There is significant concern expressed in the literature regarding the unmet health care needs and the fragmented care experienced by individuals with chronic health problems. Strong interprofessional teamwork developed through interprofessional education (IPE) has been identified as a method to address these population health issues. The purpose of this study was to evaluate the impact of a four-hour virtual/face to face IPE learning event on improving 83 occupational therapy, physical therapy, and physician assistant students’ self-efficacy in developing the four interprofessional core competencies that reflect the updates outlined in the 2016 Interprofessional Education Collaborative document regarding population health.Self-efficacy is defined as the students’ ability to consider their confidence regarding working effectively on an interprofessional team. This study utilized a non-randomized, quantitative, pretest-posttest design, and used a self-efficacy evaluation tool to measure the impact of the IPE event. A paired t-test for each of the four core competencies revealed a statistically significance difference between the pre and posttests for all core competencies (p-value <.0001). Mean scores increased, indicating improved self-efficacy for each competency. A two-way ANOVA with repeated measures determined there was no statistically significant difference between the pre and posttest scores of the three student groups with any of the four core competencies. This indicated that all student groups improved equally in all four areas. This study supported the use of an IPE event as an initial step in preparing students to become collaborative ready practitioners who are able to approach health care from a population health perspective
Robin K. Miller has completed her post professional occupational therapy doctorate with an emphasis in health and wellness from Salus University, USA. She is an associate clinical professor and the occupational therapy program director at the University of Wisconsin-LaCrosse, USA. She has published research in the area of problem based learning, the development of clinical reasoning skills, and injury prevention strategies for health care workers. Her current research interests include the ongoing progression of interprofessional collaborative skill development in health care students
Background: The United Arab Emirates (UAE) reports one of the highest prevalence rates of type 2 diabetes mellitus in the world. Prior to the onset of type 2 diabetes mellitus, a period of moderate hyperglycemia is often present, referred to as prediabetes. This is associated with significant loss of pancreatic beta cells, an increased risk of cardiovascular disease and other serious health consequences. There are gaps in the literature concerning the prevalence of prediabetes and associated risk factors, as well as predictors of conversion from prediabetes to type 2 diabetes mellitus. Objectives: The primary objective was to determine the prevalence of prediabetes and its correlates. The secondary objective was to identify major predictors of conversion from prediabetes to type 2 diabetes mellitus. Methods: This research was based on secondary data that was collected to intervene in prediabetes in Al Ain and Dubai, two cities in the UAE. In Al Ain, a random sample (n=605) of parents participated in type 2 diabetes mellitus screening in a family-based study. In Dubai, 700 Emirati adults diagnosed with prediabetes in five primary health care centers were invited to participate. Socioeconomic, lifestyle, and clinical data were collected and ethics approval and informed consent obtained. Prediabetes and type 2 diabetes mellitus were defined according to the American Diabetes Association’guidelines,based on fasting plasma glucose (FBG ≥126 mg/dl (≥ 7 mmol/l) for type 2 diabetes and 110-125 mg/dl (6.1-7 mmol/l for prediabetes) and HbA1c (≥6.5% for type 2 diabetes and HbA1c 5.7-6.4% for prediabetes). We used a multivariable multinomial logistic regression analysis to identify the correlates of prediabetes and type 2 diabetes mellitus in comparison to people with a normal glucose level in Al Ain. We used logistic regression analysis to identify the predictors of the transition from prediabetes to DM using the Dubai health center-based data. Results: The overall prevalence of prediabetes and type 2 diabetes mellitus was 37.7% and 18.7%, respectively, among participants in Al Ain. Older age, overweight, and obesity, and cigarette smoking were positive correlates of prediabetes. A secondary and higher level of education was negatively correlated with prediabetes. In Dubai, a significant proportion (23.4%) of participants with prediabetes converted to DM over a period of two years. Having a high total cholesterol and low HDL-cholesterol were significant (<0.05) predictors of prediabetes to type 2 diabetes mellitus conversion. Participants reporting vigorous physical activity for at least once a week were less likely to convert to type 2 diabetes mellitus status. Conclusion: Prediabetes is a significant public health problem in the UAE. Older age, overweight, obesity and a cigarette smoking were all found to be significant correlates of prediabetes. A high proportion of people with prediabetes converted to type 2 diabetes mellitus over a relatively short period of time. This highlights the importance of screening for, and intervention of prediabetes. Our findings were consistent with previous studies carried out in other countries.
Magnetic Nanoparticles are used for a variety of applications in medicine. This ranges from in vitro diagnostic tests, in vivo imaging, targeted drug delivery and tissue regeneration. To translate basic findings into clinical trials several requirements such as detailed synthesis and characterization of the nanoparticles, nanotoxicologicaltestings, ex vivo models to simulate in vivo conditions for appropriate adjustment of the necessary parameters and pre-clinical animal studies have to be addressed. These results are of pivotal importance to start with respective GMP production and approval, which is essential for translating these products into clinical trials (scheme).SEON (Section of Experimental Oncology and Nanomedicine) addresses these issues with a special focus on drug delivery in oncology and their promising potential applications in cardiovascular, regenerative medicine and imaging. The aim is the translation of the preclinical results into clinical trials and the respective steps necessary to gain this ambitious object. • Magnetic nanoparticles can be used in medicine for diagnostics (imaging) and therapy (Drug Targeting, Precision Medicine) • No adverse side effects due to innovative and intelligent nanoparticle based drug delivery • Translation into clinics using the SEON-concept becomes concrete reality if the respective funding is existing • High scientific, medical and economic adding value
Prof.Dr. Christoph Alexiou, received his Ph.D. in 1995 from the Technical University of Munich, Medical school. After finishing his internship in the Gastroenterology Department at the Universityhospital of the Technical University he started as a physician and researcher at the Department of oto-rhino-laryngology, head and neck surgery and founded a research group working on the field of local chemotherapy with magnetic nanoparticles (Magnetic Drug Targeting). In the year 2000 he received his degree as an ENT-Physician and 2002 he changed to the ENT-Department in Erlangen, Germany, where he performed his postdoctoral lecture qualification (Habilitation). He is working there as an assistant medical director in the clinic and leads the Section for Experimental Oncology and Nanomedicine (SEON). Since 2009 he owns the Else Kröner-Fresenius-Foundation-Professorship for Nanomedicine at the Universityhospital Erlangen. He receives grants from the European Union, German Research Community (DFG), Ministry of Education and Science (BMBF) and Bavarian State Ministry of theEnviroment and Consumer Protection and is a member of the Executive Board of the European Technology Platform for Nanomedicine (ETPN). His research is addressing the emerging fields of Diagnosis, Treatment and Regenerative Medicine using magnetic nanoparticles and the translation from basic research into clinical trials and published >150 papers in peer reviewed journals. He received for his research several national and international renowned awards
This research examines patterns of health risk behaviors among adolescents from Arab nations. We synthesize the existing literature on dietary behaviors, physical activity and sedentary behaviors. Adolescence is a period that describes the transition from childhood to young adulthood. It is an opportune time for the emergence and prevention of new behaviors, and is critical in shaping future health conditions. A large proportion of the population in Arab nations consists of youth, with about 20% of the population aged 10 to 19 years. This presents a demographic opportunity to promote health and reduce disease burdens. Public health concerns related to dietary behaviours among adolescents from Arab nations vary from high rates of eating disorders, documented evidence of high prevalence of overweight and obesity, eating attitudes that promote extreme dieting or binge eating, and evidence of vitamin D deficiencies. In some nations, these dietary behaviours exhibited gender differences. These lend their way to issues related to body image and dissatisfaction, which are magnified by low levels of physical activity and high rates of sedentary lifestyles. For example, a UAE-based study reports that the prevalence of sedentary behavior amongst adolescents is as high as 40%. These numbers are comparable to data from Morocco and Saudi Arabia. This research provides evidence in support of the need for more research and action; while research on dietary behaviours, physical activity, and sedentary behaviours has been documented, more action-based research that addresses these health risk behaviours is a requisite in dealing with these public health concerns
Dr. Caroline Barakat-Haddad has completed her PhD from McMaster University, Canada. She started her academic career as an Assistant Professor in Environmental Health at Zayed University, Dubai. She held positions at the University of Toronto Scarborough as an Assistant Professor in Health Studies, and Discipline Representative. She is currently an Associate Professor in Environmental and Occupational Health at the University of Ontario Institute of Technology, Canada. Dr. Barakat-Haddad has more than 30 publications in reputed academic sources and has presented her research at over 45 national and international venues. She serves on two editorial boards and a National Research Fund
Insufficient healthcare facilities and poor doctor-patient ratio are the two major obstacles for ensuring basic healthcare service in developing countries. The Portable Health Clinic (PHC) system has been developed as a telemedicine system with a focus on preventive healthcare to mitigate these limitations and ensuring primary healthcare services to the remote communities in affordable price. A triage process has been adopted in this PHC system and it classifies the subjects under investigation into four categories, namely,  green (healthy)  yellow (alarming)  orange (sick) and  red (emergent), based on the gradual higher risk status of their health. The subjects under orange and red are primarily diagnosed as in the risky zone who need doctor`s consultancy. However, the major part of the subjects who are diagnosed in the green and yellow can be served by the trained health workers without medication but with info-medicine. And they can be mostly prevented not to shift into the risky zone being under the guided lifestyle. Thus, PHC can reduce the pressure on the doctors by non-risk patients and enable them to focus on the risky patients who deserve better attention. This system has adopted a Tele-Pathology module to assist the remote doctors for better tele-consultancy with more diagnostic reports. The modular PHC system can be easily replicated in any country and it is already being used in Bangladesh, Cambodia, India and Pakistan. This system is found equality useful for the urban aged community for home delivery service due to its portability.
Rafiqul Islam Maruf has completed his PhD in Information Engineering from Hokkaido University, Japan. Now he is working as an Associate Professor in Kyushu University Hospital. Before that he was working as a director of Global Communication Center, the ICT based R&D center of Grameen Communications, Bangladesh, his home country. Earlier Dr. Islam worked in Japanese IT industries for more than twelve years. He has participated in many International Conference, presented his works and chaired many sessions. Dr. Islam has published a good number of research papers in reputed international journals and proceedings. His research vision is “ICT for Humanity”.
