Search results for: health risks.

Authors: W. Kongnoo, J. Loysongkroa, S. Chotivichien, N. Viriyautsahakul, N. Saiwongse

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Obesity, stunting and wasting problems among Thai school-aged children are increasing due to inappropriate food consumption behavior and poor environments for desirable nutritional behavior. Because of a low school lunch budget of only 0.40 USD per person per day, food quality is not up to nutritional standards. Therefore, the Health Department with the Education Ministry and the Thai Health Promotion Foundation have developed a quality school lunch project during 2009–2013. The program objectives were development and management of public policy to increase school lunch budget. The methods used a healthy public policy motivation process and movement in 241 local administrative organizations and 538 schools. The problem and solution research was organized to study school food and nutrition management, create a best practice policy mobilization model and hold a public hearing to motivate an increase of school meal funding. The results showed that local public policy has been motivated during 2009-2011 to increase school meal budget using local budgets. School children with best food consumption behavior and exercise increased from 13.2% in 2009 to 51.6% in 2013 and stunting decreased from 6.0% in 2009 to 4.7% in 2013. As the result of national policy motivation (2012-2013), the cabinet meeting on October 22, 2013 has approved an increase of school lunch budget from 0.40 USD to 0.62 USD per person per day. Thus, 5,800,469 school children nationwide have benefited from the budget increase.

Keywords: Public policy, Quality school lunch, Thailand.

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Authors: Saeed Rezaeian, M. Rezaee Boroon

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Nitrogen accumulates in soils during the process of fertilizer addition to promote the plant growth. When the organic matter decomposes, the form of available nitrogen produced is in the form of nitrate, which is highly mobile. The most significant health effect of nitrate ingestion is methemoglobinemia in infants under six months of age (blue baby syndrome). The mobile nutrients, like nitrate nitrogen, are not stored in the soil as the available forms for the long periods and in large amounts. It depends on the needs for the crops such as vegetables. On the other hand, the vegetables will compete actively for nitrate nitrogen as a mobile nutrient and water. The mobile nutrients must be shared. The fewer the plants, the larger this share is for each plant. Also, this nitrate nitrogen is poisonous for the people who use these vegetables. Nitrate is converted to nitrite by the existing bacteria in the stomach and the Gastro-Intestinal (GI) tract. When nitrite is entered into the blood cells, it converts the hemoglobin to methemoglobin, which causes the anoxemia and cyanosis. The increasing use of pesticides and chemical fertilizers, especially the fertilizers with nitrates compounds, which have been common for the increased production of agricultural crops, has caused the nitrate pollution in the (soil, water, and environment). They have caused a lot of damage to humans and animals. In this research, the nitrate accumulation in different kind of vegetables such as; green pepper, tomatoes, egg plants, watermelon, cucumber, and red pepper were observed in the suburbs of Mashhad, Neisabour, and Sabzevar cities. In some of these cities, the information forms of agronomical practices collected were such as; different vegetable crops fertilizer recommendations, varieties, pesticides, irrigation schedules, etc., which were filled out by some of our colleagues in the research areas mentioned above. Analysis of the samples was sent to the soil and water laboratory in our department in Mashhad. The final results from the chemical analysis of samples showed that the mean levels of nitrates from the samples of the fruit crops in the mentioned cities above were all lower than the critical levels. These fruit crop samples were in the order of: 35.91, 8.47, 24.81, 6.03, 46.43, 2.06 mg/kg dry matter, for the following crops such as; tomato, cucumber, eggplant, watermelon, green pepper, and red pepper. Even though, this study was conducted with limited samples and by considering the mean levels, the use of these crops from the nutritional point of view will not cause the poisoning of humans.

Keywords: Environmental pollution, human health, nitrate accumulations, nitrate fertilizers.

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Authors: Atul Khurana, Rajul Rastogi, Hans-Joachim Gamperl

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The pharmaceutical companies are getting more inclined towards patient support programs (PSPs) which assist patients and/or healthcare professionals (HCPs) in more desirable disease management and cost-effective treatment. The utmost objective of these programs is patient care. The PSPs may include financial assistance to patients, medicine compliance programs, access to HCPs via phone or online chat centers, etc. The PSP has a crucial role in terms of customer acquisition and retention strategies. During the conduct of these programs, Marketing Authorisation Holder (MAH) may receive information related to concerned medicinal products, which is usually reported by patients or involved HCPs. This information may include suspected adverse reaction(s) during/after administration of medicinal products. Hence, the MAH should design PSP to comply with regulatory reporting requirements and avoid non-compliance during PV inspection. The emergence of wireless health devices is lowering the burden on patients to manually incorporate safety data, and building a significant option for patients to observe major swings in reference to drug safety. Therefore, to enhance the adoption of these programs, MAH not only needs to aware patients about advantages of the program, but also recognizes the importance of time of patients and commitments made in a constructive manner. It is indispensable that strengthening the public health is considered as the topmost priority in such programs, and the MAH is compliant to Pharmacovigilance (PV) requirements along with regulatory obligations.

