Search results for: familiar and unfamiliar subjects
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2288

Search results for: familiar and unfamiliar subjects

2258 Evaluation of Joint Contact Forces and Muscle Forces in the Subjects with Non-Specific Low Back Pain

Authors: Mohammad Taghi Karimi, Maryam Hasan Zahraee

Abstract:

Background: Low back pain (LBP) is a common health and socioeconomic problem, especially the chronic one. The joint contact force is an important parameter during walking which increases the incidence of injury and degenerative joint disease. To our best knowledge, there are not enough evidences in literature on the muscular forces and joint contact forces in subjects with low back pain. Purpose: The main hypothesis associated with this research was that joint contact force of L4/L5 of non-specific chronic low back pain subjects was the same as that of normal. Therefore, the aim of this study was to determine the joint contact force difference between non-specific chronic low back pain and normal subjects. Method: This was an experimental-comparative study. 20 normal subjects and 20 non-specific chronic low back pain patients were recruited in this study. Qualysis motion analysis system and a Kistler force plate were used to collect the motions and the force applied on the leg, respectively. OpenSimm software used to determine joint contact force and muscle forces in this study. Some parameters such as force applied on the legs (pelvis), kinematic of hip and pelvic, peaks of muscles, force of trunk musculature and joint contact force of L5/S1 were used for further analysis. Differences between mean values of all data were measured using two-sample t-test among the subjects. Results: The force produced by Semitendinosus, Biceps Femoris, and Adductor muscles were significantly different between low back pain and normal subjects. Moreover, the mean value of breaking component of the force of the knee joint increased significantly in low back pain subjects, besides a significant decrease in mean value of the vertical component of joint reaction force compared to the normal ones. Conclusions: The forces produced by the trunk and pelvic muscles, and joint contact forces differ significantly between low back pain and normal subjects. It seems that those with non-specific chronic low back pain use trunk muscles more than normal subjects to stabilize the pelvic during walking.

Keywords: low back pain, joint contact force, kinetic, muscle force

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2257 Wayfinding Strategies in an Unfamiliar Homogenous Environment

Authors: Ahemd Sameer, Braj Bhushan

Abstract:

The objective of our study was to compare wayfinding strategies to remember route while navigation in an unfamiliar homogenous environment. Two videos developed using free ware Trimble Sketchup© each having nine identical turns (3 right, 3 left, 3 straight) with no distinguishing feature at any turn. Thirt-two male post-graduate students of IIT Kanpur participated in the study. The experiment was conducted in three phases. In the first phase participant generated a list of personally known items to be used as landmarks. In the second phase participant saw the first video and was required to remember the sequence of turns. In the second video participant was required to imagine a landmark from the list generated in the first phase at each turn and associate the turn with it. In both the task the participant was asked to recall the sequence of turns as it appeared in the video. In the third phase, which was 20 minutes after the second phase, participants again recalled the sequence of turns. Results showed that performance in the first condition i.e. without use of landmarks was better than imaginary landmark condition. The difference, however, became significant when the participant were tested again about 30 minutes later though performance was still better in no-landmark condition. The finding is surprising given the past research in memory and is explained in terms of cognitive factors such as mental workload.

Keywords: Wayfinding, Landmark, Homogenous Environment, Memory

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2256 Merits and Demerits of Participation of Fellow Examinee as Subjects in Observed Structured Practical Examination in Physiology

Authors: Mohammad U. A. Khan, Md. D. Hossain

Abstract:

Background: Department of Physiology finds difficulty in managing ‘subjects’ in practical procedure. To avoid this difficulty fellow examinees of other group may be used as subjects. Objective: To find out the merits and demerits of using fellow examinees as subjects in the practical procedure. Method: This cross-sectional descriptive study was conducted in the Department of Physiology, Noakhali Medical College, Bangladesh during May-June’14. Forty-two 1st year undergraduate medical students from a selected public medical college of Bangladesh were enrolled for the study purposively. Consent of students and authority was taken. Eighteen of them were selected as subjects and designated as subject-examinees. Other fellow examinees (non-subject) examined their blood pressure and pulse as part of ‘observed structured practical examination’ (OSPE). The opinion of all examinees regarding the merits and demerits of using fellow examinee as subjects in the practical procedure was recorded. Result: Examinees stated that they could perform their practical procedure without nervousness (24/42, 57.14%), accurately and comfortably (14/42, 33.33%) and subjects were made available without wasting time (2/42, 4.76%). Nineteen students (45.24%) found no disadvantage and 2 (4.76%) felt embracing when the subject was of opposite sex. The subject-examinees narrated that they could learn from the errors done by their fellow examinee (11/18, 61.1%). 75% non-subject examinees expressed their willingness to be subject so that they can learn from their fellows’ error. Conclusion: Using fellow examinees as subjects is beneficial for both the non-subject and subject examinees. Funding sources: Navana, Beximco, Unihealth, Square & Acme Pharma, Bangladesh Ltd.

Keywords: physiology, teaching, practical, OSPE

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2255 Correlation between Diabetic Cataract, HBA1C and Gurakhu, a Clinical Study in Chhattisgarh State

Authors: A. Bhattacharya, Sanjay Gupta, S. H. Bodakhe

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HbA1c is form of the haemoglobin that is used to measure the average plasma glucose concentration over prolonged periods of time. It is formed in a non-enzymatic glycation pathway by hemoglobin's exposure to plasma glucose. In diabetes mellitus, higher amounts of glycated hemoglobin, indicating poorer control of blood glucose levels, have been associated with cardiovascular disease, nephropathy, and retinopathy. Guraku’s basic components are nicotine and jaggery, jaggery is made up of sugarcane so can have a diabetogenic potential which is exacerbated in presence of nicotine. This work had done with the aim to find correlation between Diabetic cataract, HbA1c and Guraku. Subjects were enrolled according to the inclusion and exclusion criteria. In this study total 75 subjects were included. In the study it was found that people consuming Guraku had a high level of HbA1c thus are more prone to the development of diabetic cataract. Male subjects are the more than female subjects. Most of the subjects belong to the lower socioeconomical class and not very educated. It could be concluded that this type of study could be useful in indentifying number of subjects suffering from diabetic cataract whose condition get worse by use of nicotine product like Guraku and preventive measure to be taken in prevention of this type of diabetic complication.