In Serbia persons aged 65+ outnumbered those under the age of 15 (aging index was 139.5) in 2016. As vulnerable population old-aged could easily experience unmet health care needs. This cross-sectional study obtained data from the Republic of Serbia EU-SILC researches (2013 and 2016), based on a sample of 15,057 respondents (2016) and 20,069 in 2013. There were 24.7% participants 65+ years old in 2016., and 17.8% in 2013. Data was collected using questionnaires for household and for individuals.There were statistically significant differences in number of those who perceived there health as bad or very bed showing decrease of their numbers in 2016. Woman perceived their health more frequently as bad or very bad and suffering more often from chronic illness or condition. There were more participants with unmet healthcare needs in 2016. than in 2013 (14.5% vs 15.8%, p≤0.01) so as the number of those with unmet dental care needs (15.0% vs 18.2%, p≤0.01) with no statistically significant differences between man and woman. The main reasons for unmet health care needs in both years, were the price of health care services, long waiting lists and availability of health care centers.. Even nothing was changed in health care policy, participants experienced more often unmet health and dental care needs 2016. than 2013. There are no differences in access to health care for man and woman in both years. The health care has become more expensive since 2013, with a longer waiting lists and with decease in accessibility to health centers. This work was supported by COST Action 15221- Reducing Old-Age Social Exclusion: Collaborations in Research and Policy (ROSEnet).
Katarina Vojvodic is a medical doctor, specialist in Social medicine, master in Health Care Management, and PhD candidate in Public Health (all from University of Belgrade, Faculty of Medicine). She is working at the Institute of Public Health of Belgrade as a head of Department for Health Care Quality Improvement. She has been working in public health and health care management on planning, analyzing and organizing health care in Serbia. She has experience in working on the Serbian Ministry of Health’s, WHO and World Bank’s projects. She was involved in projects for implementing diagnosis related groups, health care quality and patient safety improvement. She is associate in the WHO Collaborating Center for the Injury Prevention And Safety Promotion in Serbia. Since 2016 she is a member of ROSEnet PhD forum (COST Action 15221) She has great experience in conducting continuous medical educations in the field of management, financing and quality of health care so as presenting results from her research on national and international congresses and publications.
Healthcare systems are subjectedto reforms aiming at better integratingindividuals’ well-being; their physical, mental and social status. Population health is anchored in a population approach, social determinants and the development of partnerships.In this modern context, it is imperative to consider the influence of social conditions on the health of individuals. Networks need to be created.They involve partners from various sectors(health, education, social and environment) creating alliances and coordinating activities. Experience shows thatimplementation is complex. It forces a redefinition of the core of services and challenges embedded dynamics. They call for the emergence of new organizational forms. To become institutionalized organizational forms, networks need to emerge from inter-professional and inter-organizational dynamic processes. The locus of production is no longer within the boundaries of single organizations but at the nexus of relationships between various parties that contribute to the production function. The explosion of professional and organizational boundaries forces parties to focus on their interdependencies and be more tightly coupled. Paradoxically, the system becomes more loosely-coupled, structured on various interlinked production processes or networks. Our studies show that managers need to demonstrate “reasoned creativity” based on four groups of competencies. Conceptual competencies are necessary for the capacity to deal with uncertainty. Reflective competencies are essential for the evaluation of change and performance. Clinical and relational competencies are essential to insure proximity with production units and create innovative organizational arrangements. This presentation aims at discussing the nature of changes in progress and how management can meet those challenges.
Lise Lamothe, PhD,(McGill University, Canada). Full professor, Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, Canada. More than 60 peer reviewed articles. Research interests: Governance and transformation of health organizations. Formerly manager in a teaching hospital.
Breast wire localizations are performed by a Radiologist in a hospital under imaging guidance to determine the location of a breast mass preceding surgical tissue excision. Post-wire placement, the patient is transferred to the operating room with a guidewire exiting the breast, coiled up, and taped to the skin until surgery. Wire localization processes have two negative implications. First, patient discomfort due to the external portion of the guide wire exiting the breast is uncomfortable, in addition to frightful for some patients. Secondly, there is a dependent relationship between the breast imaging schedule and the surgical schedule. Breast imaging is a busy, fast-paced, and surgical services works diligently to ensure all scheduled surgeries are performed on time. Naturally, the two department appointments must align for timely and efficient wire localization breast patients’ breast excisional biopsies. To improve patient satisfaction and separate breast imaging schedules from surgical schedules, newer breast tumor localization systems are emerging in the market. Breast [non-radioactive] Seed Localization systems follow the same process as wire localizations, except there are additional benefits beyond improving hospital workflow. As breast tumor localization systems have emerged, has the new technology proved to be more successful than the traditional wire localization device?
Jessica Peterburs is an operationl healthcare leader in Imaging Services, Departments of Breast Imaging and Ultrasound, from Advocate Aurora Health in Milwaukee, WI, USA. She is a *doctoral degree candidate with a dual concentration in Global Health Studies and Telehealth Management from Nova Southeastern University, Fort Lauderdale, FL, USA (anticipated graduation 12/2019). Global health prevention and awarenss, access to care, and health innovation are priority in her career. She has a background in sonography with 11 years of experience in general, vascular, and procedural ultrasound
Objectives:To investigateanddescribethestructure,functionsandtheactivitiesoftheinstitutionalPTCs. Study Setting:Thisstudy was conducted intheEastern CapeProvince in South Africa. Study design:This is a cross-sectional study that was aimed at exploring thestructure, activities and functions of public sector institutional Pharmaceutical and Therapeutics Committees (PTC) in the Eastern Cape (EC) Province in South Africa (SA). Data collection:A purpose-designed questionnaire including both quantitative and qualitative aspects adapted from other international studies was piloted prior to being used for data collection. The secretariats of the institutional PTCs were requested to complete the questionnaire. Data were analysed using descriptive statistics for the quantitative aspects andthematic analysis for the qualitative component of the questionnaire. Data collection commenced after approval by the relevant ethics committees had been granted. Principal findings:The results of this study suggest that in the EC province the number of active and effective PTCs is low and there is a need to assist institutions in the establishment of PTCs. Their structure is of a multi-disciplinary nature as recommended by the National Department of Health PTC policy (2015) despite a few where there are staffing problems and shortage of key professionals. The rural nature of the province, shortage of pharmacists and lack of resources has an impact on the functionality of the PTCs. Conclusions:The major gap has been observed in the operations, functions and activities of the PTCs. There is a need to educate, train and transfer skills to the members of the PTCs regarding the functioning of the PTCs, activities to be conducted and development of policies and basic documents used during meetings. Key words:Pharmaceutical and Therapeutics Committee, Pharmacy and Therapeutics Committee,institutional,hospital
Dr. V Henge-Daweti has completed her Bachelor of Pharmacy and Doctor of Pharmacy degrees at Rhodes University, Masters of Science in Medicine Pharmacy at University of Limpopo, Masters of Arts in Welfare and Public Health Management at Nelson Mandela Metro University and currently doing Post graduate Diploma in Health Economics with University of Cape Town. Dr Henge-Daweti is currently working as a clinical pharmacist and pharmacy manager at Cecilia Makiwane Hospital which is a regional hospital with tertiary services situated at Mdantsane location in East London, South Africa. She has presented in local and national conferences, conducted numerous operational research and participated in clinical trials as a study pharmacist
In the last years, one of the major problems that are still facing the European healthcare systems is the effects of the global financial crisis began in 2007. It was classified as a “health system shock” which has a large negative effect on the availability of health system resources and quality of cares. In this respect, there has been much debate about the regional healthcare expenditure and the reason why some regions spend less than others. In the literature, some scholars have attributed this to the multi-tier situation featuring the Italian National Healthcare System (INHS) where historically northern regions were faster in developing administrative and technical capacity than southern regions. Anyway, there are still many differences among Italian regions in terms of healthcare expenditure and assigned funds in comparison also with regional GDP. Therefore, among other causes that generally may affect the different National Healthcare Systems (e.g., economic trend, changing of the GDP, cutbacks policies and so on), funding for healthcare sector is a key variable to address the related regional expenditure level, since total funds destined to healthcare sector in Italy (like many UE countries) mostly stem from taxes (national/regional-based) collected from taxpayer. Unfornutately, this system is found a “bad copy” of “old” fund allocation systems, in so doing paying more attention to the efficiency rather than to the healthcare outcomes. Accordingly, the regions would run the risk of failing to guarantee essential level of cares because of the incapability in managing their money in an efficient and proper manner.
Dr. Ianni Luca is a Senior Assistant Professor of Accounting and Public Management at the Department of Management and Business Administration, University “G.d’Annunzio” of ChietiPescara, ITALY. He has been Visiting Researcher at the School of Business – University of Ballarat (Australia), and at the School of Business – University of Cardiff (UK). In 2017, he earned the National Scientific Qualification (ASN) for Associate Professor position. Main research interests focus on Lean in Healthcare, Prison Healthcare, Performance Management in Healthcare. He has published several papers in reputed journals and has served as reviewer for many scientific journals.
Social medicine is a segment of public health services aiming to improve the population's health through various preventive programmes and activities. This is why the metrics of performance measurement is a sort of a challenge, because these are activities with a qualitative outcome that requires a time lag. The research subject is the assessment of effectiveness of social medicine programmes implemented in the public health system of the Republic of Croatia. For this empirical research, data were used by the county's Teaching Institute of Public Health, Social Medicine Department. The department has three basic objectives: to assess the health and health needs of the population, to develop public health policy, and to ensure the implementation of effective programmes. The department works on various prevention activities whose outcomes should rather be measured by qualitative indicators. The aim of this research is to find the metrics that will be useful for the final outcome assessment. Adjusted Balanced Scorecard (BSC) is proposed for improving the effectiveness of performance assessment of current and future performance results. The theory and the concept of the BSC are relevant for the field of health care, but there is not much research on applying BSC in preventive activities of social medicine organised through institutes of public health. As a management tool, the BSC is suitable for designing and directing strategic and operational plans in accordance with the mission and vision of organisation units. For the purposes of social medicine activities, modified BSC helps achieve the set objectives and report critical outcomes through a strategic map. This research confirms the applicability and flexibility of BSC and contributes to developing a set of common indicators that will maintain qualitative aspects of the activities and enable effectiveness measurement.
