessing their own level of subjugation. Participants were limited to individuals who experienced non-physical abuse in their relationships. Subjugation was attributed as a “concern” or greater in 137 of the 154 participants. 11 participants were interviewed to determine their personal experiences in this abusive relationship. Common themes emerged from interviews, including that the participants worked diligently to fix these abusive relationships by regulating their own behaviors and attempting to please the offender. The results indicate a continued need for advocacy and support of this vulnerable population. Further education is indicated for mental health professionals and for individuals in or having left an abusive relationship on how to identify signs of subjugation, thereby empowering individuals to avoid future experiences of abuse.

Keywords: coercive control, intimate partner violence, subjugation, schemas, gender oppression, autonomy, gaslighting

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Authors: Maha Atout, Pippa Hemingway, Jane Seymour

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A preliminary systematic review shows that health professionals experience a tension when communicating with the parents and family members of children with life-threatening and life-limiting conditions. On the one hand, they want to promote open and honest communication, while on the other, they are apprehensive about fostering an unrealistic sense of hope. Defining the boundaries between information that might offer reasonable hope versus that which results in false reassurance is challenging. Some healthcare providers worry that instilling a false sense of hope could motivate parents to seek continued aggressive treatment for their child, which in turn might cause the patient further unnecessary suffering. To date, there has been a lack of research in the Middle East regarding how healthcare providers do or should communicate bad news; in particular, the issue of hope in the field of paediatric palliative care has not been researched thoroughly. This study aims to explore, from the perspective of patients’ mothers, physicians, and nurses, the experience of communicating and receiving bad news in the care of children with palliative care needs. Data were collected using a collective qualitative case study approach across three paediatric units in a Jordanian hospital. Two data collection methods were employed: participant observation and semi-structured interviews. The overall number of cases was 15, with a total of 56 interviews with mothers (n=24), physicians (n=12), and nurses (n=20) completed, as well as 197 observational hours logged. The findings demonstrate that mothers wanted their doctors to provide them with hopeful information about the future progression of their child’s illness. Although some mothers asked their doctors to provide them with honest information regarding the condition of their child, they still considered a sense of hope to be essential for coping with caring for their child. According to mothers, hope was critical to treatment as it helped them to stay committed to the treatment and protected them to some extent from the extreme emotional suffering that would occur if they lost hope. The health professionals agreed with the mothers on the importance of hope, so long as it was congruent with the stage and severity of each patient’s disease. The findings of this study conclude that while parents typically insist on knowing all relevant information when their child is diagnosed with a severe illness, they considered hope to be an essential part of life, and they found it very difficult to handle suffering without any glimmer of it. This study finds that using negative terms has extremely adverse effects on the parents’ emotions. Hence, although the mothers asked the doctors to be as honest as they could, they still wanted the physicians to provide them with a positive message by communicating this information in a sensitive manner including hope.

Keywords: health professionals, children, communication, hope, information, mothers, palliative care

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Authors: Dennis Okora Amima Ondieki

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Fertility transition has been identified to be affected by numerous factors. This research aimed to investigate the most real factors affecting fertility transition in Kenya. These factors were firstly extracted from the literature convened into demographic features, social, and economic features, social-cultural features, reproductive features and modernization features. All these factors had 23 factors identified for this study. The data for this study was from the Kenya Demographic and Health Surveys (KDHS) conducted in 1999-2003 and 2003-2008/9. The data was continuous, and it involved the mean birth order for the ten periods. Principal component analysis (PCA) was utilized using 23 factors. Principal component analysis conveyed religion, region, education and marital status as the real factors. PC scores were calculated for every point. The identified principal components were utilized as forecasters in the multiple regression model, with the fertility level as the response variable. The four components were found to be affecting fertility transition differently. It was found that fertility is affected positively by factors of region and marital and negatively by factors of religion and education. These four factors can be considered in the planning policy in Kenya and Africa at large.

Keywords: fertility transition, principal component analysis, Kenya demographic health survey, birth order

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Authors: Tanveer Ahmed Choudhury

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Background: Bangladesh is one of the largest deltas in the world, with high population density and high rates of poverty and illiteracy. 80% of the country is on low-lying floodplains, leaving the country one of the most vulnerable to the adverse effects of climate change: sea level rise, cyclones and storms, salinity intrusion, rising temperatures and heavy monsoon downpours. Such climatic events already limit Economic Development in the country. Although Bangladesh has had little responsibility in contributing to global climatic change, it is vulnerable to both its direct and indirect impacts. Real threats include reduced agricultural production, worsening food security, increased incidence of flooding and drought, spreading disease and an increased risk of conflict over scarce land and water resources. Currently, 8.3 million Bangladeshis live in cyclone high risk areas. However, by 2050 this is expected to grow to 20.3 million people, if proper adaptive actions are not taken. Under a high emissions scenario, an additional 7.6 million people will be exposed to very high salinity by 2050 compared to current levels. It is also projected that, an average of 7.2 million people will be affected by flooding due to sea level rise every year between 2070-2100 and If global emissions decrease rapidly and adaptation interventions are taken, the population affected by flooding could be limited to only about 14,000 people. To combat the climate change adverse effects, Bangladesh government has initiated many adaptive measures specially in infrastructure and renewable energy sector. Government is investing huge money and initiated many projects which have been proved very success full. Objectives: The objective of this paper is to describe some successful measures initiated by Bangladesh government in its effort to make the country a Climate Resilient. Methodology: Review of operation plan and activities of different relevant Ministries of Bangladesh government. Result: The following initiative projects, programs and activities are considered as best practices for Climate Change adaptation successes for Bangladesh: 1. The Infrastructure Development Company Limited (IDCOL); 2. Climate Change and Health Promotion Unit (CCHPU); 3. The Climate Change Trust Fund (CCTF); 4. Community Climate Change Project (CCCP); 5. Health, Population, Nutrition Sector Development Program (HPNSDP, 2011-2016)- "Climate Change and Environmental Issues"; 6. Ministry of Health and Family Welfare, Bangladesh and WHO Collaboration; - National Adaptation Plan. -"Building adaptation to climate change in health in least developed countries through resilient WASH". 7. COP-21 “Climate and health country profile -2015 Bangladesh. Conclusion: Due to a vast coastline, low-lying land and abundance of rivers, Bangladesh is highly vulnerable to climate change. Having extensive experience with facing natural disasters, Bangladesh has developed a successful adaptation program, which led to a significant reduction in casualties from extreme weather events. In a low income country setting, Bangladesh had successfully adapted various projects and initiatives to combat future Climate Change challenges.

