Search results for: Physician's health

Authors: Khaireyah Kh. Al-Hamad, V. Nassehi, A. R. Khan

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Air pollution is a major environmental health problem, affecting developed and developing countries around the world. Increasing amounts of potentially harmful gases and particulate matter are being emitted into the atmosphere on a global scale, resulting in damage to human health and the environment. Petroleum-related air pollutants can have a wide variety of adverse environmental impacts. In the crude oil production sectors, there is a strong need for a thorough knowledge of gaseous emissions resulting from the flaring of associated gas of known composition on daily basis through combustion activities under several operating conditions. This can help in the control of gaseous emission from flares and thus in the protection of their immediate and distant surrounding against environmental degradation. The impacts of methane and non-methane hydrocarbons emissions from flaring activities at oil production facilities at Kuwait Oilfields have been assessed through a screening study using records of flaring operations taken at the gas and oil production sites, and by analyzing available meteorological and air quality data measured at stations located near anthropogenic sources. In the present study the Industrial Source Complex (ISCST3) Dispersion Model is used to calculate the ground level concentrations of methane and nonmethane hydrocarbons emitted due to flaring in all over Kuwait Oilfields. The simulation of real hourly air quality in and around oil production facilities in the State of Kuwait for the year 2006, inserting the respective source emission data into the ISCST3 software indicates that the levels of non-methane hydrocarbons from the flaring activities exceed the allowable ambient air standard set by Kuwait EPA. So, there is a strong need to address this acute problem to minimize the impact of methane and non-methane hydrocarbons released from flaring activities over the urban area of Kuwait.

Keywords: Kuwait Oilfields, ISCST3 model, flaring, Airpollution, Methane and Non-methane.

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Authors: D. O. Omondi, M. K. Walingo, G. M. Mbagaya

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Objective: This study explored the possibility of integrating Health Belief Concepts as additional predictors of intention to adopt a recommended diet-category within the Theory of Planned Behavior (TPB). Methods: The study adopted a Sequential Exploratory Mixed Methods approach. Qualitative data were generated on attitude, subjective norm, perceived behavioral control and perceptions on predetermined diet-categories including perceived susceptibility, perceived benefits, perceived severity and cues to action. Synthesis of qualitative data was done using constant comparative approach during phase 1. A survey tool developed from qualitative results was used to collect information on the same concepts across 237 legible Type 2 diabetics. Data analysis included use of Structural Equation Modeling in Analysis of Moment Structures to explore the possibility of including perceived susceptibility, perceived benefits, perceived severity and cues to action as additional intention predictors in a single nested model. Results: Two models-one nested based on the traditional TPB model {χ2=223.3, df = 77, p = .02, χ2/df = 2.9; TLI = .93; CFI =.91; RMSEA (90CI) = .090(.039, .146)} and the newly proposed Planned Behavior Health Belief Model (PBHB) {χ2 = 743.47, df = 301, p = .019; TLI = .90; CFI=.91; RMSEA (90CI) = .079(.031, .14)} passed the goodness of fit tests based on common fit indicators used. Conclusion: The newly developed PBHB Model ranked higher than the traditional TPB model with reference made to chi-square ratios (PBHB: χ2/df = 2.47; p=0.19 against TPB: χ2/df = 2.9, p=0.02). The integrated model can be used to motivate Type 2 diabetics towards healthy eating.

Keywords: Theory, intention, predictors, mixed methods design.

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Authors: Mustafa M. Donma

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Obesity increases the risk of elevated blood pressure, which is a metabolic syndrome (MetS) component. Waist circumference (WC) is accepted as an indispensable parameter for the evaluation of these health problems. The close relationship of height with blood pressure values revealed the necessity of including height in tense indices. The association of tense indices with WC has also become an increasingly important topic. The purpose of this study was to develop a tense index that could contribute to differential diagnosis of MetS more than the indices previously introduced. 194 children, aged 6-11 years, were considered to constitute four groups. The study was performed on normal weight (Group 1), overweight + obese (Group 2), morbid obese [without (Group 3) and with (Group 4) MetS findings] children. Children were included in the groups according to the recommendations of World Health Organization based on age- and gender-dependent body mass index percentiles. For MetS group, MetS components well-established before were considered. Anthropometric measurements as well as blood pressure values were taken. Statistical calculations were performed. 0.05 was accepted as the p value indicating statistical significance. There were no statistically significant differences between the groups for pulse pressure, systolic-to-diastolic pressure ratio and tense index. Increasing values were observed from Group 1 to Group 4 in terms of mean arterial blood pressure and ADTI, which was highly correlated with WC in all groups except Group 1. Both tense index and ADTI exhibited significant correlations with WC in Group 3. However, in Group 4, ADTI, which includes height parameter in the equation, was unique in establishing a strong correlation with WC. In conclusion, ADTI was suggested as a tense index while investigating children with MetS.

Keywords: Blood pressure, metabolic syndrome, waist circumference.

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Authors: Haruo Okabayashi

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Human biological signals (pulse wave and brain wave, etc.) have a rhythm which shows fluctuations. This study investigates the relationship between fluctuations of biological signals which are shown by a finger plethysmogram (i.e., finger pulse wave) in conversation and anthropophobic tendency, and identifies whether the fluctuation could be an index of mental health. 32 college students participated in the experiment. The finger plethysmogram of each subject was measured in the following conversation situations: Fun memory talking/listening situation and regrettable memory talking/ listening situation for three minutes each. Lyspect 3.5 was used to collect the data of the finger plethysmogram. Since Lyspect calculates the Lyapunov spectrum, it is possible to obtain the largest Lyapunov exponent (LLE). LLE is an indicator of the fluctuation and shows the degree to which a measure is going away from close proximity to the track in a dynamical system. Before the finger plethysmogram experiment, each participant took the psychological test questionnaire “Anthropophobic Scale.” The scale measures the social phobia trend close to the consciousness of social phobia. It is revealed that there is a remarkable relationship between the fluctuation of the finger plethysmography and anthropophobic tendency scale in talking about a regrettable story in conversation: The participants (N=15) who have a low anthropophobic tendency show significantly more fluctuation of finger pulse waves than the participants (N=17) who have a high anthropophobic tendency (F (1, 31) =5.66, p<0.05). That is, the participants who have a low anthropophobic tendency make conversation flexibly using large fluctuation of biological signal; on the other hand, the participants who have a high anthropophobic tendency constrain a conversation because of small fluctuation. Therefore, fluctuation is not an error but an important drive to make better relationships with others and go towards the development of interaction. In considering mental health, the fluctuation of biological signals would be an important indicator.

