Search results for: Health record

Authors: Ahmad Hamidi Mohamed, Jamaluddin Othman, Mashitah Suid, Mohd Zaim Mohd Shukri

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Floods are considered an annual natural disaster in Kelantan. However, the record-setting flood of 2014 was a 'tsunami-like disaster'. A study has been conducted with the objectives to assess the economic impact of the flood to the resident of Dabong area in Kelantan Darul Naim, Malaysia. This area was selected due to the severity during the flood. The impacts of flood on local people were done by conducting structured interviews with the use of questionnaires. The questionnaire was intended to acquire information on losses faced by Dabong residence. Questionnaires covered various areas of inconveniences suffered with respect to health effects, including illnesses suffered, their intensities, duration and their associated costs. Loss of productivity and quality of life was also assessed. Inquiries were made to Government agencies to obtain relevant statistical data regarding the loss due to the flood tragedy. The data collected by giving formal request to the governmental agencies and formal meetings were done. From the study a staggering amount of losses were calculated. This figure comes from losses of property, Farmers/Agriculture, Traders/Business, Health, Insurance and Governmental losses. Flood brings hardship to the people of Dabong and these losses of home will cause inconveniences to the society. The huge amount of economic loss extracted from this study shows that federal and state government of Kelantan need to find out the cause of the major flood in 2014. Fast and effective measures have to be planned and implemented in flood prone area to prevent same tragedy happens in the future.

Keywords: economic impact, flood tragedy, Malaysia, property losses

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Authors: Oktavian Prasetia Wardana, Martono Tri Utomo, Risa Etika, Kartika Darma Handayani, Dina Angelika, Wurry Ayuningtyas

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Background: Critically ill neonates are newborn babies with high-risk factors that potentially cause disability and/or death. Scoring systems for determining the severity of the disease have been widely developed as well as some designs for use in neonates. The SNAPPE-II method, which has been used as a mortality predictor scoring system in several referral centers, was found to be slow in assessing the outcome of critically ill neonates in the Neonatal Intensive Care Unit (NICU). Objective: To analyze the predictive value of MSNS on the outcome of critically ill neonates at the time of arrival up to 24 hours after being admitted to the NICU. Methods: A longitudinal observational analytic study based on medical record data was conducted from January to August 2022. Each sample was recorded from medical record data, including data on gestational age, mode of delivery, APGAR score at birth, resuscitation measures at birth, duration of resuscitation, post-resuscitation ventilation, physical examination at birth (including vital signs and any congenital abnormalities), the results of routine laboratory examinations, as well as the neonatal outcomes. Results: This study involved 105 critically ill neonates who were admitted to the NICU. The outcome of critically ill neonates was 50 (47.6%) neonates died, and 55 (52.4%) neonates lived. There were more males than females (61% vs. 39%). The mean gestational age of the subjects in this study was 33.8 ± 4.28 weeks, with the mean birth weight of the subjects being 1820.31 ± 33.18 g. The mean MSNS score of neonates with a deadly outcome was lower than that of the lived outcome. ROC curve with a cut point MSNS score <10.5 obtained an AUC of 93.5% (95% CI: 88.3-98.6) with a sensitivity value of 84% (95% CI: 80.5-94.9), specificity 80 % (CI 95%: 88.3-98.6), Positive Predictive Value (PPV) 79.2%, Negative Predictive Value (NPV) 84.6%, Risk Ratio (RR) 5.14 with Hosmer & Lemeshow test results p>0.05. Conclusion: The MSNS score has a good predictive value and good calibration of the outcomes of critically ill neonates admitted to the NICU.

Keywords: critically ill neonate, outcome, MSNS, NICU, predictive value

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Authors: Ayorinde B. Ogunremi, Kehinde A. Adewoyin, Adebamwo Adebayo

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Record of radionuclide concentration in an environment is essential to ensure human safety due to exposure to ionizing radiation. This study aimed at assessing the radionuclide concentration and doses from soil samples in the study area. Twenty soil samples were collected and dried in the oven at 110°C to remove the moisture, pulverized, and sieved. 200 g of each of the samples were sealed in cylindrical sample holders; they were left for four weeks to attain secular equilibrium between ²²⁶Ra and its decay daughters, after which the sample was analyzed using gamma-ray spectrometry. After the well-guided procedure for the calibrations, the analysis of the samples was carried out using a well-calibrated NaI (TI) and well-shielded detector coupled to a computer resident quantum MCA2100 R Multichannel analyzer for 36,000 s. The mean activity concentrations of ⁴⁰K, ²²⁶Ra, and ²³²Th obtained were calculated to be 272.37 ± 33.58, 10.97 ± 3.24, 9.39 ± 2.27 Bqkg-1 respectively. The average absorbed dose obtained was 22.10 nGy/h. The radium equivalent activity (Raeq) was estimated to be 43.27 Bq/kg. The activity concentrations (Bq/kg) were below the recommended values, which are 420, 33, and 45 for ⁴⁰K, ²²⁶Ra, and ²³²Th, respectively. Considering the results, we conclude thus, the radiation level within the estate poses no significant health risk on dwellers and workers.