Keywords: diabetic cataract, HbA1c, Guraku, diabetogenic potential

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2254 Effects of Physical Activity on the Association of CETP Gene with HDL Cholesterol Levels in Korean Population

Authors: Jae Woong Sull, Sun Ha Jee

Abstract:

High-density lipoprotein (HDL) cholesterol levels are associated with decreased risk of coronary artery disease. Several genome-wide association studies (GWAS) for HDL cholesterol levels have implicated cholesterol ester transfer protein (CETP) as possibly causal. We tested for the association between single nucleotide polymorphisms (SNPs) in CETP gene and HDL cholesterol levels in Korean population. Subjects were selected from the Korean Metabolic Syndrome Research Initiative study in the Bundang-Gu area. A total of 2,304 individuals from Bundang-Gu were recruited in 2008. Other subjects were selected from the Severance Hospital (N=4,294). SNP rs6499861 in the CETP gene was associated with mean HDL cholesterol levels (effect per allele -2.044 mg/dL, p=7.23×10-7). Subjects with the CG/GG genotype had a 1.46 -fold (range 1.24–1.72-fold) higher risk of having abnormal HDL cholesterol levels (<40 mg/dL) than subjects with the CC genotype. When analyzed by gender, the association of CETP was stronger in women than in men. When analyzed by physical activity behavior, the association with CETP was much stronger in male subjects with low physical activity (OR=1.54, 95% CI: 1.23-1.92, P=0.0001) than in male subjects with high physical activity. This study clearly demonstrates that genetic variants in CETP influence HDL cholesterol levels in Korean adults.

Keywords: CETP, HDL cholesterol, physical activity, polymorphisms

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2253 Anti-lipidemic and Hematinic Potentials of Moringa Oleifera Leaves: A Clinical Trial on Type 2 Diabetic Subjects in a Rural Nigerian Community

Authors: Ifeoma C. Afiaenyi, Elizabeth K. Ngwu, Rufina N. B. Ayogu

Abstract:

Diabetes has crept into the rural areas of Nigeria, causing devastating effects on its sufferers; most of them could not afford diabetic medications. Moringa oleifera has been used extensively in animal models to demonstrate its antilipidaemic and haematinic qualities; however, there is a scarcity of data on the effect of graded levels of Moringa oleifera leaves on the lipid profile and hematological parameters in human diabetic subjects. The study determined the effect of Moringa oleifera leaves on the lipid profile and hematological parameters of type 2 diabetic subjects in Ukehe, a rural Nigerian community. Twenty-four adult male and female diabetic subjects were purposively selected for the study. These subjects were shared into four groups of six subjects each. The diets used in the study were isocaloric. A control group (diabetics, group 1) was fed diets without Moringa oleifera leaves. Experimental groups 2, 3 and 4 received 20g, 40g and 60g of Moringa oleifera leaves daily, respectively, in addition to the diets. The subjects' lipid profile and hematological parameters were measured prior to the feeding trial and at the end of the feeding trial. The feeding trial lasted for fourteen days. The data obtained were analyzed using the computer program Statistical Product for Service Solution (SPSS) for windows version 21. A Paired-samples t-test was used to compare the means of values collected before and after the feeding trial within the groups and significance was accepted at p < 0.05. There was a non-significant (p > 0.05) decrease in the mean total cholesterol of the subjects in groups 1, 2 and 3 after the feeding trial. There was a non-significant (p > 0.05) decrease in the mean triglyceride levels of the subjects in group 1 after the feeding trial. Groups 1 and 3 subjects had a non-significant (p > 0.05) decrease in their mean low-density lipoprotein (LDL) cholesterol after the feeding trial. Groups 1, 2 and 4 had a significant (p < 0.05) increase in their mean high-density lipoprotein (HDL) cholesterol after the feeding trial. A significant (p < 0.05) decrease in the mean hemoglobin level was observed only in group 4 subjects. Similarly, there was a significant (p < 0.05) decrease in the mean packed cell volume of group 4 subjects. It was only in group 4 that a significant (p < 0.05) decrease in the mean white blood cells of the subjects was also observed. The changes observed in the parameters assessed were not dose-dependent. Therefore, a similar study of longer duration and more samples is imperative to authenticate these results.

Keywords: anemia, diabetic subjects, lipid profile, moringa oleifera

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2252 Effect of Oral Administration of “Gadagi” Tea on Superoxide Dismutase Activity in Humans

Authors: A. M. Gadanya, B. A. Ahmad, U. Maigatari

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Effect of oral administration of Gadagi tea on superoxide dismutase activity was assessed on twenty (20) male subjects (aged 21-40years). Ten (10) male non Gadagi tea consumers (aged 20-26 years), were used as control. Blood samples were collected from the subjects and analysed for serum superoxide dismutase activity using R&D Enzyme Linked Immunosorbent Assay method (ELISA). The subjects were grouped into four based on age i.e group I (21-25 years), group II (26-30 years), and also based on duration of the tea consumption, i.e group A (5-9 years) , group B (10-14 years), group C (15-19 years) and group D (20-24 years). The subjects in group I (0.12 U mg-l +0.05), group II (0.11 U mg-l +0.01), group III (0.14 U mg-l +0.08) and group IV (0.17 U mg-l +0.11) showed increased activity of serum superoxide dismutase when compared with the control subjects (0.88 U mg-l +0.02) (P<0.05). There was no statistical significant difference in superoxide dismutase activity within the case groups (P<0.05), based on age and duration of consumption of the tea. Thus, Gadagi tea consumption could increase serum superoxide dismutase activity in humans.

Keywords: “Gadagi” tea, Serum, Superoxide dismutase, Humans.

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2251 A Robotic “Puppet Master” Application to ASD Therapeutic Support

Authors: Sophie Sakka, Rénald Gaboriau

Abstract:

This paper describes a preliminary work aimed at setting a therapeutic support for autistic teenagers using three humanoid robots NAO shared by ASD (Autism Spectrum Disorder) subjects. The studied population had attended successfully a first year program, and were observed with a second year program using the robots. This paper focuses on the content and the effects of the second year program. The approach is based on a master puppet concept: the subjects program the robots, and use them as an extension for communication. Twenty sessions were organized, alternating ten preparatory sessions and ten robotics programming sessions. During the preparatory sessions, the subjects write a story to be played by the robots. During the robot programming sessions, the subjects program the motions to be realized to make the robot tell the story. The program was concluded by a public performance. The experiment involves five ASD teenagers aged 12-15, who had all attended the first year robotics training. As a result, a progress in voluntary and organized communication skills of the five subjects was observed, leading to improvements in social organization, focus, voluntary communication, programming, reading and writing abilities. The changes observed in the subjects general behavior took place in a short time, and could be observed from one robotics session to the next one. The approach allowed the subjects to draw the limits of their body with respect to the environment, and therefore helped them confronting the world with less anxiety.