Keywords: Drug safety, good pharmacovigilance practice, patient support program, pharmacovigilance.

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Authors: M. Adamczak-Retecka, O. Hołub-Śniadach

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Dangerous of climate change is now global problem and as such has a strategic priority also for the European Union. Europe and European citizens try to do their best to cut greenhouse gas emissions, moreover they substantially encourage other nations and regions to follow the same way. The European Commission and a number of Member States have developed adaptation strategies in order to help strengthen EU's resilience to the inevitable impacts of climate change. The EU has long been a driving force in international negotiations on climate change and was instrumental in the development of the UN Framework Convention on Climate Change. As the world's leading donor of development aid, the EU also provides substantial funding to help developing countries tackle climate change problem. Global warming influences human health, biodiversity, ecosystems but also many social and economic sectors. The aim of this paper is to focus on impact of claimant change on for food security. Food security challenges are directly related to globalization, climate change. It means that current and future food policy is exposed to all cross-cutting and that must be linked with environmental and climate targets, which supposed to be achieved. In the 7th EAP —The new general Union Environment Action Program to 2020, called “Living well, within the limits of our planet” EU has agreed to step up its efforts to protect natural capital, stimulate resource efficient, low carbon growth and innovation, and safeguard people’s health and wellbeing– while respecting the Earth’s natural limits.

Keywords: Climate change, EU law, food policy, food security.

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Authors: Bill D. Geis, Frederick Newman

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Suicide and wrongful death forensic cases are the fastest rising tort in mental health law. Most suicide-related personal injury claims fall into the legal category of “wrongful death.” Though mental health experts may be called on to address a range of forensic questions in wrongful death cases, the central consultation that most experts provide is about the negligence element—specifically, the issue of whether the clinician met the clinical standard of care in assessing, treating, and managing the deceased person’s mental health care. Standards of care, varying from US state to state, are broad and address what a reasonable clinician might do in a similar circumstance. This fact leaves the issue of the suicide standard of care, in each case, up to forensic experts to put forth a reasoned estimate of what the standard of care should have been in the specific case under litigation. Because the general state guidelines for standard of care are broad, forensic experts are readily retained to provide scientific and clinical opinions about whether or not a clinician met the standard of care in their suicide assessment, treatment, and management of the case. In the past and in much of current practice, the assessment of suicide has centered on the elicitation of verbalized suicide ideation. But suicide ideation, in the matter of suicide risk determination, may be a necessary but insufficient target of lethal suicide risk assessment. Assessment of near-term suicide risk—assessment that goes beyond verbalized suicide ideation and relates to acute crisis variables—is likely needed. Specifically, such other or additional suicide risk variable assessment may be required in the context of lethal suicide risk situations, as opposed to the discernment of general, nonlethal suicide behavior as a standard of practice (whether a patient is having suicidal thoughts or exhibiting an ambivalent suicide attempt potential). In the current study, verbalized suicide ideation information was unhelpful in the assessment of lethal risk. The Lethal Suicide Risk Assessment, Acute Model, and other dynamic, near-term risk models (such as the Acute Suicide Affective Disorder Model and the Suicide Crisis Syndrome Model)—going beyond elicited suicide ideation—need to be incorporated into current clinical suicide assessment training and become the legal standard of care for expected clinical behavior. Without this expanded clinical assessment perspective, the standard of care for suicide assessment is out of sync with current knowledge—an emerging dilemma for the forensic evaluation of suicide wrongful death cases.

Keywords: Forensic evaluation, standard of care, suicide, suicide assessment, wrongful death.

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Authors: Niwatchai Namwichisirikul

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Due to the emergence of “Humanized Healthcare" introduced by Professor Dr. Prawase Wasi in 2003[1], the development of this paradigm tends to be widely implemented. The organizations included Healthcare Accreditation Institute (public organization), National Health Foundation, Mahidol University in cooperation with Thai Health Promotion Foundation, and National Health Security Office (Thailand) have selected the hospitals or infirmaries that are qualified for humanized healthcare since 2008- 2010 and 35 of them are chosen to be the outstandingly navigating organizations for the development of humanized healthcare, humanized healthcare award [2]. The research aims to study the current issue, characteristics and patterns of hospital administration contributing to humanized healthcare system in Thailand. The selected case studies are from four hospitals including Dansai Crown Prince Hospital, Leoi; Ubolrattana Hospital, Khon Kaen; Kapho Hospital, Pattani; and Prathai Hospital, Nakhonrachasima. The methodology is in-depth interviewing with 10 staffs working as hospital executive directors, and representatives from leader groups including directors, multidisciplinary hospital committees, personnel development committees, physicians and nurses in each hospital. (Total=40) In addition, focus group discussions between hospital staffs and general people (including patients and their relatives, the community leader, and other people) are held by means of setting 4 groups including 8 people within each group. (Total=128) The observation on the working in each hospital is also implemented. The findings of the study reveal that there are five important aspects found in each hospital including (1) the quality improvement under the mental and spiritual development policy from the chief executives and lead teams, leaders as Role model and they have visionary leadership; (2) the participation hospital administration system focusing on learning process and stakeholder- needs, spiritual human resource management and development; (3) the relationship among people especially staffs, team work skills, mutual understanding, effective communication and personal inner-development; (4) organization culture relevant to the awareness of patients- rights as well as the participation policy including spiritual growth achieving to the same goals, sharing vision, developing public mind, and caring; and (5) healing structures or environment providing warmth and convenience for hospital staffs, patients and their relatives and visitors.