Keywords: Anthropophobic tendency, finger plethymogram, fluctuation of biological signal, LLE.

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Authors: Arsalan Jabbar, Wajiha Javed, Nelofer Mehboob, Zahid Memon

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Introduction: There are multiple social, individual and cultural factors that influence an individual’s decision to adopt family planning methods especially among non-users in patriarchal societies like Pakistan. Non-users, if targeted efficiently, can contribute significantly to country’s CPR. A research study showed that nonusers if convinced to adopt lactational amenorrhea method can shift to long term methods in future. Research shows that if non users are targeted efficiently a 59% reduction in unintended pregnancies in Saharan Africa and South-Central and South-East Asia is anticipated. Methods: We did secondary data analysis on Pakistan Demographic Heath Survey (2012-13) dataset. Use of contraception (never-use/ever-use) was the outcome variable. At univariate level Chi-square/Fisher Exact test was used to assess relationship of baseline covariates with contraception use. Then variables to be incorporated in the model were checked for multicollinearity, confounding and interaction. Then binary logistic regression (with an urban-rural stratification) was done to find relationship between contraception use and baseline demographic and social variables. Results: The multivariate analyses of the study showed that younger women (≤ 29 years)were more prone to be never users as compared to those who were >30 years and this trend was seen in urban areas (AOR 1.92, CI 1.453-2.536) as well as rural areas (AOR 1.809, CI 1.421-2.303). While looking at regional variation, women from urban Sindh (AOR 1.548, CI 1.142-2.099) and urban Balochistan (AOR 2.403, CI 1.504-3.839) had more never users as compared to other urban regions. Women in the rich wealth quintile were more never users and this was seen both in urban and rural localities (urban (AOR 1.106 CI .753-1.624); rural areas (AOR 1.162, CI .887-1.524)) even though these were not statistically significant. Women idealizing more children (>4) are more never users as compared to those idealizing less children in both urban (AOR 1.854, CI 1.275-2.697) and rural areas (AOR 2.101, CI 1.514-2.916). Women who never lost a pregnancy were more inclined to be nonusers in rural areas (AOR 1.394, CI 1.127-1.723) .Women familiar with only traditional or no method had more never users in rural areas (AOR 1.717, CI 1.127-1.723) but in urban areas it wasn’t significant. Women unaware of Lady Health Worker’s presence in their area were more never users especially in rural areas (AOR 1.276, CI 1.014-1.607). Women who did not visit any care provider were more never users (urban (AOR 11.738, CI 9.112-15.121) rural areas (AOR 7.832, CI 6.243-9.826)). Discussion/Conclusion: This study concluded that government, policy makers and private sector family planning programs should focus on the untapped pool of never users (younger women from underserved provinces, in higher wealth quintiles, who desire more children.). We need to make sure to cover catchment areas where there are less LHWs and less providers as ignorance to modern methods and never been visited by an LHW are important determinants of never use. This all is in sync with previous literate from similar developing countries.

Keywords: Contraception, Demographic and Health Survey, Family Planning, Never users.

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Authors: Er, A. C., Rosli, M. H., Asmahani A., Mohamad Naim M. R., Harsuzilawati M.

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Dengue is a mosquito-borne infection that has peaked to an alarming rate in recent decades. It can be found in tropical and sub-tropical climate. In Malaysia, dengue has been declared as one of the national health threat to the public. This study aimed to map the spatial distributions of dengue cases in the district of Hulu Langat, Selangor via a combination of Geographic Information System (GIS) and spatial statistic tools. Data related to dengue was gathered from the various government health agencies. The location of dengue cases was geocoded using a handheld GPS Juno SB Trimble. A total of 197 dengue cases occurring in 2003 were used in this study. Those data then was aggregated into sub-district level and then converted into GIS format. The study also used population or demographic data as well as the boundary of Hulu Langat. To assess the spatial distribution of dengue cases three spatial statistics method (Moran-s I, average nearest neighborhood (ANN) and kernel density estimation) were applied together with spatial analysis in the GIS environment. Those three indices were used to analyze the spatial distribution and average distance of dengue incidence and to locate the hot spot of dengue cases. The results indicated that the dengue cases was clustered (p < 0.01) when analyze using Moran-s I with z scores 5.03. The results from ANN analysis showed that the average nearest neighbor ratio is less than 1 which is 0.518755 (p < 0.0001). From this result, we can expect the dengue cases pattern in Hulu Langat district is exhibiting a cluster pattern. The z-score for dengue incidence within the district is -13.0525 (p < 0.0001). It was also found that the significant spatial autocorrelation of dengue incidences occurs at an average distance of 380.81 meters (p < 0.0001). Several locations especially residential area also had been identified as the hot spots of dengue cases in the district.

Keywords: Dengue, geographic information system (GIS), spatial analysis, spatial statistics

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Authors: Amirali Shirazibeheshti, Tarik Radwan, Alireza Ettefaghian, Farbod Khanizadeh, George Wilson, Cristina Luca

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Anticholinergic medication has been associated with events such as falls, delirium, and cognitive impairment in older patients. To further assess this, anticholinergic burden scores have been developed to quantify risk. A risk model based on clustering was deployed in a healthcare management system to cluster patients into multiple risk groups according to anticholinergic burden scores of multiple medicines prescribed to patients to facilitate clinical decision-making. To do so, anticholinergic burden scores of drugs were extracted from the literature which categorizes the risk on a scale of 1 to 3. Given the patients’ prescription data on the healthcare database, a weighted anticholinergic risk score was derived per patient based on the prescription of multiple anticholinergic drugs. This study was conducted on 300,000 records of patients currently registered with a major regional UK-based healthcare provider. The weighted risk scores were used as inputs to an unsupervised learning algorithm (mean-shift clustering) that groups patients into clusters that represent different levels of anticholinergic risk. This work evaluates the association between the average risk score and measures of socioeconomic status (index of multiple deprivation) and health (index of health and disability). The clustering identifies a group of 15 patients at the highest risk from multiple anticholinergic medication. Our findings show that this group of patients is located within more deprived areas of London compared to the population of other risk groups. Furthermore, the prescription of anticholinergic medicines is more skewed to female than male patients, suggesting that females are more at risk from this kind of multiple medication. The risk may be monitored and controlled in a healthcare management system that is well-equipped with tools implementing appropriate techniques of artificial intelligence.