Keywords: absorbed, effective, multichannel, radionuclide

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Authors: Syed Qasim Gilani, Muhammad Umair, Muhammad Noman, Syed Bilawal Shah, Aqib Abbasi, Muhammad Waheed

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Cardiovascular Diseases(CVD's) are the major cause of death in the world. The main reason for these deaths is the unavailability of first aid for heart failure. In many cases, patients die before reaching the hospital. We in this paper are presenting innovative online health service for Cardiac Patients. The proposed online health system has two ends. Users through device developed by us can communicate with their doctor through a mobile application. This interface provides them with first aid.Also by using this service, they have an easy interface with their doctors for attaining medical advice. According to the proposed system, we developed a device called Cardiac Care. Cardiac Care is a portable device which a patient can use at their home for monitoring heart condition. When a patient checks his/her heart condition, Electrocardiogram (ECG), Blood Pressure(BP), Temperature are sent to the central database. The severity of patients condition is checked using Artificial Intelligence Algorithm at the database. If the patient is suffering from the minor problem, our algorithm will suggest a prescription for patients. But if patient's condition is severe, patients record is sent to doctor through the mobile Android application. Doctor after reviewing patients condition suggests next step. If a doctor identifies the patient condition as critical, then the message is sent to the central database for sending an ambulance for the patient. Ambulance starts moving towards patient for bringing him/her to hospital. We have implemented this model at prototype level. This model will be life-saving for millions of people around the globe. According to this proposed model patients will be in contact with their doctors all the time.

Keywords: cardiovascular disease, classification, electrocardiogram, blood pressure

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Authors: Patrik Johansson, Selina Mardh

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The present study proposes a usability test method, Atmosphere, to assess the fitness of components and interaction patterns of design systems. The method covers the user’s perception of the components of the system, the efficiency of the logic of the interaction patterns, perceived ease of use as well as the user’s understanding of the intended outcome of interactions. These aspects are assessed by combining measures of first impression, visual affordance and expectancy. The method was applied to a design system developed for the design of an electronic health record system. The study was conducted involving 15 healthcare personnel. It could be concluded that the Atmosphere method provides tangible data that enable human-computer interaction practitioners to analyze and categorize components and patterns based on perceived usability, success rate of identifying interactive components and success rate of understanding components and interaction patterns intended outcome.

Keywords: atomic design, atmosphere methodology, design system, expectancy testing, first impression testing, usability testing, visual affordance testing

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Authors: A. F. Jaber, E. Dean, M. Liu, J. He, D. Sabata, J. Radel

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Background: Stroke is a serious health care concern and a major cause of disability in the United States. This condition impacts the individual’s functional ability to perform daily activities. Predicting functional performance of people with stroke assists health care professionals in optimizing the delivery of health services to the affected individuals. The purpose of this study was to identify significant predictors of Motor FIM and of Cognitive FIM subscores among individuals with stroke after discharge from inpatient rehabilitation (typically 4-6 weeks after stroke onset). A second purpose is to explore the relation among personal characteristics, health status, and functional performance of daily activities within 2 weeks of stroke onset. Methods: This study used a retrospective chart review to conduct a secondary analysis of data obtained from the Healthcare Enterprise Repository for Ontological Narration (HERON) database. The HERON database integrates de-identified clinical data from seven different regional sources including hospital electronic medical record systems of the University of Kansas Health System. The initial HERON data extract encompassed 1192 records and the final sample consisted of 207 participants who were mostly white (74%) males (55%) with a diagnosis of ischemic stroke (77%). The outcome measures collected from HERON included performance scores on the National Institute of Health Stroke Scale (NIHSS), the Glasgow Coma Scale (GCS), and the Functional Independence Measure (FIM). The data analysis plan included descriptive statistics, Pearson correlation analysis, and Stepwise regression analysis. Results: significant predictors of discharge Motor FIM subscores included age, baseline Motor FIM subscores, discharge NIHSS scores, and comorbid electrolyte disorder (R2 = 0.57, p <0.026). Significant predictors of discharge Cognitive FIM subscores were age, baseline cognitive FIM subscores, client cooperative behavior, comorbid obesity, and the total number of comorbidities (R2 = 0.67, p <0.020). Functional performance on admission was significantly associated with age (p < 0.01), stroke severity (p < 0.01), and length of hospital stay (p < 0.05). Conclusions: our findings show that younger age, good motor and cognitive abilities on admission, mild stroke severity, fewer comorbidities, and positive client attitude all predict favorable functional outcomes after inpatient stroke rehabilitation. This study provides health care professionals with evidence to evaluate predictors of favorable functional outcomes early at stroke rehabilitation, to tailor individualized interventions based on their client’s anticipated prognosis, and to educate clients about the benefits of making lifestyle changes to improve their anticipated rate of functional recovery.