Keywords: autism spectrum disorder, robot, therapeutic support, rob'autism

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2250 The Comparison of Forward Head Posture Measurements between Dominant and Non-Dominant Sides in Male Football Players and Non-Athletes

Authors: Mohamed Gomaa Mohamed

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Background and purpose: Ideal posture involves a minimal amount of stress or strain on various body segments which are aligned and worked in harmony to protect the body from injury or progressive deformity. One of most common faulty posture encountered in clinical setting is forward head posture (FHP) that was considered one of the main predictors for neck pain. Furthermore, FHP may predispose to thoracic outlet syndrome, temporomandibular joint dysfunction, shoulder pain and headache. The large financial burden related to neck disorders management raises the need to improve the quality of assessment and rehabilitation of FHP. So, the purpose of the study is to compare between measurements of FHP as indicated with craniovertebral (CVA) and gaze angles assessed from dominant and non-dominant sides in football players who extensively use their dominant side and non-athletic subjects. Participants: Twenty-four subjects were divided into 12 football players and 12 non-athletic subjects. Methods: CVA and gaze angles were assessed through photogrammetric method. Photos were taken from dominant and non-dominant sides of the subjects while assuming standing position. Paired t-test was used to assess angles differences between dominant and non-dominant sides of the subjects. Since there were no statistical differences between CVA and gaze angles measured from dominant and non-dominant sides in each group, we pooled data together to become 24 measurements for each group (12 from dominant and 12 from non-dominant). Independent t-test was used to assess angles differences between football players and non-athletic subjects. Results: No significant differences were found between CVA and gaze angles measured from dominant and non-dominant sides of both groups (P>0.05). Also, there were no significant differences between CVA and gaze angles measured from football players and non-athletic subjects (P>0.05). Conclusion: FHP can be assessed from dominant or non-dominant sides interchangeably either in football players or non-athletic subjects. Furthermore, playing football has no impact on measurements of FHP when compared to non-athletic subjects.

Keywords: dominant side, forward head posture, football players, non-dominant side

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2249 Need for E-Learning: An Effective Method in Educating the Persons with Hearing Impairment Using Sign Language

Authors: S. Vijayakumar, S. B. Rathna Kumar, Navnath D Jagadale

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Learning and teaching are the challenges ahead in the education of the students with hearing impairment using sign language (SHISL). Either the students or teachers face difficulties in the process of learning/teaching. Communication is one of the main barriers while teaching SHISL. Further, the courses of study or the subjects are limited to SHISL at least in countries like India. Students with hearing impairment mainly opt for sign language as a communication mode. Subjects like physics, chemistry, advanced mathematics etc. are not available in the curriculum for the SHISL since their content and ideas are complex. In India, exemption for language papers is being given for the students with hearing impairment. It may give opportunity to them to secure secondary/ higher secondary qualifications. It is a known fact that students with hearing impairment are facing difficulty in their future carrier. They secure neither a higher study nor a good employment opportunity. Vocational training in various trades will land them in few jobs with few bucks in pocket. However, not all of them are blessed with higher positions in government or private sectors in competitive fields or where the technical knowledge is required. E learning with sign language instructions can be used for teaching languages and science subjects. Computer Based Instruction (CBI), Computer Based Training (CBT), and Computer Assisted Instruction (CAI) are now part-and-parcel of Modern Education. It will also include signed video clip corresponding to the topic. Learning language subjects will improve the understanding of concepts in different subjects. Learning other science subjects like their hearing counterparts will enable the SHISL to go higher in studies and increase their height to pluck a fruit of the tree of employment.

Keywords: students with hearing impairment using sign language, hearing impairment, language subjects, science subjects, e-learning

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2248 The Conceptual Exploration of Comfort Zone by Using Content Analysis

Authors: Lilla Szabó Hangya, Szilvia Jambori

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The comfort zone is less studied area in the field of psychology. One of the most important definitions is that comfort zone is a psychological state in which things feel familiar to a person with low level of anxiety and stress. But the validity of comfort zone does not confirm till now. The aim of our pilot research is to test which psychological factors could determine how young adults behave during their decision process to stay in one’s comfort zone or to leave it. Every person has a number of comfort zones, so we are not able to measure it directly, only those personality traits which predict if someone leaves his comfort zone easier or harder. In our study at first we wanted to clarify the meaning of comfort zone. 110 young adults (male: 37, female: 73; ages from 18 to 70, average age: 26,6) took part in the study. Beside their demographic datas we asked them what does the comfort zone mean for them. The results showed that the meaning of the comfort zone can be grouped in five dimensions: comfort (49,6 %), leaving it-change (8,1%), ambivalent feelings (10,6%), related to other people (10,6%), pursuit of self-realization (16,8%). Our results demonstrated age related characteristics. For young people at the age of 19 the comfort zone is related to other people, because during adolescents peer relationships become more important. Subjects at the age 20-30 answered that the comfort zone means comfort and stability for them. Their life becomes stable for a while, they are studying or working. But at the age of 25, when they finish university, most of them answered comfort zone means a changing process for them. On the other hand for subjects at the age of 27 the means of the comfort zone is pursuit of self-realization. After that period at the age of 31 when they have families and stable job the stability will also dominant. We saw that the comfort zone has much more meaning besides a pleasant psychological trait. Further we would like to determine which psychological factors relate to comfort zone, and what kind of personality traits could predict leaving or staying in one’s comfort zone. We want to observe the relationship between comfort zone and subjective well-being, life satisfaction self-efficacy or self-esteem.