Keywords: Anticholinergic medication, socioeconomic status, deprivation, clustering, risk analysis.

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Authors: Sabrin M. Al-Jafaeri, Nuri S. Madi, Mohamed H. Nahaisi

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This study was conducted to investigate the incidence of pathogenic bacteria: Salmonella, Shigella, Escherichia coli O157 and Staphylococcus aureus in cakes and tarts collected from thirtyfive confectionery producing and selling premises located within Tripoli city, Libya. The results revealed an incidence of S. aureus with 94.4 and 48.0 %, E. coli O157 with 14.7 and 4.0 % and Salmonella sp. with 5.9 and 8.0 % in cakes and tarts samples respectively; while Shigella was not detected in all samples. In order to determine the source of these pathogenic bacteria, cotton swabs were taken from the hands of workers on the production line, the surfaces of preparation tables and cream whipping instruments. The results showed that the cotton swabs obtained from the hands of workers contained S. aureus and Salmonella sp. with an incidence of 42.9 and 2.9 %, the cotton swabs obtained from the surfaces of preparation tables 22.9 and 2.9 % and the cotton swabs obtained from the cream whipping instruments 14.3 and 0.0 % respectively; while E. coli O157 and Shigella sp. were not detected in all swabs. Additionally, other bacteria were isolated from the hands of workers and the Surfaces of producing equipments included: Aeromonas sp., Pseudomonas sp., E. coli, Klebsiella sp., Enterobacter sp., Citrobacter sp., Proteus sp., Serratia sp. and Acinetobacter sp. These results indicate that some of the cakes and tarts might pose threat to consumer's health. Meanwhile, occurrences of pathogenic bacteria on the hands of those who are working in production line and the surfaces of equipments reflect poor hygienic practices at most confectionery premises examined in this study. Thus, firm and continuous surveillance of these premises is needed to insure the consumer's health and safety.

Keywords: Pathogenic bacteria, Cakes, Tarts, Confectionery producing and selling premises.

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Authors: Ebeed A. Saleh, Kadry M. Sadek, Safaa H. Ghorbal

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Due to the determination of the pollution status of fresh resources in the Egyptian territorial waters is very important for public health; this study was carried out to reveal the levels of heavy metals in the shellfish and their environment and its relation to the highly developed industrial activities in those areas. A total of 100 shellfish samples from the Rosetta, Edku, El-Maadiya, Abo-Kir and El-Max coasts [10 crustaceans (shrimp) and 10 mollusks (oysters)] were randomly collected from each coast. Additionally, 10 samples from both the water and the sediment were collected from each coast. Each collected sample was analyzed for cadmium, chromium, copper, lead and zinc residues using a Perkin Elmer atomic absorption spectrophotometer (AAS). The results showed that the levels of heavy metals were higher in the water and sediment from Abo-Kir. The heavy metal levels decreased successively for the Rosetta, Edku, El-Maadiya, and El-Max coasts, and the concentrations of heavy metals, except copper and zinc, in shellfish exhibited the same pattern. For the concentration of heavy metals in shellfish tissue, the highest was zinc and the concentrations decreased successively for copper, lead, chromium and cadmium for all coasts, except the Abo-Kir coast, where the chromium level was highest and the other metals decreased successively for zinc, copper, lead and cadmium. In Rosetta, chromium was higher only in the mollusks, while the level of this metal was lower in the crustaceans; this trend was observed at the Edku, El-Maadiya and El-Max coasts as well. Herein, we discuss the importance of such contamination for public health and the sources of shellfish contamination with heavy metals. We suggest measures to minimize and prevent these pollutants in the aquatic environment and, furthermore, how to protect humans from excessive intake.

Keywords: Atomic absorption, heavy metals, sediment, shellfish, water.

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Authors: Gerald Amatre, Julius Bunny Lejju, Morgan Andama

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Despite several interventions, jigger flea infestations continue to be reported in the Busoga sub-region in Eastern Uganda. The purpose of this study was to identify factors that expose the indigenous people to jigger flea infestations and evaluate the effectiveness of any indigenous materials used in flea control by the affected communities. Flea compositions in residences were described, factors associated with flea infestation and indigenous materials used in flea control were evaluated. Field surveys were conducted in the affected communities after obtaining preliminary information on jigger infestation from the offices of the District Health Inspectors to identify the affected villages and households. Informed consent was then sought from the local authorities and household heads to conduct the study. Focus group discussions were conducted with key district informants, namely, the District Health Inspectors, District Entomologists and representatives from the District Health Office. A GPS coordinate was taken at central point at every household enrolled. Fleas were trapped inside residences using Kilonzo traps. A Kilonzo Trap comprised a shallow pan, about three centimetres deep, filled to the brim with water. The edges of the pan were smeared with Vaseline to prevent fleas from crawling out. Traps were placed in the evening and checked every morning the following day. The trapped fleas were collected in labelled vials filled with 70% aqueous ethanol and taken to the laboratory for identification. Socio-economic and environmental data were collected. The results indicate that the commonest flea trapped in the residences was the cat flea (Ctenocephalides felis) (50%), followed by Jigger flea (Tunga penetrans) (46%) and rat flea (Xenopsylla Cheopis) (4%), respectively. The average size of residences was seven squire metres with a mean of six occupants. The residences were generally untidy; with loose dusty floors and the brick walls were not plastered. The majority of the jigger affected households were headed by peasants (86.7%) and artisans (13.3%). The household heads mainly stopped at primary school level (80%) and few at secondary school level (20%). The jigger affected households were mainly headed by peasants of low socioeconomic status. The affected community members use soil-cow dung-ash mixture to smear floors of residences as the only measure to control fleas. This method was found to be ineffective in controlling the insects. The study recommends that home improvement campaigns be continued in the affected communities to improve sanitation and hygiene in residences as one of the interventions to combat flea infestations. Other cheap, available and effective means should be identified to curb jigger flea infestations.