Keywords: climate, change, success, Bangladesh

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Authors: Gadanya, A.M., Ponfa, S., Jibril, M.M., Abubakar, S. M.

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Background: Edible insects such as grasshopper are important sources of food for humans, and have been consumed as traditional foods by many indigenous communities especially in Africa, Asia, and Latin America. These communities have developed their skills and techniques in harvesting, preparing, consuming, and preserving edible insects, widely contributing to the role played by the use of insects in human nutrition. Aim/ objective: This study was aimed at determining the effect of insect enriched sprouted soyabean /millet based food on some gut health markers in albino rats. Methods. Four different formulations of Complementary foods (i.e Complementary Food B (CFB): sprouted millet (SM), Complementary Food C (CFC): sprouted soyabean (SSB), Complementary Food D (CFD): sprouted soybean and millet (SSBM) in a ratio of (50:50) and Complementary Food E (CFE): insect (grasshopper) enriched sprouted soybean and millet (SSBMI) in a ratio of (50:25:25)) were prepared. Proximate composition and short chain fatty acid contents were determined. Thirty albino rats were divided into5 groups of six rats each. Group 1(CDA) were fed with basal diet and served as a control group, while groups 2,3,4 and 5 were fed with the corresponding complimentary foods CFB, CFC, CFD and CFE respectively daily for four weeks. Concentrations of fecal protein, serum total carotenoids and nitric oxide were determined. DNA extraction for molecular isolation and characterization were carried out followed by PCR, the use of mega 11 software and NCBI blast for construction of the phylogenetic tree and organism identification respectively. Results: Significant increase (P<0.05) in percentage ash, fat, protein and moisture contents, as well as short chain fatty acid (acetate, butyrate and propionate) concentrations were recorded in the insect enriched sprouted composite food (CFE) when compared with the CFA, CFB, CFC and CFD composite food. Faecal protein, carotenoid and nitric oxide concentrations were significantly lower (P>0.05) in group 5 in comparison to groups 1to 4. Ruminococcus bromii and Bacteroidetes were molecularly isolated and characterized by 16s rRNA from the sprouted millet/sprouted soybean and the insect enriched sprouted soybean/sprouted millet based food respectively. The presence of these bacterial strains in the feaces of the treated rats is an indication that the gut of the treated rats is colonized by good gut bacteria, hence, an improved gut health. Conclusion: Insect enriched sprouted soya bean/sprouted millet based complementary diet showed a high composition of ash, fat, protein and fiber. Thus, could increase the availability of short chain fatty acids whose role to the host organism cannot be overemphasized. It was also found to have decrease the level of faecal protein, carotenoid and nitric oxide in the serum which is an indication of an improvement in the immune system function.

Keywords: gut-health, insect, millet, soybean, sprouted

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Authors: Nisha Gaur, K.Narasimhulu, Pydi Setty Yelamarthy

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Persistent organic pollutants (POPs) have become a great concern due to their toxicity, transformation and bioaccumulation property. Therefore, this review highlights the types, sources, classification health hazards and mobility of organochlorine pesticides, industrial chemicals and their by-products. Moreover, with the signing of Aarhus and Stockholm convention on POPs there is an increased demand to identify and characterise such chemicals from industries and environment which are toxic in nature or to existing biota. Due to long life, persistent nature they enter into body through food and transfer to all tropic levels of ecological unit. In addition, POPs are lipophilic in nature and accumulate in lipid-containing tissues and organs which further indicates the adverse symptoms after the threshold limit. Though, several potential enzymes are reported from various categories of microorganism and their interaction with POPs may break down the complex compounds either through biodegradation, biostimulation or bioaugmentation process, however technological advancement and human activities have also indicated to explore the possibilities for the role of genetically modified organisms and metagenomics and metabolomics. Though many studies have been done to develop low cost, effective and reliable method for detection, determination and removal of ultra-trace concentration of persistent organic pollutants (POPs) but due to insufficient knowledge and non-feasibility of technique, the safe management of POPs is still a global challenge.

Keywords: persistent organic pollutants, bioaccumulation, biostimulation, microbial remediation

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Authors: Chung-Yuan Wang, Kai-Chun Lee, Min-Hung Wang, Yu-Ren Chen, Hung-Sheng Lin, Sen-Shan Fan