Keywords: comfort zone, development, personality trait, young adults

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2247 Effects of Flexible Flat Feet on Electromyographic Activity of Erector Spinae and Multifidus

Authors: Abdallah Mohamed Kamel Mohamed Ali, Samah Saad Zahran, Mohamed Hamed Rashad

Abstract:

Background: Flexible flatfoot (FFF) has been considered as a risk factor for several lower limb injuries and mechanical low back pain. This was attributed to the dysfunction of the lumbopelvic-hip complex musculature. Objective: To investigate the influence of FFF on electromyographic activities of erector spinae and multifidus. Methods: A cross-section study was held between an FFF group (20 subjects) and a normal foot group (20 subjects). A surface electromyography was used to assess the electromyographic activity of erector spinae and multifidus. Group differences were assessed by the T-test. Results: There was a significant increase in EMG activities of erector spinae and multifidus in the FFF group compared with the normal group. Conclusion: There is an increase in EMG activities in erector spinae and multifidus in FFF subjects compared with normal subjects.

Keywords: electromyography, flatfoot, low back pain, paraspinal muscles

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2246 Prevalence of Metabolic Syndrome among Adult Obese Type 2 Diabetic Subjects

Authors: Mehwish Azam, Muhammad Imran, Humaira Jabeen, Sumreen Begum, Rashida Qasim

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Background: Metabolic syndrome is a cluster of metabolic risk factors including obesity, glucose intolerance, insulin resistance, dyslipidemia and hypertension. Metabolic syndrome in obese and type 2 diabetic subjects increases the risk of cardiovascular diseases (CVD). Globally, the prevalence of metabolic syndrome ranges from 10%-50% and in Pakistan ranges from 18%-46%. The objective of the present study is to estimate the prevalence of metabolic syndrome (MS) in obese type 2 diabetic subjects by using International Diabetes Federation (IDF) and National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) definitions. Methods: Obese type 2 diabetic subjects and normal healthy subjects of both genders were selected from diabetic clinics and hospitals of various localities of Karachi, Pakistan. The frequency of metabolic syndrome was estimated by the proposed definitions of IDF and NCEP-ATP III. Results: The prevalence of metabolic syndrome using International Diabetes Federation (IDF) definition in obese type 2 diabetic subjects was 85.7%. It is significantly higher (p<0.05) in females (47.1%) as compared to males (38.6%). While, using National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) definition the overall prevalence of metabolic syndrome in obese type 2 diabetic subjects was 75.7%, the prevalence is significantly higher (p<0.05) in females (45.7%) than males (30.0%). Conclusion: It is concluded that, the overall prevalence of metabolic syndrome is increasing significantly in obese type 2 diabetic subjects by using IDF and NCEP–ATP III definitions. Therefore, it is need to initiate the preventive measures by arranging public awareness programmes to highlight the significance of a healthy lifestyle and emphasis should be given to reduce weight, increase physical activity, and increase intake of healthy low-glycemic-index foods.

Keywords: metabolic syndrome, diabetes mellitus, obesity, IDF, NCEP-ATP III

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2245 Encouraging the Development of Scientific Literacy in Early Childhood Institutions: Croatian Experience

Authors: L. Vujičić, Ž. Ivković, Ž. Boneta

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There is a widespread belief in everyday discourse that science subjects (physics, chemistry and biology) are, along with math, the most difficult school subjects in the education of an individual. This assumption is usually justified by the following facts: low GPA in these subjects, the number of pupils who fail these subjects is high in comparison to other subjects, and the number of pupils interested in continuing their studies in the fields with a focus on science subjects is lower compared to non-science-oriented fields. From that perspective, the project: “Could it be different? How do children explore it?” becomes extremely interesting because it is focused on young children and on the introduction of new methods, with aim of arousing interest in scientific literacy development in 10 kindergartens by applying the methodology of an action research, with an ethnographic approach. We define scientific literacy as a process of encouraging and nurturing the research and explorative spirit in children, as well as their natural potential and abilities that represent an object of scientific research: to learn about exploration by conducting exploration. Upon project completion, an evaluation questionnaire was created for the parents of the children who had participated in the project, as well as for those whose children had not been involved in the project. The purpose of the first questionnaire was to examine the level of satisfaction with the project implementation and its outcomes among those parents whose children had been involved in the project (N=142), while the aim of the second questionnaire was to find out how much the parents of the children not involved (N=154) in this activity were interested in this topic.

Keywords: documenting, early childhood education, evaluation questionnaire for parents, scientific literacy development

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2244 Healthcare Workers’ Knowledge and Attitude Toward Telemedicine During the COVID-19 Pandemic: A Global Survey

Authors: Saman Naqvi

Abstract:

Introduction: Telemedicine is the practise of providing remote healthcare to patients via the utilisation of communication technologies. Its application has become increasingly important since the Coronavirus Disease 2019 (COVID-19) pandemic. It is essential to determine the knowledge and attitudes of healthcare professionals concerning its use in order to maximise its application. Purpose: We aim to examine and evaluate the current understanding and perceptions of medical staff toward the use of telemedicine. Methods: In this cross-sectional study, we surveyed 1091 healthcare professionals worldwide. Following an extensive review of the literature, data were gathered using a questionnaire. To depict the participant profile, frequency, percentages, and cumulative percentages were determined. Results: The majority of respondents had either heard of (90.9%), seen (65.3%), or were familiar with (74.6%) how telemedicine is implemented in practice. 72.2% of people were familiar with the tools that could be applied to this technology. Those with a medical degree and experience of under five years were found to be more familiar with telemedicine. Additionally, opinions on providing healthcare remotely were largely favorable, with 80% of respondents stating that it reduced staff burden and 80.6% thinking that it eliminated unnecessary transportation costs. Furthermore, 83% expressed that it saves clinicians' time. However, 20% of participants believed telemedicine adds to staff workload and 40% of healthcare professionals felt it compromises patient privacy and information confidentiality. Conclusion: Despite being a new and developing practice in many countries, telemedicine appears to have a bright future. This is crucial during a pandemic as it provides effective healthcare while maintaining social isolation measures. Moreover, the majority of the participants in this study demonstrated a good understanding and a favorable attitude toward telemedicine.

