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Journal of Quality in Health Care And Economics

ISSN(p): | ISSN(e):2642-6250
Journal Papers (118) Details
Indexed Journal

1 Clinical Guidelines, Closing Gaps between the National Context, and the Global trends , Hussain YH*
Evidenced-based and national context orientated Guidelines help clinicians translate best evidence into best practice. A well-calipered guideline improves quality by reducing variations in healthcare delivery. Clinical Guidelines remarkably contributing to Improving diagnostic accuracy, enhancing effective therapy, and restricting ineffective – or potentially non-effective – interventions. Clinical guidelines methodology seems to be poorly defined and clearly varies at different organizations
2 Brief Analysis on Violence against Children and Adolescents , Pericles Arruda D*
According to the 2017 report of the United Nations Children’s Fund (UNICEF) [1] entitled “A familiar face: violence in the lives of children and adolescents”, every seven minutes, in some place in the world, a child or adolescent between ages 10 and 19 dies due to some act of violence. The study points out that the most vulnerable group is between 15 and 19, with three time more chances of dying violently, compared to the condition of children and adolescent between ages 10 and 14.
3 Ascites in 2nd Trimester Pregnant , Rawa Al-Ameri*
Ascites is a collection of fluid in peritoneal cavity. Abdominal distention, weight gain, shortness of breath, nausea and vomiting are most common presentation. The most common causes of ascites are Disorders related to portal hypertension as liver diseases such as cirrhosis, alcoholic hepatitis and congestive heart failure, constrictive pericarditis. A 34 year female, G3P2A0, 17 week pregnant presented to Antenatal Care Clinic for regular checkup, complaining of rapid weight gain, generalized swelling, particularly; abdominal swelling and dyspnea attacks. The patient had history of hypothyroidism on thyroxin treatment, preeclampsia in previous pregnancy. By exam, the patient seemed to be fatigued with generalized edema, lower limb edema, abdominal over distention with normal fundus size and difficult to palpate fetal parts. Ultrasound show free fluid in peritoneal cavity suggesting ascites.
4 Dental Assistance to the Child and Adolescent with Autistic Spectrum Disorder , Pinho RCM*
The term autism has an atypical history. Named in 1906 by Plouller when studying the thought processes of patients with a diagnosis of dementia, the term was only disseminated in 1911 by a report from Swiss psychiatrist Eugen Bleuler, who indicated it to be one of the fundamental symptoms of schizophrenia
5 General Medicine-Based Quality Electronic Clinical Record , Turabian JL*
The most common form of narration or biography of the disease consists of the clinical history and the annotations of the clinicians. The increasing availability of data stored in electronic health records brings substantial opportunities for advancing patient care and population health. But still there is a challenge in electronic health record in general medicine. Electronic health records for general medicine should be based on the concepts of this specialty, and the use of the tool should promote the tendency to routinely use the basic elements of general medicine. In this way, the desirable characteristics of electronic health records in general medicine are: 1) Clinical usability; 2) That is not electronic health records a barrier to communication and doctor-patient relationship; 3) Narrative; 4) Relational; 5) Flexible; 6) Decentralized base, at least in part; 7) That electronic health records show the multiplicity of chronological times; 8) Multiplicity of techniques; 9) Oriented to the context; and 10) Clinical decision support. This implies technological characteristics such as: a) free text; b) allow visualization in graphic form of multiple patient connections; c) a patient image on a timeline, to which a collection of objects can be added on screen; d) presence of clinical notes, interviews, transcriptions of audio tapes, diaries personal, video recordings, etc; e) a visualization in grid or by biological, psychological and social planes, f) and finally, the possibility that the individual himself can cooperate in his history, which also maintains and controls in part.
6 Iatrogenic Nasal Vestibular Stenosis: A Rare Cause of Apnea , Fairouz A*, Takoua B and Samia K
Nasal vestibular stenosis is a rare complication following supportive care in premature infants, causing airway and feeding difficulties in the obligate nasal breather. The imputation of the nasal continuous positive airway pressure (CPAP) in this type of complication has been increasingly described since this ventilatory mode provides an effective alternative and is routinely used at many neonatal resuscitation care units (NRCU). In the present study we describe a case of a premature neonate with severe apneas since the age of 21 days due to iatrogenic nasal synechia, following use of nasal CPAP for respiratory distress that was successfully repaired with endoscopic lysis and repeated dilatations.
7 The Deliberate Way of Comprehensive Antenatal Care , Panburana P*
In the past old days all pregnancy care was confined to the time of delivery. This is why there were high mortality and morbidity of both mothers and their babies. The concept of antenatal care was introduced in order to reduce these adverse events during pregnancy. The theory of Developmental Origin of Health and Disease (DOHaD) emphasized the correlation between fetal wellbeing in utero and the adult health and diseases. Eighty years ago, the British ministry of Health recommended the ANC should be followed as in a pyramidal visit. Women should first be seen at 16 weeks, then at 24 and 28 weeks. Thereafter, every fortnight until 36 weeks and then weekly until delivery
8 Accessibility to Medicines in Khartoum State, Sudan , Ismaeil MS and Mousnad MA*
Problem Statement: High medicines prices and unavailability of vital items in all medicine outlets of Khartoum State denied patients from getting one aspect of their basic human rights, health services. However, investigating, determinants of such phenomena and presenting information to policy makers would help to take measures that make medicines available at affordable prices. Methods: Thirty private pharmacies, thirty public outlets and eighteen non-governmental organization pharmacies and twelve private hospital outlets were visited to check medicines prices and availability. The documents of the national medicines procurement agency were reviewed. The director of the state procurement agency, three managers of pharmaceutical enterprises and the director of the national medicines and poisons board were interviewed. Key Findings: The public sector procured lowest-priced generics LPGs and originator brand OB products at 0.86 times and 1.27 times the International Reference Price. Availability of OB and LPG medicines was 3.4% and 71.4% in public sector while in private sector the availability of OB and LPG medicines was 17.9% and 83% respectively. In the public pharmacies patients paid 2.55 times and 1.92 times the International Reference Prices respectively while in private retail pharmacies LPGs and OB medicines were sold to patients at 3.01 times and 15.87 times the International Reference Price. Conclusion: Both availability and patient prices of medicines in private sector pharmacies were higher than the availability and patient prices in public sector pharmacies. Patient prices in private sector in Sudan were higher than those in Eastern Mediterranean Region Organization countries.
9 A New Social Injustice: Dying Waiting for a Donated Organ , Cantarovich F*
We are nineteen years into the 21st century and patients’ mortality rate on waiting lists has increased every year. Undoubtedly, the main factor of this crisis is the persistent insufficient social attitude towards donation
10 Postnatal Diagnosis of Sacral Agenesis with Cerebral Atrophy: A Case Report , Liadi N, Kayode Adedeji B*, Ahmed H and El Wadiah Z
Background: Caudal regression syndrome (CRS), also called sacral agenesis is a rare disorder with a spectrum of congenital malformations ranging from simple anal atresia to absence of sacral, lumbar and possibly lower thoracic vertebra. It has an overall incidence of 1 in 60,000 live births. Case Report: We present a postnatal diagnosed case of CRS, delivered at 36 weeks gestation to a multigravida with poorly controlled gestational diabetes. We highlight the associated findings, which include arthrogryposis, cerebebral atrophy, urogenital and cardiac lesions. Conclusion: Sacral agenesis is an uncommon entity; the management is quite challenging, requiring multi-disciplinary intervention. The outcome depends on the spectrum and severity of abnormalities.
11 Influence of Emotional Labour on Burnout among Nurses: A Sem Approach , Kaur S*
Background: Over the last few years, India is experiencing a revolution in health care sector. Due to increase in diseases, it has become the responsibility of hospitals and medical staff to provide the best facilities and the personal touch to the services rendered to the patients. While doing this job, the employees have to undergo through emotional labour and burnout. Objectives: The objective of this study is to find out the influence of emotional labour on burnout among nurses of selected public and private hospitals of Punjab. The total number of nurses under study was 592. Method: The Dutch Questionnaire on Emotional Labor (D-QEL) developed and validated by Nearing, et al. (2005) and burnout tool by Pines, et al. (1988) was used to assess physical, mental and emotional exhaustion. Results: Descriptive statistics was applied to check the level of emotional labour and burnout, while structural equation modeling technique was applied to find out the influence of emotional labour on burnout. Results showed that employees in selected hospitals of Punjab had moderate level of emotional labour and burnout. There was a positive significant correlation between emotional labour and burnout. Emotional labour emerged as the significant predictor of burnout as standardized regression coefficient of emotional labour and burnout was 0.74. Recommendations: Hospital authorities should provide emotional assistance to their employees by providing their employees with recreational clubs, yoga training, seminars, etc.
12 Public Health Economics Citizen Expectations, Rights and Responsibilities in the Digital Age , Wortley D*
Digital Technologies are creating an unprecedented and disruptive challenge to all aspects of society. Whilst it can be argued that these technologies, like all previous advances in human communications and knowledge, have led to significant improvements in the overall quality of life, these benefits have to be balanced against the potential costs and risks brought about by these developments. This article is a personal opinion/commentary about the impact of digital technologies on public health and the future relationship between citizens and health professionals necessary for a sustainable public health service.
13 Prevalence and Pattern of Road Traffic Accident and Injuries among Commercial Motorcyclists in Sokoto Metropolis, Sokoto, North-Western Nigeria , Lawal N, Oche MO, Isah BA, Yakubu A and Danmadami AM
Motorcycle accidents contribute significantly to the number of road traffic accidents (RTAs) in many cities in Northern Western Nigeria. This study was carried out to determine the prevalence and pattern of RTAs among commercial motorcyclists in Sokoto metropolis Nigeria. A descriptive, cross sectional study was carried out among commercial motorcyclist’s riders in 2014 in Sokoto metropolis Nigeria. The instrument of data collection was a semi-structured interviewer administered questionnaire. Data was analysed using SPSS version 20.0. A total of 307 male commercial motorcyclists participated in the study, out of which 194 (63.2%) had been involved in RTAs since they started riding. Seventy two percent (72%) attributed the last accident to Motor vehicle hit/Obstruction, Almost all were not wearing helmets when the accident occurred and sustained different form of injuries during the accident, out of which majority (37%) had Motorcycle – Motorcycle collision, lower limb was the part mostly affected 33.5% and bruises were the commonest injuries sustained
14 Stunting and Human Catastrophe in the Future (Analysis of Case Stunting in Indonesia) , Salesman F*
Stunting as an event of failure to grow as a normal human is indicated through measurements of height / age, weight/age, and various other anthropometric measurements. If it continues to adulthood, it will lose the opportunity to enjoy higher education and certain types of work that require high height and weight, even though the position promises high salary/wages to strengthen purchasing power in the family and savings for investment. The failure to deal with stunting since the embryo and the growth of children and adolescents has caused future disasters for the child concerned and for the country. This article is a content analysis of the current stunting conditions in Indonesia and the future impacts.
15 Tetravalent Flu Vaccine in Italy: A Budget Impact Analysis (BIA) , Dari S*, Simeone V and Aquilani S
Introduction: Influenza is an important problem of Public Health and source of costs: it’s the main cause of school and work absences, GP (general practitioner) consultation, hospitalization for the possible implications as well as the third leading cause of death from infectious disease preceded by HIV and Tuberculosis. An Influenza Immunization Program is free and active and it is offered by the Italian Ministry of Health (MoH) for all subjects on the basis of age ≥ 65 years old and for all subjects at a higher risk despite their age or all those subjects that have pathologies that potentially increase the risk for ongoing complications of influenza. These subjects may be vaccinated by MMG (General Practitioners), PLS (family paediatrician) or USL’s (Local Health Administration Unit) Vaccination Centre’s. The Immunization Program takes place every year for three months, commencing from October until December with over 10 million subjects in Italy, of about 15 % of the population. From 2015 -2016, in addition to Trivalent Influenza Vaccine (TIV) Quadrivalent Influenza Vaccine (QIV) is also available. QIV protects against two lineages of virus B, solving the problem for partial and total mismatch: TIVs and QIV have a similar efficacy for what concern Virus A, and similar is their safety. Aim of the Study: The study has been conducted in collaboration with GlaxoSmithKline, Italy’s Payer and Evidence Solution Function through the use of a GSK’s budget impact model. The potentially preventable influenza cases, influenzarelated complications and hospitalization resulting from an incremental use of Tetravalent vaccine (QIV) in place of Trivalent (TIV) and the relative impact on budget has been analyzed. Methods: Two scenarios were compared, a current one with data on the 2015-2016 flu immunization campaign, and a hypothetical one, which provides an increase in the market share of the QIV. The Budget Impact Analysis (BIA) considered the following input data. ï‚· Population of the province of Viterbo. ï‚· Distribution of 60.000 doses of vaccine between TIV and QIV ï‚· epidemiology of influenza in Italy;ï‚· efficacy of QIV vs TIV ï‚· Direct influenza costs. ï‚· Probability to require medical care for complications or hospitalization and related costs. The analysis considered a single-year time frame due to the seasonality of the influenza immunization campaign. Results: In the current scenario, if 35.0000 subjects are vaccinated with QIV, this will result in 1.801 cases among those vaccinated, 1.527 with complications, 176 of which will require hospitalization. In the hypothetical scenario, if 40.000 subjects were vaccinated with QIV, which is the 68 % of target population, 1.478 subjects will get sick, 1259 of which with complications and among them, 145 will be hospitalized. Therefore, the 10 % increase of QIV vaccine, would avoid 322 cases of influenza, of which 268 with complications and 31 hospitalizations. The ASL of Viterbo, thanks to a wider protection of the QIV versus TIV, would have a budget impact of -116.468 Euro. Infect, the cost sustained for the purchase of the vaccine, although increased by 2 % in comparison to the actual scenario, it is compensated by the savings originated by avoided cases of influenza, complications connected to influenza and hospitalization. Conclusion: From the preliminary analysis of the data, concentrating on the exclusive costs of purchase of the vaccines, it is evident that the increase of QIV’s quota market involves an increase of the costs, due to the greatest price of purchase, but overcoming the problematic match-mismatch of the lineage B, produces a saving of 116.468 euros. The study considered the doses of vaccine actually purchased for the influenza campaign in 2015-2016 but did not analyze age groups or administration to risk categories because the data was not available. The results obtained vary by modifying the vaccine’s method of administration and the division of market shares, while maintaining the same number of doses purchased. The data can therefore be considered preliminary and to be verified on the field.