Keywords: Cow dung-soil-ash mixture, infestations, Jigger flea, Tunga penetrans.

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Authors: E. Oke, A. O. Ladokun, J. O. Daramola, O. M. Onagbesan

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There has been a growing interest on the effects of access to pasture on poultry health status. However, there is a paucity of data on the relative benefits of grass and legume pastures. An experiment was conducted to determine the effects of rearing systems {deep litter system (DL), deep litter with access to legumes (LP) or grass (GP) pastures} haematology and serum chemistry of ISA Brown layers. The study involved the use of two hundred and forty 12 weeks old pullets. The birds were reared until 60 weeks of age. Eighty birds were assigned to each treatment; each treatment had four replicates of 20 birds each. Blood samples (2.5 ml) were collected from the wing vein of two birds per replicate and serum chemistry and haematological parameters were determined. The results showed that there were no significant differences between treatments in all the parameters considered at 18 weeks of age. At 24 weeks old, the percentage of heterophyl (HET) in DL and LP were similar but higher than that of GP. The ratio of H:L was higher (P<0.05) in DL than those of LP and GP while LP and GP were comparable. At week 38 of age, the percentage of PCV in the birds in LP and GP were similar but the birds in DL had significantly lower level than that of GP. In the early production phase, serum total protein of the birds in LP was similar to that of GP but higher (P<0.05) than that of DL. At the peak production phase (week 38), the total protein in GP and DL were similar but significantly lower than that of LP. The albumin level in LP was greater (P<0.05) than GP but similar to that of DL. In the late production phase, the total protein in LP was significantly higher than that of DL but similar to that of GP. It was concluded that rearing chickens in either grass or legume pasture did not have deleterious effects on the health of laying chickens but improved some parameters including blood protein and HET/lymphocyte.

Keywords: Rearing systems, Stylosanthes, Cynodon serum chemistry, haematology, hen.

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Authors: M. I. Ribah, M. Jibir, Y. A. Bashar, S. S. Manga

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Food safety is a significant and growing public health problem in the world and Nigeria as a developing country, since food-borne diseases are important contributors to the huge burden of sickness and death of humans. In Nigeria, traditional ready-to-eat meat products (RTE-MPs) like balangu, tsire, guru and dried meat products like kilishi, dambun nama, banda, were reported to be highly appreciated because of their eating qualities. The consumption of these products was considered as safe due to the treatments that are usually involved during their production process. However, during processing and handling, the products could be contaminated by pathogens that could cause food poisoning. Therefore, a hazard identification for pathogenic bacteria on some traditional RTE-MPs was conducted in Kebbi and Sokoto States, Nigeria. A total of 116 RTE-MPs (balangu-38, kilishi-39 and tsire-39) samples were obtained from retail outlets and analyzed using standard cultural microbiological procedures in general and selective enrichment media to isolate the target pathogens. A six-fold serial dilution was prepared and using the pour plating method, colonies were counted. Serial dilutions were selected based on the prepared pre-labeled Petri dishes for each sample. A volume of 10-12 ml of molten Nutrient agar cooled to 42-45°C was poured into each Petri dish and 1 ml each from dilutions of 102, 104 and 106 for every sample was respectively poured on a pre-labeled Petri plate after which colonies were counted. The isolated pathogens were identified and confirmed after series of biochemical tests. Frequencies and percentages were used to describe the presence of pathogens. The General Linear Model was used to analyze data on pathogen presence according to RTE-MPs and means were separated using the Tukey test at 0.05 confidence level. Of the 116 RTE-MPs samples collected, 35 (30.17%) samples were found to be contaminated with some tested pathogens. Prevalence results showed that Escherichia coli, salmonella and Staphylococcus aureus were present in the samples. Mean total bacterial count was 23.82×106 cfu/g. The frequency of individual pathogens isolated was; Staphylococcus aureus 18 (15.51%), Escherichia coli 12 (10.34%) and Salmonella 5 (4.31%). Also, among the RTE-MPs tested, the total bacterial counts were found to differ significantly (P < 0.05), with 1.81, 2.41 and 2.9×104 cfu/g for tsire, kilishi, and balangu, respectively. The study concluded that the presence of pathogenic bacteria in balangu could pose grave health risks to consumers, and hence, recommended good manufacturing practices in the production of balangu to improve the products’ safety.

Keywords: Ready-to-eat meat products, retail outlets, safety assessment, public health.

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Authors: Sanvidhan G. Suke

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This article briefly reviews the role of Indian Pharmacopoeia Commission (IPC) for publications of Indian Pharmacopoeia (IP) and National formulary of India (NFI) to some of these anticipated changes, informs constituents about how they can remain updated about progress and upcoming modifications to official texts, and invites participation in the standards-setting process, which are helpful to the practitioners, researchers, educators and policy makers in the field of health care profession.

Keywords: Addendum, Indian Pharmacopoeia, Monograph, National Formulary of India.