Keywords: Hospital administration, Humanized healthcare.

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Authors: Kyu Jin Kim, Byung Kwan Oh, Hyo Seon Park

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The seismic responses-based structural health monitoring system has been performed to prevent seismic damage. Structural seismic damage of building is caused by the instantaneous stress concentration which is related with dynamic characteristic of earthquake. Meanwhile, seismic response analysis to estimate the dynamic responses of building demands significantly high computational cost. To prevent the failure of structural members from the characteristic of the earthquake and the significantly high computational cost for seismic response analysis, this paper presents an artificial neural network (ANN) based prediction model for dynamic responses of building considering specific time length. Through the measured dynamic responses, input and output node of the ANN are formed by the length of specific time, and adopted for the training. In the model, evolutionary radial basis function neural network (ERBFNN), that radial basis function network (RBFN) is integrated with evolutionary optimization algorithm to find variables in RBF, is implemented. The effectiveness of the proposed model is verified through an analytical study applying responses from dynamic analysis for multi-degree of freedom system to training data in ERBFNN.

Keywords: Structural health monitoring, dynamic response, artificial neural network, radial basis function network, genetic algorithm.

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Authors: Antonis Skouloudis, Georgios Deligiannakis, Panagiotis Vouros, Konstantinos Evangelinos, Ioannis Nikolaou

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On November 15th, 2017, a catastrophic flash flood devastated the city of Mandra in Central Greece, resulting in 24 fatalities and extensive damages to the built environment and infrastructure. It was Greece’s deadliest and most destructive flood event for the past 40 years. In this paper, we examine the consequences of this event to small and medium-sized enterprises (SMEs) operating in Mandra during the flood event, which were affected by the floodwaters to varying extents. In this context, we conducted semi-structured interviews with business owners-managers of 45 SMEs located in flood inundated areas and are still active nowadays, based on an interview guide that spanned 27 topics. The topics pertained to the disaster experience of the business and business owners-managers, knowledge and attitudes towards climate change and extreme weather, aspects of disaster preparedness and related assistance needs. Our findings reveal that the vast majority of the affected businesses experienced heavy damages in equipment and infrastructure or total destruction, which resulted in business interruption from several weeks up to several months. Assistance from relatives or friends helped for the damage repairs and business recovery, while state compensations were deemed insufficient compared to the extent of the damages. Most interviewees pinpoint flooding as one of the most critical risks, and many connect it with the climate crisis. However, they are either not willing or unable to apply property-level prevention measures in their businesses due to cost considerations or complex and cumbersome bureaucratic processes. In all cases, the business owners are fully aware of the flood hazard implications, and since the recovery from the event, they have engaged in basic mitigation measures and contingency plans in case of future flood events. Such plans include insurance contracts whenever possible (as the vast majority of the affected SMEs were uninsured at the time of the 2017 event) as well as simple relocations of critical equipment within their property. The study offers fruitful insights on latent drivers and barriers of SMEs’ resilience capacity to flash flooding. In this respect, findings such as ours, highlighting tensions that underpin behavioural responses and experiences, can feed into: a) bottom-up approaches for devising actionable and practical guidelines, manuals and/or standards on business preparedness to flooding, and, ultimately, b) policy-making for an enabling environment towards a flood-resilient SME sector.

Keywords: Flash flood, small and medium-sized enterprises, organisational resilience capacity, disaster preparedness, qualitative study.