Neda Vitezić, is a full professor specialization Business Analysis, Controlling and Auditing at Faculty of Economics and Business, University of Rijeka, Croatia. Today she is leading MBA Controlling and is chairperson of Department of Entrepreneurship economy and Head of Association of Croatian Controllers. She leads a scientific project – A Model for Measuring the Efficiency of Public Health Services. She has published more than 130 article in scientific journals and proceedings and is visiting professor at universities in the EU and USA, member of editorial boards and international reviewer from her research field.
Studies estimating monetary values of a quality-adjusted life-year (QALY) assess effects and differences in values based on correlations with the examined determinants. Developing an instrument that would facilitate clustering outcomes into groups of related observations,could provide a new insight in economic evaluations. In this study, we aimed at identifying the most relevant determinants and developing an appropriate instrument that could be used for data clustering. Validation of the instrument will take place in a future study. The development of this instrument constitutes part of a PhD research for which the candidate holds a scholarship from Onassis Foundation. We employed the EQ-5D-3L tool to evaluate participants’ current health state and the Willingness-to-Pay (WTP) approach, within the framework of the Contingent Valuation (CV) Method, to estimate the monetary value. Determinants shown in past studies to have an impact on WTP were chosen for assessment in this instrument. An extensive literature review preceded the design of the instrument. The initial version of the instrument was revised after qualitative interviews and a pilot study. A sample of 10 persons with different demographic characteristics were recruited to complete semi-structured interviews. We analysed the interviews using the deductive approach. Following the interviews,a randomly selected (CATI-Computer Assisted Telephone Interview Method) sample of 73 persons living in Thessaloniki, Greece, completed the questionnairethrough telephone interviews. Based on the above, apart from the usual demographics (age, gender, education, marital status, occupation, income), the following WTP per QALY determinants were identified and included in the survey tool to facilitate cluster analysis: frequency of public health care services use, access to healthcare, attitudes relating to equity in access, attitudes relating to the quality of public health care services, lifestyle aspects, number of people living in the same home, prior experience with severe disease.
AfentoulaMavrodi is a Ph.D. Candidate in Health Economics at the Department of Business Administration, University of Macedonia, Greece. For her Ph.D. research, she has received a three-year scholarship from Onassis Foundation. She holds an M.Sc. in International Health Management with Distinction from Imperial College London, graduating with the Best Overall Performance. She has worked as a consulting analyst in London and as a freelance consultant in both public and private sector healthcare institutions in Greece.
Clinical coding in discharge summaries plays an important role in the healthcare management of patients; as well as communicating to healthcare staff which co-morbidities the patient has and procedures have been performed, it also provides information that is used by the hospital’s coding department. The OPCS code (Office of Population, Censuses and Surveys Classification of Surgical Operations and Procedures) is used to generate the tariff that allows the hospital to be reimbursed for the procedure. We analysed the discharge summaries for patients in the haematology department at Guy’s hospital. A baseline measurement over two months demonstrated that specific codes were constantly being missed out, resulting in an incorrect tariff being applied and an estimated loss to the Trust of £50,000. We introduced 3 interventions which included distributing a small ID sized laminated card with specific codes which were commonly missed, introducing a pro forma to give the healthcare team a structure to follow with all their discharge summaries and using a grid designed by the clinical coders to facilitate the whole coding process. These interventions were disseminated across the team, specifically to the junior doctors who most frequently complete the discharge summaries. Re-audit showed an improvement in the coding of the department and thus a decrease in the total money lost by the trust, demonstrating the effectiveness of the interventions. We suggest that similar interventions be introduced across each department to ensure accurate OPCS codes are used to produce better quality surgical discharge summaries and to ensure correct reimbursement to the Trust. This will inevitably lead to more effective spending and efficient distribution of health resources within the NHS.
Since joining King’s College London, Mohamed has been involved with studies related to medicine and theology. He recently completed an MSc in Clinical Neuroscience with a distinction. Mohamed is also a Co-Lead of the ARK Project at the university which is organizes volunteering opportunities for students at the university. These opportunities vary from feeding the homeless to helping the elderly in the community. He is also an active member of the PAL scheme which aims to help younger students with their academic studies.
The concept of cultural humility is a complex phenomenon. It flows beyond an individual or group being knowledgeable about and gaining cultural competence. Until one is able to intersect with and be accepted within a different culture, a healthcare provider may not achieve humility. This attribute is not developed from ones’ own culture, values, morals, beliefs or experiences, but instead from accepting others where they are. Cultural humility is not expressed in words nor can formal or informal training alone lead to its mastery.Instead, it is a mindset and internal spirit of accepting and being accepted by others outside ones everyday circle of experience that develops over time. For a healthcare provider such as a physician, nurse or public health professional,cultural humility is beyond “stepping into and filling ones shoes,” but being able to connect both spiritually and psychosocially with those they interact with, serve or provide care to regardless of their race, culture, sexual orientation or socioeconomic status. It is proposed that cultural humility is both learned and innate. Through verbal and non-verbal communication, relationship building and the provision or receipt of service, common denominators emerge that connecta healthcare worker to the patient/client or population they serve.Within this workshop, the concept of cultural humility will be definedthrough examplesshared bythe presenters drawn from their practice and volunteer activities.Self-reflection and short discussion among attendees will foster familiarity with this elusive component of healthcare and challenge them to develop cultural humility.
Dr. Byrne completed herDrNP from Drexel University, USA. She is Chair and Associate Professor, Department of Nursing, at The College of New Jersey and developed a global health course with a faculty-led study abroad immersion for nursing, health and exercise science, and public health students.She and her colleagues are published and have presented on topics related to their disciplines and working collaboratively to provide primary healthcare in both community and public health settings
The purpose of this study was to evaluate self-perception of health and describe the sociodemographic characteristics of older adults living in LTCF in Brazil. Methodology: this was a representative cross-sectional study conducted in the Metropolitan Area of Belo Horizonte, Minas Gerais State. The sample was comprised by 156 out of 170 LTCF, representing 3,752 older adults. To evaluate self-perception of health, interviews were conducted on a one-to-one basis with 127 participants in 47 LTCF. Participants were asked: “Overall, you would say that your health is excellent, very good, good, fair or poor? and “Compared to people of the same aged, how do you evaluate your health?”. The data collection was completed in July 2017. Findings: the mean age was 74.9 (± 8.85) years, 43.31% were single and 26.8% were illiterate. The average time of institutionalization was 5.3 years. Regarding the reasons for institutionalization, 60.6% stated that it was not their own choice, having as reasons the definition of family, abandonment or violence. Turning to self-perception of health, 53.5% evaluated your health as excellent/verygood and 65.4% as excellent/very good when compared to people of the same age. Understanding the profile of LTCF residents is the first step towards policy orientation, addressing the long-term care resources gap and the stigma about these institutions, as well as proposing actions for this public that should be considered as particularities, including their weaknesses and potentialities.
Dr. Marina Celly Souza is a Public Health registered nurse and currently Associate Professor of Public Health at The College of New Jersey. She holds a PhD in Nursing, a Master in Nursing with specializations in Gerontology and Public Health. Her research line includes aging, primary care, health education and health promotion, and social determinants of health.
The Health care delivery system in the United Arab Emirates(UAE) is a multi-sectorial system. It is composedof more than eight different sectors. Each sector is considered to be autonomous either as a regulator, operator of the healthcare services to the population or both. As a results services are not being provided in a coordinated manner as expected. Duplication, overlapping of services,variations in standards are visible. Delivering primary care services in Dubai and Sharjah as an example. Different populations are having access to different services. Ministry of Health and Prevention (MOHAP) is the federal agency of the United Arab Emirates government. In spite of that, MOHAP is not the only or the ultimatehealth regulatorthroughout the UAE. It only regulates about four Emirates out of seven in total. What about the other Emirates? In those Emirates, they regulate and provide healthcare services at the same time. With UAE, having a multi-regulatory system, it could lead to discrepancy and variation in the implementation of regulatoryactivities which could have a negative impact on the delivery and operation of the health care delivery system. For example, the pharmaceutical companies or suppliers could capture the regulator. Thus, leading to unfavorable health outcomes for the UAE population. More importantly, is the effect on the status of health and wellness of the population in the country maximized with the existing regulatory frame work. In this paper, I argue that the reform in the healthcare system and the improved mechanisms of setting priorities can maximize the health of the UAE population. This paper also focuses on the reform of the healthcare system and acknowledges that the multi-sectorial systems could face difficulties in unifying some important regulations at the national level. Therefore, it is suggested that one regulator at the federal level in UAE could solve many of the healthcare challenges facing the system today. Where possible, it can delegate its regulatory powers to those Emirates or States that have the capability to handle such responsibility, but ultimate responsibility falls back on the Federal Regulator
Name: Amina Mohammad Almarzouqi Nationality: United Arab Emirates (UAE) Educational Qualifications: 2000 - PhD. in Public Health, (Healthcare Management and Planning [Human Resources Planning & Development])Institute of Public Health, Alexandria University, Egypt 1994 - High Diploma in Healthcare Management and Planning, Institute of Public Health, Alexandria University, Egypt 1988 - Master’s Degree in Health Management, Planning, and Policy, Nuffield Institute, Leeds University, UK 1985 - Bachelor of Science in Community Health Education University of South Carolina, Columbia, USA 1973 - Diploma in Midwifery, Nursing Institute, State of Kuwait 1972 - Diploma in General Nursing, Nursing Institute, State of Kuwait EMPLOYMENT STATUS: Acting Dean, College of Health Sciences, University of Sharjah, Assistant Dean, University of Sharjah,College of Health Sciences Faculty, University of Sharjah, College of Health Sciences, Health Services Administration Department Visiting Faculty, University of Sharjah, College of Health Sciences, Health Services Administration Department Adjunct Faculty, Women Higher Colleges of Technology, Health Sciences, HIM Program, Sharjah Adjunct Faculty, College of Health Sciences, University of Sharjah Advisory Board member, Health Services Administration, College of Health Sciences, UOS Technical Advisor, Ministry of Health, UAE Nominated Vice Chancellor, University of Sharjah, (UOS) Dean of Students’ Affairs (women), UOS. Acting Dean Health Sciences College, University of Sharjah, UAE Faculty member at Department of Health Services Administration (HSA), College of Health Sciences (CHS), UOS Chairperson of Clinical Nutrition Program, CHS, UOS Chairperson of Health Services Administration, CHS, UOS Acting Director of Health Care Services, UOS Worked in Ministry of Health & Prevention in UAE for 37 years, recently working in University of Sharjah, UAE. Socially active and qualified as Subject Matter Expert in the Health Management, Planning & Policy.