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Authors: Yu-Yu Wang, Shih-Hua Hsieh, Ru-Shian Hsieh

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Wishes and choices being respected, and the right to be supported rather than coerced, have been internationally recognized as the human rights of persons with mental illness. In Taiwan, ‘coerced hospitalization’ has become difficult since the revision of the mental health legislation in 2007. Despite trend towards human rights, the real problem families face when their family members are in mental health crisis is the lack of alternative services. This study aims to explore: 1) When is hospitalization seen as the only solution by family members? 2) What are the barriers for arranging hospitalization, and how are they managed? 3) What have family carers learned, in their experiences of caring for their family members with mental illness? To answer these questions, qualitative approach was adopted, and focus group interviews were taken to collect data. This study includes 24 family carers. The main findings of this research include: First, hospital is the last resort for carers in helplessness. Family carers tend to do everything they could to provide care at home for their family members with mental illness. Carers seek hospitalization only when a patient’s behavior is too violent, weird, and/or abnormal, and beyond their ability to manage. Hospitalization, nevertheless, is never an easy choice. Obstacles emanate from the attitudes of the medical doctors, the restricted areas of ambulance service, and insufficient information from the carers’ part. On the other hand, with some professionals’ proactive assistance, access to medical care while in crisis becomes possible. Some family carers obtained help from the medical doctor, nurse, therapist and social workers. Some experienced good help from policemen, taxi drivers, and security guards at the hospital. The difficulty in accessing medical care prompts carers to work harder on assisting their family members with mental illness to stay in stable states. Carers found different ways of helping the ‘person’ to get along with the ‘illness’ and have better quality of life. Taking back ‘the right to control’ in utilizing medication, from passiveness to negotiating with medical doctors and seeking alternative therapies, are seen in many carers’ efforts. Besides, trying to maintain regular activities in daily life and play normal family roles are also experienced as important. Furthermore, talking with the patient as a person is also important. The authors conclude that in order to protect the human rights of persons with mental illness, it is crucial to make the medical care system more flexible and to make the services more humane: sufficient information should be provided and communicated, and efforts should be made to maintain the person’s social roles and to support the family.

Keywords: Family carers, coercive treatment, independent living, mental health crisis, persons with mental illness.

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Authors: Yi-Yun Ko, Der-Ming Liou

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The Electronic Health Record (EHR) system is very general and we should pay more attention to a patient-s privacy. The patient-s consent is one of the elements when dealing with privacy topics. This study focuses on the creating and managing of patient consent. The integration of the HL7 standards and the IHE BPPC profile provides a base for the creation of patient consent. Establishing the platform offers the patients a way to create, revoke or update their consents. Through this platform, they can manage their consents in an easier manner.

Keywords: consent, EHR, HL7, IHE

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Authors: Christina Van Wingerden

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The aim of this paper is to propose pedagogical design for learning management systems (LMS) that offers greater inclusion for students based on a number of theoretical perspectives and delineated through an example. Considering the impact of COVID-19, including on student mental health, the research suggesting the importance of student sense of belonging on retention, success, and student well-being, the author describes intentional LMS design incorporating theoretically based practices informed by critical theory, feminist theory, indigenous theory and practices, and new materiality. This article considers important aspects of these theories and practices which attend to inclusion, identities, and socially just learning environments. Additionally, increasing student sense of belonging and mental health through LMS design influenced by adult learning theory and the community of inquiry model are described.  The process of thinking through LMS pedagogical design with inclusion intentionally in mind affords the opportunity to allow LMS to go beyond course use as a repository of documents, to an intentional community of practice that facilitates belonging and connection, something much needed in our times. In virtual learning environments it has been harder to discern how students are doing, especially in feeling connected to their courses, their faculty, and their student peers. Increasingly at the forefront of public universities is addressing the needs of students with multiple and intersecting identities and the multiplicity of needs and accommodations. Education in 2020, and moving forward, calls for embedding critical theories and inclusive ideals and pedagogies to the ways instructors design and teach in online platforms. Through utilization of critical theoretical frameworks and instructional practices, students may experience the LMS as a welcoming place with intentional plans for welcoming diversity in identities.

Keywords: Belonging, critical pedagogy, instructional design, Learning Management System, LMS.

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Authors: Maria C. Proença, Maria T. Rebelo, Maria J. Alves, Sofia Cunha

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Vector-borne diseases are transmitted to humans by mosquitos, sandflies, bugs, ticks, and other vectors. Some are re-transmitted between vectors, if the infected human has a new contact when his levels of infection are high. The vector is infected for lifetime and can transmit infectious diseases not only between humans but also from animals to humans. Some vector borne diseases are very disabling and globally account for more than one million deaths worldwide. The mosquitoes from the complex Culex pipiens sl. are the most abundant in Portugal, and we dispose in this moment of a data set from the surveillance program that has been carried on since 2006 across the country. All mosquitos’ species are included, but the large coverage of Culex pipiens sl. and its importance for public health make this vector an interesting candidate to assess risk of disease amplification. This work focus on ports and airports identified as key areas of high density of vectors. Mosquitoes being ectothermic organisms, the main factor for vector survival and pathogen development is temperature. Minima and maxima local air temperatures for each area of interest are averaged by month from data gathered on a daily basis at the national network of meteorological stations, and interpolated in a geographic information system (GIS). The range of temperatures ideal for several pathogens are known and this work shows how to use it with the meteorological data in each port and airport facility, to focus an efficient implementation of countermeasures and reduce simultaneously risk transmission and mitigation costs. The results show an increased alert with decreasing latitude, which corresponds to higher minimum and maximum temperatures and a lower amplitude range of the daily temperature.

Keywords: Human health, risk assessment, risk management, vector-borne diseases.

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Authors: K. A. Ghazaryan, H. S. Movsesyan, N. P. Ghazaryan

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The present study was aimed in assessing the heavy metal pollution of the soils around Agarak copper-molybdenum mine complex and related environmental risks. This mine complex is located in the south-east part of Armenia, and the present study was conducted in 2013. The soils of the five riskiest sites of this region were studied: surroundings of the open mine, the sites adjacent to processing plant of Agarak copper-molybdenum mine complex, surroundings of Darazam active tailing dump, the recultivated tailing dump of “ravine - 2”, and the recultivated tailing dump of “ravine - 3”. The mountain cambisol was the main soil type in the study sites. The level of soil contamination by heavy metals was assessed by Contamination factors (Cf), Degree of contamination (Cd), Geoaccumulation index (I-geo) and Enrichment factor (EF). The distribution pattern of trace metals in the soil profile according to Cf, Cd, I-geo and EF values shows that the soil is much polluted. Almost in all studied sites, Cu, Mo, Pb, and Cd were the main polluting heavy metals, and this was conditioned by Agarak copper-molybdenum mine complex activity. It is necessary to state that the pollution problem becomes pressing as some parts of these highly polluted region are inhabited by population, and agriculture is highly developed there; therefore, heavy metals can be transferred into human bodies through food chains and have direct influence on public health. Since the induced pollution can pose serious threats to public health, further investigations on soil and vegetation pollution are recommended. Finally, Cf calculating based on distance from the pollution source and the wind direction can provide more reasonable results.