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Authors: Gülden Küçükakça, Şefika Dilek Güven, Rahşan Kolutek, Seçil Taylan

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Objective: Nursing students face with stress factors affecting academic performance and quality of life as from first moments of their educational life. Stress causes health problems in students such as physical, psycho-social, and behavioral disorders and might damage formation of professional identity by decreasing efficiency of education. In addition to determination of stress experienced by nursing students during their education, it was aimed to help review theoretical and clinical education settings for bringing stress of nursing students into positive level and to raise awareness of educators concerning their own professional behaviors. Methods: The study was conducted with 315 students studying at nursing department of Semra and Vefa Küçük Health High School, Nevşehir Hacı Bektaş Veli University in the academic year of 2015-2016 and agreed to participate in the study. “Personal Information Form” prepared by the researchers upon the literature review and “Nursing Education Stress Scale (NESS)” were used in this study. Data were assessed with analysis of variance and correlation analysis. Results: Mean NESS Scale score of the nursing students was estimated to be 66.46±16.08 points. Conclusions: As a result of this study, stress level experienced by nursing undergraduate students during their education was determined to be high. In accordance with this result, it can be recommended to determine sources of stress experienced by nursing undergraduate students during their education and to develop approaches to eliminate these stress sources.

Keywords: Stress, nursing education, nursing student, nursing education stress.

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Authors: Ilelabayo I. Adebisi, Yetunde R. Okeyinka, Abdulrasaq K. Ayinla

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Architectural design is a complex process especially when the issue of user’s comfort, building sustainability and energy efficiency needs to be addressed. The current energy challenge and the seek for an environment where users will have a more physiological and psychological comfort in this part of the world have led various researchers to constantly explore the concept of passive design techniques. Passive techniques are design strategies used in regulating building indoor climates and improving users comfort without the use of energy driven devices. This paper describes and analyses the significance of passive techniques on indoor climates and their impact on thermal comfort of building users using LAUTECH College of health sciences Ogbomoso as a case study. The study aims at assessing the appropriateness of the passive strategies used in achieving comfort in their buildings with a view to evaluate their adequacy and effectiveness and suggesting how comfortable their building users are. This assessment was carried out through field survey and questionnaires and findings revealed that strategies such as Orientation, Spacing, Courtyards, window positioning and choice of landscape adopted are inadequate while only fins and roof overhangs are adequate. The finding also revealed that 72% of building occupants feel hot discomfort in their various spaces and hence have the urge to get fresh air from outside during work hours. The Mahoney table was used to provide appropriate architectural design recommendations to guide future designers in the study area.

Keywords: Energy challenge, passive cooling, techniques, thermal comfort, users comfort.

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Authors: E. Grochowska-Niedworok, K. Brukało, M. Hadasik, M. Kardas

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Consumption of vegetables by school children and adolescents is essential for their normal growth, development and health, but a significant minority of the world's population consumes the right amount of these products. The aim of the study was to evaluate the preferences and frequency of consumption of vegetables by school children and adolescents. It has been assumed that effectively implemented nutrition education programs should have an impact on increasing the frequency of vegetable consumption among the recipients. The study covered 514 students of five schools in the Opole Voivodeship aged 9 years to 22 years. The research tool was an author's questionnaire, which consisted of closed questions on the frequency of vegetable consumption and the use of 10 ways to treat them. Preferences and frequencies are shown in percentages, while correlations were estimated on the basis of Cramer`s V and gamma coefficients. In each of the examined age groups, the relationship between sex and vegetable consumption (the Cramer`s V coefficient value was 0.06 to 0.38) was determined and the various methods of culinary processing were used (V Craméra was 0.08 to 0.34). For both sexes, the relationship between age and frequency of vegetable consumption was shown (gamma values ranged from ~ 0.00 to 0.39) and different cooking methods (gamma values were 0.01 to 0.22). The most important determinant of nutritional choices is the taste and availability of products. The fact that they have a positive effect on their health is only in third position. As has been shown, obesity prevention programs can not only address nutrition education but also teach about new flavors and increase the availability of healthy foods. In addition, the frequency of vegetable consumption can be a good indicator reflecting the healthy behaviors of children and adolescents.

Keywords: Children and adolescents, frequency, welfare rate, vegetables.

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Authors: Dalyah Y. Al-Jamal, Maryam H. Eshtaiwi, Liyakathunisa Syed

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Connecting health services with technology has a huge demand as people health situations are becoming worse day by day. In fact, engaging new technologies such as Internet of Things (IOT) into the medical services can enhance the patient care services. Specifically, patients suffering from chronic diseases such as cardiac patients need a special care and monitoring. In reality, some efforts were previously taken to automate and improve the patient monitoring systems. However, the previous efforts have some limitations and lack the real-time feature needed for chronic kind of diseases. In this paper, an improved process model for patient monitoring system specialized for cardiac patients is presented. A survey was distributed and interviews were conducted to gather the needed requirements to improve the cardiac patient monitoring system. Business Process Model and Notation (BPMN) language was used to model the proposed process. In fact, the proposed system uses the IOT Technology to assist doctors to remotely monitor and follow-up with their heart patients in real-time. In order to validate the effectiveness of the proposed solution, simulation analysis was performed using Bizagi Modeler tool. Analysis results show performance improvements in the heart monitoring process. For the future, authors suggest enhancing the proposed system to cover all the chronic diseases.