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Taiwan National Health Insurance (NHI) was launched in 1995. It is an important social welfare policy in Taiwan. Regardless of the diversified social and economic status, universal coverage of NHI was assured. In order to regain better self-care performance, stroke people received in-patient and out-patient rehabilitation. Though NHI limited the rehabilitation frequency to one per day, the cost of rehabilitation still increased rapidly. Through the intensive rehabilitation during the post-stroke rehabilitation golden period, stroke patients might decrease their disability and shorten the rehabilitation period. Therefore, the aim of this study was to investigate the effect of intensive post-acute stroke rehabilitation in hospital under per diem payment. This study was started from 2014/03/01. The stroke patients who were admitted to our hospital or medical center were indicated to the study. The neurologists would check his modified Rankin Scale (mRS). Only patients with their mRS score between 2 and 4 were included to the study. Patients with unclear consciousness, unstable medical condition, unclear stroke onset date and no willing for 3 weeks in-patient intensive rehabilitation were excluded. After the physiatrist’s systemic evaluation, the subjects received intensive rehabilitation programs. The frequency of rehabilitation was thrice per day. Physical therapy, occupational therapy and speech/swallowing therapy were included in the programs for the needs of the stroke patients. Activity daily life performance (Barthel Index) and functional balance ability (Berg Balance Scale) were used to measure the training effect. During 3/1 to 5/31, thirteen subjects (five male and eight female) were included. Seven subjects were aged below 60. Three subjects were aged over 70. Most of the subjects (seven subjects) received intensive post-stroke rehabilitation for three weeks. Three subjects drop out from the programs and went back home respectively after receiving only 7, 10, and 13 days rehabilitation. Among these 13 subjects, nine of them got improvement in activity daily life performance (Barthel Index score). Ten of them got improvement in functional balance ability (Berg Balance Scale). The intensive post-acute stroke rehabilitation did help stroke patients promote their health in our study. Not only their functional performance improved, but also their self-confidence improved. Furthermore, their family also got better health status. Stroke rehabilitation under per diem payment was noted in long-term care institution in developed countries. Over 95% populations in Taiwan were supported under the Taiwan's National Health Insurance system, but there was no national long-term care insurance system. Most of the stroke patients in Taiwan live with his family and continue their rehabilitation programs from out-patient department. This pilot study revealed the effect of intensive post-acute stroke rehabilitation in hospital under per diem payment. The number of the subjects and the study period were limited. Thus, further study will be needed.

Keywords: rehabilitation, post-acute stroke, per diem payment, NHI

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Authors: Nora Alkharji, Wafa Fallatah

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Introduction: One of the major issues to consider when is deciding on what to feed a baby is the quality of the food itself. Whilst commercially prepared infant formulas are a nutritious alternative to breast milk, and even contain some vitamins and nutrients, most major medical organizations consider breastfeeding the best nutritional option for babies. Choosing whether to breastfeed or formula feed your baby is one of the first decisions expectant parents will make. The American Academy of Pediatrics (AAP) is in agreement with other organizations such as the American Medical Association (AMA), the American Dietetic Association (ADA), and the World Health Organization (WHO) in recommending breastfeeding as the best nutrition for babies and best suited for a baby's digestive system. In addition, breastfeeding helps in the combatting of infections, prevention of allergies, and protection against various chronic conditions. The decision to breastfeed or formula feed one’s baby is a very personal one. However, certain points need to be clarified regarding the nutritional value of breastfeeding versus formula feeding to allow for informed decision-making. Methodology: -A formal debate about whether to breastfeed or formula feed babies as the better choice. -There will be two debaters, both lactation consultants -Arguments will be based on evidence-based medicine -Duration period of debated: 45 min Result: Clarification and heightened awareness of the benefits of breastfeeding. Conclusion: This debate will make the choice between breastfeeding or formula feeding a relatively easy one to make by both health worker and parents.

Keywords: breastmilk, formula milk, nutritional, comparison

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Authors: Juan Pablo Hervas-Perez, Jesus Guodemar-Perez, Montserrat Ruiz-Lopez, Elena Sonsoles Rodriguez-Lopez, Noemi Mayoral-Gonzalo, Eduardo Cimadevilla Fernandez-Pola, Mario Caballero-Corella

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Physiotherapy is a healthcare discipline that covers many fields of action within the recovery and prevention of health. Some are well known, but others, such as working with newborns and premature children are not so. Physical therapist functions are well defined, but the impression of the population is that there are other professionals who can develop them, and a large part are unknown. Objective: To evaluate the level of knowledge of the sample on the role of the physiotherapist in general, and more specifically in the neonatal intensive care (NICU) units, and estimate your level of notions on the development centered care (DCC). Method: A descriptive, transversal, observational and prospective study developed on a 125 participants' sample. Results: From the sample studied, 87.2% had already had contact with physiotherapy previously. An 80.9% believed that the physiotherapist intervention was decisive for the cure, and 84.0% would recommend physiotherapy treatment to others. Of the total surveyed, 98.0% felt that the physiotherapist is who should run the physiotherapeutic treatments, but shares with other professions 71.0% of votes. The field's best-known work is rehabilitation (94.0%); Neonatology is on the 4th place (66.0% of votes). Conclusions: Many areas of work of physical therapy are unknown to a big part of the population, including the own health workers. Less than half of the sample meets the DCC, and only 58% of the interviewed physiotherapists know them.

Keywords: functions of physiotherapist, neonatal intensive care, physiotherapy, prematurity

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Authors: Gemma A. Gruyal

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Plants can contain a wide variety of substances with antioxidative properties which are associated to important health benefits. These positive health effects are of great importance at a time when the environment is laden with many toxic substances. Five selected herbal plants namely, Mimosa pudica, Phyllanthus niruri, Ceiba pentandra, Eleusine polydactyla and Trema amboinensis, were chosen for the experiment to investigate their total phenolics content and antioxidant activities using ABTS radical cation decolorization power, and ferric reducing antioxidant power. The total phenolic content of each herbal plants ranges from 0.84 to 42.59 mg gallic acid equivalent/g. The antioxidant activity in the ABTS radical cation decolorization power varies from 0.005 to 0.362 mg trolox equivalent/g and the FRAP ranges from 0.30 to 28.42 mg gallic acid equivalent/g. Among the five medicinal plants, Mimosa pudica has been an excellent performer in terms of the 3 parameters measured; it is followed by Phyllanthus niruri. The five herbal plants do not have equivalent antioxidant power. The relative high values for M. pudica and P. niruri supports the medicinal value of both plants. The total phenolics, ABTS and FRAP correlate strongly with one another.