Background: Foreign body aspiration is a common life threatening emergency but largely preventable problem. It refers to aspiration of an object into the respiratory system and is a serious potentially fatal event. There is an increase in the number of headscarf pin aspiration cases among young girls as a result of increase in the number of veiling population. A hijab is a kind of head cover, worn for religious intentions; with the number of hijab wearing population increasing all over the world, attention must be brought to the risk associated with holding the hijab pins in the mouth. Aim: To study the practice of hijab pin use among Islam women and to identify the practice of holding the pin in the mouth. Materials and methods: Around 270 Islam women are interviewed in the study. Participants were students and relatives of the patients visiting Yenepoya Medical College hospital, Mangalore, India. The study was approved by the Institutional ethics committee. A questionnaire was provided to record the socio-demographic details and the practice of hijab pin use. Results: Among these 270 Islamic women, 260 (96.3%) of them wear hijab. 221 (81.85%) women use hijab pins to hold different layers of hijab. 191(70.74%) of them hold the hijab pins in between the lips when they adjust the layers of hijab. 72(26.67%) women had occasions when the hijab pin slipped into their mouth and 10 (3.70%) of them have aspirated the hijab pin accidentally. Maximum hijab pin use is in the age group between 21 to 40 years (89.44%) and least in the elderly (6.66%). Occasions when the pin slipped into the mouth or aspirations both are maximum in the below 20 years group (39.28%) and (7.14%) respectively. Both are nil in elderly. Conclusion: Accidental foreign body aspiration of hijab pins is a preventable problem. Appropriate education and intervention need to be planned as more young population is getting involved.
Dr Anil Kakunje, is currently the Professor and Head, Department of Psychiatry, Yenepoya Medical College, Mangalore, India. He has 37 publications in scientific journals, 42 citations and has edited 2 books. He is current field editor of Indian Journal of Psychiatry and immediate past editor of Indian Psychiatric society, Karnataka branch. His areas of interest are Psychopharmacology and cultural psychiatry
Suicides and suicide attempts are one of the biggest problems and challenges in the context of public health. What are we doing to prevent this? Suicide and suicide attempts have their social and economic dimensions. Suicide is the leading cause of death worldwide. The World Health Organization (WHO) recommends the development of regional suicide prevention programs. Based on data from the WHO, data provided by EU countries and literature data on the subject, statistics on the scale of suicides and suicide attempts have been presented. According to police data, 15 people die in Poland every day in suicide (more than in car accidents). In 2017, there were 5227 suicides and more than 11,000 suicide attempts. There were 730 suicidal attempts among adolescents, and 28 children before the age of 12 killed themselves. This problem also applies to seniors, over 600 committed suicides in 2017. The report presents the state of work for the development of Suicide Prevention Programs in Europe and Poland. Research methods used: primary and secondary data analysis, critical literature analysis, surveys and structured interviews.
Iwona Mazur has completed his PhD from Jagiellonian University in Krakow, Poland, and 13th University of Paris. She is an economist and an expert in the field of mental healthcare management. She is the Assistant Professor of public health and health management of the Wroclaw Medical University (Department of Public Health). She is also the CEO of the Day Centre for Psychiatry for Children in Wroclaw. She is an attendant of many meetings and international conferences dedicated to mental health, public health. She is the author of many scientific articles concerning public health, psychiatry care and management of health care system.
Health consciousness fosters attention of individuals to health and health promotion. A lot of studies show, that there is a relation between health consciousness and preventive health behaviour (Gould, 1990; Hong, 2009; Chihwel, 2013). The aim of our study was to investigate links between young adults’ health consciousness, health locus of control and smoking, alcohol and drug consumption. 217 young adults participated in the study (60,4 % females, 39,56% males). The age - 18¬-29 years. Health Consciousness Scale (Hong, 2009), Multidimensional Health Locus of Control scale (Wallston, 1978) and specially designed questionnaire about smoking, alcohol and drug consumption were used. The results indicated that health consciousness and health locus of control are related. Higher points of health consciousness means that internal and powerful others health locus of control points will also be higher. Health consciousness of non-smokers is higher than smokers. Smoking is predicted by health consciousness and alcohol and drug consumption. No link was found between health consciousness and alcohol or drug consumption. These results are not consistent with previous studies. We can assume, that young people do not consider alcohol consumption and marihuana smoking (which is the most popular drug at this age) as health risk behaviour. Health locus of control is related to smoking and drug use. We conclude that health consciousness and health locus of control concepts could replace each other in the surveys. Health consciousness concept can be useful in searching for new and effective ways of health interventions.
Laima Bulotaite is professor of psychology at Psychology Institute, Vilnius university, Lithuania. Her research interests are in health psychology field, she is especially interested in health risk behaviour. She has published more than 50 scientific papers, participated in conferences in EU and other countries. Professor participates in a number of national and international projects. She is an author or co-author of some books on health and addiction psychology. Agne Kazeviciute is health psychologist, who just started her career. Her interests are in the field of health promotion and disease prevention.
The prevalence of malnutrition is still one of the major underlying problems for morbidity and mortality. In Bangladesh, infant and young child suffer from one or more forms of malnutrition.Bangladesh has the sixth highest prevalence of childhood underweight among all countries of the world and it ranks 25th in terms of prevalence of child stunting, 4.1 million children born with low birth weight, 55% of children under age 6 months are exclusively breastfed. The Nutrition Intervention Project of BRAC aims to reduce malnutrition among pregnant-lactating women, adolescent girls, and young children in order to reduce mortality and morbidity, particularly among poor and socially excluded populations. This project targeted 33 millions of populationamong 23 districts of Bangladesh. Through home visits,front line workers of BRAC provide mothers of children 0-24 months of age IYCF counseling, demonstrationsand through social mobilization sessions on IYCF raise awareness and seek commitments to action.Key messages are delivered on early initiation of breastfeeding, exclusive breastfeeding from birth up to six months and age appropriate complementary feeding. Regular collection of data and assessment of routine issues quarterly is being done to track the findings. The project after running almost one and half years, total individual counseling sessions conducted with mother’s of children (0-6m):1557120, and among them 1091853 children (0-6) are exclusively breastfed. Moreover, total counseling and demonstration conducted for mother's of children (6-24m): 709845 and among them 293995 children (7-24)have consumed minimum acceptable diet. The outcome shows how counseling through home visits, social mobilizationand monitoring can improve Infant and Young child feeding practice within communities.
Dr. Mithun Gupta has completed her Masters of Public Health from National Institute of Preventive and Social Medicine(NIPSOM), Bangladesh. She has been working in public health since last six years. She is now the Senior Sector Specialist of Health, Nutrition and Population department of BRAC, World’s number one development organization. She has worked with the research team of NIPSOM and participated in several conferences to share her experiences in working with the community people. Recently in 2017, her abstract on Oral health Literacy and Psychosocial factors of Child care giver has been published on 2nd World congress on Medical sociology and community health.
Many people with Chronic Obstructive Pulmonary Disease (COPD) are socially isolated and have reduced mental well-being. To combat social isolation and loneliness, Making Waves (MW) clinics are an assets-based and co-created initiative that are co-ordinated by NHS services with third sector partners. The clinics provide social activities, peer and clinical support. The aim of this evaluation was to understand how this collaborative community-based healthcare model can be spread successfully. NHS ethical approval for this prospective observational study was obtained in March 2017. A purposive sample of 145 people with COPD were recruited from across seven MW sites in the Midlands, England. Measures of health status were obtained at baseline, 3 months and 6 months, resulting in a final sample of 67. Qualitative evaluation was also explored. Repeated measures ANOVA demonstrated statistically significant improvement in meanEQ-5D VAS(55.421.84) and CAT(24.67.55) scores to (61.122.73) and (23.97.62)respectively from baseline to 6 months (p<.05). Patient Activation Measure indicated 35% of participants increased at least one level of activation to self-manage their COPD at 6 months. Qualitative evaluation suggested MW clinics were highly valued, improved mental well-being and reduced feelings of social isolation. Successful spread required effective use of local partnerships, with active support from commissioners and clinicians. Preliminary findings suggest that this model of healthcare can be beneficial for patients with COPD and could potentially result in healthcare savings. Further independent investigation is required but this novel approach may also be beneficial for people with other long-term conditions.
Sean is a Lecturer in Sport, Exercise and Physiotherapy at Coventry University, UK. His main area of interest is physical activity and impact upon long term health across the lifespan. He undertook a fieldworker role on this multi-regional project in collaboration with many other health professionals, volunteers and charities. He would like to thank the participants, his colleagues both internal and external to Coventry University, for making this project possible. He is also grateful to the Health Foundation and NHS England for providing funding for this project, which was obtained by the senior project team.
To successfully tackle the problems with the underutilization of primary care in rural China, it is important to align resource allocation with the preferences of the rural population. However, despite growing interest in the factors influencing the rural population’s choice of facility, it is unclear how much weight should be placed on these factors, especially under different scenarios of disease severity. In the first study to elicit quantified trade-offs among influential factors in choosing health care facilities, we carried out a discrete choice experiment (DCE) on 559 residents in rural China. Each questionnaire contained 12 questions on choice, with each question assigned a scenario of either mild (PM) or severe (PS) disease. The factors regarding the availability and affordability of a facility, such as visit time, travel time, and out-of-pocket cost, were highly valued. When all facilities changed simultaneously from the worst to the best case, a huge increase (from 4.8% to 66.5%) in the choice probability (CP) of visiting a facility was observed under PM whereas there was no significant change under PS. Specifically, the CP of a township health center (THC) could increase from 2.8% to 48.7% under PM and from 28.8% to 87.9% under PS when it changed from worst to best case. We concluded that rural residents relied on THCs substantially as the first-contact facility for both mild and severe disease. Upskilling, improvements on drug availabilityand equipment of THCs– can induce potential medical care seeking, and redirect patient flow from higher level hospitals to THCs.