Keywords: functional performance, predictors, stroke, recovery

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Authors: Ntokozo Mthembu

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Access to relevant health indicates people’s likelihood of survival, including craft of indigenous healing and its related practitioners- izinyanga. However, the emergence of a dreaded novel corona virus - COVID-19 that has engulfed almost the whole world has necessitated the need to revisit the state of traditional healers in South Africa. This circumstance tended to expose the reality of social settings in various social structures and related policies including the manner coloniality reveal its ugly head when it comes treatment between western and African based therapeutic practices in this country. In attempting to gain a better understanding of such experiences, primary and secondary sources were consulted when collecting data that perusal of various literature in this instance including face-to-face interviews with traditional healers working on the street of Tshwane Municipality in South Africa. Preliminary findings revealed that the emergence of this deadly virus coincided with the moment when the government agenda was focussed on fulfilment of its promise of addressing the past inequity practices, including the transformation of medical sector. This scenario can be witnessed by the manner in which government and related agencies such as health department keeps on undermining indigenous healing practice irrespective of its historical record in terms of healing profession and fighting various diseases before times of father of medicine, Imhotep. Based on these preliminary findings, it is recommended that the government should hasten the incorporation of African knowledge systems especially medicine to offer alternatives and diverse to assess the underutilised indigenous African therapeutic approach and relevant skills that could be useful in combating ailments such as COVID 19. Perhaps, the plural medical systems should be recognized and related policies are formulated to guarantee mutual respect among citizens and the incorporation of healing practices in South African health sector, Africa and in the broader global community.

Keywords: indigenous healing practice, inyanga, COVID-19, therapeutic, urban, experience

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Authors: O. O. Fola-Matthews, O. O. Soyinka, D. N. Bitalo

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Nigeria is one of the major shark fishing nations in Africa, but its fisheries managers still record catch data in aggregates ‘sharks’ with no species-specific details. This is because most of the shark specimens look identical in morphology, and field identification of some closely related species is tricky. This study uses DNA barcoding as a method to identify shark species from five different landing areas off the Nigerian Coast. 100 dorsal fins were sampled in order to provide a Chondrichthyan sequence that would be matched to reference specimens in a DNA barcode database

Keywords: BOLD, DNA barcoding, nigeria, sharks

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Authors: David Maina Muthegethi

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The Victoria Basin is associated with gateway for migration to Southern part of Africa. Different communities migrated through the region including the Bantus and Nilotic communities that occupy present day Kenya and Tanzania. A distinct culture of dry-stone technology emerged around 15th century current era, a period associated with peopling of the western Kenya region. One of the biggest dry-stone walls enclosure is Thimlich Ohinga archaeological site. The site was constructed around fourteenth century current era. Architectural design was oval shaped stone structures that were around 4 meters and 2 meters in length and width respectively. The main subsistence strategies of the community that was crop faming, pastoralism, fishing, hunting and gathering. This paper attempts to examine gender dynamics of Thimlich Ohinga society. At that end, attempts are made to infer gender roles as manifested in archaeological record. Therefore, the study entails examination of material evidence excavated from the site. Also, ethnoarchaeological study of contemporary Luo community was undertaken in order to make inferences and analogies concerning gender roles of Thimlich Ohinga society. Overall, the study involved examination of cultural materials excavated from Thimlich Ohinga, extensive survey of the site and ethnography of Luo community. In total, an extensive survey and interviews of 20 households was undertaken in South Kanyamkango ward, Migori County in Western Kenya. The key findings point out that Thimlich Ohinga gender identities were expressed in material forms through architecture, usage of spaces, subsistence strategies, dietary patterns and household organization. Also, gender as social identity was dynamic and responsive to diversification of subsistence strategies and intensification of regional trade as documented in contemporary Luo community. The paper reiterates importance of ethnoarchaeological methods in reconstruction of past social organization as manifested in material record.

Keywords: ethnoarchaeological, gender, subsistence patterns, Thimlich Ohinga

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Authors: Zubdahe Noor, Haseeb Athar

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In this article, first a relation for conditional expectation is developed and then is used to characterize a general class of distributions F(x) = 1-e^(-ah(x)) through conditional expectation of difference of pair of generalized order statistics. Some results are reduced for particular cases. In the end, a list of distributions is presented in the form of table that are compatible with the given general class.

Keywords: generalized order statistics, order statistics, record values, conditional expectation, characterization

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Authors: Usama Bin Zubair, Syed Azhar Ali

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Introduction: Depression is emerging as a major public health problem in all parts of the world. Developing countries have a unique socioeconomic structure that affects the lives of its inhabitants in several ways. Going abroad for employment is one of the common social problems which have been faced by young males in developing countries. This included both highly qualified individuals as well as the labor class. Objective: To determine the difference in the presence of depressive symptoms among pregnant women with husbands living abroad and those with husbands living with them in Azad Jammu and Kashmir. Methods: The sample population comprised of pregnant women reporting for an antenatal checkup at Amna hospital Rawalakot. Cases constituted the pregnant women with husbands living abroad while controls were the pregnant women with husbands living with them. Patient health questionnaire-9 (PHQ-9) was used to record the presence and severity of depressive symptoms. Age, gestation, parity, rural or urban origin, education, level of family income, daily contact hours on the telephone or what’s app, previous pregnancy loss or complications, number of years abroad and visits to home per year were associated with the presence of depressive symptoms. Findings: The mean age of the study participants was 29.73 ±5.395 years. Sixty-six had significant depression in the case group, while 14 had in the control group (p-value<0.001). Education and rural background had a significant difference between the case and the control group. Less number of visits per year of the husband was strongly linked with the presence of depressive symptoms among the cases. Conclusion: Pregnant women with husbands abroad were found more prone to develop depressive symptoms as compared to those with husbands living with them. Special attention should be paid to the women whose husband had a lesser number of visits to the country.