Keywords: ABTS, FRAP, Leaf extracts, phenol

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Authors: Man Ying Kang, Joshua Kin Man Nan

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The prolonged pandemic has posed alarming public health challenges to various parts of the world, and face-to-face mental health treatment is largely discounted for the control of virus transmission, online psychological services and self-help mental health kits have become essential. Online self-help mindfulness-based interventions have proved their effects on fostering mental health for different populations over the globe. This paper was to test the effectiveness of an online short-term audio-based mindfulness (SAM) program in enhancing wellbeing, dispositional mindfulness, and reducing stress and negative affect in community settings in China, and to explore possible mechanisms of how dispositional mindfulness, stress, and negative affect influenced the intervention effects on wellbeing. Community-dwelling adults were recruited via online social networking sites (e.g., QQ, WeChat, and Weibo). Participants (n=100) were randomized into the mindfulness group (n=50) and a waitlist control group (n=50). In the mindfulness group, participants were advised to spend 10–20 minutes listening to the audio content, including mindful-form practices (e.g., eating, sitting, walking, or breathing). Then practice daily mindfulness exercises for 3 weeks (a total of 21 sessions), whereas those in the control group received the same intervention after data collection in the mindfulness group. Participants in the mindfulness group needed to fill in the World Health Organization Five Well-Being Index (WHO), Positive and Negative Affect Schedule (PANAS), Perceived Stress Scale (PSS), and Freiburg Mindfulness Inventory (FMI) four times: at baseline (T0) and at 1 (T1), 2 (T2), and 3 (T3) weeks while those in the waitlist control group only needed to fill in the same scales at pre- and post-interventions. Repeated-measure analysis of variance, paired sample t-test, and independent sample t-test was used to analyze the variable outcomes of the two groups. The parallel process latent growth curve modeling analysis was used to explore the longitudinal moderated mediation effects. The dependent variable was WHO slope from T0 to T3, the independent variable was Group (1=SAM, 2=Control), the mediator was FMI slope from T0 to T3, and the moderator was T0NA and T0PSS separately. The different levels of moderator effects on WHO slope was explored, including low T0NA or T0PSS (Mean-SD), medium T0NA or T0PSS (Mean), and high T0NA or T0PSS (Mean+SD). The results found that SAM significantly improved and predicted higher levels of WHO slope and FMI slope, as well as significantly reduced NA and PSS. FMI slope positively predict WHO slope. FMI slope partially mediated the relationship between SAM and WHO slope. Baseline NA and PSS as the moderators were found to be significant between SAM and WHO slope and between SAM and FMI slope, respectively. The conclusion was that SAM was effective in promoting levels of mental wellbeing, positive affect, and dispositional mindfulness as well as reducing negative affect and stress in community settings in China. SAM improved wellbeing faster through the faster enhancement of dispositional mindfulness. Participants with medium-to-high negative affect and stress buffered the therapy effects of SAM on wellbeing improvement speed.

Keywords: mindfulness, negative affect, stress, wellbeing, randomized control trial

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Authors: Viknesh Kasthuri, Victoria Angenent-Mari, Jade Wexler

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The COVID-19 pandemic dramatically altered the landscape of asylum medicine. Brown Human Rights Asylum Clinic (BHRAC) is a medical-student-run asylum clinic that provides pro-bono medical evaluations and forensic affidavits for individuals seeking asylum in New England. After the outbreak of COVID-19 in March 2020, BHRAC experienced numerous changes both in the number of clients requesting services as well as in the resource needs of these clients. Uniquely, BHRAC assesses the needs of clients during their affidavit interview and seeks to address these needs by connecting clients to local community organizations and resources. Data regarding the specific needs of clients range from 2019-present day. Analysis of internal BHRAC’s internal data suggested a small increase in requests for assistance with light and gas (from 5% of total resource requests pre-COVID to 11%), as well as a decrease in requests for mental health services (from 20% of resources pre-COVID to 13% post-COVID). Furthermore, BHRAC witnessed a decline in clinic volume during the second half of 2020. In short, our data suggest that the pandemic affected asylum seekers' access to medico-legal services and the resources they need. Future research with larger sample sizes and in other geographic locations is required to determine the holistic impact of the COVID-19 pandemic on asylum seekers.

Keywords: asylum clinic, asylum medicine, COVID, social determinants of health

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Authors: Fiona Lourenco, William Allen

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Dentofacial deformities are primarily surgically treated via orthognathic surgery. Health-related quality of life is concerned with aspects of quality of life that relate specifically to an individual’s health. Design and Setting: Retrospective analysis of patients who had orthognathic surgery from January 2018 - December 2022 at the trust using the previously validated Orthognathic Quality of Life questionnaire (OQoL). Materials and Methods: 32 Patient questionnaires (which included pre-operative and post-operative separate sections) were obtained via telephone survey. The data was analysed using the two-tailed paired t-test and Wilcoxon signed-rank test. Results: The change in perception post-surgery was highly significant (both tests resulted in p<0.001 for overall analysis as well as for each domain). Overall, a 74% improvement in QoL was seen following orthognathic surgery. Reports of improvement in each domain were as follows: 71% in the social aspect of the deformity domain, 76% in facial aesthetics, 60% in function, and 57% improvement in awareness of facial deformity. Conclusion: The assessment of QoL is becoming progressively imperative in clinical research. The above data shows that orthognathic surgery has a significant improvement in the QoL of patients post-operatively. The results demonstrate improvement in all domains, with perceptions in facial aesthetics seeing the highest change post-operatively.