Yun Liu is a Chinese PhD candidate (4th year, Health Services Management)at Erasmus University Rotterdam, the Netherlands. She holds a BSc in pharmacology and an MSc in pharmacokinetics from Capital Medical University, China, and an MSc in health economics from Erasmus University Rotterdam.Before entering the PhD program in 2015, she had multiple publications in pharmacology. Currently she has two publications and two working papers as first author in health services research. Her dissertation will examine the patient preferences for health care facilities in China by using both qualitative and quantitative methods.
Globally ischemic stroke is second leading cause of mortality and morbidity among adult population. Prompt diagnosis of ischemic stroke sub-type can lead to better clinical outcomes. This study aimed to adapt and develop mHealth based android application ‘InstaDx’ and validate the application in two phases, to assist ischemic stroke sub-type diagnosis for use among neurology residents against a Stroke Expert. InstaDx uses an evidence-based algorithm to diagnose ischemic stroke sub-type in the presence of multiple competing mechanisms to minimize misdiagnosis and improve prognosis. In the first phase, algorithms of sub-type diagnosis were created through standard guidelines and then transferred into InstaDx. In the second phase a validation study was conducted at Aga Khan University Hospital, Karachi from March-August 2017. 228 consecutive patients of age ≥18 years (62.59±14.60), presenting in emergency department with neurological deficits consistent with stroke were recruited and InstaDx was used by residents. 11.84% patients receive revascularization with tissue plasminogen activator. Sensitivity and specificity of InstaDx for large artery arthrosclerosis was 65.91 and 73.57%, small artery atherosclerosis was 56.25 and 84.18 % and cardio aortic embolism was 58.33 and 99.17%, respectively against Stroke Expert diagnosis. Focus group discussions were used to assess the user feedback in third phase which revealed acceptance of InstaDx as an educational tool by the residents suggesting advanced diagnostic capacities. InstaDx proved to be a valuable sensitive and highly specific mHealth based application for diagnosing subtype of ischemic stroke. It provides standard algorithm to confidently assess ischemic stroke patient. Clinical-Trials-Registration-URL:https://clinicaltrials.gov/ct2/show/NCT03080233
Saadia Sattar completed her Masters in Epidemiology & Biostatistics from Aga Khan University Hospital in 2017. Currently she is working with Tabba Heart Institute which is a non-profit organization focused on preventive and interventional management in the area of neuro-cardiovascular research. Her designation is Clinical Research Consultant and currently she is supervising multiple clinical trials with respect to homeostasis and radiation exposure during vascular procedures. As an enthusiast young researcher, portraying her interest through previous publications in stroke neurology her research focus is towards behavioral modification and preventive modalities improving disease prognosis in the field of vascular biology
Healthcare systems, particularly hospitals in low income countries(LICs) mainly in Sub-Saharan Africa (SSA) face major health work force labor issue challenges while having to deal with extraordinary high burdens of disease. The effectiveness of Human Resource Management (HRM) is therefore of particular interest for these SSA hospitals. While, in general the relationship between HRM and hospital performance is extensively investigated, most of the underlying empirical evidence is from western countries, and may have limited validity in SSA. Evidence on this relationship for SSA hospitals is scarce and scattered. We present a systematic review of empirical studies investigating the relationship between HRM and performance in SSA hospitals. Following the PRISMA protocol and searching in seven data bases (i.e. Embase, Medline, Web of science, Cochrane, PubMed, Cinahl, Google scholar) yielded 2252 hits, and a total of 111 included studies which represent 19 out of 45 SSA countries. From an HR perspective, most studies researched HRM bundles that combined practices from the practices domains motivation enhancing, skills enhancing, and empowerment enhancing. Motivation-enhancing practices were most frequently researched, followed by skills enhancing practices and empowerment-enhancing practices. Few studies focused on single HRM practices (instead of bundles). Training and education were the most researched single practices, followed by task shifting. From a performance perspective, our review reveals that employee(nurses, physicians, midwives) outcomes and organizational outcomes are frequently researched, whereas team outcomes and patient outcomes are significantly less researched. Most studies report HR interventions to have positively impacted performance in one way or another. As researchers have studied a wide variety of (bundled) interventions and outcomes, our analysis doesn’t allow to present a structured set of effective one-to-one relationships between specific HR interventions and performance measures. Instead, we find that specific outcome improvements can be accomplished by different HR interventions, and conversely that similar HR interventions are reported to affect different outcome measures. In view of the high burden of disease, our review identified remarkable little evidence on the relationship between HR and patient outcomes. Moreover, the presented evidence often fails to provide contextual characteristics which are likely to induce variety in the performance effects HR interventions. Coordinated research efforts to advance the evidence base are called for. Key words:HRM, SSA, employee outcome, team performance, patient outcome, hospital, health workforce, healthcare system low-income countries, systematic review
Mental health problems are common among Vietnam adolescent. However, studies focus on private high school students are limited.This study aims to examine mental health status and related factors among private high school students in Hanoi, Viet Nam. A cross-sectional study was conducted among 342 students in a private school in 2016 using a self- administered structure questionnaire. In addition, we conducted in- depth interviews and focus group discussion with six students, three teachers, the school's principal and school health staff. Strengths and Difficulties Questionnaire (SDQ) was used as mental health screening instrument. The result showed that mean age of participant is 16,79 ± 0,88. 62,2% participant are boys. With the cut-off point of 15, 27% of students were screened with mental health problems; it is not significantly higher in girls (30,2%) than boys (25%). Prevalence of participants with conduct and peer relationship problems are similar (24.7%). Bivariable analysis indicated various factors associated with mental health problems of students such as: academic, athletic, social, and personal behaviors. Multinomial logistic regressions show that studying time and frequency of playing game have significant association with prevalence of mental health problems.The prevalence of students with mental health problems in our study is higher than some previous studies in Vietnam and shows the need of developing and implementing intervention programs at school to improve mental wellbeing of student.
Linh Dang has completed her Master of Public Health in Hanoi University of Public Health in Vietnam. She has been working at Institute of Population, Health and Development since 2010 as a researcher
Analysis of deaths among Russian population from vascular diseases requiring surgical treatment for 2010-2016 made it possible to form indicator mortality from surgical vascular diseases. Proportion of causes requiring surgical treatment (I70.0, I70.1 and I70.2) was 42.2% among men and 26.9% among women in «Atherosclerosis» mortality in 2010, and 70.0% and 44.2% in 2016 respectively. Mortality from “Diseases of arteries, arterioles and capillaries” was almost completely determined by diseases requiring surgical treatment (I71, I72, I73.9, I74, I77.0, I77.1, I77.2, I77.4, I77.5 and I78.0). In 2010, the analyzed causes accounted or 98.1% of men deaths and 97.9% of women deaths, 99.0% and 98.9% in 2016 respectively. In mortality from "Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified" proportion increased to 48.3% among men and to 72.4% among women. Proportion of surgical vascular diseases (I80.1, I80.2, I82.1, I82.2, I82.3, I82.8, I82.9, I83.9) also increased from 64.1% among men and 69.9% among women to 72.9% and 81.4% respectively. Total mortality from surgical vascular diseases is increasing: from 16.8 per 100 000 among men and 12.3 among women to 21.5 and 15.9, respectively. Some diseases fell out of focus of ongoing programs aimed at reducing cardiovascular mortality. Introduction into practice of the proposed statistical indicator of mortality from surgical vascular diseases will make it possible to objectively evaluate effectiveness of measures aimed at reducing mortality.
Aleksandr V. Zubko has completed medical faculty of I.M. Sechenov First Moscow State Medical University (Sechenov University), postgraduated in field of cardiovascular surgery and public health. He is researcher in the department of analyses of health statistics. He has published more than 15 papers in scientific journals
Russia is in third stage of epidemiological transition: circulatory diseases and neoplasms are leading death causes and infections are on the eleventh ranking place. In post-Soviet period, increase in infectious mortality was observed, while it was decreasing before. Negative mortality trends were formed by mortality of people of working ages with maximum increase at age of 30-39 years. Mortality from infections of the second stage of epidemic transition, which predominate mainly among children and elderly (intestinal infections, parasitosis), are at a low level. However, cumulative incidence of acute intestinal infections also stopped its decline, which may indicate slowdown in process of improving socio-economic situation. Similarly, death from septicemia is at stable level during 25 years. The increase in infectious mortality is due to increase primarily in mortality of people of working age from HIV/AIDS, secondly, in mortality of women of working age from tuberculosis, and finally in mortality of adults from viral hepatitis. The important fact is that, first, the most critical situation exists in people aged 20-39, who are most active in terms of social, economic and, what is of crucial importance to Russia, reproductive aspects. Second, in the gender perspective, regardless of age, evolution of infectious disease mortality in females (both in terms of death decline rates and structure) has a more negative scenario compared to males. Therefore, the social significance of infectious mortality is not reduced. It is social determinants that contribute to deviation from the classical theory of epidemiological transition.
Tamara Sabgayda has completed her PhD and D.Sc. from Martsinovsky Institute of Medical Parasitology and Tropical Medicine. She graduated Medico-biological faculty of the 2nd Moscow medical institute with specialization in medical and biological cybernetic. She is Chief Researcher in department of analysis of health statistics. She has published more than 90 papers in reputed journals.