Keywords: depression, pregnancy, lack of support, war zone

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Authors: Catelyn Coyle, Helena Kwakwa

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Objective: As novel and better tolerated therapies become available, effective HCV testing and care models become increasingly necessary to not only identify individuals with active infection but also link them to HCV providers for medical evaluation and treatment. Our aim is to describe an effective HCV testing and linkage to care model piloted in a network of five community health centers located in Philadelphia, PA. Methods: In October 2012, National Nursing Centers Consortium piloted a routine opt-out HCV testing model in a network of community health centers, one of which treats HCV, HIV, and co-infected patients. Key aspects of the model were medical assistant initiated testing, the use of laboratory-based reflex test technology, and electronic medical record modifications to prompt, track, report and facilitate payment of test costs. Universal testing on all adult patients was implemented at health centers serving patients at high-risk for HCV. The other sites integrated high-risk based testing, where patients meeting one or more of the CDC testing recommendation risk factors or had a history of homelessness were eligible for HCV testing. Mid-course adjustments included the integration of dual HIV testing, development of a linkage to care coordinator position to facilitate the transition of HIV and/or HCV-positive patients from primary to specialist care, and the transition to universal HCV testing across all testing sites. Results: From October 2012 to June 2015, the health centers performed 7,730 HCV tests and identified 886 (11.5%) patients with a positive HCV-antibody test. Of those with positive HCV-antibody tests, 838 (94.6%) had an HCV-RNA confirmatory test and 590 (70.4%) progressed to current HCV infection (overall prevalence=7.6%); 524 (88.8%) received their RNA-positive test result; 429 (72.7%) were referred to an HCV care specialist and 271 (45.9%) were seen by the HCV care specialist. The best linkage to care results were seen at the test and treat the site, where of the 333 patients were current HCV infection, 175 (52.6%) were seen by an HCV care specialist. Of the patients with active HCV infection, 349 (59.2%) were unaware of their HCV-positive status at the time of diagnosis. Since the integration of dual HCV/HIV testing in September 2013, 9,506 HIV tests were performed, 85 (0.9%) patients had positive HIV tests, 81 (95.3%) received their confirmed HIV test result and 77 (90.6%) were linked to HIV care. Dual HCV/HIV testing increased the number of HCV tests performed by 362 between the 9 months preceding dual testing and first 9 months after dual testing integration, representing a 23.7% increment. Conclusion: Our HCV testing model shows that integrated routine testing and linkage to care is feasible and improved detection and linkage to care in a primary care setting. We found that prevalence of current HCV infection was higher than that seen in locally in Philadelphia and nationwide. Intensive linkage services can increase the number of patients who successfully navigate the HCV treatment cascade. The linkage to care coordinator position is an important position that acts as a trusted intermediary for patients being linked to care.

Keywords: HCV, routine testing, linkage to care, community health centers

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Authors: Mochammad Indra Permana, Andhiani Sharfina Arnellya, Dika Pramita Destiani, Budhi Prihartanto

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Cardiovascular disease is the cause of the highest mortality rates in the world. The number of cardiovascular disease patients is increasing every year. Data obtained from World Health Organization (WHO) that 17,5 million people died from this disease. The condition of cardiovascular diseases such as atrial fibrillation, myocardial infarction, venous thromboembolism, and several other conditions need anticoagulant therapy. Results of the anticoagulant therapy are measured not only by the effectiveness of International Normalized Ratio (INR) value but also by the quality of life of the patients. The purpose of this study was to determine the quality of life of patients on oral anticoagulant therapy in outpatient cardiac department Dr. Hasan Sadikin central general hospital, Bandung, Indonesia. This is a cross-sectional study with collecting data from the quality of life questionnaire and medical record of the patients. The results of this study showed that 28 patients (46,7%) had a good quality of life, 30 patients (50%) had a moderate quality of life, and 2 patients (3,3%) had a poor quality of life with no significant differences in quality of life based on age, gender, diagnosis, and duration of drug use.

Keywords: anticoagulant, cardiovascular diseases, INR, quality of life

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Authors: Lise P. Labéjof, Krisnayne S. Ribeiro, Nicolle P. dos Santos

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An unrecorded experiment of use of the smartphone as a tool for practical classes of histology is presented in this article. Behavior, learning of the students of three science courses at the University were analyzed and compared as well as the mode of teaching of this discipline and the appreciation of the students, using either digital photographs taken by phone or drawings for record microscopic observations, analyze and interpret histological sections of human or animal tissues.