Keywords: Agarak copper-molybdenum mine complex, heavy metals, soil contamination, enrichment factor, Armenia.

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Authors: Juliana A. Galhardi, Daniel M. Bonotto

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Coal is an important non-renewable energy source of and can be associated with radioactive elements. In Figueira city, Paraná state, Brazil, it was recorded high uranium activity near the coal mine that supplies a local thermoelectric power plant. In this context, the radon activity (Rn-222, produced by the Ra-226 decay in the U-238 natural series) was evaluated in groundwater, river water and effluents produced from the acid mine drainage in the coal reject dumps. The samples were collected in August 2013 and in February 2014 and analyzed at LABIDRO (Laboratory of Isotope and Hydrochemistry), UNESP, Rio Claro city, Brazil, using an alpha spectrometer (AlphaGuard) adjusted to evaluate the mean radon activity concentration in five cycles of 10 minutes. No radon activity concentration above 100 Bq.L-1, which was a previous critic value established by the World Health Organization. The average radon activity concentration in groundwater was higher than in surface water and in effluent samples, possibly due to the accumulation of uranium and radium in the aquifer layers that favors the radon trapping. The lower value in the river waters can indicate dilution and the intermediate value in the effluents may indicate radon absorption in the coal particles of the reject dumps. The results also indicate that the radon activities in the effluents increase with the sample acidification, possibly due to the higher radium leaching and the subsequent radon transport to the drainage flow. The water samples of Laranjinha River and Ribeirão das Pedras stream, which, respectively, supply Figueira city and receive the mining effluent, exhibited higher pH values upstream the mine, reflecting the acid mine drainage discharge. The radionuclides transport indicates the importance of monitoring their activity concentration in natural waters due to the risks that the radioactivity can represent to human health.

Keywords: Radon, radium, acid mine drainage, coal

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Authors: Rhoda M. Darkwah, Patrick B. Cobbinah

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Urban greenery remains the bastion of urban landscape and a key to sustainable development due to its integral connections to the general health and wellbeing of urban residents. However, in an era of rapid urbanisation, recent studies indicate that urban greenery, especially ecologically sensitive areas, in many African cities is becoming increasingly depleted. Given the scale and rate of natural and anthropogenic change, effective management of urban greenery as the ultimate goal of restoring depleting urban landscapes is urgent. This review advocates for an urban resilience model to managing urban greenery.

Keywords: Green spaces, resilience, urbanisation, urban greenery.

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Authors: Erica Cochran Hameen, Bobuchi Ken-Opurum, Shalini Priyadarshini, Berangere Lartigue, Sadhana Anath-Pisipati

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School districts throughout the United States are constantly seeking measures to improve test scores, reduce school absenteeism and improve indoor environmental quality. It is imperative to identify key building investments which will provide the largest benefits to schools in terms of improving the aforementioned factors. This study uses Analysis of Variance (ANOVA) tests to statistically evaluate the impact of a school building’s mechanical and plumbing characteristics on a child’s educational performance. The educational performance is measured via three indicators, i.e. test scores, suspensions, and absenteeism. The study investigated 125 New York City school facilities to determine the potential correlations between 50 mechanical and plumbing variables and the performance indicators. Key findings from the tests revealed that elementary schools with pneumatic systems in “good” condition have 48.8% lower percentages of students scoring at the minimum English Language Arts (ELA) competency level compared with those with no pneumatic system. Additionally, elementary schools with “unit heaters/cabinet heaters” in “good to fair” conditions have 1.1% higher attendance rates compared to schools with no “unit heaters/cabinet heaters” or those in inferior condition. Furthermore, elementary schools with air conditioning have 0.6% higher attendance rates compared to schools with no air conditioning, and those with interior floor drains in “good” condition have 1.8% higher attendance rates compared to schools with interior drains in inferior condition.

Keywords: Academic attendance and performance, mechanical and plumbing systems, schools, student health.

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Authors: R. Bužgová, R. Kozáková, M. Škutová, M. Bar, P. Ressner, P. Bártová

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Introduction: Currently, there has been an increasing concern about the provision of palliative care in non-oncological patients in both professional literature and clinical practice. However, there is not much scientific information on how to provide neurological and palliative care together. The main objective of the project is to create and to verify a concept of neuro-palliative and rehabilitative care for patients with selected neurological diseases in an advanced stage of the disease and also to evaluate bio-psychosocial and spiritual needs of these patients and their caregivers related to the quality of life using created standardized tools. Methodology: Triangulation of research methods (qualitative and quantitative) will be used. A concept of care and assessment tools will be developed by analyzing interviews and focus groups. Qualitative data will be analyzed using grounded theory. The concept of care will be tested in the context of the intervention study. Using quantitative analysis, we will assess the effect of an intervention provided on the saturation of needs, quality of life, and quality of care. A research sample will be made up of the patients with selected neurological diseases (Parkinson´s syndrome, motor neuron disease, multiple sclerosis, Huntington’s disease), together with patients´ family members. Based on the results, educational materials and a certified course for health care professionals will be created. Findings: Based on qualitative data analysis, we will propose the concept of integrated care model combining neurological, rehabilitative and specialist palliative care for patients with selected neurological diseases in different settings of care and services. Patients´ needs related to quality of life will be described by newly created and validated measuring tools before the start of intervention (application of neuro-palliative and palliative approach) and then in the time interval. Conclusion: Based on the results, educational materials and a certified course for doctors and health care professionals will be created.

Keywords: Multidisciplinary approach, neuropalliative care, research, quality of life.