The development of new human settlements and rapid urbanization across South Africa has seen an emergence of social entrepreneurships that include among others, child care services that are intended to provide a service to working families. This phenomenon has inherent health and safety risk factors associated with unregulated security, health and safety practices. A door-to-door centre drive and walk through visual assessment, checklist audits and standardised centre manager questionnaires to survey child security, safety and health risks knowledge, attitudes and practices by child care centre owners/managers in the designated health district (n=35). Two (n=2) 5% responses were unusable they were from centers that feared that authorities will victimise them and shut their businesses. Overall infrustructure risks were recorded at 36% high risk, 24% moderate risk and 41% low risk therefor yielding a 33% risk. In terms of food quality and child feeding practices, the survey the risk assessment analyses yielded 27% moderately risk n=4 (27%) to low risk n=9 37% then high risk n=15 (46%). Health and hygiene risk assessment yielded high risk practice at 41% ,moderate risk at 27% and low risk at 28% with a total of 32% overall risk. Safety and medical emergency practice risk levels were recorded at 41% high risk practices, 29% moderate risk levels and only 27% low risk levels thus yielding average 36% risk at this key factor. Overall only 57% n= 16 have registered with City of and are members of an organised and formal child care association. A total of 12 child care centre managers have experienced at least more than one negative security, safety and health incident in the centre. Cause-specific child mortality and morbidity rate (per 100 000 population)
Mr Gert Matshoge has completed his Masters degree in integrated school health programmes from Tshwane University of Technology, South Africa and now a doctoral candidate at TUT. He is a community Based Health Care project manager for university social uplifment programmes that include training for graduate nurse education and post basic occupational health nursing and management. He studied further work experience in occupational health and safety in petroleum industry in Southern Africa with BP, prison health care, chemical industry and motor manufacture with FORD SA.
As early as 1992, the World Health Organization commenced with advocacy for school health services that would strengthen schools’ capacity as a healthy environment for living, learning and working. Safety and security in South African schools has become one of the most problematic areas for school-going children and their teachers. Children’s general wellness, psychosocial development, and academic achievement is negatively affected. The situation that has recently been characterized by a surge of violence, bullying; discrimination; and sex crimes among others.Safety and security services not and community preventive health promotion events are not integrated into school health services just as it was promulgated in the Integrated School Health Policy.This was a descriptive quantitative study conducted in Pretoria, South Africa among conveniently sampled schools to assess the compliance of Integrated School Health Policy’s safety and security elements. The schools’ principals completed questionnaires while the researchersused a checklist to assess basic infrastructural and school community health-related risk behaviours. The findings indicate that there is general non-compliance to the safety and security element of the Integrated School Health Policy. The checklist findings revealed many discrepancies in terms schools’ compliance to safety, health and security elements.In conclusion, compliance to Integrated School Health Policy’shas not progressed to achieve the strategic objectives for health care reforms in South African schools.
Richard, M. Rasesemola has completed his Mastersin Nursing from Tshwane University of Technology, South Africa and he is currently a PhD candidate form the same institution. He has published 2 papers in an accredited journal and presented in 7 conference, 6 local and 1 international conference. His areas of interset include reproductive health, schoold health, public health policies and non-communicable diseases. He is a member of Junior Public Health Association of South Africa (JuPHASA). He currently works as lecturer at Tshwane Universit of Technology
Background A food poisoning outbreak was reported from food safety department of General Health Affair of Al-Madinah on Friday, third of March 2017, when seven cases visited the primary health care of Alyeettmah (Al-Madinah) complaining of gastro-intestinal symptoms after eating meal on previous day in Alyteemah restaurant. Cases reached 69 in the next 3 days and team from field epidemiology training program (FETP) visited area and conducted an epidemiological investigation to assess extent of outbreak; identify source and provide recommended measures to prevent future outbreaks. Methods A descriptive study was conducted, case was defined as any person who ate from Alyteemah restaurant, between Thursday and Friday 3-4 March 2017, and developed one of the following symptoms: fever, abdominal pain, diarrhea, nausea, or vomiting. Detailed inspection of mess for hygiene and sanitary status, cooking and storage procedure related to food handlers and restaurant were carried out. Samples from food handlers (stools, nails, and nasal swabs)and uncooked food were taken for lab analysis. Results 69 people met our case definition. The most frequent food items were Mayo-Sauce (98.6%) and fried chicken (95.7%). Restaurant was newly open.72.73% and 27.27% of patient were positive for Salmonellae and S. Aureus respectively. 75% of the throat swabs of food handlers were positive for Staph aureus. One stool sample of food-handler was positive with Salmonellae. Conclusion The food handlers were source of infection,but they were asymptomatically where they infected mayo-sauce. Adding vinegar to mayo-sauce will make it a perfect media for Salmonellae and this should be incriminated. Increasing awareness of food handlers by educating them about the proper way of washing their hands in warm running water along with soaps. Key words: Salmonellae, Food poisoning, Mixed outbreak
Oral health is the most neglected area of public health, thus, developing global policies in oral health promotion, and oral disease prevention is necessary. The Primary Health Workers of the barangays, known as Barangay Health Workers (BHWs), are the primary health care service providers. They need to be trained by dental professionals on the necessary skills, knowledge and approaches essential to deliver basic oral health care messages and referral services. This study determined the basic oral health care knowledge among BHWs using descriptive survey method. The researcher-made questionnaire was distributed to randomly selected 132 BHWs. Results revealed that majority of BHWs had no proper oral health training in the last five years. They were highly knowledgeable about the relationship and effects of oral health to general health, structures, and functions of oral cavity and screening and recognition of observable oral diseases. But, BHWs had less knowledge on basic oral hygiene and necessity and practices of a dental visit. Statistical analysis showed that knowledge on screening and recognition of observable oral diseases among age groups are significantly different. The educational attainment differs significantly regarding knowledge of basic oral hygiene and recognition of observable oral diseases. Knowledge on the relationship of oral health to general health was highly related to detection and identification of noticeable oral diseases which is highly related to knowledge of necessity and practices of a dental visit. This study is vital in conducting intensive training among BHWs to improve the delivery of quality essential oral health care services.
GRACE V. VILLANUEVA completed her MAREXA from Silliman University, Philippines, a licensed environmental planner, and led numerous internationally and locally funded projects.
This study aims to assess the Critical Illness Insurances(CII)effects on underuse of dialysisamong End-stage renal disease patients(ESRD) and evaluated medical cost of patients with maintenance dialysis in ruralareas in China. Mixed cross-section data of ESRD patients in maintenance hemodialysis (HD) were collected in New Rural Cooperative Medical Scheme (NCMS) system by diagnosis and medical records in Xiantao city in China during 2010-2016. 4,013 ESRD patients were included in this study.General information (age, gender) of ESRD patient was collected. Total medical expenditure (TME), out-of-pocket (OOP)payments and effective reimbursement rate (ERR) were estimated to evaluate financial burden with descriptive statistics and rank sum test.Patients with ESRD were followed each year until they ceased hemodialysis, and underuse of dialysis was measured with hemodialysis adherence rate.After Critical Illness Insurances implementation, the OOP payments of all patients with regular hemodialysis significantly decreased from RMB 8,510 in 2010 to RMB 4,632 in 2016(P<0.001), ERR increased by 20% over seven years(P<0.001). Hemodialysis adherence rate for three years increased from 19.52% to 26.34%, and the OOP of patients insisted dialysis also decreased from RMB11,996 to RMB5,672.The Critical Illness Insurances effectively decreased the financial burden and improved dialysis access of ESRD patients. But the underuse of dialysis was still a serious issue in China, and more practice need be implemented in healthcare underuse pattern
Junnan Jiang has completed his master from Huazhong University of Science and Technology, Wuhan, China. And she is studying her Ph.D. at this school. He has published more than 2 papers in reputed journals, and participated the international health conferences in Yale University, USA
Since the Alma-Ata conference, the empowerment of patients has evolved as one of the health promotion strategies in the Ottawa Charter of 1986, and nowadays as one of the general principles of the WHO Global Plan of Action for global prevention and control of Chronic non-communicable diseases (CNCD). However, despite these many contributions to the improvement of the quality of healthcare, little evidences exist in Sub-Saharan Africa (SSA). The purpose of the communication is to present how the existing interventions within the health system of the SSA countries contribute to patient empowerment. A systematic review of published articles until 31 July 2018 from the model « PRISMA-P 2015 » was made.A combination of the keywords and MeSH terms was used to carry out the documentary search in six databases. The results reveal that several interventions targeting patient empowermentwere implementedsince the beginning of the years 2000, to controland prevent CNCD, based only on the micro level.This is mainly clinically based interventions (80%), which targets case management, in an individual approach. They mainly targeted cardiovascular diseases (42%), diabetes (23%), cancers (15%), respiratory diseases (9%) and others (11%).These interventions define patient empowerment as a process that allows them to have better control over their own health, which goes through learning, control and meaning. However, no study evaluated the three levels. The health care system in SSA remains highly paternalistic, and the different approaches that promote the development of patient empowerment are very poorly evaluated or non-existent.
Amélie Mogueois a PhD candidate at University of Montreal, Canada. She is working in the control of Chronic non-communicable diseases, trought patient empowement. She has published 3 papers in reputed journals and is currently working on several other articles for publication.
Objectives: A lot of surveys against chronic disease patients have been carried out, but the item nonresponse in surveys could lead to incorrect findings. From social perspective, item nonresponse would emerge when respondents keep silent in surveys. However, causes of keeping silent are unknown until now. This study, therefore, aims to identify characteristics of the item nonresponse and find the factors affecting chronic disease patient's silence in rural China. Methods: Cross-sectional survey data from patients with chronic diseases from rural China were analyzed. A total of 1099 patients were included in this study. Chi-square test and cumulative logistic regression analysis were used to examine associations of item nonresponse with socio-demographic characteristics, accessibility to health-care services, health status, and health knowledge level. Results: It is found that household income (21.8%), the danger of passive smoking (14.9%),health-care follow up services such as doctor’s skill (20.2%), doctor’s attitude (19.1%), health care environment (19.5%), and service times (11.1%) have higher item nonresponse rates. Among the 1099 questionnaires, the majority of the items nonresponse numbers are under 3 in one questionnaire (84.3%). Among all significant predictors, It is found that respondents in central provinces(OR=2.311, 95%CI=0.532-1.144, P<0.001) of rural Chinese with exceed 8 household members(OR=2.691, 95%CI=-1.632-0.349, P=0.002), multiple chronic diseases(OR=3.320, 95%CI=-1.673-0.727, P<0.001), and lower health knowledge level(OR=2.112, 95%CI=0.405-1.090, P<0.001) have more item nonresponse numbers, in other words, they are more likely to keep silent. Compared with education level of high school and above, when the participants who are illiteracies (OR=2.159, 95%CI=0.254-1.285, P=0.003), primary school (OR=2.161, 95%CI=0.249-1.294, P=0.004), junior school (OR=2.070, 95%CI=0.160-1.296, P=0.012), the number of item nonresponse seems to increase. Conclusion: This study shows the characteristics and influencing factors of item nonresponse of chronic disease patient surveys in rural China. This study not only contributes to investigation practice, but also points out health institutions should improve the quality of follow up services and government should pay more attention to care about the vulnerable groups, especially chronic disease patients in rural areas.