16 Flaws in the Literature , Wagner HL*
In 1986 a family physician, Marc Jamoulle, et al. [1] coined the idea of quaternary prevention. It was another era, and the perspective we face at that moment was that we would be able to offer to our patient’s good care without harm with excessive intervention. It remains, but the problem now is even bigger.
17 Prevalence of Common Diseases in a Perturbed Wetland Community of Okorombokho in the Niger-Delta Region, Nigeria , Atting I *, Akpan I, Umoh G and Bassey E
Disease outbreak is a major challenge facing many coastal and rural areas due to factors such as inadequate safe water supply, poor sanitation and living conditions. These conditions make human beings vulnerable to infections of varying types, and if neglected, can result in loss of lives. Against this backdrop, prevalence of common diseases in a perturbed wetland of Okorombokho community in Eastern Obolo LGA, Akwa Ibom State, Nigeria was investigated. A stratified random sampling technique was used in choosing the study population. A total of 200 questionnaires were retrieved from the respondents and this, together with the Focus Group Discussion (FGD) served as the instruments of data collection. The common diseases that were prevalent in this community in order of increasing magnitude were: Malaria, 87.0% in adults and 44.0% in children, Typhoid fever, 24.0% in adults and 13.5% in children; Diarrhea, 11.0% in adults and 30.0% in children; Dysentery, 15.0% in adults, and 22.5% in children; while Cholera in adults and children was8.0% and 4.0%, respectively. The study showed that lack of potable water supply, use of aquatic ecosystems as dumpsites for wastes, open defecation in water, poor sanitary and environmental conditions and lack of well-equipped modern health care facilities were the enabling factors for the prevalence of these diseases in this community. This calls for prompt responses from the governments, environmental and health protection agencies and community-based organizations in the prevention, control and eradication of these diseases by providing necessary health facilities with adequate personnel and other needed health resources that will ensure that the coastal and rural dwellers live a healthy life.
18 Evaluation of Prescription Pattern and its Economic Losses at Sudan National Medical Supplies , Mohamed TE and Awad MM*
Rational: Studies conducted showed that there were gaps regarding the rational use of medicines (RUM). Aims and Objectives: to evaluate of prescriptions pattern and its economic losses at National Medical Supplies Fund (NMSF) Khartoum pharmacy, using WHO indicators. Method: A cross-sectional study was conducted using random sampling method, a total of 100 prescriptions were collected and analyzed from May- July 2016. Index of Rational Drug Prescribing (IRDP), dispensing, health facility and complementary indicators were selected and used as an indicator of RUM. Main Results: the mean values of prescribing indicators of RUM were estimated to be within the WHO optimal values for number of drugs per prescription (2.5 Vs >3) and antibiotics (5% vs. >30%), However, the discrepancy was reported regarding the injections indicator which was found to be more than the WHO optimal value (31% vs. >10%) and generics to be less than the WHO optimal value (30% vs. 100%).The economic loss due to irrational use of injections was high (85%). Conclusions: Strategies and interventions are desirable to promote RUM and minimize the consequences of using injectable medicines.
19 Can India Achieve Universal Health Coverage by 2030? , K. Suresh*
Universal Health Coverage (UHC) launched by World Health Organization in 2013 is meant to promote the human right to health that would make the biggest impact on global health. Every country in the world has committed to get this done by target year 2030, so has India too. The core tents of UHC are prioritizing the poorest and vulnerable, increased reliance on public funding, reduce Out of pocket expenditures and strengthen country’s health system. Its essentials include National Health Policies, Health Financing for UHC, Health Statistics & Information system for programming, skilled health human resource, Essential drugs & supplies and service delivery, quality and safety. Sir Joseph Bhore (Health Survey and Development) committee submitted its first ever report of 1946 that was guided by the principal of ‘nobody should be denied access to health services for his inability to pay' with a focus on rural areas. That was accepted by independent India and a start was made in 1952 to setup primary health centers to provide integrated promotive, preventive, curative and rehabilitative services to the rural population, as a component of wider Community Development Program. Until seventh five-year plans Governments made a lot of radical statements, recommended progressive measures but did not take adequate action. The first ever National Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002 and then in 2017. The NHPs 1&2 missed systematic health system development and encouraged plucking low lying fruits. The 7 Key Policy Shifts in NHP 2017 that might change the health of the country are: 1. Assured comprehensive care at community level that has continuity with higher levels. 2. In Secondary and Tertiary Care: From an input oriented, budget line financing to an output based strategic purchasing of secondary and tertiary care. 3. From user fees & cost recovery based Public Hospitals to assured free, diagnostic and emergency services to all public health facilities. 4. From normative approaches in the Infrastructure & Human Resource Development to targeted approaches to reach under-serviced areas. 5. From token under-financed interventions to scaling up with a focus on urban poor, establish linkages with national programs, achieving convergence among wider determinants of health under In Urban Health initiative.6. Integration of National Health Programs with health systems for their own effectiveness and in turn strengthening health systems efficiency. 7. A three-dimensional mainstreaming of Indian system (Ayurveda, Yoga, Unani, Siddha and Homeopathy- AYUSH) of health services to contribute for the health of the people. India has also started some newer initiatives like Swachh Bharat Mission, Smart City Mission and National Nutrition Mission all of them will facilitate achieving Universal Health Care. There are multiple challenges India faces, namely i) Low public outlay so far had made it impossible for the public sector to respond to the growing health needs of the population that needs transformational initiative in health financing, public private mix in service delivery, ii) To move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service, that has been committed in NHP 2017 aiming to undertake path breaking interventions to holistically address health (covering prevention, promotion and ambulatory care), at primary, secondary and tertiary level, iii) Aggressive implementation of agreed strategies and intensive monitoring of achieving set targets by set time line and iv) The only other challenge is ensuring accountability, through good governance. We do have good plans & strategies, but accountability is missing. Accountability can be enforced only when there is clear chain of command. India has emerged as the global pharmacy for inexpensive drugs and vaccines and the goal now is to make available in every village and urban community in the next decade. Last but most important is to involve people in deciding health priorities, own interventions through IEC social mobilization and community system strengthening to lower inequities.
20 Suggestions to Address the Increase in Demand and Costs in General Medicine: Escaping From a "Black Hole" and from Boomerang Effect , Turabian JL*
General practice of care plays a central role in effective and cost-effective health care. General practitioner (GP) has a solid position: each resident is on the list with a GP is accessible to everyone, and GP handles most of the health problems and coordinates the referral to specialized care. But, utilization rates increase, as do their costs, and this may indicate an inefficient use of health services. The typical response is the increase in the supply of resources, which causes a "black hole" or “boomerang” effect. This article exposes the idea that the increase in demand and assistance at the level of general medicine cannot be resolved by increasing the supply of resources, but rather that the organization of medical practice and technical actions are the main causes that increase health demand, which is inefficient, expensive and iatrogenic. It is the existing trends of medicalization that increase the prevalence of the disease and its treatment, when for example, from the beginning treatment it is made with drug associations, with use of higher doses of drugs, with screening and preventive counselling that are not based in scientific evidence, etc. To avoid the increase in demand, and get out of "black hole", the hypothesis is presented that achieving a more reflexive and critical GP, who in every consultation, is prepared to understand and solve the query "in another way", in biopsychosocial terms and avoiding medicalization, and also delegating and working in a team, but keeping leadership of patient management in each clinical problem, can be a real filter for the introduction of medical measures that are little contrasted at the individual and population level, both from the clinical, ethical, quality, epidemiological and economic points of view.
21 Politics Power & Health Policy , Sanders K*
On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA), which informally became known as “Obamacare”. Obamacare was designed primarily to protect the benefits of those that hold insurance policies and to close the gap between those with insurance and those without by extending health coverage to more US citizens than ever before.
22 Perception and Level of Awareness among Healthcare Professionals in Saudi Arabia about Pharmacoeconomics , Awad MM*, Izham MIM, Mohammad AK and Ranya B
Pharmacoeconomics (PE) is a relatively new field of study, with concepts, methods and applications that have made increasing contributions to health care. PE discipline is quite new in this region. The low inawareness about the importance of it could affect pharmacy education and research
23 Newborn Vaccination and Jaundice , Rawa Al Ameri*
Vaccination of newborn has many controversial issues which are not supported by scientific studies and could be considered as cultural myths but they are still followed in primary health care in the Middle East including Iraq. Despite the major changes that are introduced to the Iraqi Health System by progressing a Family Medicine Board training program but unfortunately this expertise are not used properly. Vaccination is contraindicated, in general; to any condition in a recipient that increases the risk for a serious adverse reaction while a precaution to vaccination is any condition under which vaccines should not be administered
24 Emergency Dispatch Center-Three Tactical Dilemmas , Rotaru LT*
An integrated emergency dispatch is a specialized structure. It receives calls through emergency numbers, select, alerts and coordinates all the intervention crews of specialized intervention services, medical and nonmedical, responsible for solving crises. Thus viewed, an emergency dispatch is the revolving board for the management of informational and operational resources in pre-hospital emergency intervention and an important factor in medical patient’s management and their flux dispersion to Emergency Departments.
25 Effects of “Fall Risk Assessment Training” on Knowledge and Skills of Nurses , Joshi BS* and Solankhi G
Introduction: “Patient fall” has become one of the major concerns in hospital settings. Time to time assessment of patients is needed to identify vulnerable patients who are at risk of fall. Hence, “fall risk assessment” helps to plan appropriate preventive measures to minimize patients’ fall; all healthcare professionals and especially nurses play major role. Fall risk assessment training helps to improve knowledge and skills of nurses related to the same. Methodology: Pre and posttest design was used in this study. 22 nurses were purposefully selected from male and female medicine wards of a multispecialty teaching hospital. Single, short duration training on fall risk assessment was imparted to them with power point presentation. Nurses’ knowledge and skills were tested with the help of case study followed by assessing patient for risk of fall. Results: All 22 nurses had completed general nursing and midwifery training. Nurses ranged from 21years to 40 years of age. Work experience varied among nurses ranging from less than 2 years to more than 13 years. Study results confirmed that knowledge and skills score of nurses improved after the training which confirms that fall risk assessment training was effective.
26 Health and Wellbeing Networks for Older People: A Scoping Review for Future Research , Meads G* and Lees AL
The context of escalating need for government funded health care services encourages policymakers to develop new enterprises which can relieve demand for statutory services. This concept based article reports a scoping review designed to identify priorities for a research agenda of organisational studies which can examine these enterprises, and their emerging relational networks, within an expanding health and wellbeing sector. The review includes a thematic analysis in which transferable learning from recent ethnographic studies in Australia and the United Kingdom is presented. This is supported by lessons drawn from expert subject advice in follow up research projects and applications. The two countries were originally selected because of their rapid new development of wellbeing services. Overall findings point to distinct types of relational network, and informal leaderships emerging to facilitate wider access to social enterprises and informal health and wellbeing services. As ‘actor networks’ these are classified by their material features. Spiritual leaders and resources are shown to contribute significantly to these networks, which also incorporate sports, arts and therapeutic practices. With public health and social care strategically aligned in many market based systems globally, the review concludes that research on alternative network development processes is required for local authorities with community development responsibilities. Overlapping relationships between alternative networks may offer the prospect of more holistic approaches to public health and health care quality that reduce pressures on government funded interventions.
27 Study of the Trend of Respiratory and Extra-Respiratory Tuberculosis in a Southern Region of Romania between 2011- 2018 , Grecu VI, Olteanu M, Maceseanu AV, Nitu FM, Calarasu C* and Turcu AA
Aim: To describe the trend of Tuberculosis in an endemic area by analysing all cases of respiratory and extra-respiratory Tuberculosis (TB) in Dolj County, a Southern region of Romania, between 2011-2018 and discuss results. Method and Material: Retrospective study of all TB cases registered in official records of Clinical Hospital of Infectious Diseases and Pneumophtisiology "Victor BabeÅŸ" Craiova and TB Ambulatory Clinic of Craiova, between 01.01.2011- 31.12.2018. We used all files of all patients registered with TB. We didn’t apply any inclusion and exclusion criteria. Results: We analyzed 4112 cases of TB divided in 3353 respiratory TB cases and 759 extra-respiratory TB cases. The number of respiratory TB cases has dropped from 588 cases in 2011 to 325 cases in 2017, with a tendency to grow again in 2018 when 377 cases were registered. The same tendency for extra-respiratory TB: we registered 150 cases in 2011 dropping down to 49 cases in 2018. Most frequent extra-respiratory cases were Pleural TB-423 cases, Lymph node TB111 cases and bones and joints TB-80 cases. 65% of all extra-respiratory TB cases were confirmed either by histopathological or identifying acid fast bacilli. Other results will be presented in the article below. Conclusions: We consider that an analysis of the current situation of the respiratory and extra-respiratory Tuberculosis status in Dolj County in the context of a descending trend of endemic TB in our country can provide epidemiological and clinical evidence the good management of TB cases respecting National TB Control Guidelines.
28 Emergency Room Health Care Professionals Need Ongoing Education in Caring For the Mental Health Patient: A Literature Review , Deright E, Hussey K and Abigail Mitchell RN*
The prevalence of mental health disorders shows how real this spectrum of illness is in the United States, with 44.7 million people estimated to be affected in 2016 (National Institute of Mental Health, 2017). The frequency of their presentation to emergency rooms and the need of healthcare providers to be properly prepared to care for these patients are increasing. Literature demonstrates that providers feel ill prepared and lack of confidence to care for the acutely mentally ill patient. This puts the patient and the provider at a safety risk. This paper is a brief literature review based on the need for healthcare providers to be educated on this population.