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Authors: Yi-Fan Lin, Peter P. Howley, Frank A. Tuyl

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Quality measurement and reporting systems are used in healthcare internationally. In Australia, the Australian Council on Healthcare Standards records and reports hundreds of clinical indicators (CIs) nationally across the healthcare system. These CIs are measures of performance in the clinical setting, and are used as a screening tool to help assess whether a standard of care is being met. Existing analysis and reporting of these CIs incorporate Bayesian methods to address sampling variation; however, such assessments are retrospective in nature, reporting upon the previous six or twelve months of data. The use of Bayesian methods within statistical process control for monitoring systems is an important pursuit to support more timely decision-making. Our research has developed and assessed a new graphical monitoring tool, similar to a control chart, based on the beta-binomial posterior predictive (BBPP) distribution to facilitate the real-time assessment of health care organizational performance via CIs. The BBPP charts have been compared with the traditional Bernoulli CUSUM (BC) chart by simulation. The more traditional “central” and “highest posterior density” (HPD) interval approaches were each considered to define the limits, and the multiple charts were compared via in-control and out-of-control average run lengths (ARLs), assuming that the parameter representing the underlying CI rate (proportion of cases with an event of interest) required estimation. Preliminary results have identified that the BBPP chart with HPD-based control limits provides better out-of-control run length performance than the central interval-based and BC charts. Further, the BC chart’s performance may be improved by using Bayesian parameter estimation of the underlying CI rate.

Keywords: Average run length, Bernoulli CUSUM chart, beta binomial posterior predictive distribution, clinical indicator, health care organization, highest posterior density interval.

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Authors: Pawel Sowa, Joachim Bargiel

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This paper presents modern solutions of distributed generation in rural communities aiming at the improvement of energy and environmental security, as well as power supply reliability to important customers (e.g. health care, sensitive consumer required continuity). Distributed sources are mainly gas and biogas cogeneration units, as well as wind and photovoltaic sources. Some examples of their applications in a selected Silesian community are given.

Keywords: Energy security, power supply reliability, power engineering, mini energy centers.

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Authors: Maya Rupert, Salima Hassas, Carlos Li, John Sherwood

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Online Communities are an example of sociallyaware, self-organising, complex adaptive computing systems. The multi-agent systems (MAS) paradigm coordinated by self-organisation mechanisms has been used as an effective way for the simulation and modeling of such systems. In this paper, we propose a model for simulating an online health community using a situated multi-agent system approach, governed by the co-evolution of the social and spatial organisations of the agents.

Keywords: multi-agent systems, organizations, online communities.

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Authors: R. Pääkkönen, L. Korpinen

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This study aimed to evaluate parameters influencing well-being and how to maintain well-being as long as possible after retirement. There is contradictory information on the health changes after retirement in Finland. This work is based on interviews, statistics, and literature evaluation of Finland. Most often, balance, multitasking reaction time, and adaptation of vision in dim and darks areas are worsened. Slowing is one characteristic that is difficult to measure properly. The most important is try to determine ways to manage daily activities and symptoms of disease after retirement. Medicine is advancing, problems are often also on the economic side. Information of technical aids is important. It is worth planning a retirement age.

Keywords: Retirement, working, aging, wellness.

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Authors: Zahraa Albasry, Hadeel D. Najim, Anmar Al-Taie

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Background: Hypertension is considered as one of the most important causes of cardiovascular complications and one of the leading causes of worldwide mortality. Identifying the potential risk factors associated with this medical health problem plays an important role in minimizing its incidence and related complications. The objective of this study is to explore the prevalence of receptor sensitivity regarding assess and understand the perception of specific predictive confounding factors on the prevalence of hypertension (HT) among a sample of Iraqi population in Baghdad, Iraq. Materials and Methods: A randomized cross sectional study was carried out on 100 adult subjects during their visit to the outpatient clinic at a certain sector of Baghdad Province, Iraq. Demographic, clinical and health records alongside specific screening and laboratory tests of the participants were collected and analyzed to detect the potential of confounding factors on the prevalence of HT. Results: 63% of the study participants suffered from HT, most of them were female patients (P < 0.005). Patients aged between 41-50 years old significantly suffered from HT than other age groups (63.5%, P < 0.001). 88.9% of the participants were obese (P < 0.001) and 47.6% had diabetes with HT. Positive family history and sedentary lifestyle were significantly higher among all hypertensive groups (P < 0.05). High salt and fatty food intake was significantly found among patients suffered from isolated systolic hypertension (ISHT) (P < 0.05). A significant positive correlation between packed cell volume (PCV) and systolic blood pressure (SBP) (r = 0.353, P = 0.048) found among normotensive participants. Among hypertensive patients, a positive significant correlation found between triglycerides (TG) and both SBP (r = 0.484, P = 0.031) and diastolic blood pressure (DBP) (r = 0.463, P = 0.040), while low density lipoprotein-cholesterol (LDL-c) showed a positive significant correlation with DBP (r = 0.443, P = 0.021). Conclusion: The prevalence of HT among Iraqi populations is of major concern. Further consideration is required to detect the impact of potential risk factors and to minimize blood pressure (BP) elevation and reduce the risk of other cardiovascular complications later in life.

Keywords: Correlation, hypertension, Iraq, risk factors.