Keywords: healthcare system, global survey, knowledge, attitude, covid 19, telemedicine

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2243 Variation of Refractive Errors among Right and Left Eyes in Jos, Plateau State, Nigeria

Authors: F. B. Masok, S. S Songdeg, R. R. Dawam

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Vision is an important process for learning and communication as man depends greatly on vision to sense his environment. Prevalence and variation of refractive errors conducted between December 2010 and May 2011 in Jos, revealed that 735 (77.50%) out 950 subjects examined for refractive error had various refractive errors. Myopia was observed in 373 (49.79%) of the subjects, the error in the right eyes was 263 (55.60%) while the error in the left was 210(44.39%). The mean myopic error was found to be -1.54± 3.32. Hyperopia was observed in 385 (40.53%) of the sampled population comprising 203(52.73%) of the right eyes and 182(47.27%). The mean hyperopic error was found to be +1.74± 3.13. Astigmatism accounted for 359 (38.84%) of the subjects, out of which 193(53.76%) were in the right eyes while 168(46.79%) were in the left eyes. Presbyopia was found in 404(42.53%) of the subjects, of this figure, 164(40.59%) were in the right eyes while 240(59.41%) were in left eyes. The number of right eyes and left eyes with refractive errors was observed in some age groups to increase with age and later had its peak within 60 – 69 age groups. This pattern of refractive errors could be attributed to exposure to various forms of light particularly the ultraviolet rays (e.g rays from television and computer screen). There was no remarkable differences between the mean Myopic error and mean Hyperopic error in the right eyes and in the left eyes which suggest the right eye and the left eye are similar.

Keywords: left eye, refractive errors, right eye, variation

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2242 Science Subjects Studied and Relation to Income after University Graduation: An Empirical Analysis in Japan

Authors: Kazuo Nishimura, Junichi Hirata, Tadashi Yagi, Junko Urasaka

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This paper is an investigation of the effect of science education during the high school education how science graduates of universities are appreciated in the labor market in Japan. We conducted a survey utilizing the internet and analyzed the subjects they were good at and their annual income. The results confirm that among science graduates, workers adept at physics tend to have higher incomes compared to workers good at other subjects. Generational analysis based on the curriculum guideline amendments reveals that the generational difference is small among science majors who are good at physics.

Keywords: curriculum, income, physics, science

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2241 Creating a Safe Learning Environment Based on the Experiences and Perceptions of a Millennial Generation

Authors: E. Kempen, M. J. Labuschagne, M. P. Jama

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There is evidence that any learning experience should happen in a safe learning environment as students then will interact, experiment, and construct new knowledge. However, little is known about the specific elements required to create a safe learning environment for the millennial generation, especially in optometry education. This study aimed to identify the specific elements that will contribute to a safe learning environment for the millennial generation of optometry students. Methods: An intrinsic qualitative case study was undertaken with undergraduate students from the Department of Optometry at the University of the Free State, South Africa. An open-ended questionnaire survey was completed after the application of nine different teaching-learning methods based on the experiential learning cycle. A total number of 307 questionnaires were analyzed. Two focus group interviews were also conducted to provide additional data to supplement the data and ensure the triangulation of data. Results: Important elements based on the opinions, feelings, and perceptions of student respondents were analyzed. Students feel safe in an environment with which they are familiar, and when they are familiar with each other, the educators, and the surroundings. Small-group learning also creates a safe and familiar environment. Both these elements create an environment where they feel safe to ask questions. Students value an environment where they are able to learn without influencing their marks or disadvantaging the patients. They enjoy learning from their peers, but also need personal contact with educators. Elements such as consistency and an achievable objective also were also analyzed. Conclusion: The findings suggest that to respond to the real need of this generation of students, insight must be gained in students’ perceptions to identify their needs and the learning environment to optimize learning pedagogies. With the implementation of these personalized elements, optometry students will be able to take responsibility and accountability for their learning.

Keywords: experiences and perceptions, safe learning environment, millennial generation, recommendation for optometry education

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2240 Plasma Electrolytes and Gamma Glutamyl Transpeptidase (GGT) Status in Dementia Subjects in Southern Nigeria

Authors: Salaam Mujeeb, Adeola Segun, Abdullahi Olasunkanmi

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Dementia is becoming a major concern as the world population is increasing and elderly populations are being neglected. Liver and kidney Diseases have been implicated as risk factors in the etiology of Dementia. This study, therefore, evaluates the plasma Gamma Glutamyl Transferase (GGT) activity and plasma Electrolytes in other to find an association between the biomarkers and Dementia. The subjects (38) were age and sex-matched with their corresponding controls and structured questionnaires were used to obtain medical information. Using spectrophotometric and ion selective Electrode techniques respectively, we found and elevated GGT activity in the Dementia Subjects. Remarkably, no association was found between the plasma Electrolytes level and Dementia subjects. It was also observed that severity of Dementia worsens with age. Moreover, the condition of the dementia subjects worsens with reducing weight. Furthermore, the presence of Comorbidity e.g. Hypertension, Obesity, Diabetes and Habits like Smoking, Drugs and Alcohol consumption interferes with Electrolyte balance. Weight loss monitoring and IBM check are advised in Elderly individuals particularly females as they may be inductive of early or future cognitive impairments. Therefore, it might be useful as an early detection tool. Government and society should invest more on the Geriatric population by establishing Old people's home and providing social care services.

Keywords: clinical characteristics, dementia, electrolytes, gamma glutamyl transpeptidase, GGT

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2239 Detection of Arterial Stiffness in Diabetes Using Photoplethysmograph

Authors: Neelamshobha Nirala, R. Periyasamy, Awanish Kumar

Abstract:

Diabetes is a metabolic disorder and with the increase of global prevalence of diabetes, cardiovascular diseases and mortality related to diabetes has also increased. Diabetes causes the increase of arterial stiffness by elusive hormonal and metabolic abnormalities. We used photoplethysmograph (PPG), a simple non-invasive method to study the change in arterial stiffness due to diabetes. Toe PPG signals were taken from 29 diabetic subjects with mean age of (65±8.4) years and 21 non-diabetic subjects of mean age of (49±14) years. Mean duration of diabetes is 12±8 years for diabetic group. Rise-time (RT) and area under rise time (AUR) were calculated from the PPG signal of each subject and Welch’s t-test is used to find the significant difference between two groups. We obtained a significant difference of (p-value) 0.0005 and 0.03 for RT and AUR respectively between diabetic and non-diabetic subjects. Average value of RT and AUR is 0.298±0.003 msec and 14.4±4.2 arbitrary units respectively for diabetic subject compared to 0.277±0.0005 msec and 13.66±2.3 a.u respectively for non-diabetic subjects. In conclusion, this study support that arterial stiffness is increased in diabetes and can be detected early using PPG.