29 Polypharmacy is an Indicator of Bad Practice and Low Quality in General Medicine , Turabian JL*
Quality indicators are increasingly used as a tool to achieve safe and quality clinical care. A significant number of them focus on drug therapy, but few address the problem of polypharmacy in general medicine. All patients, especially elderly patients, those with certain pathologies, those with multimorbidity, or those who live in institutions, are exposed to polypharmacy. The prescription of contraindicated or potentially inappropriate medications is also common. Although polypharmacy is sometimes unavoidable, this indicator has been associated with increased morbidity and mortality. The prevalence of polypharmacy is high, and could reach 20%. But, the main thing is that there is a great variability among general practitioners (GPs), which can vary from 4-5% until 18-30% according to GP, in the same geographical area and with lists of random and similar patients. Thus, the main cause of polypharmacy (of excessive use of drugs) is the professional; the prevalence of polypharmacy does not justify itself exclusively by the presence of the multimorbidity or of elderly people, neither is randomly distributed. Polypharmacy does not depend on the size GP' patients list (large lists may have little polypharmacy and small lists a lot of polypharmacy). It can be hypothesized that the presence of polypharmacy is an indicator of malpractice and poor quality of the general medical service, which should be used to improve the clinical care of patients. Therefore, it is imperative to monitor and optimize the use of medications in general medicine. This creates an opportunity to minimize adverse outcomes related to the use of medications and to improve the quality of care, possible cost savings and improve clinical outcomes. Additional research should deepen this proposal that high frequency of polypharmacy between different practices in general medicine is an indicator of poor quality of care in those GPs.
30 Evaluation of Prescribing Pattern of the Referring Cases at Sudan National Health Insurance Fund , Shagali Hana EH*, Sahal Elmardi A and Mousnad MA
Background: Irrational drug use is a worldwide health problem. A high rate of medical utilization, especially in antibiotics prescribing were observed in the National Health Insurance Fund in Sudan. The aim of this study was to evaluate prescribing pattern. Methods: A retrospective cross-sectional descriptive study was conducted using World Health Organization (WHO) core drug use indicators for three months January, February and March 2011 in the Referring case office in the NHIF. Results: A total of 396 prescriptions were collected, 99 prescriptions from each of the selected four states in Sudan (North, Gazirea, North Kordoufan, and Kassala) for three months January, February and March. The overall results for the four states verify that the average number of drug per prescription was 2.87 ±1.72. 38.32% of drugs were prescribed by generic name. Percentage of drug prescribed from Essential drug list of Sudan was 91.52%. Antibiotics and injections encountered were 47.73%, and 29.79% respectively. Conclusion: The finding of this study shows a trend towards irrational prescribing. So, there is great need for effective intervention strategies to encourage the physicians and pharmacists in promoting more rational drug use
31 Towards Improving the Health Outcome of Hivaids Patients Receiving Antiretroviral Drugs in Low-Income Communities: Will Incorporating Food Supplementation Make a Difference? , Timiun GA*
The benefits of ART in assisting patients recover from debilitating health conditions and assuming their social responsibilities have been reported in Haiti, South Africa and Tanzania. However, lack of food may be a factor influencing the recovery of those on ART from debilitating health conditions. This paper discusses the possible impact of incorporating food supplementation in the care of individuals on ART in low income communities and health outcome in Nigeria. A sample of 1,621 respondents was collected using multi-stage and purposive sampling methods. Structured and in-depth interviews were used for data collection. SPSS (version 21) was used for quantitative data analysis while the qualitative data was analysed thematically. There are 46.3% maen and 53.7% women. Generally, their income is low, 70.7% are earning less than N25, 000 (approximately $125 USD) per month. It is evident that some low income HIV/AIDS patients receiving treatment in Nigeria, and perhaps in other low income communities lack food. Those who are unable to adequately feed themselves would experience longer period of recuperation from debilitating health conditions; thereby hiking the possibility of stigmatisation and tendency to avoid nearby treatment centres where they (HIV patients) would be sighted collecting drugs, which may sometimes lead to the inability to replenish exhausted stock of drugs, and treatment failure among low income earners. Food supplementation may assist in improving the health outcomes of HIV/AIDS patients if it is incorporated in the overall treatment package. It would also enhance sustainable fight against HIV/AIDS pandemic, given that effective preventive measures are in place against its continuous spread and those already infected are adequately cared for. Incorporating food supplementation in the overall treatment package of HIV/AIDS patients in low income communities who not able to adequately feed themselves would make a difference in their health outcomes. Keywords: HIV/AIDS; Antiretroviral; Health outcome; Low income; Food supplementation.
32 Successful Behavior Change Communication Process to Reduce Postpartum Alcohol Intake , Rajapaksa Hewageegana NS* and Samarage S 
To implement a Behavior Change Communication process (BCC) and to evaluate its impact on alcohol use of the plantation postpartum mothers (PPM) was the objective of this study. A cross sectional descriptive study using mixed methods. An interviewer administered questionnaire to 452 randomly selected PPM at Assessment (pre-intervention) and after 6 months on 205 PPM who had undergone the BCC. A self-administered questionnaire administered to randomly select 60 ward staff pre and post intervention to assess the BCC provided to PPM. Focus groups and in-depth interviews were undertaken with plantation community to understand the behavior of alcohol consumption in the postpartum period. Thirty-five (35) nursing staff (58.5%) had advise on adverse effects of alcohol to the plantation mothers after delivery in the pre-intervention sample it increased to 57 nurses (95%) at the post intervention assessment p <0.001. PPM, 63.2% in the pre-intervention taken alcohol reduced to 19.5% in the evaluation (p< 0.001). The use of alcohol with related to breast-feeding reduced significantly in the post-intervention sample (p< 0.001). BCC can significantly reduce alcohol use of PPM.
33 Health and Heritage , Srivastava AK*
Healthy cities create healthy people and it can be vice versa as well. However, the first responsibility should be shouldered by the people who are living in cities is also undeniable. With the decline in environment, slogans like ‘Green city Clean city’ are popular to create awareness among people. But what has led us to the realization of such slogans? May be because now we are confirmed that if our cities are fine than only we will be fine. Health of human being and health of environment cannot be seen in isolation, as both affect each other. Impact of environment on health is well researched in order to make people more environment friendly and health conscious because changing the human behavior is a preventive health which is cost effective than the curative health.
34 Children with Cerebral Palsy in Primary Health Care , Rawa Al Ameri*
Cerebral palsy is a group of disorders that cause developmental disabilities that result in considerable functional limitations. It affects a child’s ability to move and maintain balance and posture
35 Addressing the Crisis in Campus Counseling Centers: An Organizational Perspective , Tavallali LM* and Cox RW
The challenges for those responsible for the mental health of students on the campus are multi-faceted and complex. These medical challenges are exacerbated by the administrative realities that there is no consistent process for seeking a standard of mental health care on college campuses. This is not about the professionalism of those in counseling centers. This preliminary study examines the organizational processes and practices that are used to help students. Two topics stand out from this analysis. First is that the needs of the student/client are too complex for the simplistic self-reporting entry systems. Second is that the current models fail to capture critical and crisis needs and may not even be effective at providing timely assistance for the least complex and most straight-forward, much less the more critical problems.
36 The Extent to which Managers in Jordanian Private Hospitals Perceive the Importance of Marketing Knowledge , Hashem TN* and Suleiman O
This study aimed at identifying the extent to which managers in Jordanian private hospitals recognize the importance of marketing knowledge. The population consisted of managers in the Jordanian private hospitals. A convenience sample was selected from 60 managers, 40 questionnaires were returned for analysis, representing 66.67% of the sample size. By using Spssv23 program, several results were concluded. For instance, by using one sample t-test, it was found that there is a high level of awareness among managers in Jordanian private hospitals toward the importance of marketing knowledge and its dimensions (knowledge of patients, knowledge of health services and knowledge of competitors). The researchers recommended that the managers in hospitals must understand the marketing knowledge and should be aware of applying its dimensions in such a way as to gain strength to face competition in the local or forgien market.
37 Lessons for Educators , Pericles Arruda D*
From my experience as a supervisor in institutions that serve children, adolescents, juveniles, and families, I decided to systematize some practical-reflective basics with the objective of contributing to the professional performance of various actors.
38 Bedside Report and its Effects on Patients and Nurses: A Quality Improvement Project , Lozeau L* , Dawson DL* and Loukissa D
Aim: The aim of this project was to investigate how re-education on bedside reporting would affect Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, medication errors, patient falls, and Registered Nurse’s (RN) perceptions of bedside report at a Magnet designated community hospital. Background: It has been well documented that bedside report improves patient safety and satisfaction, and nurse satisfaction. However, bedside report at this particular institution was inconsistently performed. Method: Data was collected on HCAHPS scores, medication errors, and patient falls. A pre and post survey assessing nurse’s perception of bedside report was completed. The Clinical Patient Experience Manager began training in June of 2016. Results: The results of the project suggested that bedside report shows improvement on HCAHPS scores, patient falls, medication errors, and nurse’s perception of bedside report. Conclusion: The improved outcome measures may be attributed to the communication between staff and the patients that occurs during bedside report. Implications for Nursing Management: Nurse leaders are responsible for ensuring the success of their team through effective communication, meeting quality measures, and improving patient satisfaction. Innovative leaders should encourage and monitor this handoff process to maintain the practice of bedside report hospital-wide.
39 Weight Management of Urban Educated Elderly for Healthy Ageing , Suresh K*
Background: UNICEF, India country office has seen hundreds of its staff retiring in last 15 years. The UNICEF retired staff Association has been organizing reunion for their members since 2015. These meetings were general get together and spending happy time together. Sightseeing, entertainment and organizational update including the benefits for the retired staff were the agenda. In their 2017 reunion in Bhubaneshwar, Odisha, the organizers had arranged a session on health challenges and management practices among retired colleagues. Retired health colleagues under the leadership of the author facilitated discussions and collated some useful management practices. Based on the individual or spouse’s experiences of the best practices some guidelines were prepared and shared based to all. On the request of some of the colleagues in April 2018 a set of dietary advises series called “Awareness for Healthy Ageing of Senior-citizens And Selfempowerment (AHASAS) were prepared by this author and shared. One of the initial guidelines included suggestions to reduce the obesity that was shared to all 106 staff by this author after collating the data on overweight and obesity. A total of 23 Obese people based on their BMI out of 106 were identified and individual counselling regarding the dietary requirements of the senior citizen in terms of calories, proteins and fats along with exercise regimen, sleep improvement practices and a list of dietary items with their Glycaemic Index levels were collated and shared again. Objective: To Assess if the Diet, exercise and sleep advises in general and inter-personal counselling on the willing overweight retired staff of an organization will be effective.
40 Prescribing Pattern of Ceftriaxone among Inpatients Admitted to Emergency Room in Military Hospital-Omdurman, Sudan , Hussien Faki LA and Awad MM*
Objectives: A new onset of ceftriaxone resistance is serious complication of therapy which is leading to a new treatment strategies or drugs. The aim of this study was to identify ceftriaxone regimens, estimate the cost of it per prescription and determine the prescriber adherence to ceftriaxone prescription protocol. Methods: A retrospective observational hospital-based study, conducted in emergency room at Military HospitalOmdurman in period from October 2017 to March 2018, on patients who took ceftriaxone. The data collected by using a pretested designed data collection sheet. The collected data were analyzed by SPSS version (23). Results: A total of 90 patients were included, out of them 93.30% of patients received ceftriaxone for other conditions rather than for meningitis, pneumonia and enteric fever. The majority of studied patients were in the age group more than 60 years (35.6%), (50%) were females. Almost all patients studied did not make culture and sensitivity test and prescribed by brand name. Most patients were dosed as 1g (83.30%) and duration of therapy was found to be high in the range 5-7 days and 7-14 days (32.2%). Most of the interaction made by co-administration of other drugs with ceftriaxone was serious (50%). Conclusions: The cost was found to be high. The prescribing pattern of ceftriaxone according to it is regimens written by doctors, the cost and adherence of the prescriber to ceftriaxone prescription protocol reveal that irrational use of ceftriaxone or improper use.
41 Health Insurance and Health , Jingxian WU*
According to the World Health Organization Report, “promoting and protecting health is essential to human welfare and sustained economic and social development” [1]. Health not only matters for everyone, but also for the whole nation. Given the highest priority to population health for socioeconomic development, national health security should be a profound political issue as national governments are required to satisfy their people’s health expectations and reach Universal Health Coverage (UHC) by establishing universal health care systems based on circumstances within the country.
42 The Role of Catholic Church in Improving the Quality of Human Resources in Diocese Ruteng-Indonesia , Salesman F*, Tapung MM and Gobang YKGD
Background: The Catholic Church in Diocese Ruteng is 107 years old. The spread of Catholic religion has grown with the number of followers of 87.95% of the total population. In addition to the spread of Catholicism, missionaries opened institutions for education, health, and economic empowerment of their people. Purpose: This study revealed the role of missionaries in Diocese Ruteng to increase HDI (Human Development Index) in their region. Method: Using descriptive analysis with triangulation approach, publication data of the Nusa Tenggara Timur Statistics Agency, Catholic Church documents, and media publications about the performance of missionaries in Diocese Ruteng Results. The average school years of residents aged 10 years and over in 2015 amounted to 6.69 years, 2016 amounting to 6.74, on 2017 amounting to 6.86 years. The average life expectancy in 2015 was 65.94 years, 2016 was 66.41 years, and 66.48 years. The average per capita expenditure for 2015 is IDR (Indonesian Rupiah). 6,377,000, 2016 IDR. 6,517,000, 2017 IDR.6,623,000. Average HDI, in 2015 amounted to 59.37, in 2016 amounted to 59.90 years, and 2017 amounted to 60.93 years. Conclusion: The Catholic Church in Diocese Ruteng for 107 years has played a role in increasing HDI in its territory. The challenge of cyber technology is making the church act as a balancing agent so that Catholic faith is not eroded. Emphasis on sacramental services is improved along with diversification of educational services. Health and economic strengthening.