Keywords: Business process model and notation, cardiac patient, cardiac monitoring, heart monitoring, healthcare, internet of things, remote patient monitoring system, process model, telemedicine, wearable sensors.

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Authors: Alan Crowle, Philpp Thies

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s the floating offshore wind turbine industry continues to develop and grow, the capabilities of established port facilities need to be assessed as to their ability to support the expanding construction and installation requirements. This paper assesses current infrastructure requirements and projected changes to port facilities that may be required to support the floating offshore wind industry. Understanding the infrastructure needs of the floating offshore renewable industry will help to identify the port-related requirements. Floating offshore wind turbines can be installed further out to sea and in deeper waters than traditional fixed offshore wind arrays, meaning it can take advantage of stronger winds. Separate ports are required for substructure construction, fit-out of the turbines, moorings, subsea cables and maintenance. Large areas are required for the laydown of mooring equipment, inter array cables, turbine blades and nacelles. The capabilities of established port facilities to support floating wind farms are assessed by evaluation of size of substructures, height of wind turbine with regards to the cranes for fitting of blades, distance to offshore site and offshore installation vessel characteristics. The paper will discuss the advantages and disadvantages of using large land based cranes, inshore floating crane vessels or offshore crane vessels at the fit-out port for the installation of the turbine. Water depths requirements for import of materials and export of the completed structures will be considered. There are additional costs associated with any emerging technology. However, part of the popularity of Floating Offshore Wind Turbines stems from the cost savings against permanent structures like fixed wind turbines. Floating Offshore Wind Turbine developers can benefit from lighter, more cost effective equipment which can be assembled in port and towed to site rather than relying on large, expensive installation vessels to transport and erect fixed bottom turbines. The ability to assemble Floating Offshore Wind Turbines equipment on shore means minimising highly weather dependent operations like offshore heavy lifts and assembly, saving time and costs and reducing safety risks for offshore workers. Maintenance might take place in safer onshore conditions for barges and semi submersibles. Offshore renewables, such as floating wind, can take advantage of this wealth of experience, while oil and gas operators can deploy this experience at the same time as entering the renewables space. The floating offshore wind industry is in the early stages of development and port facilities are required for substructure fabrication, turbine manufacture, turbine construction and maintenance support. The paper discusses the potential floating wind substructures as this provides a snapshot of the requirements at the present time, and potential technological developments required for commercial development. Scaling effects of demonstration-scale projects will be addressed; however the primary focus will be on commercial-scale (30+ units) device floating wind energy farms.

Keywords: Floating offshore wind turbine, port logistics, installation, construction.

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Authors: Lucy Ampaw-Asiedu, Terri R. Norton

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In the wake of recent disasters happening around the world such as earthquake in Italy (January, 2017); hurricanes in the United States (US) (September 2016 and September 2017); and compounding disasters in Haiti (September 2010 and September 2016); to our best knowledge, never has the world seen the need to work on preemptive rather than reactionary measures to salvage this situation than now. Tornadoes are natural hazards that mostly affect mid-western and central states in the US. Tornadoes, like all natural hazards such as hurricanes, earthquakes, floods and others, are very destructive and result in massive destruction to homes, cause billions of dollars in damage and claims many lives. Healthcare facilities in general are vulnerable to disasters, and therefore, the safety of patients, health workers and those who come in to seek shelter should be a priority. The focus of this study is to assess disaster management measures instituted by healthcare facilities. Thus, the sole aim of the study is to examine the vulnerabilities and the design of safe spaces in healthcare facilities in Central US. Objectives that guide the study are to primarily identify the impacts of tornadoes in hospitals and to assess the structural design or specifications of safe spaces. St. John’s Regional Medical Center, now Mercy Hospital in Joplin, is used as a case study. Preliminary results show that the lateral base shear of the proposed design to be 684.24 ton (1508.49kip) for the safe space. Findings from this work will be used to make recommendations about the design of safe spaces for health care facilities in Central US.

Keywords: Disaster management, safe spaces, structural design, tornado, vulnerability.

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Authors: M. A. Abou Donia, A. A. K. Abou-Arab, Nevin E. Sharaf, A. K. Enab, Sherif R. Mohamed