Keywords: area under rise-time, AUR, arterial stiffness, diabetes, photoplethysmograph, PPG, rise-time (RT)

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2238 Screening of Risk Phenotypes among Metabolic Syndrome Subjects in Adult Pakistani Population

Authors: Muhammad Fiaz, Muhammad Saqlain, Abid Mahmood, S. M. Saqlan Naqvi, Rizwan Aziz Qazi, Ghazala Kaukab Raja

Abstract:

Background: Metabolic Syndrome is a clustering of multiple risk factors including central obesity, hypertension, dyslipidemia and hyperglycemia. These risk phenotypes of metabolic syndrome (MetS) prevalent world-wide, Therefore we aimed to identify the frequency of risk phenotypes among metabolic syndrome subjects in local adult Pakistani population. Methods: Screening of subjects visiting out-patient department of medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad was performed to assess the occurrence of risk phenotypes among MetS subjects in Pakistani population. The Metabolic Syndrome was defined based on International Diabetes Federation (IDF) criteria. Anthropometric and biochemical assay results were recorded. Data was analyzed using SPSS software (16.0). Results: Our results showed that dyslipidemia (31.50%) and hyperglycemia (30.50%) was most population specific risk phenotypes of MetS. The results showed the order of association of metabolic risk phenotypes to MetS as follows hyperglycemia>dyslipidemia>obesity >hypertension. Conclusion: The hyperglycemia and dyslipidemia were found be the major risk phenotypes among the MetS subjects and have greater chances of deceloping MetS among Pakistani Population.

Keywords: dyslipidemia, hypertention, metabolic syndrome, obesity

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2237 Developing a Driving Simulator with a Navigation System to Measure Driver Distraction, Workload, Driving Safety and Performance

Authors: Tamer E. Yared

Abstract:

The use of driving simulators has made laboratory testing easier. It has been proven to be valid for testing driving ability by many researchers. One benefit of using driving simulators is keeping the human subjects away from traffic hazards, which drivers usually face in a real driving environment while performing a driving experiment. In this study, a driving simulator was developed with a navigation system using a game development software (Unity 3D) and C-sharp codes to measure and evaluate driving performance, safety, and workload for different driving tasks. The driving simulator hardware included a gaming steering wheel and pedals as well as a monitor to view the driving tasks. Moreover, driver distraction was evaluated by utilizing an eye-tracking system working in conjunction with the driving simulator. Twenty subjects were recruited to evaluate driver distraction, workload, driving safety, and performance, as well as provide their feedback about the driving simulator. The subjects’ feedback was obtained by filling a survey after conducting several driving tasks. The main question of that survey was asking the subjects to compare driving on the driving simulator with real driving. Furthermore, other aspects of the driving simulator were evaluated by the subjects in the survey. The survey revealed that the recruited subjects gave an average score of 7.5 out of 10 to the driving simulator when compared to real driving, where the scores ranged between 6 and 8.5. This study is a preliminary effort that opens the door for more improvements to the driving simulator in terms of hardware and software development, which will contribute significantly to driving ability testing.

Keywords: driver distraction, driving performance, driving safety, driving simulator, driving workload, navigation system

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2236 Lifelong Multiple Victimization among Native and Immigrant Women in Portugal: Prevalence and Emotional (Dis)Adjustment

Authors: Mariana Goncalves, Marlene Matos

Abstract:

Despite the scientific attention that it has received, the research on the victimization of women continues to neglect some factors that may enhance the risk of women to victimization. This study sought to identify the prevalence and the lifelong trajectories of multiply victimized women (childhood, adolescence, and adulthood), the co-occurrence of different types of victimization, the contexts of occurrence and emotional adjustment and resilience. We used a convenience sample of 120 women multiply victimized, including 35 Portuguese natives and 85 immigrant women (e.g., Brazilian, African) who were recruited from support institutions and shelters. The results documented the similarities and differences concerning victimization between these groups and the intersectional factors that may elucidate vulnerability to victimization. There was a high co-occurrence of types of victimization, particularly in adulthood. The victimization reported occurred frequently in different contexts: familiar, workplace and helping institutions. A higher number of victimization experiences was related with more emotional symptomatology, less familiar cohesion and less social resources. The implications of the results are discussed.

Keywords: multiple victimization, lifetime, natives, immigrants, prevalence, emotional adjustment

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2235 Weight Loss and Symptom Improvement in Women with Secondary Lymphedema Using Semaglutide

Authors: Shivani Thakur, Jasmin Dominguez Cervantes, Ahmed Zabiba, Fatima Zabiba, Sandhini Agarwal, Kamalpreet Kaur, Hussein Maatouk, Shae Chand, Omar Madriz, Tiffany Huang, Saloni Bansal

Abstract:

The prevalence of lymphedema in women in rural communities highlights the importance of developing effective treatment and prevention methods. Subjects with secondary lymphedema in California’s Central Valley were surveyed at 6 surgical clinics to assess demographics and symptoms of lymphedema. Additionally, subjects on semaglutide treatment for obesity and/or T2DM were monitored for their diabetes management, weight loss progress, and lymphedema symptoms compared to subjects who were not treated with semaglutide. The subjects were followed for 12 months. Subjects who were treated with semaglutide completed pre-treatment questionnaires and follow-up post-treatment questionnaires at 3, 6, 9, 12 months, along with medical assessment. The untreated subjects completed similar questionnaires. The questionnaires investigated subjective feelings regarding lymphedema symptoms and management using a Likert-scale; quantitative leg measurements were collected, and blood work reviewed at these appointments. Paired difference t-tests, chi-squared tests, and independent sample t-tests were performed. 50 subjects, aged 18-75 years, completed the surveys evaluating secondary lymphedema: 90% female, 69% Hispanic, 45% Spanish speaking, 42% disabled, 57 % employed, 54% income range below 30 thousand dollars, and average BMI of 40. Both treatment and non-treatment groups noted the most common symptoms were leg swelling (x̄=3.2, ▁d= 1.3), leg pain (x̄=3.2, ▁d=1.6 ), loss of daily function (x̄=3, ▁d=1.4 ), and negative body image (x̄=4.4, ▁d=0.54). Subjects in the semaglutide treatment group >3 months of treatment compared to the untreated group demonstrated: 55% subject in the treated group had a 10% weight loss vs 3% in the untreated group (average BMI reduction by 11% vs untreated by 2.5%, p<0.05) and improved subjective feelings about their lymphedema symptoms: leg swelling (x̄=2.4, ▁d=0.45 vs x̄=3.2, ▁d=1.3, p<0.05), leg pain (x̄=2.2, ▁d=0.45 vs x̄= 3.2, ▁d= 1.6, p<0.05), and heaviness (x̄=2.2, ▁d=0.45 vs x̄=3, ▁d=1.56, p<0.05). Improvement in diabetes management was demonstrated by an average of 0.9 % decrease in A1C values compared to untreated 0.1 %, p<0.05. In comparison to untreated subjects, treatment subjects on semaglutide noted 6 cm decrease in the circumference of the leg, knee, calf, and ankle compared to 2 cm in untreated subjects, p<0.05. Semaglutide was shown to significantly improve weight loss, T2DM management, leg circumference, and secondary lymphedema functional, physical and psychosocial symptoms.