43 Intention to Implement a Healthy Lifestyle: Does Acculturation Make a Difference? , Deshields S, Joachim Celestin M, Lara M1, Miller LM, DaCosta Davis SS, Montgomery S and Clarke C*
Studies have examined the relationship between acculturation and a healthy lifestyle within a representative population of Latinos. However, few studies describe the impact of acculturation on Latino individuals’ intent to adopt a healthier lifestyle and diet. The purpose of this study was to examine the association between acculturation and intent to change one’s diet and exercise habits to achieve a healthier lifestyle. In a survey administered to 50 Latinos in Perris, California we found that US birth was significantly associated with increased intent to eat healthy (p<.01) and intent to exercise (p<.05), suggesting the need to address acculturation when considering lifestyle recommendations.
44 Review of Management Strategies to Achieve Vision 2020 in India with Emphasis on Cataract Related Blindness , Mukherjee B*
A review article to find out possible managerial solutions in order to achieve elimination of cataract related blindness in India by 2020. About 285 million people are visually impaired globally of which 39 million are blind. 80 percent of the total or 228 million people have avoidable blindness suffering from cataract, trachoma, onchocerciasis, refractive error, childhood blindness, low vision, glaucoma and diabetic retinopathy. Vision 2020 was initiated in February 1999 by WHO and IAPB to eliminate avoidable blindness. Prevalence of blindness in India is 1 percent. 7.2 million Indians are blind due to cataract and 6.5 million cataract cases are added every year. Presently India is performing 6 million cataract surgeries annually. Will India be able to achieve Vision 2020, since 50 plus age group population is increasing? These are the possible managerial solutions:  Proper execution of 12th five year plan of National Program for Control of Blindness at government level.  Wider coverage of the below poverty line population under Rastriya Swastha Bima Yojona.  Training and implementation of low cost high volume cataract surgery like Manual Small Incision Cataract Surgery.  Involvement of more corporates to perform Corporate Social Responsibility through eye institutions in order to remove cataract related blindness.
45 Looking at a Large-Scale Clinical Studies from a Local Perspective , Todic MR*
Medical science perceives randomized clinical trials (RCT) as the gold standard in the development of new drugs and source of providing valuable new treatment options. RCT results are indisputably used in the production of therapeutic guidelines and healthcare policy making. The health authorities of most developed countries are aware of the benefits of large-scale clinical trials. Thus, their websites often include sections dedicated to those. Issues they typically address include the application process for clinical trials or the potential benefits and risks for the participants
46 Revolutionizing Healthcare through Technology , Yanamandra R*
Healthcare industry has been one of the fastest growing industries in the recent past. Advancements in medical research, medical technology, population growth, increasing awareness about preventive healthcare and medical insurance are among the many factors contributing towards this growth.
47 Vitamin D Deficiency among Depressed Women , Rawa Al Ameri*
Introduction: Iraq is a sunny country so the risk of vitamin d deficiency is underestimated. Vitamin d deficiency is used to be related to rickets in children and osteomalacia in adults, so other symptoms are somewhat undistinguished. In recent years, many patients presented to primary health care with symptoms of fatigue, tiredness, bone and back pain, depression, hair loss, and muscle pain, as these symptoms raise the suspicion that vitamin d deficiency is becoming a concerning issue. Inadequate vitamin d level is an international topic now a day. Cases of depression are so common in daily routine work in primary health care, especially in women. In recent years marked attention is applied to support the depressed patients in primary health care. Objectives:-Assessment of 25 (OH) D levels in depressed women.-Assessment of vitamin D deficiency according to age groups and pregnancy state. Methods and Results: This is a cross-sectional study, a comprehensive sampling technique, included 108 women, above fifteen years old, presented to primary health care with symptoms of depression. The women have been sent for vitamin d level assessment. The results showed Vitamin d deficiency in a 100% of participated depressed women, including 40 pregnant. Serum vitamin d level is assessed by using 25(OH) vitamin D ELISA kit, which is available in most labs in the area of the primary health care center. The results showed 100% inadequate level of serum 25(OH) D, 79.1% of depressed women had deficient state while 20.9% of women had insufficienttiter. Discussion and Conclusion: Family physician has an important role in the detection of psychological cases including depression and offering a plan for management and follow up. Randomized trials suggest that vitamin D supplementation can improve mood and health status in women. The current study gives a conclusion that vitamin d deficiency could be associated with depression in women.
48 Investigating the Performance of Baharloo Hospital during 2004 to 2014 (Case Study) , Jafari M, Masoumi-Goudarzi M, Hosseini SE and Mahmoudian P*
Context: Today health care organizations are complex organizations that need strong support of management in the field of evaluating performance. Objectives: The purpose of this study was to investigate ten years performance of Baharloo education Center. Methodology: This research is a case study that has been conducted in two quantitative and qualitative stages. In the first stage, the trend of changes in performance indicators was identified. In the second phase, the root causes of change and success, the challenges were examined over a 10-year period. Results: In this study, hospital indicators were categorized into three groups: input, process, and output (outcomes), and studied. Conclusions: Organizations should do some sort of rotation from traditional systems to new management systems. Performance management is a continuous performance improvement process that helps organizations find ways to better support their organizational and staffing roles. Key words: Performance, Baharloo Education Center, hospital indicators.
49 Evaluation of Drug Use at Four Hospitals in Khartoum, Sudan , Abbas O, Saeed AA, Hassan TM and Mousnad MA*
Background: Drug use is a complex subject involving the prescriber, the dispenser, the patient and pharmaceutical institutions. Inappropriate drug use is the problem of the whole world; however, the degree of the problem is higher in developing countries like Sudan. Objective: The present study was carried out to assess the pattern of drug use by using World Health Organization’s Patient Care indicator in Selected Health Facilities in Khartoum state. Method: A descriptive, quantitative and cross-sectional study was conducted among hospital outpatients. The sample was selected using systematic random sampling. In each hospital, patient care indicators were investigated through collection of data on 268 patient encounters, determination of consultation time and dispensing time for 268 patients, and by interview of 268 patients for the evaluation of dispensing practices. Results: The mean consultation time was found to be 13.93 minutes, whereas the mean dispensing time was found to be 122.78 seconds, the total number of drugs prescribed was 1080, and the percentage of medications actually dispensed in the hospitals was calculated to be 58.98%, percentage of drug adequately labelled was 8.96%, Patients who knew their dosage forms accurately were found, 180 patients. Conclusion: The result of the resent study indicates that the patient consulting time, medications, labeling and availability of key drugs in the hospitals are inadequate. These patient care indicators need special attention for improvement. Professionals of all levels of health care, management and leaders should be trained in quality issues. Essential drug supply management systems should be established to ensure availability of key drugs in the outpatient pharmacies of the hospitals.
50 Cleaner Production in Order to Save the Health of Human and Environment: A Review , Sherani SH*
The present review paper highlights the concept of cleaner production in order to save the health of human and environment. Cleaner production is a practical method that is implemented in an organization to reduce the damages and risks towards humans and environment. CP promotes the concept of sustainable development in which we consider economy and environment both together. Production in which we don’t consider impacts on human health and environment always create some major problems or issues. To create more sustainable methods of production, there needs to be a shift in attitudes and behavior towards sustainable development or pollution free production. Cleaner production focuses on a new way about processes, products and services to find better way to minimize the impacts on human health and environment. Companies/ organizations that follow the concept of sustainable development in their production always gain the confidence of public and improve the public image towards them. Moreover, CP improves the company performance, Makes companies more profitable and competitive and reduces the overall emission level of pollutants into the air, water and soil and maximizes the product output.
51 Detection of Plasmodium Falciparum and Pfmdr Gene Among HIV Patients Attending Clinic in a Tertiary Hospital in South-South Nigeria Using a Nested PCR Technique , Atting IA*, Amadi CP and Ekuma AE
In this study, the prevalence rate of falciparum malaria, the risk factors associated with HIV and CD4 count level in association with malaria parasite were determined while the Pfmdr mutant resistant gene of falciparum species was detected in HIV patients attending Clinic in a Tertiary Hospital in South-south Nigeria. Subjects were purposively selected as they came for treatment and screened for falciparum malaria. Of the 67 subjects enrolled in the study, 35% were HIV positive adults, while 32% were HIV negative adults (Controls). They were in the age range of 20-56 years with a mean age of 34.84±9.86 standard deviation (SD). Out of 35 HIV adult patients, 25%t of the HIV patients were on treatment for HIV and other opportunistic infections. Twenty-one percent admitted that they took anti-malaria drugs every three months, 31% attested to the use of long lasting insecticide treated nets while 4% did not use treated nets. Microscopic examination revealed 5.7% of falciparum malaria, while Nested PCR detected 8.7% falciparum malaria in the DNA extract sample of these patients. A total of five HIV positive patients were infected with falciparum malaria, giving a prevalence rate of 14.2% of co-infected patients with malaria parasite. None of the HIV negative subjects had falciparum malaria. This is probably due to their regularly sleeping under long lasting insecticide treated nets. There was no significant difference between malaria parasite infection by gender (P = 0.88), age group (P=0.17), and CD4+ count (O.R:1.0, P=0.81). Plasmodium falciparum multidrug resistant gene (Pfmdr) analysis did not undergo mutation. Based on the result it is recommended that HIV patients regularly sleep under long lasting insecticide treated nets. There is need to improve the quality of health care, especially as regards malaria prevention and treatment offered to HIV patients.
52 The Initiative IdeiaSUS and the Perspectives of a Collaborative Network: For an Ecology of Locoregional Knowledge , Fernandes VR, Coelho de Amorim A*, Vicente da Silva JP, Sergio JV, Filho EC, Carrera JL, Le Cocq C, Magalhaes M, Machado K and Mariano G
This is a paper about IdeiaSUS, an Oswaldo Cruz Foundation’s initiative associated with CONASS & CONASEMS, two health secretaries organizations of nationwide, which attempts to focus on a theoretical framework to structure a collaborative network of practices and experiences within SUS, the Unified Health System of Brazil. Our intent was to address how a comprehensive methodology might help tangible local knowledge emerge as a territorial innovation by fostering social mobilization, with the purpose of characterizing whether these arrangements converge to what is called a community of practices. The authors emphasize that the existence of IdeiaSUS/Fiocruz as a collaborative platform opens new perspectives for the analysis and systematization of registered practices, as well as the establishment of curatorships in collaboration with academic consortia and partners of Fiocruz/Conass/Conasems, which in recent years has promoted the discussion of health practices by professionals and managers in SUS.
53 Organization Culture of Safety-Comparison of Two Periods, before and after Intervention , Niv Y* and Zetland R
Background: Since 1999, when the Institute of Medicine declared that “To err is human” and recommended to avoid “blaming and shaming”, our culture of safety changed tremendously. Nowadays we try to investigate errors and adverse events, to learn from mistakes, and prevent future sentinel events and patients’ suffering. Objective: The aim of our study is to assess the change in staff members’ attitude towards the hospital culture of safety in 2017 in comparison to 2015, and to associate this attitude to improvement in quality indicators and reports of “near miss” cases. Methods: A questionnaire was introduced to staff members in Rabin Medical Center in 2015, and in 2017 after an intervention. We compared the results looking for change in staff members’ attitude towards patient’s safety. We also compared the results of quality indicators and number of adverse events reported before and after the intervention. Results: Comparing the results of the questionnaires there is a significant improvement in 13 out of 15 items. The RR was 1.555 with 95%CI 1.370-1.766 (P<0.0001). The differences were statistically significant in 7 items and with a trend in 2 items. Comparing the performance of the quality indicators there is also a significant improvement in 18 out of 24 measures. The RR was 1.236 with 95%CI 1.220-1.253 (P<0.0001). The differences were statistically significant in 10 indicators and with a trend in 2 indicators. Conclusions: We believe that quality improvement plans will really change the staff approach and behavior towards a better safety culture in the hospital.
54 Public Health Schools in India Need to Go Beyond Syllabus , Suresh K*
What tops the priority chart for recruiters in Public Health in India today? Skills of Field epidemiology, working under local constraints, out-off box innovation, client centric approaches in hospitals management, business attitude and aptitude, presentation and communication. The ancient Indian system of education had an integrated approach to training of head (mind), hand (skills), and heart (human values and ethics). However, most of the present-day MPH courses are designed to expose candidates to 5 core discipline areas of public health-Biostatistics, Epidemiology, Environmental Health, Health Policy and Health Administration and Social and behavioural sciences. It goes without saying that Public Health Management education must fall in line with almost all other disciplines, where there is a conscious effort to align not only with the evolving technology but also business dynamics. Teaching scholars about the feelings of others lays the foundation for strong interpersonal skills that will be invaluable in their professional and personal lives. To address the widening skill-gap, primarily introducing industry exposure and latest trends in the filed epidemiology, vaccinology, national health programs and health facilities management at different levels of the local health system is the need of the time. Secondly the classroom experiences need to evolve from scholars competing for grades to scholars working together learning to form friendships and deal with complex social interactions. For students, it may be a touch difficult to zero in on a skill set that would stand them in good stead. Faculty must know the ground reality and students should be exposed to it directly. Counselling and mentoring play a crucial role here. The newer Public Health recruitment demands have got to enter the syllabus of the mainstream master’s in Public Health courses if any country wants to prepare students for the future that awaits them. In moderns Public Health postgraduate courses whenever a theory is taught, it must be related to something in the real world or from real time data. Even in the exit examinations, theory questions and practical’s must be from the real world. Teaching methodologies must look at going beyond the pedagogical lectures, books, presentations and internet search to designing a curriculum that offers holistic education.
55 Coronavirus and State Actions: Questions By and For Policy Planners and Analysts , Dikeos CG*
The coronavirus outbreak and crisis has a wide range and multiplicity of repercussions, not just medical, but also social (loss of loved ones, mourning, bereavement, isolation), economic (activity restrictions, sales down-turn, company close-downs, loss of productivity combined with sickabsence payments), and political (postponing elections).
56 Managing Quality in Health and Social Care Services; an Exemplary Review of a Center in London , Baguma JC and Obeta MU*
Total quality management is day by day showing increasingly high profile of activity and research interest in health and social care. Internal and external stakeholders play their roles to ensure adequate quality care delivery. A care center can use a laid down approved and regulatory standard to improve their services of care. Though challenges such as leadership and management, training, staff and insufficient resources can affect the quality of care, regulatory bodies like NICE and CQC can make health and social care centers to achieve a desired quality service in London. It is therefore, imperative and adequate to carry out internal or external quality assessment of care centers regularly to aid improving the system and quality of care for clients’ utmost satisfaction.