Keywords: dentofacial, oral, facial asymmetry, orthognathic surgery, quality of life

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Authors: Ammaarah Gamieldien

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Depression is a very common and serious mental illness that has a significant impact on both the social and economic aspects of sufferers worldwide. This study aimed to investigate the association between body mass index (BMI), blood pressure, and lipid profiles with mental health symptoms in university students. Secondary objectives included the associations between the variables (BMI, blood pressure, and lipids) with themselves, as they are key factors in cardiometabolic disease. Sixty-three (63) students participated in the study. Thirty-two (32) were assigned to the control group (minimal-mild depressive symptoms), while 31 were assigned to the depressive group (moderate to severe depressive symptoms). Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI) were used to assess depressive scores. Anthropometric measurements such as weight (kg), height (m), waist circumference (WC), and hip circumference were measured. Body mass index (BMI) and ratios such as waist-to-hip ratio (WHR) and waist-to-height ratio (WtHR) were also calculated. Blood pressure was measured using an automated AfriMedics blood pressure machine, while lipids were measured using a CardioChek plus analyzer machine. Statistics were analyzed via the SPSS statistics program. There were no significant associations between anthropometric measurements and depressive scores (p > 0.05). There were no significant correlations between lipid profiles and depression when running a Spearman’s rho correlation (P > 0.05). However, total cholesterol and LDL-C were negatively associated with depression, and triglycerides were positively associated with depression after running a point-biserial correlation (P < 0.05). Overall, there were no significant associations between blood pressure measurements and depression (P > 0.05). However, there was a significant moderate positive correlation between systolic blood pressure and MADRS scores in males (P < 0.05). Depressive scores positively and strongly correlated to how long it takes participants to fall asleep. There were also significant associations with regard to the secondary objectives. This study indicates the importance of determining the prevalence of depression among university students in South Africa. If the prevalence and factors associated with depression are addressed, depressive symptoms in university students may be improved.

Keywords: depression, blood pressure, body mass index, lipid profiles, mental health symptoms

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Authors: Nahid Salarkia, Nasrin Omidvar, Erfan Ghassemi, Vahideh Arab-Salari, Tirang Reza Neyestani

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Background: Household food insecurity has an adverse impact on the maternal mental health. This study was carried out to assess the relationship between household food insecurity, maternal depression and mother’s self-efficacy in Varamin, Iran, in 2014. Methods: In this cross-sectional study 423 mothers with children under 2 years old, with mean age 28.1±5.2 year; weight 66.3±13.4 kg; height 160.3± 5.7 cm and BMI 25.7±4.8 kg/m2 were selected by a multistage random sampling scheme. The instruments were: Beck Depression Inventory (BDI-III) and mother’s self-efficacy questionnaire. Data was analyzed using χ2 test, ANOVA and Pearson correlation. Results: Mildly, moderately and severely food insecure households were 39.5, 9.7 and 3.1%, respectively. Mild, moderate and sever depression was: 18.7, 13.9 and 5.7%. Mean score of depression in moderate and severe food insecure (8.6±5.3) was more than mild food insecure (4.8±4.7) and food secure (3.1±3.6) mothers. Frequency of very good, good and low mother’s self-efficacy were 62.8, 36.5, and 0.7%, respectively. Very good mother’s self-efficacy in food secure mothers (33.4%) was more than mild (25.4%) and moderate-sever food insecure groups (4%). There was a negative significant association between household food insecurity and mother’s self-efficacy (r= -0.297, p<0.01), and between mother’s depression and self-efficacy (r= -0.309, p=0.001). Conclusion: Empowerment of mothers with educational programs and social support can decrease mothers’ depression and increase self-efficacy that lead to improve maternal practices in food insecure households.

Keywords: Household food insecurity, Iran, mothers, physiological characteristics, self-efficacy

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Authors: Vidhya Venugopal, Rekha S.

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Introduction: Climate change and the growing frequency of higher average temperatures and heat waves have detrimental health effects, especially for certain vulnerable groups with limited socioeconomic status (SES) or physiological capacity to adapt to or endure high temperatures. Little research has been conducted on the effects of heat stress on pregnant women and fetuses in tropical regions such as India. Very high ambient temperatures may worsen Adverse Pregnancy Outcomes (APOs) and are a major worry in the scenario of climate change. The relationship between rising temperatures and APO must be better understood in order to design more effective interventions. Methodology: We conducted an observational cohort study involving 865 pregnant women in various districts of Tamil Nadu districts between 2014 and 2021. Physiological Heat Strain Indicators (HSI) such as morning and evening Core Body Temperature (CBT) and Urine Specific Gravity (USG) were monitored using an infrared thermometer and refractometer, respectively. A validated, modified version of the HOTHAPS questionnaire was utilised to collect self-reported health symptoms. A follow-up was undertaken with the mothers to collect information regarding birth outcomes and APOs, such as spontaneous abortions, stillbirths, Preterm Birth (PTB), birth abnormalities, and Low Birth Weight (LBW). Major findings of the study: According to the findings of our study, ambient temperatures (mean WBGT°C) were substantially higher (>28°C) for approximately 46% of women performing moderate daily life activities. 82% versus 43% of these women experienced dehydration and heat-related complaints. 34% of women had USG >1.020, which is symptomatic of dehydration. APOs, which include spontaneous abortions, were prevalent at 2.2%, stillbirth/preterm birth/birth abnormalities were prevalent at 2.2%, and low birth weight was prevalent at 16.3%. With exposures to WBGT>28°C, the incidence of miscarriage or unexpected abortion rose by approximately 2.7 times (95% CI: 1.1-6.9). In addition, higher WBGT exposures were associated with a 1.4-fold increased risk of unfavorable birth outcomes (95% Confidence Interval [CI]: 1.02-1.09). The risk of spontaneous abortions was 2.8 times higher among women who conceived during the hotter months (February – September) compared to those women who conceived in the cooler months (October – January) (95% CI: 1.04-7.4). Positive relationships between ambient heat and APOs found in this study necessitate further exploration into the underlying factors for extensive cohort studies to generate information to enable the formulation of policies that can effectively protect these women against excessive heat stress for enhanced maternal and fetal health.