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Lead (Pb) poisoning is one of the most common and preventable environmental health problems. There are different sources of environmental pollution with lead as lead alkyl additives in petrol and manufacturing processes. Pb in the atmosphere can be deposited in urban soils, and may then be re-suspended to re-enter the atmosphere. This could increase human exposure to Pb and cause long-term health effects. Thus, monitoring Pb pollution is considered one of the major tasks in controlling pollution. Scalp hair can be utilized for the determination of lead (Pb) concentration. It provides a lasting record of metal intakes of weeks or even months, and for most metals, their accumulation in hair reflects their accumulation in the whole body. This work was conducted to investigate the concentration of lead in male scalp hair of Cairo (residential-traffic and residential-industrial) and rural residents after twenty years of phasing out of leaded gasoline. Results indicated that the mean concentration of lead in hair of residential-traffic (9.7552 μg/g ±0.71) and residential-industrial (12.3288 μg/g ±1.13) was significantly higher than that in rural residents (4.7327 μg/g ±0.67). The mean concentration of lead in hair of resident’s industrial areas was the highest among Cairo residents and not the traffic areas as it was before phasing out of leaded gasoline. Twenty years of phasing out of leaded gasoline in Cairo has greatly improved the lead pollution among residents of traffic areas, but industrial areas residents were still suffering from lead pollution, which needs more efforts to control the sources of lead pollution.

Keywords: Heavy metals, lead, hair, biological sample, urban pollution, rural pollution.

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Authors: Trina Isabel D. Santiago, Daniel C. Chua, Jumee F. Tayaban, Joseph Daniel S. Timbol, Joshua M. Yanes

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Numerous instances of human rights violations on healthcare workers have been reported during the COVID-19 pandemic in the Philippines. This paper aims to explore these civil and political rights violations and propose recommendations to address these. Our review shows that a wide range of civic and political human rights violations have been committed by individual citizens and government agencies on individual healthcare workers and health worker groups. These violations include discrimination, red-tagging, evictions, illegal arrests, and acts of violence ranging from chemical attacks to homicide. If left unchecked, these issues, compounded by the pandemic, may lead to the exacerbations of the pre-existing problems of the Philippine healthcare system. Despite all pre-existing reports by human rights groups and public media articles, there still seems to be a lack of government action to condemn and prevent these violations. The existence of government agencies which directly contribute to these violations with the lack of condemnation from other agencies further propagate the problem. Given these issues, this policy brief recommends the establishment of an interagency task force for the protection of human rights of healthcare workers as well as the expedited passing of current legislative bills towards the same goal. For more immediate action, we call for the establishment of a dedicated hotline for these incidents with adequate appointment and training of point persons, construction of clear guidelines, and closer collaboration between government agencies in being united against these issues.

Keywords: COVID-19 pandemic, healthcare workers, human rights violations, Philippines.

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Authors: I. Szer, J. Szer, K. Czarnocki, E. Błazik-Borowa

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People on construction scaffoldings work in dynamically changing, often unfavourable climate. Additionally, this kind of work is performed on low stiffness structures at high altitude, which increases the risk of accidents. It is therefore desirable to define the parameters of the work environment that contribute to increasing the construction worker occupational safety level. The aim of this article is to present how changes in microclimate parameters on scaffolding can impact the development of dangerous situations and accidents. For this purpose, indicators based on the human thermal balance were used. However, use of this model under construction conditions is often burdened by significant errors or even impossible to implement due to the lack of precise data. Thus, in the target model, the modified parameter was used – apparent environmental temperature. Apparent temperature in the proposed Scaffold Use Risk Assessment Model has been a perceived outdoor temperature, caused by the combined effects of air temperature, radiative temperature, relative humidity and wind speed (wind chill index, heat index). In the paper, correlations between component factors and apparent temperature for facade scaffolding with a width of 24.5 m and a height of 42.3 m, located at south-west side of building are presented. The distribution of factors on the scaffolding has been used to evaluate fitting of the microclimate model. The results of the studies indicate that observed ranges of apparent temperature on the scaffolds frequently results in a worker’s inability to adapt. This leads to reduced concentration and increased fatigue, adversely affects health, and consequently increases the risk of dangerous situations and accidental injuries

Keywords: Apparent temperature, health, safety work, scaffoldings.

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Authors: Sanjeev Sharma, Suman Lata

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With the availability of diverse printed, electronic literature and web sites on medical and health related information, it is impossible for the medical professional to get the information he seeks in the shortest possible time. For all these problems information literacy is the only solution. Thus, information literacy is recognized as an important aspect of medical education. In the present study, an attempt has been made to know the information literacy skills of the faculty and students at medical colleges of Haryana, Punjab and Chandigarh. The scope of the study was confined to the 12 selected medical colleges of three States (Haryana, Punjab, and Chandigarh). The findings of the study were based on the data collected through 1018 questionnaires filled by the respondents of the medical colleges. It was found that Online Medical Websites (such as WebMD, eMedicine and Mayo Clinic etc.) were frequently used by 63.43% of the respondents of Chandigarh which is slightly more than Haryana (61%) and Punjab (55.65%). As well, 30.86% of the respondents of Chandigarh, 27.41% of Haryana and 27.05% of Punjab were familiar with the controlled vocabulary tool; 25.14% respondents of Chandigarh, 23.80% of Punjab, 23.17% of Haryana were familiar with the Boolean operators; 33.05% of the respondents of Punjab, 28.19% of Haryana and 25.14% of Chandigarh were familiar with the use and importance of the keywords while searching an electronic database; and 51.43% of the respondents of Chandigarh, 44.52% of Punjab and 36.29% of Haryana were able to make effective use of the retrieved information. For accessing information in electronic format, 47.74% of the respondents rated their skills high, while the majority of respondents (76.13%) were unfamiliar with the basic search technique i.e. Boolean operator used for searching information in an online database. On the basis of the findings, it was suggested that a comprehensive training program based on medical professionals information needs should be organized frequently. Furthermore, it was also suggested that information literacy may be included as a subject in the health science curriculum so as to make the medical professionals information literate and independent lifelong learners.