57 Pharmacoepidemiological Profiles of Oral Hypoglycemic Agents in Elbanjadeed Hospital, Khartoum, Sudan , Babiker Abadi AE, Mousnad MA*, Altayeb A and Mahmoud M
Background: Diabetes is a metabolic disorder resulting in chronic microvascular and macrovascular complications. Diabetes affects an increasing number of patients, globally, by the year 2030, the number expected to more than double. Hypertension affects about 60% of patients with type 2 diabetes. Aim: The present study was planned with the objective of the utilization of oral antidiabetic drugs in Elbanjadeed hospital in Khartoum North. The study also aimed to determine what is the consumption rate of oral antidiabetic agents in Elbanjadeed also to identify what are the most prescribing oral antidiabetic drugs in the hospital. Methods: The study design was a cross-sectional prospective study design, drug utilization data was collected in 2013. ATC/ DDD methodology, WHO prescribing indicators were selected and used, collected data were analyzed using appropriate statistical techniques. As per the study criteria, data were collected from 150 prescriptions of diabetic patients who were admitted during the April and May 2013. Main results: The study results showed that was predominant in male more than female. age group (41-60) was the active diabetic age group. Metformin was the most prescribed antidiabetic drug. Alimentary tract and Metabolism was the most prescribed drug class because it includes the antidiabetic drugs. The most disorders associated with diabetes was Cardiovascular disorder which affects about (27%) of diabetic patients. Average cost was 115.8 (SDG) which was very high because the average number of drug per prescription was high. The average number of drugs per prescription was 4.3 and the percentage of generic drug prescribed was 66.7%. The percentage of the number of drugs in EML was 60.1%. Conclusions: The study showed that male was predominant more than female, the active age group of diabetes was (41-60), metformin was the most prescribed oral antidiabetic and cardiovascular problems were the most disorder associated with diabetes.
58 Everything is in the Vagus Nerve what is the Relationship between Chronic Fatigue Syndrome (CFS) and Coronavirus? , Selma S*
The vagus nerve, also known as the pneumogastric nerve, is the tenth pair of cranial nerves, involved in many functions of the body.
59 Non‑Melanoma Skin Cancer (NMSC): Extramammary Paget ’s Disease , Eftimie LG, Costache DO, Uscatu CD*, Glogojeanu RR and Costache RS
Non-melanoma skin cancer (NMSC) comprises squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and several rare skin tumors (i.e., Extramammary Paget’s disease), being the most common malignancy affecting people worldwide. It represents the majority of skin cancers and a significant percentage of all malignancies. Despite increasing public awareness and scientific interest, the incidence of NMSC is constantly increasing. Even though most NMSC`s are associated with less aggressive behavior, they can still be invasive locally and cause extensive damage to neighboring structures, inducing significant morbidity. Also, different types and subtypes of NMSC tend to have frequent recurrences and may have significant metastatic potential. As a direct consequence, NMSC has become an important issue for healthcare systems with a significant socio-economic impact.
60 Coronavirus, Inequality and Indifference , Arruda DP*
The purpose of this text is to present some information and questions to reflect on the current coronavirus pandemic. The intention is not to exhaust the topic or propose answers to the current situation – I would not be able to do that-but to suggest some ideas for discussion, considering the time and place in which this text is prepared. I am writing from Brazil and seeing what is happening in other countries, during this pandemic. Many facts will still emerge, before its publication, as well as after, but these do not invalidate this contribution.
61 Impact of Lebanese Accreditation Process on Hospital Profitability: Case Study , Mansour V*, Abouhaidar M and Oleik A
Accreditation has become a significant feature in health care systems worldwide and a quality improvement tool that enhanced its standing in the health sector. It played a role in developing the quality of care and patient safety, nevertheless, the accreditation process implies an important financial burden on healthcare institutions. The purpose of this study is to identify the impact of Lebanese accreditation on hospital profitability by analyzing costs of accreditation, its impact on staff using SEAM (Socio-Economic Approach of Management) approach, and its influence on patient satisfaction. This study was designed to be qualitative: the first part of the study is interventional. Interviews in a hospital in Lebanon were done with staff from all levels and departments. The second part is related to the comparison of financial indicators (return on investment and contribution margin per hour), number of patients, and their satisfaction rate before and after accreditation (2010-2012). The results presented a considerable financial weight for accreditation. Lebanese accreditation has led to a positive impact on hospital profitability through quality of care increasing patient satisfaction, leading to patient retention and acquisition. On the other hand, accreditation has also manifested a negative effect on the health of staff by stressing them out through the heavy workload.
62 The Importance of Physical Exercise in Covid-19 Pandemic , Oliveira MR*
The pandemic caused by the novel corona virus, named by the world health organization (WHO) COVID-19, presented among acute viral infections, with a high rate of transmission, especially in the elderly population, riskfactors carriers and cardiovascular, pulmonary, renal and immunological comorbidities. Currently, it is considered a major public health issue because it causes a great burden on the health system, especially in the high complexity.
63 The Detrimental Effects of Surgical Smoke: Promoting Safety in an Operating Room Team-A Mixed Methods Approach , Cobar SA, Stragg A and Abigail Mitchell RN*
Background: Electrosurgical or electrocautery technology is one of the most widely used in the world, yet no federal agency has mandated the use of electrosurgical filter devices for the protection of surgical teams. Currently, there are 500,000 operating room workers in the U.S. Objective: To identify and appraise perceived barriers and benefits that impact implementation of a hospital-approved electrosurgical filter device that reduces the exposure of surgical smoke by a surgical team. Utilize that data to implement a filter device and collect feedback. Methods: The study is a quality improvement project that involved mixed methods. Because there were no patients involved, an institutional review board approval was deemed unnecessary. The operating room staff in an acute care hospital completed a nine-question survey to determine the pre-intervention perceptions of the staff. There were 53 pre-surveys handed out and 42 of them were returned-a 79% response rate. After the implementation of the device, focus groups were organized to collect feedback. Findings: The main barrier expressed by the operating room staff was perceived cost of a system that would be effective in surgical smoke removal. The main perceived benefit from the use of an electrocautery filter device was the decrease in surgical smoke. Conclusion: Four out of the 11 in the surgeon group expressed overall satisfaction with the filter device. Seven of the 20 (35%) who provided feedback said they were satisfied and that same percentage expressed looking forward to future use of the filter device. Thirty percent (30%) of respondents voiced reports of no smell, and 25% said they felt the filter device was useful in reducing surgical smoke.
64 Fixing Sickness Care Component of Comprehensive Primary Health Care in India , Suresh K*
With recent Coronal virus Pandemic India, hopefully public health in general and comprehensive primary health care will come to the forefront. The focus will shift from private hospitals to government hospitals as private hospitals are too small to handle large-scale health emergencies and care of the poor. And instead of sourcing medical devices and equipment and drugs from abroad, everything will be sourced from India. In February 2017, Government of India promised to upgrade 150,000 existing HSCs and PHCs into Health and Wellness Centres (HWCs) that will switch from “selective” to “comprehensive primary health care” and start providing the larger package of services in Public Sector Health. Empowering paramedical workers for early diagnosis and dispensing pre-decided drugs began way back in 1953 for Malaria control. The training of Multipurpose Health Workers (Male and Female) introduced capacity building for minor ailments treatment in 1974. Later vertical interventions at community level, like Control of diarrheal diseases (1980), Acute Respiratory infections (1990), standalone new-born care and integrated management of neonatal and childhood illnesses (IMNCI) in early 2000 were added in the job descriptions of the health workers. NHP 2017 makes it mandatory to run outpatient clinics for 6 hours every day at the HWCs, institutionalizing regular sickness care services at the community level for comprehensive health care. The design of HWCs and the delivery of services build on the experiences and lessons learnt from the National Health Mission, India’s flagship programme for strengthening health systems. To address the expanded service delivery package will require reorganization of work processes, addressing the continuum of care across facility levels; moving from episodic pregnancy and delivery, new born and immunization services to chronic care services; instituting screening and early treatment programmes; ensuring high-quality clinical services; using information and communications technology, focusing on health promotion and addressing health literacy. The announcement of HWCs received wide coverage and attention. However, promises are an integral part of Indian polity; the challenge is implementation as witnessed being part of the health system by the author since 1968. The first Health and Wellness Centre (HWC) under Ayushman Bharat was inaugurated by the Prime Minister at on 14/04/2018. Since then 29214 AB-HWC are reported functional as on 30.01.2020. The word functional is used for issuing government order or at the most change of the sign board of the facility. Two years down the line there is hardly any visible change in the strategy ofproviding sickness care for six hours a day as envisaged and starting of the new interventions included in service package on the ground level. The availability of services would evolve in different states gradually, depending on three factors- a) the availability of suitably skilled human resources at the HWC, b) the capacity at district/sub-district level to support the HWC in the delivery of that service, and c) the ability of the state to ensure uninterrupted supply of medicines and diagnostics at the level of HWC. This article analyses the existing primary health care system in the country, challenges of establishing HWCs for CPHC specially at HSC level and the way forwards.
65 Risks Affecting Quality in the New Clinic San Sebastian Girardot, Colombia , Castro Mesa EP, Velandia Villalba MO and Betancur Pulgarin CL*
Introduction: In Colombia, as in the rest of the world, the aim is to articulate the entire health system in order to verify quality, and it is important to implement mechanisms and tools that constantly evaluate the quality offered by each of the actors. Objective: Determine the existing risks that affect the quality of hospital and emergency services in the new clinic San Sebastián Girardot, Colombia, based on current regulations in the sector, to obtain the organization’s accreditation. Methodology: A descriptive observational quantitative investigation was carried out, on primary sources, internal and external clients of Nueva Clínica San Sebastián, with secondary sources, the institution’s quality files, for the identification of risks. Was used to collect the information The SERVQUAL MODEL, Parasunaman model. To obtain the Service Quality Index, the model presents five dimensions also known as quality dimensioning indicators. Ethical aspects: According to the Declaration of Helsinki, 1975, Resolution 8430 of 1993 del and resolution 0413 of 2018, it is a research without risk, institutional consent was obtained. Results: The univariate analysis showed 62.3% for the expectations of the client and their perception in relation to the services provided, with great satisfaction and moderate satisfaction of 57%. With external clients, it was found that users have moderate satisfaction in all dimensions, the dimension of sensitivity or response capacity has a higher degree of satisfaction in users, in relation to meeting their expectations, with 85%, followed by the security dimension with 58%, and empathy with 57%. Conclusion: Research indicates that both internal and external clients report less than 50% satisfaction and in some cases they are totally dissatisfied, which constitutes a risk for the institution.
66 Will Patient Generated Health Data Accurately be Incorporated into the Electronic Health Record if used to Diagnose or Treat Patients? , Skrocki M*
Patient-generated health data (PGHD), is a term encompassing all forms of data that patients provide on their own. The custodian of the Electronic Medical Record is the person who has been designated responsible for the care, custody, and control of the health record for such persons or institutions that prepare and maintain records of healthcare. The official custodian or designee should be authorized to certify records and supervise all inspections and copying or duplication of records. 
67 The Quality of Health Care and the Quality Of Life of Persons with Intellectual Disabilities: A Call for Disability-Inclusive Answers during Coronavirus Pandemics , Santos S*
The COVID-19 pandemic is a major public health issue that has changed the way persons are living. Many governments were initially focused on immediate solutions, especially at the health system level. However, all political and practical measures implementation should analyze the impact of coronavirus on life as a whole and not only in one life-domain. The current period does not affect everyone the same
68 News Antibiotic Innovation Crisis , Lopez-Tris CJ and Lopez-Tricas JM*
There is a growing and justified concern in the pharmaceutical field for what can be called an innovation crisis in the development of novel antibiotics. The issue has transcended the health field, having been debated at a meeting of the World Economic Forum.
69 Fear, Reaction and Rational Behavior to Covid-19 in Public, Health Professionals and Policy Planners , Vinod Nikhra*
THE COVID-19 ICEBERG: Being highly infectious disease, COVID-19 can spread exponentially but most of those infected remain asymptomatic or develop mild symptoms, thus may remain undetected. In fact, the majority of COVID-19 iceberg is made up of the dormant undetected cases forming the submerged part of the iceberg. The undetected cases of COVID-19 infection can be quantified through serological tests for presence of antibodies against the SARS-CoV-2 in a given population which form the basis of sero-surveys to provide crucial data. Age Groups and Perceived Covid-19 Threat: The millennials or Gen Y (women more than men) appear to be more fearful compared to other age-groups for contracting the infection. Whereas, the older generations (Gen X and older, Gen Alpha), are the most vulnerable but less afraid of the virus and the disease than millennials. Across the Generations, those belonging to the Gen Z are found to have least fear and low susceptibility. Fear and Other Reactions to Covid-19: Though case-counts and fatalities are been relatively higher in Europe and the US, as compared to most Asian countries, fear to the viral infection by residents of Asian countries including India was on higher side. Most of the respondents to global survey have been found to be fearful of contracting the infection. Apart from this, fears about the availability of essentials and access to various amenities afflict the susceptible populations. The key concerns by the healthcare professionals involve prevention from exposure to the infection, the adequate protection, and their personal and social support. Conclusion: Protecting Communities: The aphorism, prevention is better than the cure, fits the COVID-19, as presently there are no specific treatment modalities available. The fear may be the key to prevent the disease by using barriers like face masks and to practice social distancing. The lockdown measures enforced by various governments in countries around world work on basis of curtailing infection by distancing, isolation, quarantine measures. With the swift of growth of critically ill COVID-19 patients, it requires utilizing all clinicians within a medical center to significantly improve the critical care capacity. As the elective surgery and alike activities are cancelled or postponed, the hospitals become focused facilities for COVID-19 with all the medical and paramedical staff working for the cause.