Keywords: heat exposures, community, pregnant women, physiological strain, adverse outcome, interventions

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Authors: Youn Young Shim, Ji Hye Kim, Jae Youl Cho, Martin JT Reaney

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Flaxseed (Linumusitatissimum L.) is gaining popularity in the food industry as a superfood due to its health-promoting properties. Linusorbs (LOs, a.k.a. Cyclolinopeptide) are bioactive compounds present in flaxseed exhibiting potential health effects. The study focused on the effects of processing and storage on the stability of flaxseed-derived LOs added to various bakery products. The flaxseed meal fortified gluten-free (GF) bakery bread was prepared, and the changes of LOs during the bread-making process (meal, fortified flour, dough, and bread) and storage (0, 1, 2, and 4 weeks) at different temperatures (−18 °C, 4 °C, and 22−23 °C) were analyzed by high-performance liquid chromatography-diode array detection. The total oxidative LOs and LO1OB2 were almost kept stable in flaxseed meals at storage temperatures of 22−23 °C, −18 °C, and 4 °C for up to four weeks. Processing steps during GF-bread production resulted in the oxidation of LOs. Interestingly, no LOs were detected in the dough sample; however, LOs appeared when the dough was stored at −18 °C for one week, suggesting that freezing destroyed the sticky structure of the dough and resulted in the release of LOs. The final product, flaxseed meal fortified bread, could be stored for up to four weeks at −18 °C and 4 °C, and for one week at 22−23 °C. All these results suggested that LOs may change during processing and storage and that flaxseed flour-fortified bread should be stored at low temperatures to preserve effective LOs components.

Keywords: linum usitatissimum L., flaxseed, linusorb, stability, gluten-free, peptides, cyclolinopeptide

Procedia PDF Downloads 181

Authors: Karina Peron, Ricardo Ghelman, Monica Taminato, Katia R. Oliveira, Debora C. A. Rodrigues, Juliana R. C. Mumme, Olga K. M. Sunakozaua, Georg Seifert, Vicente O. Filho

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The nurse is the most available health professional for the interventions of support in the integrative approach in hospital environment, therefore a professional group key to changes in the model of care. The central components in the performance of anthroposophic nursing procedures are direct physical contact, promotion of proper rhythm, thermal regulation and the construction of a calm and empathic atmosphere, safe for patients and their caregivers. The procedures of anthroposophic external therapies (AET), basically composed of the application of compresses and the use of natural products, provide an opportunity to intensify the therapeutic results through an innovative, complementary and integrative model in the university hospital. The objective of this work is to report the implementation of a program of nursing techniques (AET) through a partnership between the Pediatric Oncology Sector of the Department of Pediatrics of the Faculty of Medicine of the University of Sao Paulo and Charite University of Berlin, with lecturers from Berlin's Integrative Hospital Havelhöhe and Witten-Herdecke Integrative Hospital, both in Germany. Intensive training activities of the Hospital's nursing staff and a survey on AET needs were developed based on the most prevalent complaints in pediatric oncology patients in the three environments of the Hospital of Pediatric Oncology: Bone Marrow Transplantation Unit, Intensive Care Unit and Division of Internal Patients. We obtained the approval of the clinical protocol of external anthroposophic therapies for nursing care by the Ethics Committee and the Academic Council of the Hospital. With this project, we highlight the key AET needs that will be part of the standard program of pediatric oncology care with appropriate scientific support. The results of the prevalent symptoms were: vomiting, nausea, pain, difficulty in starting sleep, constipation, cold extremities, mood disorder and psychomotor agitation. This project was the pioneer within the Integrative Pediatrics Program, as an innovative concept of Medicine and Integrative Health presented at scientific meetings.

Keywords: integrative health care, integrative nursing, pediatric nursing, pediatric oncology

Procedia PDF Downloads 267

Authors: T. Valdbjørn Rasmussen

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Design criteria for achieving an acceptable indoor radon concentration are presented in this paper. The paper suggests three design criteria. These criteria have to be considered at the early stage of the building design phase to meet the latest recommendations from the World Health Organization in most countries. The three design criteria are; first, establishing a radon barrier facing the ground; second, lowering the air pressure in the lower zone of the slab on ground facing downwards; third, diluting the indoor air with outdoor air. The first two criteria can prevent radon from infiltrating from the ground, and the third criteria can dilute the indoor air. By combining these three criteria, the indoor radon concentration can be lowered achieving an acceptable level. In addition, a cheap and reliable method for measuring the radon concentration in the indoor air is described. The provision on radon in the Danish Building Regulations complies with the latest recommendations from the World Health Organization. Radon can cause lung cancer and it is not known whether there is a lower limit for when it is not harmful to human beings. Therefore, it is important to reduce the radon concentration as much as possible in buildings. Airtightness is an important factor when dealing with buildings. It is important to avoid air leakages in the building envelope both facing the atmosphere, e.g. in compliance with energy requirements, but also facing the ground, to meet the requirements to ensure and control the indoor environment. Infiltration of air from the ground underneath a building is the main providing source of radon to the indoor air.

Keywords: radon, natural radiation, barrier, pressure lowering, ventilation

Procedia PDF Downloads 355

Authors: Porntip Ruengtam

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This article is an extension of previous research presenting the relevant factors related to environmental perceptions, residential community, and the design of a healing environment, which have effects on the well-being and requirements of Thai elderly. Research methodology began with observations and interviews in three case studies in terms of the management processes and environment design of similar existing projects in Thailand. The interview results were taken to summarize with related theories and literature. A questionnaire survey was designed for data collection to confirm the factors of requirements in a residential community intended for the Thai elderly. A structural equation model (SEM) was formulated to explain the cause-effect factors for the requirements of a residential community for Thai elderly. The research revealed that the requirements of a residential community for Thai elderly were classified into three groups when utilizing a technique for exploratory factor analysis. The factors were comprised of (1) requirements for general facilities and activities, (2) requirements for facilities related to health and security, and (3) requirements for facilities related to physical exercise in the residential community. The results from the SEM showed the background of elderly people had a direct effect on their requirements for a residential community from various aspects. The results should lead to the formulation of policies for design and management of residential communities for the elderly in order to enhance quality of life as well as both the physical and mental health of the Thai elderly.