Yiqing Mao is a doctoral student in School of medicine and Health Management, Huazhong University of Science and Technology. She has published more than 10 papers in Chinese journals. Hang Fu is a researcher in China Hospital Development Institute, and has completed his PhD from Huazhong University of Science and Technology. He has published more than 10 papers in reputed journals.
Quality of care is a priority of health systems that seek to improve the efficiency and effectiveness of care provided at the hospital level as well as at the level of primary health care facilities. It is a dynamic and multidimensional concept that is hard to measure and there are many ways of its evaluation. In this sense, the World health organization (WHO)has proposed in the Eastern Mediterranean Region(EMRO)a list of indicators to use to assess the quality of primary care. The aim of our study was to assess the quality of primary health care in Nabeul using the indicators proposed by WHO. Methods: Using the list of 34 indicators developed by WHO, we have looked at the different dimensions of quality of care (accessibility, safety of care, efficiency, effectiveness, patient centeredness, timeliness)It is a descriptive and evaluative study including cross-sectional, retrospective surveys in three primary health care centers (PHCC) in Nabeul between 2015 and 2016. Results: Out of the three PHCC,17% of the population served was registered with a difference noted between urban and rural areas. The reference rateat the second level of care was 19%.69.5% of pregnant women had their first visit in the first quarter and 52% had at least 4 perinatal consultations.The average waiting time to see the doctor was 114 minutes.The antibiotic prescription rate was 46.7%.For effectiveness of chronic disease management, only 19.6% of diabetics were balanced and 62.6% of hypertensive patients had a controlled hypertension.None of the patients had a cardiovascular risk assessment or anti-smoking advice. The immunization coverage rate for children was 86.1%.Compliance with hand hygiene was noted in 62% of acts. Conclusion: The quality of care remains a difficult concept to measure which seems satisfactory in certain aspects and is suffering from weaknesses requiring corrective actions in other aspects hence the importance of its continuous evaluation to ensure its improvement.
In Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV AIDS) patients, Cryptococcus meningitis is a serious fungal infection. India ink test is the most used method for laboratory rapid detection of Cryptococcus neoformans in CSF (cerebrospinal fluid) specimens. Use of CrAg (Cryptococcus Antigen) for laboratory detection of cryptococcus neoformans from cerebrospinal fluid will help reduce mortality. It is important therefore to compare the sensitivity of India ink test and CrAg against fungal culture for diagnosis of fungal meningitis in HIV AIDS patients. The main aim of this presentation is to compare level of patients missed during laboratory diagnosis of Cryptococcus meningitis by use of India Ink and CrAg. It was found out that cryptococcus meningitis in this study accounted for prevalence of 18% of defining illnesses in HIV/AIDS patients at Moi Teaching and Referral Hospital (M.T.R.H). Risk ratio of CrAg compared to India ink in this study gave an estimate of 2.12 which is statistically significant at 95% confidence interval of confidence limits of 1.65 and 2.74. The level of patients missed for cryptococcus meningitis using India ink was found to be 55.5% compared to 5.6% patients missed by CrAg. Based on the study, it was suspected that more missed cases were to be reported at M.T.R.H if continued use of India ink for diagnosis of cryptococcus meningitis, therefore, CrAg test recommended to India ink test (that was used routinely for diagnosis of cryptococcus meningitis).
Ms Nancy Mbae is pursuing PhD in epidemiology at Jomo Kenyatta University of Agriculture and Technology Moi University. I completed master of public health- epidemiology and disease control specialization from Moi University, Bachelor of Science in medical microbiology and post graduate Diploma in psychological counseling from the Kenya Institute of psychological counseling. I have diverse research experience while working at The Moi Teaching and Referral Hospital, Kenya Institute of Public Policy and Research Analysis, Futures Group International and Kenya Methodist University. Presently, am working at Kenya Methodist university, Kenya as an assistant lecturer public health.
Healthcare systems, particularly hospitals in low income countries(LICs) mainly in Sub-Saharan Africa (SSA) face major health work force labor issue challenges while having to deal with extraordinary high burdens of disease. The effectiveness of Human Resource Management (HRM) is therefore of particular interest for these SSA hospitals. While, in general the relationship between HRM and hospital performance is extensively investigated, most of the underlying empirical evidence is from western countries, and may have limited validity in SSA. Evidence on this relationship for SSA hospitals is scarce and scattered. We present a systematic review of empirical studies investigating the relationship between HRM and performance in SSA hospitals. Following the PRISMA protocol and searching in seven data bases (i.e. Embase, Medline, Web of science, Cochrane, PubMed, Cinahl, Google scholar) yielded 2252 hits, and a total of 111 included studies which represent 19 out of 45 SSA countries. From an HR perspective, most studies researched HRM bundles that combined practices from the practices domains motivation enhancing, skills enhancing, and empowerment enhancing. Motivation-enhancing practices were most frequently researched, followed by skills enhancing practices and empowerment-enhancing practices. Few studies focused on single HRM practices (instead of bundles). Training and education were the most researched single practices, followed by task shifting. From a performance perspective, our review reveals that employee(nurses, physicians, midwives) outcomes and organizational outcomes are frequently researched, whereas team outcomes and patient outcomes are significantly less researched. Most studies report HR interventions to have positively impacted performance in one way or another. As researchers have studied a wide variety of (bundled) interventions and outcomes, our analysis doesn’t allow to present a structured set of effective one-to-one relationships between specific HR interventions and performance measures. Instead, we find that specific outcome improvements can be accomplished by different HR interventions, and conversely that similar HR interventions are reported to affect different outcome measures. In view of the high burden of disease, our review identified remarkable little evidence on the relationship between HR and patient outcomes. Moreover, the presented evidence often fails to provide contextual characteristics which are likely to induce variety in the performance effects HR interventions. Coordinated research efforts to advance the evidence base are called for.
Cigarettes smoking is the leading cause of chronic diseases, disability and mortality around the world. A large body of research evidence suggests the negative relationship between cigarette prices and smoking prevalence. Furthermore, young adults appeared to be more responsive to increases in cigarette prices. The prevalence of smoking in Belarus is among the highest in the world. During the recent five years, the Belarusian government has adopted a comprehensive range of measures designed to reduce tobacco-related burden. The aim of this paper was to estimate the relationship between tobacco excise taxes, real cigarette prices, cigarettes consumption per capita and smoking prevalence rates in Belarus. Methods: Trends in tobacco excise taxes, real cigarette prices, cigarettes consumption per capita and smoking prevalence rates between 2010 and 2015 were compared. Results: Between 2010 and 2015 excise tax rates and real cigarette prices have increased by 1.5 times, the level of cigarettes consumption per capita decreased by 16%, while the smoking prevalence rates decreased by 6.1% among men and by 9.2% among women. A Spearman’s correlation analysis suggests a statistically significant negative association between real cigarette prices and cigarettes consumption per capita (r=-.099; p<0.000). The youngest age groups of both men and women did experienced a greater decrease in the smoking prevalence rates: in the age group 16-19 years old the smoking prevalence rates decreased by 28.9% among men and by 12.7% among women; in the age group 20-29 years the smoking prevalence rates decreased by 10.8% among men and by 30.1% among women. The real cigarette prices were significantly associated with both male and female smoking prevalence rates. The relationship between real cigarette prices and smoking prevalence rates was stronger for the age groups 16-19 and 20-29 years. Conclusions: The results from this study suggest an inverse aggregate-level relationship between real cigarette prices, cigarettes consumption per capita and smoking prevalence rates. The outcomes also indicate that yang adults are particularly sensitive to reduction in the cigarette affordability. These findings suggest that the excise tax increase is among the most effective tobacco control strategy.
Dr. Yury Evgeny Razvodovsky is currently holding a position of Professor in International Academy of Sobriety. He has worked as associate professor in the Department of Psychiatry and a senior research scientist in the Scientific Laboratory (Alcohol and Drug-Related Problems Research Group) at the Grodno State Medical University (Belarus). He has published about 1000 papers in English and Russian language peer-reviewed journals and 30 monographs. He is a founding member of the International Society of Addiction Medicine (ISAM), presiding member of the International Academy of Sobriety (IAS), national representative for Belarus of World Suicidology Net and is an active member of National Association of Psychiatrists. His research interests include the epidemiology of suicides and different aspects of alcohol and drug-related problems.
Maternal mortality rates continue to soar high in Northern Nigeria despite all sorts of interventions being put in place. This has necessitated the need to emphasize on Emergency Obstetric Care (EmOC) to tackle obstetric complications which are the largest direct causes of maternal mortality. The study was conducted to assess the availability of Emergency Obstetric Care facilities in Zaria Local Government Area (LGA) located in Northern Nigeria. This was a hospital based cross- sectional descriptive study carried out in Zaria LGA. Data was collected from seven public health facilities using a structured interviewer administered questionnaire. Only 1 health facility met the criteria for Comprehensive Emergency Obstetric Care (CEOC), while none of the designated Basic Emergency Obstetric Care (BEOC) met the UN criteria for such designation. Only 8% of births took place in the health facilities and 0.7% of deliveries were by caesarean section. The met need for EmOC in Zaria LGA was 25.1%. Human resources were lacking in number and skills. Some key drugs and equipment needed to carry out signal function were also absent. Public health facilities in Zaria did not meet the requirements of the United Nations (UN) process indicators. There is need to upgrade the health facilities with the necessary human resource, equipment and facilities to enable them perform their designated EmOC functions.