70 Family Medicine Specialist S’ Opinions on COVID19 Active Screening and Surveillance , Rawa Al Ameri*
Introduction: COVID19 pandemic forced ministries of health across the world to invent additional measures for control. Active screening is one of these tools. It includes asking questions, taking temperatures and doing rapid test for COVID19 in persons with risk factors. A team of a family medicine physician, lab worker, and administrative is formed. They visit homes with positive cases, making physical exam and COVID19 rapid test to contacts of the cases. Subject and Method: An electronic questionnaire is introduced to family physicians specialists in family medical centers in Baghdad. 99 physicians respond to questionnaire for one week. The questionnaire involved two sections; the 1st one asked if the screening surveillance is necessary for COVID19 control from physician s’ point of view. The 2nd section states the reasons of their opinions. Results: The study included 99 family medical physicians, 56 said yes; screening is necessary to control viral spread while, 43 said no. Discussion and Conclusions: Active screening required intense efforts by medical team with limited resources and hot weather. Rapid test of COVID19 is screening test so it is not detecting all infected people, including some with clinical disease compatible with COVID-19. The study gives a conclusion that there is a controversy about active screening.
71 Addressing Health Crisis among Pregnant Women with Disabilities: From the Zimbabwean and Zambian Point of View , Chigunwe G* and Mphande F
Projects that address changing values in our communities and that have impact on needs technology as well as addressing the health for all should be considered in all African countries. COVID19 is a point of argument. During this study, African leaders were running around for intervention measures and protection of their people from Corona virus. One wonders if the state of urgency would have been the same if COVID19 affected only those who cannot communicate such as the poor and those with disabilities. The latter minority groups have always been dying of preventable diseases such as Malaria and malnutrition whilst most women with disabilities experience maternal challenges in most African countries. Zimbabwean government indulged in the construction of alternative sanitary facilities in schools, clinics and hospitals. This move alleviated the sanitary and hygiene challenges faced by Zimbabweans. Studies revealed that persons with physical disabilities accessed most of these public institution toilets by leaving their wheelchairs outside then crawl on their hands and feet despite the dirty toilet floors. Most public toilet corridors were too narrow for wheelchairs to manoeuvre and there were no rails for support. In a study to examine the coping mechanisms and adaptation of women with physical disabilities in such an environment, qualitative methodology was used. Ethnography was used to gather data in Bindura district of Zimbabwe and Lusaka district of Zambia. Cross-sectional research was employed and interviews and questionnaire were data collection instruments. It was found that difficulty in accessing health institutions buildings and sanitary facilities made women with disabilities indulge in alternative, unhealthy practices which included home pregnancy delivery as well as failure to take their babies for baby health check clinic. While the UN Convention on the Rights of Persons with Disabilities emphasis on inclusive health, rehabilitating all institutions cannot be achieved now in Zimbabwe and Zambia due to economic crisis. However, SDGs can still be met by adopting policies that ensure healthy lives and wellbeing for all. Pregnant Women with Disabilities Community Care Model (PWwDCCM) can be adopted as an integrated home care model. This would be a holistic approach to managing pregnant women with disabilities as well as participation of health personnel and community members. Thus the two countries can contribute significantly in reducing the global maternal mortality ratio as well as preventing deaths of new born babies.
72 The Use of Telemedicine in Pulmonary Conditions , Martini N, Panthappattu J, Verma S and Khanijo S*
Telemedicine is the use of digital technology that, remotely, allows patients to receive healthcare services from their providers. It is cost efficient, easily accessible and can improve access to medical care among patients in rural communities. However, the growth of telemedicine has been slow due to skepticism and privacy concerns. Nevertheless, the recent outbreak of COVID-19 has brought telemedicine into the limelight. A Medline/PubMED search was performed to find articles with “telemedicine” as a heading.
73 Characterization of the Socioeconomic Inequity Attributable to Smoking , Gonzalez ES and Hernandez FF*
Background: The socioeconomic inequity attributable to smoking is a social untouchable cost. It has several forms to impact over the economy and the society in general. At same time, each impact form determines a form of socioeconomic inequity attributable to smoking. Each impact form has associated a particular social cost and particularly fiscal which relevancy will depend from the impact magnitude. Objective: To characterize the socioeconomic inequity attributable to smoking. Material and Methods: Was maddening an analytic research about the socioeconomic inequity attributable to smoking. The theatrical methods utilized were the comparative, the inductive-deductive and the analysis and synthesis. As empiric method was utilized the bibliographic research. Results: The socioeconomic inequity attributable to smoking is given by the social costs attributable to smoking. The main costs are determined by the cost over the Public Health and the costs because of the labor productivity lose attributable to smoking. Conclusion: Smoking is a risk factor with several social and economic impacts. Each form to impact over the morbidity and the mortality carries to a particular form of socioeconomic inequity. This condition determines the multi-dimensional research from smoking for a better control over this risk factor.
74 Potential Impact of COVID-19 Pandemic on the Socio-Economic Situations in Nigeria: A Huge Public Health Risk of unprecedented Concern , Obioma A*, Reuben AA and Elekwachi AB
Introduction: Severe acute respiratory syndrome coronavirus-2 is the causative virus for COVID-19. This is the latest coronavirus responsible for the shutting down of various aspects of human livelihood, as well as various sectors of the global economy, thereby having scathing socio-economic consequences on the entire global world. COVID-19 pandemic is currently a leading topic in Public Health discussion outcome. The focus has been hugely placed on how to limit the spread and flatten the curve of infections and deaths in regions and across the globe. The strategies employed in carrying out this task involved all procedures to limit human interaction through social distancing by enforcements of lockdowns, self-isolation, quarantine, border closure, as well as the shutdown of the various sectors of the economy. This has greatly affected the socio-economy of the world in various ways that shall be discussed in this article. Method and Methodology: The study approached employed in developing this article is the systematic review approach wherein a critical analysis of peer-reviewed and online news published articles were carried out and data relevant to the topic of discourse were applied. Keywords relevant to the topics were used to search through various databases with relevant articles included and the rest that could not meet up with the criteria of purpose were excluded. Background Knowledge: COVID-19 belongs to the Coronavirus family of viruses and is responsible for causing severe acute respiratory syndrome in those infected. While many patients are asymptomatic or may show only mild symptoms such as loss of smell and taste, fever and cough which may resolve after some days, some other patients may develop more serious complications such as severe acute respiratory disease and may require oxygen therapy and intensive care. This could lead to the death of some patients, and is mostly in people who are immune-compromised or have a history of underlying diseases such as diabetes. The mode of spread involves the inhalation of virus filled aerosol, or picking up of viral particles from surfaces by hand and touching, eyes, nose or face. Therefore measure for prevention involves social distancing, decontamination, wearing of face masks and practice of hand hygiene by constantly washing or using alcohol-based hand sanitizers. Findings/Results: The number of COVID-19 cases has risen to over ten million cases within six months of the outbreak with over five hundred thousand deaths as of 25th at June, 2020. The rise in number of cases led to the implementation of various measures such shutdown of industries, schools, businesses, religious activities as well as every endeavour that leads toassociation of people. This has led to great losses being incurred in various sectors of the economy. Lack of interaction has also proven to have some psychological implications, especially in people undergoing quarantine. Conclusion and Recommendation: While the cases of COVID-19 continues to rise, people must continue to adhere to the precautionary measures set up by world governing bodies, to ensure that the curve of the spread of the virus is flattened while waiting on the combined efforts of various research institutions working on vaccines to yield positive results.
75 Invoking the Epidemic Diseases Act of 1897 was a Jugaad Approach to Systemic Crises Like Covid 19 Pandemic in India , Suresh K*
The world’s most trusted English dictionary Oxford has officially accepted the word ‘Jugaad’ in their 2017 update. According to the dictionary, noun Jugaad means a flexible approach to solve a problem that uses limited resources in an innovative way. People living in North India, especially in the states of Uttar Pradesh, Haryana, Punjab, and parts of northern Rajasthan, have seen this vehicle on the highways, in villages and small towns, carrying people, livestock and agricultural produce
76 Covid 19-India: Enigma of Saving Lives or Economy , Suresh K*
Introduction: The entire world is assuming that it is fighting a war against Covid 19. After more than six months since the world first heard of the novel Corona virus, we still do not know many things about it. This pandemic will amplify existing social fractures and inequalities. Purpose: The purpose of this paper is to highlight the economic impact of the pandemic due to rising joblessness and shrinking economies, investments in building infrastructure and cost of care in hospitals and subsistence to the poor and labourers etc Design: This is a review of Covid 19 pandemic its impact on health and economic of India Findings: The immediate impact of the COVID-19 virus- fear, illness, and death are explicit. Indirect health effects like more people dying of other chronic morbidities due to poor access to services during lockdowns and denying of non-emergency care for over 6 months. Most importantly people are losing trust in healthcare system. The issue of political consequenceshow world powerful countries choose to look after themselves versus the rest of the world that will define global politics over the coming decades. As some governments face perceived or actual failure to protect their citizens, leading to blame others. The issue of the social and economic impact due to rising joblessness and shrinking economies, investments in building infrastructure and cost of care in hospitals and subsistence to the poor and labourers is yet to be realized fully. The economic consequences of the pandemic may well be more significant for India than the epidemiological impact compared to any other large developing country. Conclusion: A valuable debate about whether India has the fiscal room to afford a substantial stimulus that is taking place. it is important to note that the size of India’s support program is by far the lowest, as a percentage of GDP, among the top 10 global economies. If policymakers make it abundantly clear that unconventional policies will be time- and event-specific and would be unwound once its objectives are achieved, the financial macro stability will not be affected. On the brighter side, investors should start focusing on a targeted fiscal package to be able to contain the immediate downside. Materials & Methods: Data Collection Methodology: This paper used the data from WHO dashboard, Ministry of Health & Family Welfare, GOI India or States National Health Mission websites or other websites, WHO dashboard or other websites like John Hopkins’s University, CDC Atlanta, NSSO, Google and Wikipedia etc. I have also used the data as reported in daily new papers, mainly Times of India, Bangalore, Delhi and Mumbai editions and other national English dailies and regional vernacular print media in southern states. Study Setting & Sampling: The review covers entire country by major states and cities setting. Being the secondary data review no sampling was done
77 Awareness of Sudanese Married Women among the Use of Hormonal Contraceptive , Mohamed R, Suliman S, Arabi TY, Mousnad MA*, Saeed AA and Aldosh A
Objective: To determine the awareness of Sudanese women about the use of hormonal contraceptive, knowledge about the different type of hormonal contraception, common side effects caused by a hormonal contraceptive, to assess attitude about the use of hormonal contraceptive and to find out the knowledge of women about emergency Contraceptives. Methodology: Cross-sectional study conducted in-depth interviews with women consulting at obstetrics and geriatric hospital in Omdurman military hospital. A total of 335 women participated in the study. Results: Among the 335 women included in the study (335 women) were 58.8% of them were housewives, (29.2%) women were employers, moreover, Medical field, their number (11.4%) women and only (0.6%) women have not answered. The educational level of the participants as In level, University was (54.9%) women, A secondary level of education, were (31.9%) woman, Basic education level, their number were (11.1%) women, Uneducated women, were (1.8%) women, and there were only one woman declined to answer. (65.4%) from the women in the study had birth less than 4 children, (29.6%) women had birth more than 4children, while there were (5%) women hadn’t birthed. 82.7% from the women in the study were using contraceptives (60.6% were used contraceptive pills, 22.1% were used transdermal patches or injectable contraceptive) while 17.3% not used contraceptives. Conclusion: awareness of Sudanese women about the use of hormonal contraceptive was good, the most side effects was hair loss, change in mood and weight changes, the attitude to use hormonal contraceptive was most related to refuse the husbands to use it and personal beliefs, the knowledge of emergency contraceptive was low in women. Most of the women use contraceptive for family planning reasons. Half of the women were found to be lack of knowledge about more advantages of using contraceptive other than family planning.
78 Pandemic of Cardiovascular Diseases among Post-Menopausal Women; A Brain Storming Update , Alamgir MA*, Alamgir SI and Khan MA
Among the non-communicable diseases, the cardiovascular events (coronary heart diseases, stroke) are the number one killer of human beings. Among the victims half are women. If we further categorize the women of different age groups, postmenopausal are frequently affected. The present paper aims to review the pathophysiological aspects of this fact and remind the general measures to prevent these events.
79 The Medical Director in Healthcare Institution: From Monitoring to Management for a Safer and Enhanced Quality of Clinical Care , Elkhoury Ziad and Kossaify Antoine*
In a healthcare facility, the medical director is expected to monitor and manage the overall medical facets that may affect the institutional healthcare system; in this regard, the role of the medical director in regulating and improving the institutional healthcare system is predominant and should be a priority and a continuous concern of note, the role of the medical director is changing over time and it is evolving from what was a strictly “medical” function to an expanded set of roles which are more administrative and managerial rather than purely medical. The medical director position and function in a healthcare facility should inspire and enhance the spirit of professionalism, excellence and fairness, also the medical director is expected to ensure appropriate quality of care and patient safety and satisfaction, along with adequate filling and completion of medical records, medical teaching and training. In this document, we sought to make a quick review to highlight the impact of the Med on the healthcare system with an insight into management and improvement strategies.
80 Lockdown and Your Eyes , Mukherjee B*
All of us are subjected to three months of lockdown period due to Covid 19 pandemic. We are now forced to work from home and our children are attending on line virtual classes. Therefore our usage of computer, smart phone, television and other electronic devices has increased considerably. It has been estimated that in the last three months, screen time of our population has increased by 30 -40%. The common nomenclature used to describe all these devices is VDU (Video display unit). In this article, I shall discuss the common problems faced by VDU users and their possible remedies in layman’s terms.