Keywords: elderly, environmental design, residential community, structural equation modeling

Procedia PDF Downloads 314

Authors: Tero Huhtala, Minna Pikkarainen, Saila Saraniemi

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Information technology has long been used as an enabler of exchange for goods and services. Services are evolving from generic to personalized, and the reverse use of customer data has been discussed in both academia and industry for the past few years. This article presents the results of an empirical case study in the area of preventive health care services. The primary data were gathered in workshops, in which future personal data-based services were conceptualized by analyzing future scenarios from a business perspective. The aim of this study is to understand business model transformation in emerging personal data ecosystems. The work was done as a case study in the context of occupational healthcare. The results have implications to theory and practice, indicating that adopting personal data management principles requires transformation of the business model, which, if successfully managed, may provide access to more resources, potential to offer better value, and additional customer channels. These advantages correlate with the broadening of the business ecosystem. Expanding the scope of this study to include more actors would improve the validity of the research. The results draw from existing literature and are based on findings from a case study and the economic properties of the healthcare industry in Finland.

Keywords: ecosystem, business model, personal data, preventive healthcare

Procedia PDF Downloads 252

Authors: C. Silvestros, K. Mellou, T. Georgakopoulou, A. Koustenis, E. Kokkinou, C. Botsi, A. Terzidis

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'PHILOS – Emergency health response to refugee crisis' is a programme of the Greek Ministry of Health, implemented by the Hellenic Center for Disease Control and Prevention (HCDCP) funded by the Asylum, Migration and Integration Fund (AMIF) of EU’s DG Migration and Home Affairs. One of the main objectives of the program is the immunization coverage of the target – population to assure the prevention of vaccine-preventable diseases. The program foresees vaccination needs assessment of children hosted at camps at the mainland and implementation of interventions to cover the vaccination gaps in co-operation with the Ministry of Health. The National Immunization Advisory Committee in Greece recommended that MMR (Measles, Mumps, and Rubella), PCV (Pneumococcal conjugate vaccine) and HEXA (diphtheria, tetanus, pertussis, polio, hepatitis B and Haemophilus influenzae type b) vaccines should be performed in priority. Recording was completed at 24 camps (May - June 2017); 3381 children (0-18 years) were recorded. The median number of children hosted at each camp was 95 (range: 5-553). For 68% of the children, the WHO vaccination booklet was available. 44%, 48.5% and 61% of the children were vaccinated with at least one dose of PCV, HEXA, and MMR, respectively. The proportion of vaccinated children for the three vaccines mentioned above is significantly lower for the remaining doses; PCV (second dose 8%, third dose 1.3%), HEXA (second dose 13%, third dose 2.7%, forth dose 0.1%) and MMR (second dose 23%). None of the 37 (10 from Afghanistan, 3 from Bangladesh, 23 from Pakistan, 1 from Syria) recorded unaccompanied children did not have a WHO vaccination booklet and were considered unvaccinated. There is no differentiation in vaccination coverage among different ethnicities. Massive catch up vaccination was performed at 4 camps, and 671 vaccinations were performed (245 PCV, 307 HEXA, and 119 MMR). Similar interventions are planned for all camps of the country. Recording reveled gaps in vaccination coverage of the population, mainly because of the mobility of the population, the influx of refugees- which is still ongoing- and new births. Mass vaccination campaigns are considered vital in order to increase vaccination coverage, and continuous efforts are needed in order all children living at the camps to have full access to the National Childhood Immunization Program.

Keywords: vaccine preventable, refugee–migrants camps, vaccination coverage, PCV, MMR, HEXA

Procedia PDF Downloads 186

Authors: Dganit Sharon, Raghda Alnabilsy

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The goal of this qualitative research was to sound the voices of Jewish and Arab women in Israel who had experienced obstetric violence, to learn the consequences of the violence to them on different levels and over time, and to present their coping strategies from their perspective. Another goal was to expand the research knowledge on an issue that has not been studied among Arab and Jewish women in Israel. The premise of this study is the feminist approach that aims to promote human rights, and to eradicate phenomena related to cultural, structural, gender and patriarchal structures of women, their bodies, and their health. The research was based on the qualitative-constructivist methodology, by means of thematic analysis of 20 in-depth semi-structured interviews. Two main themes emerged from the analysis. First, the physical and emotional consequences of obstetric violence, consequences to spousal relationships, and mistrust of the health system and service providers. Second, women’s coping strategies with obstetric violence that included repression and avoidance as a way of coping with the pain and trauma of the abuse; garnering inner strengths, resilience, knowledge and awareness of the delivery process; recruiting and relying on external help; sharing on social media, and discussions with other women who had similar experiences; or reaching out to therapists / legal aid / public complaints.

Keywords: obstetric violence, Jewish and arab women in israel, consequences, coping strategies, gender-related perspective

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Authors: Poonam Singh, Surendra Prasad, William Aalbersberg

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Iron the most essential trace element in human nutrition. Its deficiency has serious health consequences and is a major public health threat worldwide. The common deficiencies in Fiji population reported are of Fe, Ca and Zn. It has also been reported that 40% of women in Fiji are iron deficient. Therefore, we have been studying the bioavailability of iron in commonly consumed Fiji foods. To study the bioavailability it is essential to assess the iron contents in raw foods. This paper reports the iron contents and its bioavailability in commonly consumed foods by multicultural population of Fiji. The food samples (rice, breads, wheat flour and breakfast cereals) were analyzed by atomic absorption spectrophotometer for total iron and its bioavailability. The white rice had the lowest total iron 0.10±0.03 mg/100g but had high bioavailability of 160.60±0.03%. The brown rice had 0.20±0.03 mg/100g total iron content but 85.00±0.03% bioavailable. The white and brown breads showed the highest iron bioavailability as 428.30±0.11 and 269.35 ±0.02%, respectively. The Weetabix and the rolled oats had the iron contents 2.89±0.27 and 1.24.±0.03 mg/100g with bioavailability of 14.19±0.04 and 12.10±0.03%, respectively. The most commonly consumed normal wheat flour had 0.65±0.00 mg/100g iron while the whole meal and the Roti flours had 2.35±0.20 and 0.62±0.17 mg/100g iron showing bioavailability of 55.38±0.05, 16.67±0.08 and 12.90±0.00%, respectively. The low bioavailability of iron in certain foods may be due to the presence of phytates/oxalates, processing/storage conditions, cooking method or interaction with other minerals present in the food samples.