Keywords: Information, information literacy, medical colleges, medical professionals.

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Authors: Pegah Farokhzad

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Family has a crucial role in maintaining the physical, social and mental health of the children. Most of the mental and anxiety problems of children reflect the complex interpersonal situations among family members, especially parents. In other words, anxiety problems of the children are correlated with deficit relationships of family members and improper childrearing styles. The parental child rearing styles leads to positive and negative consequences which affect the children’s mental health. Therefore, the present research was aimed to compare the parental childrearing styles and anxiety of children with stuttering and normal population. It was also aimed to study the relationship between parental child rearing styles and anxiety of children. The research sample included 54 boys with stuttering and 54 normal boys who were selected from the children (boys) of Tehran, Iran in the age range of 5 to 8 years in 2013. In order to collect data, Baum-rind Childrearing Styles Inventory and Spence Parental Anxiety Inventory were used. Appropriate descriptive statistical methods and multivariate variance analysis and t test for independent groups were used to test the study hypotheses. Statistical data analyses demonstrated that there was a significant difference between stuttering boys and normal boys in anxiety (t = 7.601, p< 0.01); but there was no significant difference between stuttering boys and normal boys in parental childrearing styles (F = 0.129). There was also not found significant relationship between parental childrearing styles and children anxiety (F = 0.135, p< 0.05). It can be concluded that the influential factors of children’s society are parents, school, teachers, peers and media. So, parental childrearing styles are not the only influential factors on anxiety of children, and other factors including genetic, environment and child experiences are effective in anxiety as well. Details are discussed.

Keywords: Anxiety, Childrearing Styles, Stuttering.

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Authors: A. E. Mukhametov, M. T. Yerbulekova, D. R. Dautkanova, G. A. Tuyakova, G. Aitkhozhayeva

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The accumulation of heavy metals in food is a constant problem in many parts of the world. Vegetable oils are widely used, both for cooking and for processing in the food industry, meeting the main dietary requirements. One of the main chemical pollutants, heavy metals, is usually found in vegetable oils. These chemical pollutants are carcinogenic, teratogenic and immunotoxic, harmful to consumption and have a negative effect on human health even in trace amounts. Residues of these substances can easily accumulate in vegetable oil during cultivation, processing and storage. In this article, the content of the concentration of heavy metal ions in vegetable oils of Kazakhstan production is studied: sunflower, rapeseed, safflower and linseed oil. Heavy metals: arsenic, cadmium, lead and nickel, were determined in three repetitions by the method of flame atomic absorption. Analysis of vegetable oil samples revealed that the largest lead contamination (Pb) was determined to be 0.065 mg/kg in linseed oil. The content of cadmium (Cd) in the largest amount of 0.009 mg/kg was found in safflower oil. Arsenic (As) content was determined in rapeseed and safflower oils at 0.003 mg/kg, and arsenic (As) was not detected in linseed and sunflower oil. The nickel (Ni) content in the largest amount of 0.433 mg/kg was in linseed oil. The heavy metal contents in the test samples complied with the requirements of regulatory documents for vegetable oils. An assessment of the health risk of vegetable oils with a daily consumption of 36 g per day shows that all samples of vegetable oils produced in Kazakhstan are safe for consumption. But further monitoring is needed, since all these metals are toxic and their harmful effects become apparent only after several years of exposure.

Keywords: Kazakhstan, oil, safety, toxic metals.

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Authors: Rudy Bahouth, Farouk Benmeddour, Emmanuel Moulin, Jamal Assaad

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Guided ultrasonic waves are used in Non-Destructive Testing and Structural Health Monitoring for inspection and damage detection. Recently, wireless data transmission using ultrasonic waves in solid metallic channels has gained popularity in some industrial applications such as nuclear, aerospace and smart vehicles. The idea is to find a good substitute for electromagnetic waves since they are highly attenuated near metallic components due to Faraday shielding. The proposed solution is to use ultrasonic guided waves such as Lamb waves as an information carrier due to their capability of propagation for long distances. In addition to this, valuable information about the health of the structure could be extracted simultaneously. In this work, the reliable frequency bandwidth for communication is extracted experimentally from dispersion curves at first. Then, an experimental platform for wireless communication using Lamb waves is described and built. After this, coherent demodulation algorithm used in telecommunications is tested for Amplitude Shift Keying, On-Off Keying and Binary Phase Shift Keying modulation techniques. Signal processing parameters such as threshold choice, number of cycles per bit and Bit Rate are optimized. Experimental results are compared based on the average bit error percentage. Results has shown high sensitivity to threshold selection for Amplitude Shift Keying and On-Off Keying techniques resulting a Bit Rate decrease. Binary Phase Shift Keying technique shows the highest stability and data rate between all tested modulation techniques.