Keywords: diabetes, secondary lymphedema, semaglutide, obesity

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2234 Spectral Analysis of Heart Rate Variability for Normal and Preeclamptic Pregnants

Authors: Abdulnasir Hossen, Alaa Barhoum, Deepali Jaju, V. Gowri, L. Al-Kharusi, M. Hassan, K. Al-Hashmi

Abstract:

Preeclampsia is a pregnancy disorder associated with increase in blood pressure and excess amount of protein in the urine. HRV analysis has been used by many researchers to identify preeclamptic pregnancy from normal pregnancy. A study in this regard to identify preeclamptic pregnancy in Oman from normal pregnant was conducted on 40 subjects (20 patients and 20 normal). The subjects were collected from two hospitals in Oman. A Fast Fourier transform (FFT) spectral analysis has shown that patients with preeclamptic pregnancy have a reduction in the power of the HF band and an increase in the power of the LF band of HRV compared with subjects with normal pregnancy. The accuracy of identification obtained was 80%.

Keywords: preelampsia, pregnancy hypertension, normal pregnant, FFT, spectral analysis, HRV

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2233 Walking Progression in Ambulatory Individuals with Spinal Cord Injury Who Daily Walked with a Walking Device

Authors: Makamas Kumprou, Pipatana Amatachaya, Sugalya Amatachaya, Thiwabhorn Thaweewannakij, Preeda Arayawichanon

Abstract:

Many individuals with spinal cord injury (SCI) need an ambulatory assistive device (AAD) to promote their independence and experience of task-specific walking practice. Without a periodic follow-up for their walking progression, however, many individuals may use the same AAD even though up to 66% of them had the potential to progress walking ability. This may distort their optimal ability and increase the possibility of having negative impacts due to the long-lasting used of an AAD. However, these findings were cross-sectionally collected without data confirmation for the benefit or negative impacts of those who changed the types of AAD used. Therefore, this study prospectively assessed the proportion of ambulatory individuals with SCI who were able to progress their walking ability as determined using a type of AAD, and the changes of their functional ability as well as the incidence of falls over 6 months. Twenty-four subjects with SCI who daily walked with an AAD were involved in the study for 2 visits over 6 months. At the first visit (baseline assessments), the subjects were assessed for their spatiotemporal variables (i.e., cadence, step length, stride length, and step symmetry) and walking ability using the 10-meter walk test (10MWT). Then, they were assessed for the possibility of their walking progression as determined using the ability of walking with the least support AAD with no more than contact guarding assist. Those who were capable of changing an AAD were trained for the ability to walk with a new AAD. Thereafter, all subjects were monthly monitored for incidence of fall over 6 months. At the second visit (after 6 months followed-up), subjects were reassessed for their spatiotemporal variables and 10MWT. The findings indicated that, of all 24 subjects, 8 subjects (33.3%) were able to walk with less support AAD than their usual one. The walking cadence, step length symmetry, and walking ability of these subjects improved significantly greater than those who walked with the same AAD (p < 0.05). Among these subjects, one subject (12.5%) reported fell (3 times) during the follow-up period, whereas 5 subjects (31.3%) who walked with the same AAD experienced at least one fall (range 1 – 16 times). The findings indicated that a large proportion of ambulatory individuals with SCI who daily walked with an AAD could progress their walking ability, whereby their walking ability and safety also significantly improved after they walked with an optimal AAD. The findings suggest the need for a periodic follow-up for an appropriate AAD used for these individuals.

Keywords: walking device, walker, crutches, cane, rehabilitation

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2232 Training Hearing Parents in SmiLE Therapy Supports the Maintenance and Generalisation of Deaf Children's Social Communication Skills

Authors: Martina Curtin, Rosalind Herman

Abstract:

Background: Deaf children can experience difficulties with understanding how social interaction works, particularly when communicating with unfamiliar hearing people. Deaf children often struggle with integrating into a mainstream, hearing environments. These negative experiences can lead to social isolation, depression and other mental health difficulties later in life. smiLE Therapy (Schamroth, 2015) is a video-based social communication intervention that aims to teach deaf children skills to confidently communicate with unfamiliar hearing people. Although two previous studies have reported improvements in communication skills immediately post intervention, evidence for maintenance of gains or generalisation of skills (i.e., the transfer of newly learnt skills to untrained situations) has not to date been demonstrated. Parental involvement has been shown to support deaf children’s therapy outcomes. Therefore, this study added parent training to the therapy children received to investigate the benefits to generalisation of children’s skills. Parents were also invited to present their perspective on the training they received. Aims: (1) To assess pupils’ progress from pre- to post-intervention in trained and untrained tasks, (2) to investigate if training parents improved their (a) understanding of their child’s needs and (b) their skills in supporting their child appropriately in smiLE Therapy tasks, (3) to assess if parent training had an impact on the pupil’s ability to (a) maintain their skills in trained tasks post-therapy, and (b) generalise their skills in untrained, community tasks. Methods: This was a mixed-methods, repeated measures study. 31 deaf pupils (aged between 7 and 14) received an hour of smiLE Therapy per week, for 6 weeks. Communication skills were assessed pre-, post- and 3-months post-intervention using the Communication Skills Checklist. Parents were then invited to attend two training sessions and asked to bring a video of their child communicating in a shop or café. These videos were used to assess whether, after parent training, the child was able to generalise their skills to a new situation. Finally, parents attended a focus group to discuss the effectiveness of the therapy, particularly the wider impact, i.e., more child participation within the hearing community. Results: All children significantly improved their scores following smiLE therapy and maintained these skills to high level. Children generalised a high percentage of their newly learnt skills to an untrained situation. Parents reported improved understanding of their child’s needs, their child’s potential and in how to support them in real-life situations. Parents observed that their children were more confident and independent when carrying out communication tasks with unfamiliar hearing people. Parents realised they needed to ‘let go’ and embrace their child’s independence and provide more opportunities for them to participate in their community. Conclusions: This study adds to the evidence base on smiLE Therapy; it is an effective intervention that develops deaf children’s ability to interact competently with unfamiliar, hearing, communication partners. It also provides preliminary evidence of the benefits of parent training in helping children to generalise their skills to other situations. These findings will be of value to therapists wishing to develop deaf children’s communication skills beyond the therapy setting.