Keywords: iron, bioavailability, Fiji foods, in vitro technique, human nutrition

Procedia PDF Downloads 531

Authors: Rhaetian Bern D. Azaula

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The Philippines' indigenous population, estimated to be 10%-20%, is protected by the Indigenous Peoples Rights Act (IPRA), passed in 1997. However, due to their isolation and limited access to basic services such as health education or needs for health assistance, the law's implementation remains a challenge. As traditional medicine continues to play a significant role in society as the prevention and treatment of some illnesses, it is still customary and widely used to use plants in both traditional and modern ways; however, commercially prepared drugs are progressively advanced as time goes by. Therefore, the purpose of this quantitative study is to investigate the indigenous community at Barangay Magsikap General Nakar, Quezon, and analyze the factors that affect the respondent’s preferences in an indigenous community and reasons for patronizing traditional and commercially prepared medicines and proposes updated health education strategies and instructional materials. Slovin's formula was utilized to reduce the total population representation, followed by stratified sampling for proportional allocation of respondents. The study selects respondents (1) from an Indigenous Community in Barangay Magsikap, General Nakar, Quezon, (2) aged 60 and above, and (3) who are willing to participate. The researcher utilized a checklist-based questionnaire with a Tagalog version, and a Likert Scale was utilized to assess the respondent's choices on selected items. The researcher obtained informed consent from the indigenous community's regional and local office, the chieftain of the tribe, and the respondents, ensuring confidentiality in the collection and retrieval of data. The study revealed that respondents aged 60-69, males with no formal education, are unemployed and have no income source. They prefer traditional medicines due to their affordability, availability, and cultural practices but lack safe preparation, dosages, and contraindications of used medicines. Commercially prepared medications are acknowledged, but respondents are not fully aware of proper administration instructions and dosage labels. Recommendations include disseminating approved herbal medicines and ensuring proper preparation, indications, and contraindications.

Keywords: traditional medicine, commercially prepared medicine, indigenous community, elderly adult

Procedia PDF Downloads 75

Authors: Tsega Asresa Mengistu, Getahun Tigistu

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Computer vision is an artificial intelligence subfield that allows computers and systems to retrieve meaning from digital images. It is applied in various fields of study self-driving cars, video surveillance, agriculture, Quality control, Health care, construction, military, and everyday life. Aromatic and medicinal plants are botanical raw materials used in cosmetics, medicines, health foods, and other natural health products for therapeutic and Aromatic culinary purposes. Herbal industries depend on these special plants. These plants and their products not only serve as a valuable source of income for farmers and entrepreneurs, and going to export not only industrial raw materials but also valuable foreign exchange. There is a lack of technologies for the classification and identification of Aromatic and medicinal plants in Ethiopia. The manual identification system of plants is a tedious, time-consuming, labor, and lengthy process. For farmers, industry personnel, academics, and pharmacists, it is still difficult to identify parts and usage of plants before ingredient extraction. In order to solve this problem, the researcher uses a deep learning approach for the efficient identification of aromatic and medicinal plants by using a convolutional neural network. The objective of the proposed study is to identify the aromatic and medicinal plant Parts and usages using computer vision technology. Therefore, this research initiated a model for the automatic classification of aromatic and medicinal plants by exploring computer vision technology. Morphological characteristics are still the most important tools for the identification of plants. Leaves are the most widely used parts of plants besides the root, flower and fruit, latex, and barks. The study was conducted on aromatic and medicinal plants available in the Ethiopian Institute of Agricultural Research center. An experimental research design is proposed for this study. This is conducted in Convolutional neural networks and Transfer learning. The Researcher employs sigmoid Activation as the last layer and Rectifier liner unit in the hidden layers. Finally, the researcher got a classification accuracy of 66.4 in convolutional neural networks and 67.3 in mobile networks, and 64 in the Visual Geometry Group.

Keywords: aromatic and medicinal plants, computer vision, deep convolutional neural network

Procedia PDF Downloads 443

Authors: Poonam Goswami

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Background: The diagnosis of a serious illness like cancer can have an impact on a patient’s emotional well-being and may result in psychological symptoms, anxiety, depression, and loss of control. Advance care planning discussions ensure patients’ values and goals of care, including patients’ freedom to choose their place of death, are respected. Unfortunately, these discussions are often delayed and are not initiated early in patients’ cancer trajectory. As a result, patients’ wishes often remains unknown until the last phase of their life. Evidence suggests that many patients inappropriately receive aggressive treatment near the end of life, which does lead to higher resource utilization, decreased quality of life, and increased cost. Additionally, the novel coronavirus disease 2019 (COVID-19) pandemic challenged the health care systems worldwide and raised important ethical issues, especially regarding the potential need for rationing health care in the context of scarce resources and crisis capacity. The importance of goal concordant care is now even substantially important and is heightened in the context of this pandemic. Problem: Although there is growing evidence on the effects of the ACP on the completion of advanced directives, improved patient and family concordance for preferences for medical care, and receipt of care, there is still a lack of standardized ACP conversation strategies for patients with cancer. Methods: The Key concepts of ACP include (1) assessing patient and family readiness, (2) identifying a surrogate decision maker ( medical power of attorney), (3) exploring patient and family understanding of the disease and treatment options,(4) discussing the values and goals of care, and options for end-of-life care, (5) documenting patient preferences in the medical record, and (6) revisiting the discussions at every change in the treatment plan and /or change in clinical status, including at every hospitalization. Conclusion/Implication for practice: Advance Care Planning (ACP) and end-of-life (EOL) discussions are important for patients, families, and health care providers. Adopting the verbal and nonverbal communication strategies can help overcome the barriers to effective communication on these difficult discussions. ACP with goals of care discussions should not be delayed until the patient is hospitalized.

Keywords: advance care planning, end of life, cancer, global, pandemic

Procedia PDF Downloads 130