Keywords: cell phone, digital micrographies, learning of sciences, teaching practices

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Authors: Chun-Liang Wu, Kai-Ping Shaw, Cheng-Ping Yu, Wu-Chien Chien, Hsiao-Ting Chen, Shao-Huang Wu

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Objective: This study analyzed three criminal judicial cases. We applied the damage analysis of the two vehicles to verify other evidence, such as dashboard camera records of each accident, reconstruct the scenes, and pursue the truth. Methods: Evidence analysis, the method is to collect evidence and the reason for the results in judicial procedures, then analyze the involved damage evidence to verify other evidence. The collision damage analysis method is to inspect the damage to the vehicles and utilize the principles of tool mark analysis, Newtonian physics, and vehicle structure to understand the relevant factors when the vehicles collide. Results: Case 1: Sedan A turned right at the T junction and collided with Scooter B, which was going straight on the left road. The dashboard camera records showed that the left side of Sedan A’s front bumper collided with the body of Scooter B and rider B. After the analysis of the study, the truth was that the front of the left side of Sedan A impacted the right pedal of Scooter B and the right lower limb of rider B. Case 2: Sedan C collided with Scooter D on the left road at the crossroads. The dashboard camera record showed that the left side of the Sedan C’s front bumper collided with the body of Scooter D and rider D. After the analysis of the study, the truth was that the left side of the Sedan C impacted the left side of the car body and the front wheel of Scooter D and rider D. Case 3: Sedan E collided with Scooter F on the right road at the crossroads. The dashboard camera record showed that the right side of the Sedan E’s front bumper collided with the body of Scooter F and rider F. After the analysis of the study, the truth was that the right side of the front bumper and the right side of the Sedan F impacted the Scooter. Conclusion: The application of collision damage analysis in the reconstruction of a sedan-scooter collision could discover the truth and provide the basis for judicial justice. The cases and methods could be the reference for the road safety policy.

Keywords: evidence analysis, collision damage analysis, accident reconstruction, sedan-scooter collision, dashboard camera records

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Authors: Boitumelo Ditshwane, Zelda Janse van Rensburg, Wanda Jacobs,

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Health literacy is defined as competencies and skills that individuals need to find, comprehend, evaluate, and use to make knowledgeable choices to improve their health and well-being. Low health literacy has been found to affect people’s ability to take care of their own health. Incomprehension of health education and health care instructions due to low health literacy is often due to information given at a level that is above the patient’s level of understanding. The study aimed to test the health literacy levels of South African PHC patients using a previously developed health literacy assessment tool. Determining health literacy levels may assist PHC nurses in providing health education and health care instructions to the patient on the patient’s level of understanding and, therefore, ensuring positive health outcomes for the patient. A health literacy assessment tool, translated into ten official South African languages, was used to quantitatively determine the health literacy levels of 400 PHC patients in five clinics in Gauteng, South Africa. Patients’ health literacy levels were tested in English, and nine other official languages spoken in South Africa and were compared. The results revealed that patients understand information better when given in their preferred language. Giving health education in a language and level that is better understood by the patient may lead to better health outcomes and prevent adverse health. Patients may better understand instructions provided, be more likely to follow the correct route of medication, honor appointments, comply with medication, and thus have better treatment outcomes.

Keywords: health literacy, primary health care, South Africa, patients

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Authors: M. A. Riurean, S. Heijnen, C. A. Knott, J. Makinde, D. Gotti, J. VD. Kamp

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Objectives: The current study is done in preparation for a randomized controlled study investigating the effects of an implicit motor learning protocol implemented using an extension-supporting glove. It will explore different protocols to find out which is preferred when studying motor learn-ing in the chronic stroke population that struggles with hand spasticity. Design: This exploratory study will follow 24 individuals who have a chronic stroke (> 6 months) during their usual care journey. We will record the results of two 9-Hole Peg Tests (9HPT) done during their therapy ses-sions with a physiotherapist or in their home before and after 4 weeks of them wearing an exten-sion-supporting glove used to employ the to-be-studied protocols. The participants will wear the glove 3 times/week for one hour while performing their activities of daily living and record the times they wore it in a diary. Their experience will be monitored through telecommunication once every week. Subjects: Individuals that have had a stroke at least 6 months prior to participation, hand spasticity measured on the modified Ashworth Scale of maximum 3, and finger flexion motor control measured on the Motricity Index of at least 19/33. Exclusion criteria: extreme hemi-neglect. Methods: The participants will be randomly divided into 3 groups: one group using the glove in a pre-set way of decreasing support (implicit motor learning), one group using the glove in a self-controlled way of decreasing support (autonomous motor learning), and the third using the glove with constant support (as control). Before and after the 4-week period, there will be an intake session and a post-assessment session. Analysis: We will compare the results of the two 9HPTs to check whether the protocols were effective. Furthermore, we will compare the results between the three groups to find the preferred one. A qualitative analysis will be run of the experience of participants throughout the 4-week period. Expected results: We expect that the group using the implicit learning protocol will show superior results.

Keywords: implicit learning, hand spasticity, stroke, error minimization, motor task

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Authors: Shu-Hsi Ho

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The problems of aging and number of widowed peers gradually rise in Taiwan. It is worth to concern the related issues for elderly after the death of a spouse. Hence, this study is to examine the impact of spousal death on the surviving spouse’s self-perceived health and mental health for the elderly in Taiwan. A cross section data design and ordered logistic regression models are applied to investigate whether marriage is associated significantly to self-perceived health and mental health for the widowed older Taiwanese. The results indicate that widowed marriage shows significant negative effects on self-perceived health and mental health regardless of widows or widowers. Among them, widows might be more likely to show worse mental health than widowers. The belief confirms that marriage provides effective sources to promote self-perceived health and mental health, particularly for females. In addition, since the social welfare system is not perfect in Taiwan, the findings also suggest that family and social support reveal strongly association with the self-perceived health and mental health for the widows and widowers elderly.