81 Epidemiological Survey of Candida Species Isolated from Immunocompromised Hosts at the University of Nigeria Teaching Hospital, Enugu State , Uchegbu UN*, Onyemelukwe NF, Amah HC, Uche-Uchegbu N, Uduji HI, Ndukwe CK and Oparaocha SC
Candida species are excessively abundant in nature as free living organisms with the ability to infect humans and animals worldwide. They are notorious for their unbending resistance to the common azoles used in the treatment of Candidiasis in immunocompromised patients, hence making correct identification indispensable. In this study, 315 clinical specimens were collected from patients with one form of immunosuppression or the other while 150 swab samples were collected from the patients’ immediate environment. The samples were cultured on SDA and ChromAgar for identification of Candida species. The isolates were further identified to the species level using conventional methods based on their Gram reactions and Germ tube test. 158 biological specimens yielded Candida species; which represents an incidence rate of (50.2%), while 34(22.7%) of the environmental samples yielded Candidal growth. The identified isolates are; Candida metapsilosis, C. albicans, C. parapsilosis, C. orthopsilosis and C. tropicalis. These findings about the environmental pathogens are essential as they will help in developing effective preventive and therapeutic strategies against invasive candidiasis from the C. albicans and nonalbicans Candida (NAC) pathogens. More so, the identification of the Candida species from the environment gives an idea of the development of possible re-infection of the immunocompromised patients by the organisms in the environment. The environmental candidiasis may also account for the much talked about resistance to the common antifungal drugs.
82 The Impact of COVID-19 on the Management of BPH: How Can We Manage the Backlog of Patients? , Chughtai B, Cutone B, Alshak M, Mafilios M*, Bhattacharyya SK and Elterman DS
It is estimated that more than 30 million elective surgical procedures were cancelled during the initial 12-week peak of the COVID-19 pandemic, causing an unprecedented backlog of operations in hospitals worldwide. In order to manage this backlog while minimizing in-hospital viral transmission, providers can prioritize elective procedures that use fewer operative services or can be performed outside the hospital setting. We examined physician operative service times for seven surgical techniques for managing benign prostatic hyperplasia and found that minimally invasive surgical techniques take substantially less operative time than more invasive surgical procedures and also offer the option of an entirely out of hospital procedure. As physicians manage the backlog of BPH elective surgeries that were canceled or postponed due to the COVID-19 outbreak, surgical recovery plans should consider BPH procedures that minimize overall operative time in order to reduce the risks of exposing patients to perioperative or iatrogenic COVID-19 infection.
83 Does Covid 19 Pandemic Challenge Decade of Healthy Ageing?? , Suresh K*
A pandemic, by definition, represents worldwide, simultaneous epidemics caused by a novel pathogen. The multinational nature of such an event inevitably leads to cross-national comparisons of epidemic growth, impact, and public health response. The intercountry comparisons are vulnerable to attribution of individual-level outcomes to aggregate exposures. Age is one such confounder known to be associated with COVID-19 severity and case fatality. As the countries like Japan, Italy, France, UK, USA have disadvantage of skewed population of elderly, India on the other hand has comparatively younger adults more. On 3 August 2020, the 73rd World Health Assembly endorsed 2020-2030 as ‘The Decade of Healthy Ageing’-a process of developing and maintaining the functional ability that enables wellbeing in older age. The 2020 observance is expected to promote a Global Strategy and Action plan and monitor the progress and challenges in their realization by countries. The SARS COV 2 virus that causes COVID-19 infects people of all ages. However, evidence to date suggests that two groups of people are at a higher risk of getting severe COVID-19 disease. These are older people over 60 years and those with underlying medical conditions. As per UN estimates the current (2019) share of population over the age of 60 in India is 8 % and is projected to increase to nearly 20 percent by 2050. The reported share of Covid 19 cases as of first week August 2020 was 12% and proportion of fatalities was 50% in that age group largest among all age cohorts. Those older than 75 form 2% of India’s population but account for 14% of the total Covid deaths. Covid 19 Pandemic worldwide is prolonging for more than 6 months, second peaks are being witnessed already in some countries and expected in India by December 2020 due winter and stubble burning in North India,. With no definitive treatment protocol, over-stretched health system and uncertainties of vaccine availability to common population. I suspect it will be a big challenge to the objective of Decade (2020-2030) of Health Ageing. This article presents an early overview of the observed and potential impacts of the COVID-19 on the Global Healthy Ageing Decade commitments. I argue that the effects of COVID-19 are determined mainly by anthropogenic factors. Most Public Health Professionals opine that the impact of higher case fatality among senior citizens will continue to have on the quality of the elderly at least for this decade. Most elderly with comorbidities will succumb and those who survive through the pandemic will continue to be healthier and be well equipped to face future pandemics if any. Materials & Methodology: For this paper, the National, Covid-19 cumulative unreleased data of infection, cases, and death by August 2020 from the MOH&FW, GOI has been used. I also accessed print media especially Times of India, Hindustan Times, and Live Mint, all state capital editions. Data of aged population was taken from UN estimation, age composition and Covid 19 data by countries from https://coronavirus.jhu.edu/ and CIA Factbook, 2020 has been used.
84 Handling COVID 19: Minimizing our Blind Spots by Using Checklists and Promoting Collaborative Culture , Lateef F*
“Blind spots” may refer to a topic, a theme or an area where we lack understanding, are unable to see it clearly, do not realize how critical this particular area is, or it represents an area where we fail to exercise judgement or execute discrimination. Blind spots may be at the individual, organization or even governmental level. Whenever we are unaware of something, whether it is in our physical environment, how we behave or our personal attributes, there is the potential for a lack of insight which can take place at a critical moment or time. Even as everyone and every organization want to be prepared to handle challenges and crises, there may be blind spots, which might be overlooked. Thus it is useful and practical for us to be aware of this, be more ‘conscious’ about it and have review from a ‘fresh pair of eyes’. Working in inter-professional and collaborative teams, with open mindset, simplifying complicated and hierarchical work processes, having backup contingency plans as well as adapting to the rapid changes are some suggestions to help minimize these blind spots. The author is an emergency physician in Singapore, working at the frontline and shares candidly her views and opinion in this paper.
85 Effect of Stigma on Quality of Life of People with Sexually Transmitted Infections , Aggarwal S*, Mahajan N and Singh T
Sexually transmitted infections (STIs) are known for causing burden of mortality and morbidity along with psychosocial consequences among individuals suffering from STIs due to perceived stigma against them at community levels. Therefore, this mini review aims to summarize the effect of stigma on the quality of life of people with STIs. People with STIs and their families often experience shame, anxiety, isolation, social boycott, rejection by the surrounding communities. Fear of isolation and prejudices in the society causes the sufferer to keep their disease status undisclosed even to their families because they are afraid of being socially boycotted. The reluctancy and attitude of concealment of information regarding their health leads to complications in health seeking practices. Therefore, several initiatives have been pioneered by governmental and nongovernmental agencies in India to provide timely diagnosis and treatment for STIs in total confidentiality. Additionally, financial assistance, education and employment opportunities have also been sought for them. Prevention of the infection, proper awareness and education, reduction in complications related to treatment and healthcare seeking may be beneficial to reduce the transmission of STIs to a large extent. Socio-behavioural research to understand and estimate stigma and discrimination towards people suffering from STIs should be conducted to quantify the levels of stigma at various levels. Such studies will provide an opportunity for formulating guidelines which are more inclusive for individuals with STIs in order to destigmatize STIs in communities.
86 Machine Learning to Predict 5-Year Survival among Pediatric Acute Myeloid Leukemia Patients and Development of OSPAM-C Online Survival Prediction Tool , Das AK*, Mishra S, Mishra DK and Gopalan SS
Introduction: Acute myeloid leukemia (AML) accounts for a fifth of childhood leukemia. Although survival rates for AML have greatly improved over the past few decades, they vary depending on demographic and AML type factors. We predict the fiveyear survival among pediatric AML patients using machine learning algorithms and deploy the best performing algorithm as an online survival prediction tool. Methods: Pediatric patients (0 to 14 years) with microscopically confirmed AML were extracted from the Surveillance Epidemiology and End Results (SEER) database (2000-2011) and randomly split into training and test datasets (80/20 ratio). Four machine learning algorithms (logistic regression, support vector machine, gradient boosting, and K nearest neighbor) were trained on features to predict five-year survival. Performances of the algorithms were compared and the best performing algorithm was deployed as an online prediction tool. Results: A total of 1,477 patients met our inclusion criteria. The gradient boosting algorithm was the best performer in terms of discrimination and predictive ability. It was deployed as the online survival prediction tool named OSPAM-C (https://ashisdas.shinyapps.io/ospam/). Conclusions: Our study provides a framework for the development and deployment of an online survival prediction tool for pediatric patients with AML. While external validation is needed, our survival prediction tool presents an opportunity to reach informed clinical decision-making for AML patients.
87 Performance Evaluation on Science and Innovation Management Process in A Cuban Medical University , Guillermo RC* and Arialys HN
Quality represents a form of management focused and concerned on user satisfaction, as well as processes and results improvement. In an institution like the university, quality must involve all academic and administrative activities. Many higher education institutions use generic quality management models as a way to improve the performance of their processes and to introduce control mechanisms for efficiency seeking. In this regard, universities have developed performance evaluation indicator systems based on academic’s scientific productivity. The main reason behind evaluation through performance criteria is that these measures drive improvement on the quality of service delivery. A critical analysis shows that difficulties persist in facing quality assessment processes and discrete values are observed in the indicators from a quantitative point of view. The purpose of this study is to evaluate the performance of the Science and Innovation Management process at the University of Medical Sciences of Matanzas as a contribution to institutional accreditation achievement. Methodology & Theoretical Orientation: it was carried out a non-experimental, descriptive and quantitative cross-sectional research around performance evaluation. A diagnosis and subsequent analysis of Science and Technological Innovation processes based on relevant indicators was performed. Findings: The budget spending for research activities is, in general, not satisfactory; only 14.3% of academic departments execute more than 50%. However, there is an increase in evaluation costs, with values range from 28% to 36%. Conclusion & Significance: The application of generic quality tool to evaluate the performance of the Science and Innovation process at the Medical University, proved to be relevant to boost quality and efficiency based improvement in academic processes.
88 Sudan National AIDS Spending Assessment Rounds: A Systematized Review , M. Kheir Sara Gabrallah, Habbani Khalid and Mousnad MA*
Introduction: HIV/AIDS continues to be a major global health issue, claimed more than 35 million lives so far. In 2017, 1.8 million people becoming newly infected and 940,000 people died from HIV-related causes around the world and approximately 36.9 million people were living with HIV at the end of 2017. Sudan has conducted three rounds of National AIDS spending assessment (NASA). Those rounds was not published or reviewed. Aims: to systematize review Sudan National AIDS Spending Assessment (NASA) conducted rounds. Methods: A systematized literature review, qualitative retrospective analytical study. It composed of the current literature that clarifying the research question. SALSA framework was selected and used in this study. Three countries NASA exercise reports China, Iran and Nigeria were selected to be in comparison with Sudan. Results: Sudan NASA showed that international donors are the main financer for HIV/AIDS services in Sudan. HIV/AIDS spending by Spending Categories (ASC) and beneficiary population revealed that Sudan spent more in programmatic and administration category and non-targeted interventions respectively. Conclusion: Sudan needs to solve its HIV/AIDS financing paradox to step up funding efficiently and sustainably HIV/AIDS services to end HIV/AIDS epidemic by 2030.
89 Postgraduate Trainer Course: The Smoking Economic Burden by Morbidity , Hernandez FF* and Gonzalez ES
Background: The research and analysis from smoking must be from several points of view. Nevertheless the smoking economic burden by morbidity must be strongly researched since the Health Economy. The usefulness from postgraduate course about this subject offer the opportunity to generalize the whole knowledge obtained. Thus more health professional will be better capacitated to make better measures from the smoking economic impact over the Public Health. Objective: To design a postgraduate trainer course about the measurement from the smoking economic burden by morbidity. Materials and Methods: Were used the inductive – deductive and the comparative as theorical methods. As empiric method was used the bibliographic research. Results: The suggested course has the particularity of be contextualized agree to general learning needs from health professionals related to the smoking economic control. The course has the characteristic that each subject is supported by the previous. Conclusion: Was designed a postgraduate trainer course for health professionals related with the smoking economic control. The course is agreed to general learning needs from health professionals related to the smoking economic control.
90 Postgraduate Course: Smoking Vs. Labor Productivity , Hernandez FF* and Gonzalez ES
Background: Smoking is close related with no-communicable illness. As consequence from the smoking impact over morbidity and mortality smokers laboring reduces the self labor productivity agree to tobacco consumption. The smoking complexion duties to research and explain it in a multi dimensional form. Also, a postgraduate education is necessary to generalize the knowledge obtained. Objective: To design a postgraduate course about the relation between smoking and the labor productivity. Materials and Methods: Theoric methods: inductive – deductive and comparative. Empiric method: bibliographic research. Results: The postgraduate course “Smoking vs. labor productivity” focus the attention in the relation between smoking and labor productivity. This course was designed especially for health professionals. Nevertheless is recommended the inclusion of professionals from economic sciences to make richer the discussion in class. Conclusions: It designed a postgraduate course about the relation between smoking and labor productivity. This course saves the condition doing that each subject is supported by the previous.
91 Assessment of Economic Burden due to Alcohol Consumption among Residents of Slum Area of Belagavi City , Khulal R*, Bhatta L, Mubashir A and Narasannavar A
Background: Alcohol consumption is an inseparable addiction to all around the world including India in the current scenario. Both direct and indirect cost of the economic burden of alcohol, consumption was estimated to be 0.45%-5.44% of Gross -Domestic Product (GDP). In 2012 alone more than 5.9% of death has occurred due to alcohol consumption. In India total of 30% of the total population consumes alcohol, as per census 2011, 51.1/100,000 male consume alcohol and 27.1/100,000 female consume alcohol. In India total loss of GDP due to alcohol-related disease is said to be 1.45% which is Rs 3,127 billion ($48.11 billion) is the economic burden on the health system. Death due to alcohol consumption in India in the year 2012 is 3.3 million. As in India alcohol consumption has increased by 38% from 2010 to 2017, is from 4.3 liters to 5.9 liters/ adult/ years. In India alcohol is a major source of income from beverage taxes across the country and in case of Karnataka 25% of the budget is generated for the tax of selling alcoholic beverages. Methodology: A cross sectional study was conducted in slum areas of Belagavi. The source of data was permanent resident of the slum area Belagavi city who consumes any kind of alcohol beverages. Data collection was done by using pre designed and pre-tested questionnaire. Simple random sampling technique was used for recruiting participants. Total participant were 154 in this study. Results: out of total participants 29.9% drink alcohol often. Type of alcohol beverage used were Beer 9%, wine 6%, Rum 17.5% and whiskey 76%. The participants who were guilty of alcohol consumption were 57% whereas 42.9% did not feel guilty for consuming alcohol. Significant association was found with the income and amount spent for purchase of alcohol. (P value= <0.001). Conclusion: Alcohol consumption has been major problem in the present society. There is significant association found between income and the amount spent for alcohol. As income is directly associated with alcohol consumption.