Keywords: deaf children, generalisation, parent involvement, social communication

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2231 Prevalence of Malocclusion and Assessment of Orthodontic Treatment Needs in Malay Transfusion-Dependent Thalassemia Patients

Authors: Mohamed H. Kosba, Heba A. Ibrahim, H. Rozita

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Statement of the Problem: The life expectancy for transfusion-dependent thalassemia patients has increased dramatically with iron-chelation therapy and other modern management modalities. In these patients, the most dominant maxillofacial manifestations are protrusion of zygomatic bones and premaxilla due to the hyperplasia of bone marrow. The purpose of this study is to determine the prevalence of malocclusion and orthodontic treatment needs according to the Dental Aesthetic Index (DAI) among Malay transfusion-dependent thalassemia patients. Orientation: This is a cross-sectional study consist of 43 Malay transfusion-dependent thalassemia patients, 22 males, and 19 females with the mean age of 15.9 years old (SD 3.58). The subjects were selected randomly from patients attending Paediatrics and Internal Medicine Clinic at Hospital USM and Hospital Sultana Bahiyah. The subjects were assessed for malocclusion according to Angle’s classification, and orthodontic treatment needs using DAI. The results show that 22 of the subjects (51.1%) have class II malocclusion, 12 subjects (28%) have class І, while 9 subjects (20.9%) have class Ⅲ. The assessment of orthodontic treatment needs to reveal 22 cases (51.1%) fall in the normal/minor needs category, 12 subjects (28%) fall in the severe and very severe category, while 9 subjects (20.9%) fall in the definite category. Conclusion & Significance: Half of Malay transfusion-dependent thalassemia patients have Class Ⅱmalocclusion. About 28% had malocclusion and required orthodontic treatment. This research shows that Malay transfusion-dependent thalassemia may require orthodontic management; earlier intervention to reduce the complexity of the treatment later, suggesting functional appliance as a suitable treatment option for them, a twin block appliance together with headgear to restrict maxillary growth suggested for management. The current protocol implemented by the Malaysian Ministry of Health for the management of these patients seems to be sufficient since the result shows that about 28% require orthodontic treatment need, according to DAI.

Keywords: prevalence, DAI, thalassaemia, angle classification

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2230 Multiscale Entropy Analysis of Electroencephalogram (EEG) of Alcoholic and Control Subjects

Authors: Lal Hussain, Wajid Aziz, Imtiaz Ahmed Awan, Sharjeel Saeed

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Multiscale entropy analysis (MSE) is a useful technique recently developed to quantify the dynamics of physiological signals at different time scales. This study is aimed at investigating the electroencephalogram (EEG) signals to analyze the background activity of alcoholic and control subjects by inspecting various coarse-grained sequences formed at different time scales. EEG recordings of alcoholic and control subjects were taken from the publically available machine learning repository of University of California (UCI) acquired using 64 electrodes. The MSE analysis was performed on the EEG data acquired from all the electrodes of alcoholic and control subjects. Mann-Whitney rank test was used to find significant differences between the groups and result were considered statistically significant for p-values<0.05. The area under receiver operator curve was computed to find the degree separation between the groups. The mean ranks of MSE values at all the times scales for all electrodes were higher control subject as compared to alcoholic subjects. Higher mean ranks represent higher complexity and vice versa. The finding indicated that EEG signals acquired through electrodes C3, C4, F3, F7, F8, O1, O2, P3, T7 showed significant differences between alcoholic and control subjects at time scales 1 to 5. Moreover, all electrodes exhibit significance level at different time scales. Likewise, the highest accuracy and separation was obtained at the central region (C3 and C4), front polar regions (P3, O1, F3, F7, F8 and T8) while other electrodes such asFp1, Fp2, P4 and F4 shows no significant results.

Keywords: electroencephalogram (EEG), multiscale sample entropy (MSE), Mann-Whitney test (MMT), Receiver Operator Curve (ROC), complexity analysis

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2229 Understanding the First Mental Breakdown from the Families’ Perspective Through Metaphors

Authors: Eli Buchbinder

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Introduction. Language is the basis to our experience as human being. We use language in describing our experiences and construct meaning and narratives from experiences. Metaphors are a valuable linguistic tool commonly use. Metaphors link two domains that are ordinarily not related. Metaphors achieve simultaneously multi-level integration: abstract and concrete, rational and imaginative, familiar and the unfamiliar, conscious and preconscious/unconscious. As such, metaphors epistemological and ontological tool that are important in social work in every field and domain. Goals and Methods The presentation’s aim is to validate the value of metaphors through the first psychiatric breakdown is a traumatic for families. The presentation is based on two pooled qualitative studies. The first study focused on 12 spouses: 7 women and 5 men, between the ages of 22 and 57, regarding their experiences and meanings of the first psychiatric hospitalization of their partners diagnosed with affective disorders. The second study focused on 10 parents, between the ages of 47 and 62, regarding their experiences and meanings following their child's first psychotic breakdown during young adulthood. Results Two types of major metaphors evolved from the interviews in farming the trauma of the first mental breakdown. The first mode - orientation (spatial) metaphors, reflect symbolic expression of the loss of a secure base, represented in the physical environment, e.g., describing hospitalization as "falling into an abyss." The second mode- ontological metaphors, reflect how parents and spouses present their traumatic experiences of hospitalization in terms of discrete, powerful and coherent entities, e.g., describing the first hospitalization as "swimming against the tide." The two metaphors modes reflect the embodiment of the unpredictability, being mired in distress, shock, intense pain and the experience the collapse of continuity on the life course and cuts off the experience of control. Conclusions Metaphors are important and powerful guide in assessing individuals and families’ phenomenological reality. As such, metaphors are useful for understanding and orientated therapeutic intervening, in the studies above, with the first psychiatric hospitalization experienced, as well as in others social workers’ interventions.

Keywords: first mental breakdown, metaphors, family perspective, qualitative research

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