Keywords: logistic regression models, self-perceived health, widow, widower

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Authors: Nevruz Zogu, Shpetim Rezniqi

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In the framework of transformational economic development social pluralism and the free, market health systems operating in the countries of our region are naturally involved in a process of profound change and reform. Health systems actually represent complex ensembles centers and public and private institutions (domestic and foreign), who administer substantial amounts of human, technological, material, financial, information and scientific facts • The goal of health systems is much more than medical care. It includes the promotion, protection, treatment and rehabilitation of health of the population. • Meeting the needs of increasingly diverse broader health services efficient, secure the quality and affordability of their increasing cost of unstoppable, requires the necessary reform of health systems and implementing policies and new management methods, to ensure effectiveness and health benefits as higher population.

Keywords: health, management, economy, finance

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Authors: Wanda Luen-Wun Siu, Xiaowen Zhang

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The COVID-19 pandemic has presented an opportune time for China to deploy its health diplomacy around the world. This paper focused on China’s health diplomacy along the path of its Health Silk Road, with particular emphasis on the Middle East and Europe amid COVID-19. This paper employed a retrospective literature review, analyzed China’s health diplomacy in such regions to cultivate bilateral and multilateral relationships. And findings argued that such health diplomacy is a success, and Beijing has assumed a leadership role in the world’s health governance. This research contributes to the literature in health diplomacy and suggests that amid the ever changing international order, China has exerted great effort in its health diplomacy and established itself as a responsible world power.

Keywords: china’s health silk road, COVID-19, europe, middle east

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Authors: Y. B. Sharma, K. B. Biswas

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This research project examines a 5000 cal yr BP sediment core record to reveal the consequences of human impact and climate variability on the tropical dry forests of the Mahi river basin, western India. To date there has been little research to assess the impact of climate variability and human impact on the vegetation dynamics of this region. There has also been little work to link changes in vegetation cover to documented changes in the basin hydrology over the past 100 years – although it is assumed that the two are closely linked. The key objective of this research project therefore is to understand the driving mechanisms responsible for the abrupt changes in the Mahi river basin as detailed in historical documentation and its impact on water resource management. The Mahi river basin is located in western India (22° 11’-24° 35’ N 72° 46’-74° 52’ E). Mahi river arises in the Malwa Plateau, Madhya Pradesh near Moripara and flows through the uplands and alluvial plain of Rajasthan and Gujarat provinces before draining into the Gulf of Cambay. Palaeoecological procedures (sedimentology, geochemical analysis, C&N isotopes and fossil pollen evidences) have been applied on sedimentary sequences collected from lakes in the Mahi basin. These techniques then facilitate to reconstruct the soil erosion, nutrient cycling, vegetation changes and climatic variability over the last 5000 years. Historical documentation detailing changes in demography, climate and landscape use over the past 100 years in this region will also be collated to compare with the most recent palaeoecological records. The results of the research work provide a detailed record of vegetation change, soil erosion, changes in aridity, and rainfall patterns in the region over the past 5000 years. This research therefore aims to determine the drivers of change and natural variability in the basin. Such information is essential for its current and future management including restoration.

Keywords: human impact, climate variability, vegetation cover, hydrology, water resource management, Mahi river basin, sedimentology, geochemistry, fossil pollen, nutrient cycling, vegetation changes, palaeoecology, aridity, rainfall, drivers of change

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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

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Authors: Aneal Khan, Elleine Allapitan, Desmond Koo, Katherine-Ann Piedalue, Shaneel Pathak, Utkarsh Subnis

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Background: Disease management of metabolic, genetic disorders is long-term and can be cumbersome to patients and caregivers. Patient-Reported Outcome Measures (PROMs) have been a useful tool in capturing patient perspectives to help enhance treatment compliance and engagement with health care providers, reduce utilization of emergency services, and increase satisfaction with their treatment choices. Currently, however, PROMs are collected during infrequent and decontextualized clinic visits, which makes translation of patient experiences challenging over time. The GRIT study aims to evaluate a digital health journal application called Zamplo that provides a personalized health diary to record self-reported health outcomes accurately and efficiently in patients with metabolic, genetic disorders. Methods: This is a randomized controlled trial (RCT) (1:1) that assesses the efficacy of Zamplo to increase patient activation (primary outcome), improve healthcare satisfaction and confidence to manage medications (secondary outcomes), and reduce costs to the healthcare system (exploratory). Using standardized online surveys, assessments will be collected at baseline, 1 month, 3 months, 6 months, and 12 months. Outcomes will be compared between patients who were given access to the application versus those with no access. Results: Seventy-seven patients were recruited as of November 30, 2021. Recruitment for the study commenced in November 2020 with a target of n=150 patients. The accrual rate was 50% from those eligible and invited for the study, with the majority of patients having Fabry disease (n=48) and the remaining having Pompe disease and mitochondrial disease. Real-time clinical responses, such as pain, are being measured and correlated to disease-modifying therapies, supportive treatments like pain medications, and lifestyle interventions. Engagement with the application, along with compliance metrics of surveys and journal entries, are being analyzed. An interim analysis of the engagement data along with preliminary findings from this pilot RCT, and qualitative patient feedback will be presented. Conclusions: The digital self-care journal provides a unique approach to disease management, allowing patients direct access to their progress and actively participating in their care. Findings from the study can help serve the virtual care needs of patients with metabolic, genetic disorders in North America and the world over.