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Authors: Tuba Tekin, Nurcan Baglam, Emine Dincer

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This study aimed to examine the effects of nutrition education received by university students on sustainable healthy eating behaviors and adherence to the Mediterranean diet. The 2nd, 3rd, and 4th-grade university students studying at the Faculty of Health Sciences, Nutrition and Dietetics, Midwifery, Nursing, Physical Therapy, and Rehabilitation departments of universities in Turkey were included in the study. Students' adherence to the Mediterranean diet was evaluated using the Mediterranean Diet Adherence Scale, and their sustainable and healthy eating behaviors were evaluated using the Sustainable and Healthy Eating Behaviors Scale. In addition, the body weight and height of the students were measured by the researchers, and the Body Mass Index (BMI) value was calculated. A total of 181 students, 85 of whom were studying in the Department of Nutrition and Dietetics and 96 of whom were educated in other departments, were included in the study; 75.7% of the students in the sample are female, while 24.3% are male. The average body weight of the students was 61.17 ± 10.87 kg, and the average BMI was 22.04 ± 3.40 kg/m2. While the mean score of the Mediterranean Diet Adherence Scale was 6.72 ± 1.84, in the evaluation of adherence to the Mediterranean diet, it was determined that 25.4% of the students had poor adherence and 66.9% needed improvement. When the adherence scores of students who received and did not receive nutrition education were compared, it was discovered that the students who received nutrition education had a higher score (p < 0.05). Students who received nutrition education had a higher total score on the Sustainable and Healthy Eating Behaviors scale (p < 0.05). A moderately positive correlation was found between the Sustainable and Healthy Eating Behaviors scale total score and the Mediterranean Diet Adherence scores (p < 0.05). As a result of the linear regression analysis, it was revealed that a 1-unit increase in the Mediterranean diet adherence score would result in a 1.3-point increase in the total score of the Sustainable and Healthy Eating Behaviors scale. Sustainable and healthy diets are important for improving and developing health and the prevention of diseases. The Mediterranean diet is defined as a sustainable diet model. The findings revealed the relationship between the Mediterranean diet and sustainable nutrition and showed that nutrition education increased knowledge and awareness about sustainable nutrition and increased adherence to the Mediterranean diet. For this reason, courses or seminars on sustainable nutrition can be organized during educational periods.

Keywords: Healthy eating, Mediterranean diet, nutrition education, sustainable nutrition.

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Authors: Saimir Heta, Kers Kapa, Rialda Xhizdari, Ilma Robo

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Despite the existence of different dental specialties, the dentist-patient relationship is unique, in the very fact that the treatment is performed by one doctor and the patient identifies the malpractice presented as part of that doctor's practice; this is in complete contrast to cases of medical treatments where the patient can be presented to a team of doctors, to treat a specific pathology. The rules of dental ethics are almost the same as the rules of medical ethics. The appearance of dental malpractice affects exactly this two-party relationship, created on the basis of professionalism, without deviations in this direction, between the dentist and the patient, but with very narrow individual boundaries, compared to cases of medical malpractice. Malpractice can have different reasons for its appearance, starting from professional negligence, but also from the lack of professional knowledge of the dentist who undertakes the dental treatment. It should always be seen in perspective that we are not talking about the individual - the dentist who goes to work with the intention of harming their patients. Malpractice can also be a consequence of the impossibility, for anatomical or physiological reasons of the tooth under dental treatment, to realize the predetermined dental treatment plan. On the other hand, the dentist himself is an individual who can be affected by health conditions, or have vices that affect the systemic health of the dentist as an individual, which in these conditions can cause malpractice. So, depending on the reason that led to the appearance of malpractice, the method of treatment from a legal point of view also varies, for the dentist who committed the malpractice, evaluating the latter if the malpractice came under the conditions of applying the rules of dental ethics. The deviation from the predetermined dental plan is the minimum sign of malpractice and the latter should not be definitively related only to cases of difficult dental treatments. The identification of the reason for the appearance of malpractice is the initial element, which makes the difference in the way of its treatment, from a legal point of view, and the involvement of the dentist in the assessment of the malpractice committed, must be based on the legislation in force, which must be said to have their specific changes in different states. Malpractice should be referred to, or included in the lectures or in the continuing education of professionals, because it serves as a method of obtaining professional experience in order not to repeat the same thing several times, by different professionals.

Keywords: Dental ethics, malpractice, negligence, legal basis, continuing education, dental treatments.

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Authors: Meghna Maiti, Utpal Roy

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In India, till today, malaria is considered to be one of the significant infectious diseases. Most of the cases regional geographical factors are the principal elements to let the places a unique identity. The incidence and intensity of infectious diseases are quite common and affect different places differently across the nation. The present study aims to identify spatial clusters of hot spots and cold spots of malaria incidence and their seasonal variation during the three periods of 2012-2014, 2015-2017 and 2018-20 in the state of West Bengal in India. As malaria is a vector-borne disease, numbers of positive test results are to be reported by the laboratories to the Department of Health, West Bengal (through the National Vector Borne Disease Control Programme). Data on block-wise monthly malaria positive cases are collected from Health Management Information System (HMIS), Ministry of Health and Family Welfare, Government of India. Moran’s I statistic is performed to assess the spatial autocorrelation of malaria incidence. The spatial statistical analysis mainly Local Indicators of Spatial Autocorrelation (LISA) cluster and Local Geary Cluster are applied to find the spatial clusters of hot spots and cold spots and seasonal variability of malaria incidence over the three periods. The result indicates that the spatial distribution of malaria is clustered during each of the three periods of 2012-2014, 2015-2017 and 2018-20. The analysis shows that in all the cases, high-high clusters are primarily concentrated in the western (Purulia, Paschim Medinipur districts), central (Maldah, Murshidabad districts) and the northern parts (Jalpaiguri, Kochbihar districts) and low-low clusters are found in the lower Gangetic plain (central-south) mainly and northern parts of West Bengal during the stipulated period. Apart from this seasonal variability inter-year variation is also visible. The results from different methods of this study indicate significant variation in the spatial distribution of malaria incidence in West Bengal and high incidence clusters are primarily persistently concentrated over the western part during 2012-2020 along with a strong seasonal pattern with a peak in rainy and autumn. By applying the different techniques in identifying the different degrees of incidence zones of malaria across West Bengal, some specific pockets or malaria hotspots are marked and identified where the incidence rates are quite harmonious over the different periods. From this analysis, it is clear that malaria is not a disease that is distributed uniformly across the state; some specific pockets are more prone to be affected in particular seasons of each year. Disease ecology and spatial patterns must be the factors in explaining the real factors for the higher incidence of this issue within those affected districts. The further study mainly by applying empirical approach is needed for discerning the strong relationship between communicable disease and other associated affecting factors.

Keywords: Malaria, infectious diseases, spatial statistics, spatial autocorrelation, LISA.

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