Samira has completed a Masters degree in Reproductive Health from Bayero University Kano. She is currently lecturing at Federal University Birnin Kebbi, Nigeria where she also serves as the departmental Exam Officer. She has some publications in reputed journals, and also serves as Community trainer on Nutrition in Kebbi state Nigeria.
We aimed to improve the knowledge, attitude and perception regarding betel quid, areca-nut and chewable tobacco use and their harmful effects such as oral cancers among students of grade 6 to10.Material and Methods: A school-based cluster randomized control trial was carried out in 18 secondary schools targeting male and female students from grades 6 to 10 in Karachi. Intervention comprised of a 30 minute power point presentation, two posters, and one pictorial booklet and a video game on the hazards of use of various tobacco products. Primary outcome was Knowledge about hazards of smokeless tobacco (SLT) and Secondary outcome measures were 1) Attitude about hazards of SLT and 2) Perception about hazards of SLT.Results: We enrolled 738 participants in intervention group and 589 in the control group. Mean score of knowledge significantly improved in intervention as compared to control group (p value <0.01). Generalized estimating equations were used to assess the association of various factors with knowledge regarding harmful effects of SLT use. Significant predictors of increase in knowledge score were found in children: who had seen any anti SLT messages on social media in the past 30 days, who were getting information regarding harmful effects of SLT use in school or textbooks and who had friends using SLT. Intention to quit was found to be proportionately higher (33%) in the intervention group after intervention as compare to control group. Conclusions: A school-based intervention was effective in increasing knowledge regarding the harmful effects of SLDT use and increasing intention to quit smokeless tobacco use among school going adolescents. Introduction of such educational programmes on a regular basis in schools or as part of school curriculum can have an impact on reducing prevalence of SLT use.
Dr Shafquat Rozi is working in the Department of Community Health Sciences, Aga Khan University (AKU), Karachi, Pakistan as an Assistant Professor since 2014. She has done her PhD in statistics from the Department of Mathematics & Statistics, Lancaster University, UK in 2013. She is working on different community based, hospital based, and school based research projects on various public health issues and application of advance statistical methods to make appropriate inferences and conclusions of clinical/health data. She has published 23 research papers in good peer reviewed journals.
Health is both a social and economic necessity. A basic level of health care needs to be assured to every citizen of the country to ensure physical and mental well-being of all the people. Technical Efficiency is defined as the effectiveness with which a given set of inputs is used to produce an output. Technical Efficiency addresses the issue of using given resources to maximum advantage; the productive ability to choose different combinations of resources to achieve maximum health benefit for a given cost. The Study has attempted to measure the technical efficiencies of health care facilities in all the districts of Uttar Pradesh and Maharashtra using data envelopment analysis and to determine relationship between Technical Efficiency of Public Health facilities with process indicators of Maternal Care.Data Envelopment Analysis is used to measure the efficiency of the Public Health Facilities. DEA is used to measure the district-wise efficiency of the healthcare system. DEA, as an analysis tool, has flexibility in handling multiple inputs and outputs, which makes it suitable for measuring the efficiency of hospitals that use multiple inputs to produce multiple outputs. The finding suggest that only 13 percentage of the healthcare facilities were acting as fully efficient facilities in the districts of Uttar Pradesh and 28 percentage in Maharashtra are fully efficient. There are various districts which have an efficiency score of more than 1 indicating the fact that the facility must increase its output levels to become efficient. The findings suggest that there exist individual districts who have efficiency less than 1 in some of the Healthcare System. To become efficient, these districts should be able to reduce their inputs without having to reduce their outputs regardless of the price of inputs.An important case is the district of Ratnagiri in Maharashtra; it is fully efficient in two out of the three health facilities regarding ANC, IFA tablets, delivery conducted and post-natal checkup. However, the prevalence of provision of all above mentioned services are very low. The results obtained in the study quantifies the efficiency of various services provided at public health sector at district level. However, it is not of much participation in some districts of Uttar Pradesh and Maharashtra.
Cheryl NathanelAnandas has completed her M.Sc. in Biostatistics and Demography in May 2018 from the International Institute for Population Sciences, India. She has first-hand experience in the handling of huge data set like the National Family Health Survey, India. She has knowledge of various statistical software such as STATA and SPSS.
Globally ischemic stroke is second leading cause of mortality and morbidity among adult population. Prompt diagnosis of ischemic stroke sub-type can lead to better clinical outcomes. This study aimed to adapt and develop mHealth based android application ‘InstaDx’ and validate the application in two phases, to assist ischemic stroke sub-type diagnosis for use among neurology residents against a Stroke Expert. InstaDx uses an evidence-based algorithm to diagnose ischemic stroke sub-type in the presence of multiple competing mechanisms to minimize misdiagnosis and improve prognosis. In the first phase, algorithms of sub-type diagnosis were created through standard guidelines and then transferred into InstaDx. In the second phase a validation study was conducted at Aga Khan University Hospital, Karachi from March-August 2017. 228 consecutive patients of age ≥18 years (62.59±14.60), presenting in emergency department with neurological deficits consistent with stroke were recruited and InstaDx was used by residents. 11.84% patients receive revascularization with tissue plasminogen activator. Sensitivity and specificity of InstaDx for large artery arthrosclerosis was 65.91 and 73.57%, small artery atherosclerosis was 56.25 and 84.18 % and cardio aortic embolism was 58.33 and 99.17%, respectively against Stroke Expert diagnosis. Focus group discussions were used to assess the user feedback in third phase which revealed acceptance of InstaDx as an educational tool by the residents suggesting advanced diagnostic capacities. InstaDx proved to be a valuable sensitive and highly specific mHealth based application for diagnosing subtype of ischemic stroke. It provides standard algorithm to confidently assess ischemic stroke patient.
Saadia Sattar completed her Masters in Epidemiology & Biostatistics from Aga Khan University Hospital in 2017. Currently she is working with Tabba Heart Institute which is a non-profit organization focused on preventive and interventional management in the area of neuro-cardiovascular research. Her designation is Clinical Research Consultant and currently she is supervising multiple clinical trials with respect to homeostasis and radiation exposure during vascular procedures. As an enthusiast young researcher, portraying her interest through previous publications in stroke neurology her research focus is towards behavioral modification and preventive modalities improving disease prognosis in the field of vascular biology.
Smoking- a global public health concernis one of the major life style risk factors for multiple adverse health conditions. Tobacco companies are smartly using social media platforms with commercial mindset. This study aims to determineinfluence of social media on smoking among university students in a low-middle income country like Bangladesh. It is a cross-sectional study with mixed method approachfrom the students (N=612) two public and two private universities in Dhaka, Bangladesh. The meanage of the respondents was 21.7(±3.2) years. The estimated prevalence of smoking was 33.5%where 38.8% smoked daily.There was significant effect of social media (20.3%) peer group on initiation (46%) of smoking. The results indicated that there was strong association (P<0.01) between consumption of smoking and average hours spent with friends and social media per day. The results revealed that about half of the students used at least one social media on regular basis including Facebook mostly (48%) and YouTube (47%). The smokers significantly liked more of the postings on smoking rather than other issues such as profile picture, celebrity related post, social post and blog postthan the non-smokers (P<0.001). By qualitative analysis, it was explored that smokers were constantly in touch with social media groups promoting harmful smoking behavior. Some celebrity pictures and videos whilst smoking directly influenced them to initiate or maintain their smoking status. The study indicates high prevalence of smoking cigarettes among the university students and relevant policy regarding social media is required to address this emerging threat.
Dr. NaymUddin Roby has completed his Master is Public Health from North South University, Bangladesh and Post Graduate Diploma from Dhaka University, Bangladesh. He is the founder and CEO of Meduscope, a mhealth enterprise to promote health and wellbeing. He has been working with public health foundation as an executive, Bangladesh and convener and editorial board member of 6th International Public health conference in Dhaka. His publications include research interest of epidemiology, mhealth, non-communicable diseases and physical activity
In many countries, reforms of public healthcare systems do not successfully achieve desired results. Command and control from governments does not allow for adequate management of reforms. Indeed, public healthcare systems are pluralistic contexts, involving multiple actors with diverging objectives, but remaining linked through ties of interdependence. The government cannot envision itself as a supreme power or as a single actor who does not have to share its authority. It must comply with the stakeholders' views and insure the clarity of the expectations. To pilot major transformations in such contexts, our in depth study of public healthcare systems reform suggests that governments need to use instruments that serve at establishing and maintaining relationships and that help them frame and orient change processes. Our communication is based on an in-depth research carried out in a Canadian province (New-Brunswick), where a reform is underway. It aimed at analysing how government must adapt to the dynamic interactions of the actors involved, and mobilizes various instruments to respond accordingly. Our study illustrates how a reform takes place over a long period of time and that its evolution is out of the government's control. In addition to taking into account the views and interests of stakeholders and influence their behaviours, the government must set goals, share them and commit to performance measurements to closely monitor progress and readjust in a timely manner.
Stéphanie Collin, PhD (School of Public Health, Université de Montréal). Assistant professor, École des Hautes Études Publiques (HEP), Université de Moncton, Canada. Research interests: Governance of HC reforms. Strategy professor.
This study aimed to assess the prevalence of upper limb pain and disability and to investigate potential correlated factors among university students in Jordan. Methods: A cross sectional observational research design was conducted using the Disability of Arm, Shoulder, and Hand Assessment (DASH). The DASH was distributed to 2100 students from the population of 2 public and 2 private universities in the north of Jordan. Data was analyzed using descriptive statistics and multivariate logistic model for associative analysis. Results: A number of 1929 questionnaires were returned with 90% response rate. The prevalence of upper limb disability among university students was 24%. Several factors were found significantly associated with upper limb pain and disability among university students that can be categorized as factors related to the use of smart phone, computer use, and other factors related to the presence of other musculoskeletal problems, not living with their families, using public transportation (bus), and daily housekeeping. Conclusion: The results of this study can be used to promote health and wellbeing of university students, improve their academic performance and future career, and may assist in developing appropriate interventions. Identifying high risk groups will assist in early identifications, screening and prevention programs of upper limb pain and disability among university students.