Keywords: eHealth, mobile health, rare disease, patient outcomes, quality of life (QoL), pain, Fabry disease, Pompe disease

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Authors: Ha Hai Duong, Amnon Levy Livermore, Kankesu Jayanthakumaran, Oleg Yerokhin

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The issues of economic development, the environment and human health have been investigated since 1990s. Previous researchers have found different empirical evidences of the relationship between income and environmental pollution, health as determinant of economic growth, and the effects of income and environmental pollution on health in various regions of the world. This paper concentrates on integrative relationship analysis of GDP, carbon dioxide emissions, and health services and population health in context of Vietnam. We applied the dynamic generalized method of moments (GMM) estimation on datasets of Vietnam’s sixty-three provinces for the years 2000-2010. Our results show the significant positive effect of GDP on emissions and the dependence of population health on emissions and health services. We find the significant relationship between population health and GDP. Additionally, health services are significantly affected by population health and GDP. Finally, the population size too is other important determinant of both emissions and GDP.

Keywords: economic development, emissions, environmental pollution, health

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Authors: Wanda Luen-Wun Siu, Xiaowen Zhang

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The outbreak of the COVID-19 epidemic has caused great difficulties for South-South cooperation, but there are also opportunities. China’s health diplomacy has changed from dispatching medical teams, assisting in the construction of hospitals, and encouraging medical investment in the Africa health sector. This paper adopted a retrospective review of China’s health diplomacy in Africa from 1963 to 2020. Findings suggested that China has a preference for aiding Africa health infrastructure and sending medical teams to African countries. China’s health diplomacy in Africa is a success and has established secure diplomatic relations with African countries, thanks to the medical and health assistance to Africa over 60 years. This research contributes to the literature of health diplomacy and foreign relations and indicates that China’s health aid has fostered cooperation at the medical and diplomatic levels.

Keywords: Africa, china’s health diplomacy, COVID-19, bilateral relations

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Authors: Petcharat  Kerdonfag, Surasak Taneepanichskul, Winai Wadwongtham

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Industrial noise is usually considered as the main impact of the environmental health and safety because its exposure can cause permanently serious hearing damage. Despite providing strictly hearing protection standards and campaigning extensively encouraging public health awareness among industrial workers in Thailand, hazard noise-induced hearing loss has dramatically been massive obstacles for workers’ health. The aims of the study were to explore and specify the hearing threshold levels among steel industrial workers responsible in which higher noise levels of work zone and to examine the relationships of hearing loss and workers’ age and the length of employment in Samut Prakan province, Thailand. Cross-sectional study design was done. Ninety-three steel industrial workers in the designated zone of higher noise (> 85dBA) with more than 1 year of employment from two factories by simple random sampling and available to participate in were assessed by the audiometric screening at regional Samut Prakan hospital. Data of doing screening were collected from October to December, 2016 by the occupational medicine physician and a qualified occupational nurse. All participants were examined by the same examiners for the validity. An Audiometric testing was performed at least 14 hours after the last noise exposure from the workplace. Workers’ age and the length of employment were gathered by the developed occupational record form. Results: The range of workers’ age was from 23 to 59 years, (Mean = 41.67, SD = 9.69) and the length of employment was from 1 to 39 years, (Mean = 13.99, SD = 9.88). Fifty three (60.0%) out of all participants have been exposing to the hazard of noise in the workplace for more than 10 years. Twenty-three (24.7%) of them have been exposing to the hazard of noise less than or equal to 5 years. Seventeen (18.3%) of them have been exposing to the hazard of noise for 5 to 10 years. Using the cut point of less than or equal to 25 dBA of hearing thresholds, the average means of hearing thresholds for participants at 4, 6, and 8 kHz were 31.34, 29.62, and 25.64 dB, respectively for the right ear and 40.15, 32.20, and 25.48 dB for the left ear, respectively. The more developing age of workers in the work zone with hazard of noise, the more the hearing thresholds would be increasing at frequencies of 4, 6, and 8 kHz (p =.012, p =.026, p =.024) for the right ear, respectively and for the left ear only at the frequency 4 kHz (p =.009). Conclusion: The participants’ age in the hazard of noise work zone was significantly associated with the hearing loss in different levels while the length of participants’ employment was not significantly associated with the hearing loss. Thus hearing threshold levels among industrial workers would be regularly assessed and needed to be protected at the beginning of working.