Keywords: Lamb Wave Communication, wireless communication, coherent demodulation, bit error percentage.

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Authors: Edith Esparza-Young, Ángel M. Matos, Yaritza Gonzalez, Kirthana Sugunathevan

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Introduction: This research describes the existing medical school program which supports a multicultural setting and bilingualism. The rise of Spanish speakers in the United States has led to the recruitment of bilingual medical students who can serve the evolving demographics. This paper includes anecdotal evidence, narratives and the latest research on the outcomes of supporting a multilingual academic experience in medical school and beyond. People in the United States will continue to need health care from physicians who have experience with multicultural competence. Physicians who are bilingual and possess effective communication skills will be in high demand. Methodologies: This research is descriptive. Through this descriptive research, the researcher will describe the qualities and characteristics of the existing medical school programs, curriculum, and student services. Additionally, the researcher will shed light on the existing curriculum in the medical school and also describe specific programs which help to serve as safety nets to support diverse populations. The method included observations of the existing program and the implementation of the medical school program, specifically the Accelerated Review Program, the Language Education and Professional Communication Program, student organizations and the Global Health Institute. Concluding Statement: This research identified and described characteristics of the medical school’s program. The research explained and described the current and present phenomenon of this medical program, which has focused on increasing the graduation of bilingual and minority physicians. The findings are based on observations of the curriculum, programs and student organizations which evolves and remains innovative to stay current with student enrollment.

Keywords: Bilingual, English, medicine, doctor.

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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: Z. Nurzaireena, K. Azalea, T. Azirawaty, S. Jameela, G. Muralitharan

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The aim of this study is the review of the management practices of sickle cell disease patients during pregnancy, as well as the maternal and neonatal outcome at Ampang Hospital, Selangor. The study consisted of a review of pregnant patients with sickle cell disease under follow up at the Hematology Clinic, Ampang Hospital over the last seven years to assess their management and maternal-fetal outcome. The results of the review show that Ampang Hospital is considered the public hematology centre for sickle cell disease and had successfully managed three pregnancies throughout the last seven years. Patients’ presentations, managements and maternal-fetal outcome were compared and reviewed for academic improvements. All three patients were seen very early in their pregnancy and had been given a regime of folic acid, antibiotics and thrombo-prophylactic drugs. Close monitoring of maternal and fetal well being was done by the hematologists and obstetricians. Among the patients, there were multiple admissions during the pregnancy for either a painful sickle cell bone crisis, haemolysis following an infection and anemia requiring phenotype- matched blood and exchange transfusions. Broad spectrum antibiotics coverage during and infection, hydration, pain management and venous-thrombolism prophylaxis were mandatory. The pregnancies managed to reach near term in the third trimester but all required emergency caesarean section for obstetric indications. All pregnancies resulted in live births with good fetal outcome. During post partum all were nursed closely in the high dependency units for further complications and were discharged well. Post partum follow up and contraception counseling was comprehensively given for future pregnancies. Sickle cell disease is uncommonly seen in the East, especially in the South East Asian region, yet more cases are seen in the current decade due to improved medical expertise and advance medical laboratory technologies. Pregnancy itself is a risk factor for sickle cell patients as increased thrombosis event and risk of infections can lead to multiple crisis, haemolysis, anemia and vaso-occlusive complications including eclampsia, cerebrovasular accidents and acute bone pain. Patients mostly require multiple blood product transfusions thus phenotype-matched blood is required to reduce the risk of alloimmunozation. Emphasizing the risks and complications in preconception counseling and establishing an ultimate pregnancy plan would probably reduce the risk of morbidity and mortality to the mother and unborn child. Early management for risk of infection, thromboembolic events and adequate hydration is mandatory. A holistic approach involving multidisciplinary team care between the hematologist, obstetricians, anesthetist, neonatologist and close nursing care for both mother and baby would ensure the best outcome. In conclusion, sickle cell disease by itself is a high risk medical condition and pregnancy would further amplify the risk. Thus, close monitoring with combine multidisciplinary care, counseling and educating the patients are crucial in achieving the safe outcome.

Keywords: Anemia, haemoglobinopathies, pregnancy, sickle cell disease.

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