Keywords: hearing threshold levels, hazard of noise, hearing loss, audiometric testing

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Authors: Sharmila Dahal Paudel

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Background: There are around twenty-four thousand to twenty-eight thousand Female Sex Workers in Nepal. FSWs are the vulnerable groups for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) infections which directly and indirectly ease to reduce the quality of life of such groups. Due to their highly marginalized status, FSWs in Nepal have limited access to information about reproductive health and safe sex practices. The objectives of the study are to assess the quality of life of female sex workers and the factors affecting them. Materials and Methods: A descriptive cross-sectional study with methodological triangulation was conducted among 108 FSWs on the basis of service record of selected organization of Pokhara valley. The complete enumerative sampling was used to select FSWs. Structured interview schedule, WHOQOL-BREF and in-depth questionnaire were used to collect the data. The descriptive and inferential statistics were used to interpret the result. Results: The mean age of participants were 23.44 years and the mean quality of life score was 174.06 ranging from 56.54 to 370.78. Among the domain scores, the mean score is highest in social domain (55.89) followed by physical (45.42), psychological (39.27) and the environmental (34.23). Regarding the association of QOL with socio-demographic, occupation and health-related variables, the multi-linear regression suggests that the satisfaction with occupation was highly significant with the total QOL score (B=-50.50, SE=10.46; p= <0.001) and there is negative relation between QOL and feeling of exploitation and facing STI problems. This means those who feels exploited have significantly less QOL comparing with those who did not feel the same. In correlation analysis, all the domains are positively co-related with each domain which is found to be significant at 1% level of significance. Conclusion: The highest mean score was in social domain, and the lowest is in environmental domain which suggests that the items included in environmental domains could not be utilized or hindrance were there.

Keywords: FSWs, HIV, QOL, WHOQOL-BREF

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Authors: Sandra Thompson, Paul Dervan

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Ireland’s first Technological University (TU Dublin) was established on 1st January 2019, and its creation is an exciting new milestone in Irish Higher Education. TU Dublin is now Ireland’s biggest University supporting 29,000 students across three campuses with 3,500 staff. The University aspires to create work-ready graduates who are socially responsible, open-minded global thinkers who are ambitious to change the world for the better. As graduates, they will be enterprising and daring in all their endeavors, ready to play their part in transforming the future. Feedback from Irish employers and students coupled with evidence from other authoritative sources such as the World Economic Forum points to a need for greater focus on the development of students’ employability skills as they prepare for today’s work environment. Moreover, with an increased focus on Universal Design for Learning (UDL) and inclusiveness, there is recognition that students are more than a numeric grade value. Robust grading systems have been developed to track a student’s performance around discipline knowledge but there is little or no global consensus on a definition of transversal skills nor on a unified framework to assess transversal skills. Education and industry sectors are often assessing one or two skills, and some are developing their own frameworks to capture the learner’s achievement in this area. Technological University Dublin (TU Dublin) have discovered and implemented a framework to allow students to develop, assess and record their transversal skills using transformative learning theory. The model implemented is an adaptation of Student Transformative Learning Record - STLR which originated in the University of Central Oklahoma (UCO). The purpose of this paper therefore, is to examine the views of students, staff and employers in the context of deploying a Transformative Learning model within the University to assess transversal skills. It will examine the initial impact the transformative learning model is having socially, personally and on the University as an organization. Crucially also, to identify lessons learned from the deployment in order to assist other Universities and Higher Education Institutes who may be considering a focused adoption of Transformative Learning to meet the challenge of preparing students for today’s work environment.

Keywords: assessing transversal skills, higher education, transformative learning, students

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Authors: Ladislas Havugimana, Véronique Zinnen, Mary Hadley, Jean Claude Mwumvaneza, Francois Régis Habarugira, Silas Rudasingwa, Victor Ndaruhutse, Evelyne Bocquet

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Rwanda's health systems face various challenges, including low health infrastructure coverage (the objective is to have at least one health center per administrative sector) and insufficient qualified human resources for infrastructure maintenance and financing. Moreover, there is no policy for the preventive maintenance of infrastructures for the health sector. This paper presents action research conducted in seven districts, focusing on the impact of health infrastructure's quality on maternal and neonatal care, with the support of the Belgian cooperation agency through Enable Barame project.

Keywords: health infrastructure, maintenance, maternity, neonatology

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Authors: Ahmed Hamzi, Bryan Norman

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Having scribes help document patient records in electronic health record systems can improve hospitalists’ productivity. But hospitals need to determine the optimum number of scribes to hire to maximize scribe cost effectiveness. Scribe attendance uncertainty due to planned and unplanned absences is a primary challenge. This paper presents simulation and analytical models to determine the optimum number of scribes for a hospital to hire. Scribe staffing practices vary from one context to another; different staffing scenarios are considered where having extra attending scribes provides or does not provide additional value and utilizing on-call scribes to fill in for potentially absent scribes. These staffing scenarios are assessed for different scribe revenue ratios (ratio of the value of the scribe relative to scribe costs) ranging from 100% to 300%. The optimum solution depends on the absenteeism rate, revenue ratio, and desired service level. The analytical model obtains solutions easier and faster than the simulation model, but the simulation model is more accurate. Therefore, the analytical model’s solutions are compared with the simulation model’s solutions regarding both the number of scribes hired and cost-effectiveness. Additionally, an Excel tool has been developed to facilitate decision-makers in easily obtaining solutions using the analytical model.

Keywords: hospitalists, workload, optimization cost, economic analysis

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