92 Leveraging Virtual Concepts during Pandemic , Wahag Al Mashaer Osman Mahgoub, Noha Saleh OS Ahmed* and Sherman Jabonete Dumaguin
The world is undergoing many technological innovations which progressively take place in many industries. Virtual concepts are among the innovations that are frequently handled in many studies as a promising innovation. The existence of COVID-19 pandemic had enforced healthcare organizations to adopt virtual concepts in providing education, training and support for their clinical staff. In this context, this study aimed to assess the effectiveness of virtual tools used during pandemic on the quality of the services provided by Nursing Informatics Department - Hamad Medical Corporation Qatar. The data analyzed in this study was collected by a questionnaire to end-users and interviews questions to clinical leaders. Sampling was created as of 17% (541 /3190) of the end users and all the nursing leaders assigned in the treatment sites. According to the study results, it was concluded that virtual concepts implementations were satisfying 80% of the respondents where they have agreed on its effectiveness. It was also perceived that the participants were more engaged in their learning process which is among the factors that impact the participants’ high satisfaction rate. Additionally, participants agreed that the use of the virtual tools enabled effective utilization of resources to face the challenging demands of nursing workforce. The paper recommends conducting further studies on the factors influencing virtual team performance and motivation and its impact on learning outcomes and other studies on the impact of applying the same technology on individuals with disabilities or had different inadequacies and assesses the outcomes. In conclusion, the new normal has set the path for transforming the training and support provided to clinicians through applying virtual concepts where it is required to forecast the necessary trainings needed in the future to streamline the digital health education using telemedicine.
93 The Use of Personal Protective Equipment (PPE) during the Covid 19 Pandemic: Developed and Developing Country Review , Mutekanga DR*
This is a short review paper examining the use of the Personal Protective Equipment (PPE) and Personal Protective Processes (PPP) during this Covid 19 pandemic and looking at the differences and similarities between developing and developed countries in relationship to very high Covid 19 levels in most developed countries visa vee relatively low levels in most African countries. The review also raises several questions leading to need for further study, examination, discussion and review and these include: why there is low Covid 19 cases and incidences in African countries, the role of environmental factors on the life of the Corona Virus causing COVID 19 and the impact of both PPE and PPP on the levels of transmission and capacity to control COVID 19 in both developed and developing countries.
94 The Perils of Covid-19 in Nepal: Implication for Maternal Health , Chaulagain K* and Nepal A
Coronavirus (COVID-19) belongs to severe acute respiratory syndrome-corona virus-2 (SARS-Cov-2) family which is characterized as a pandemic by WHO in March 2020. With the declaration of the COVID-19 pandemic by WHO, Nepal imposed nationwide lockdown to control the transmission chain of the disease. The lockdown extended almost for 4 months which affected health system operations and management. The stress in the health system affected the access and utilization of maternal health services. As estimated by UNFPA, the pandemic could double or triple maternal deaths in Nepal by next year, due to low uptake of maternal health services such having skilled healthcare providers assist in births, delivering in health facilities, or accessing contraception. Fear of disease transmission and low trust in the maternal health services among the women, families and communities is also causes of the low uptake of the services. The COVID-19 is threatening the achievement that Nepal has acquired in maternal health outcomes in the last decade, therefore, the government need to prioritize the maternal health services during the pandemic era to avoid preventable deaths and accelerate the progress toward sustainable development goals. Appropriate interventions such as promoting hand hygiene, improve local government engagement, training and capacity building of the health workers to run the regular maternal health services, adoption of the technical guidance of the WHO for the treatment of the pregnant/postpartum women with COVID-19 symptoms/diagnosed case must be initiate by the government at each level of care. Context-specific awareness raising and behavior change communication strategy should be adopted to promote fact related COVID-19 among the community. Access to quality of care is the constitutional rights of every Nepali citizen which must be ensured at any time at any cost.
95 Health Education Strategy for Improving the Attitude of Adults towards Covid-19 Precautions in Udenu , Ruphina UN, Matthias UA and Michael OU*
Introduction: Due to the rising cases of COVID-19 in Nigeria, the government has adopted some safety precautions to control the spread. However, the poor attitude of adults towards COVID-19 safety precautions has aided the spread of the virus. Objective: This study investigated health education strategy for improving the attitude of adults towards COVID-19 safety precautions in Udenu. Methods: The study is naturalistic observation study. The attitude of adults in Udenu towards COVID-19 towards COVID-19 safety precautions was observed before and after implementing a health education strategy so as to determine the effectiveness of the strategy in improving the attitude of adults towards COVID-19 safety precautions. 4 communities in Udenu were observed for the study. Results: The findings revealed that there was a significant improvement in the attitude of the adult towards COVID-19 safety precautions after receiving health education. Hence, more community health workers should be trained by Nigerian Center for Disease Control (NCDC).
96 Transgender Population’s Health Teaching: Reflexions on Teacher Perception , Bervian E, Marques Martins LBM, Montenegro MD, Felisbino AS, Sanches LC and Ribeiro ER*
This work aims to understand the perception of instructors about the teaching of trans people in health during the medical course, considering how training can influence the treatment, reception and access of these people in primary care. Twenty four interviews were conducted with professors from a Faculty of Medicine in Curitiba, Paraná, Brazil. The study of the interviews was based on the Content Analysis of Moraes (1999). It defined 5 categories of analysis: “conceptual dimension”, “biological dimension”, "social dimension", "pedagogical dimension" and "skills development". It is possible to conclude that the pedagogical approach during graduation presents many flaws, being necessary to show the relevance for the medical community in the sense of inserting the theme in the university's curriculum.
97 Factors Affecting Mortality Risk of Patients Due to COVID-19 Outbreak: A Case Study , Karevan A, Limon S, Tee KF*
Human societies are dealing with infectious diseases for centuries. The consequences of this infectious disease outbreak are multifaceted. Apart from socio-economic disruption, the outbreak also causes thousands of humans’ lives. The recent COVID-19 is the deadliest of this century’s outbreak already causes hundreds of thousands of lives all over the world. Several studies have been conducted to identify the virus’s nature, its severity compared to other flu viruses and methods of spread. However, there has been no study that emphasizes the quantitative analysis of mortality risk of patients considering different clinical and social circumstances which are also known as factors. In this case study, real-life mortality data have been analyzed and the severity effect of different factors on mortality due to COVID-19 has been categorized. Considering all factors simultaneously, a method to estimate the mortality risk index of patients is also presented. The estimated mortality risk index results show how different combinations of factors have influenced the mortality chances of patients differently
98 African Americans Healthcare Disparities and Inclusive Practice; A Literature Review , Shayna S Perdue RN, BSN, FNP(s) and Dr. Abigail Mitchell RN, MSN, MBA
African American culture is both fascinating and immense. Unfortunately, there are many disproportions faced by African Americans, which result in barriers to care. There have been a few themes identified in the literature. The themes include: Barriers to care for women, men, children, and then disease specific. Only around 10% of African Americans receive referrals to a health professional for assistance. This literature review provides information on each theme but also the importance of being culturally competent to provide positive outcomes for this population as health care providers. African American culture is both fascinating and immense. Unfortunately, there are many disproportions faced by African Americans, which result in barriers to care. For example, there is no solid percentage of African Americans diagnosed with depression; however a prevalence rate is thought to be around 9% to 13% of the population. Only around 10% of African Americans receive referrals to a health professional for assistance, and around 40% choose to seek assistance from their clergy.
99 Challenges Encountered by Mental Health Workers in Rwanda; Current Situation and Future Needs , Balthazar N*
The burden of mental health has become a great concern for public health as the diseases caused by mental health is ranking second worldwide. According to the HWO countries of Low- and Middle-Income Countries (LMICs) don’t allocate enough financial means to mental healthcare. The lack of will or interest in mental health in these countries causes different challenges in this sector. Rwanda as one of LMICs is not served on the challenges although it might have its particularities. This study aimed to explore the challenges encountered by Rwandan local mental health workers within and outside of their demanding work. Method: An interpretative qualitative mixed with quantitative design. The self-administrated questionnaire with open-ended questions, demographic data as well as qualitative data was systematically prepared, explained, and given to respondents. The questionnaire was completed by sixty mental health workers from various institutions with mental health in Rwanda. SPSS was used in quantitative data analysis while the main part of data used Thematic analysis for qualitative data analysis. Results: The main results immersed in themes that consist of the shortage of; salary, poverty of mental health seekers, culture, and beliefs toward mental health, training, and professional development of mental health works. The study concluded with a better understanding of challenges in mental health practice in Rwanda and the outcome could be used to decrease challenges for mental health professionals and sustain of the mental healthcare system in Rwanda.
100 Uncertainty in the New Appearance of a New Strain of Covid-19 in the World. Lethal or Non-Lethal? , Sacasa Escala JG*
In the UK, a new variant called SARS-CoV-2 VUI was discovered. This variant is defined by the spread of a mutation of the SARS-CoV-2 peak protein (S). The S gene encodes the spike glycoprotein, which binds to host ACE2 receptors and is required for the initiation of infection.
101 Analysis of Clinical Features and Transmission of Potential of COVID-19 Infection from Pregnant Mother to Baby , Dutta S* and Bandyopadhyay SK
Pregnant woman needs special care by an experience doctors. During the time of pregnancy of woman several disorders such as diabetes and high blood pressure may occur and these increase the risk for the baby. So it is needed to consult experienced gynaecologist to get in the best physical condition possible before they become pregnant. It is also needed to assess that if there is any possibility of premature birth. This paper indicates the problems related to pregnant woman during COVID-19 and analysed the chronic illnesses and other health complications.
102 Did the COVID-19 Pandemic Makes Scientists Forget 'Primum Non-Nocere', One of the Most Important Principles Of Bioethics? , Karaosmanoglu HK*
The famous Latin phrase, the origin is uncertain ‘’Primum non-nocere (first, no harm)’’ is one of the principal precepts of bioethics that all students are taught in medical schools and is a fundamental principle world
103 Back to Medical Ethics , Welles JF*
Although nobody much reads the original Hippocratic Oath any more, it is essentially a commitment to keeping trade secrets. The modern version focuses on not taking advantage of patients sexually while providing medical care directed toward their health and well-being. Unfortunately, it does not address the current, rampant corruption of financial abuse which the insurance industry imposes on American physicians. How many time a day does a doctor provide services which are not necessary for the patient’s health?.
104 Health Care Ethics Informed Consent, Quality of Life, and Full Disclosure , Kuriakose S*
Health care ethics have taken an importance not appreciated in times past as a person’s individual wishes are emphasized and respected more robustly in the 21st century. A patient has the individual right to decide his/her care and what steps can be taken (or not) based on their own beliefs, priorities, and wishes. It is imperative that clinicians and healthcare institutions, including all stakeholders, respect these right-including informed consent, a patient’s wish for their specific quality of life, and their acceptance of not prolonging treatment. Informed disclosure continues to be the ethical standard that providers must follow to allow patients (perhaps after discussion with their families) to decide how to proceed in terms of their own healthcare. Attempts to minimize mortality are not the goal of healthcare, rather the drive should be to improve health outcomes by improving the quality of life remaining while ensuring that the patient has full knowledge of their condition, treatment options, and prognosis. Healthcare ethics demand that patients be equal partners with their medical providers in deciding the future of their healthcare and be not dissuaded from asking questions and demanding proper and accurate answers. This paper dwells on the most common aspects of healthcare ethical dilemmas and the proper mechanisms to deal with these issues.
105 A Systematic Review of Studies on Social Skills Development for Adolescents with Autism Spectrum Disorders , Almalki I, Al-Masaeed M*, ALSABABHA R and Alqudah M
Aim and Significance: The systematic literature review is developed as an investigation of existing and recommended evidence based social skills and strategies to adopt in improving adolescents with ASD social skills. The systematic review was developed based on the understanding that a majority of the studies have focused on children below 11 years social skills. The need to analsye and establish the age specific social skills and strategies required informed the review development. This ystematic review evaluates the available published studies on group-based social skills interventions in the United States and the realm of Canada to improve the social skills among adolescents with ASD Methods: The systematic review developed an online search for peer reviewed articles published on the Medline, PsycINFO, Psychoarticle, Psychology and behaviour and Web of Science, through a PubMed-NCBI, an EBSCO and the Ovid databases. Key words and phrases were used to search for relevant literature. Once results were obtained, an inclusion and exclusion criteria was applied to narrow down the studies to applicable and most relevant studies. Results and Discussion: Three categories of social skills interventions have been identified to be effective in improving social and communication skills. They are (i) the use of the PEERS, (ii) social skills training group and (iii) group skills training. The recommendation for future research should focus on comparing protocols of various social skills training in clinical settings of the real-world.
106 Pharmacovigilance in Sudan: Knowledge, Attitudes and Behaviour among Community Pharmacists , Babiker Osman AMH and Mohamed Awad M*
Background: Adverse drug reaction monitoring and reporting require a multidisciplinary approach and pharmacists have a major role to play in this matter. Under-reporting of the ADRs by the prescribers is a common problem in devolving countries. Aim: To assess the knowledge, attitude and behaviour of community pharmacists toward pharmacovigilance in Khartoum city. Method: Descriptive cross-sectional study among 258 community pharmacists during the period from October to November 2017 using a pre-designed questionnaire. The study was evaluated participants regarding knowledge on drug safety in routine practice, the knowledge and attitude of community pharmacists toward ADR reporting and their behaviour on ADR related aspects. Result: Out of 325 participants, most of them were male (50.8%) with age group From 18 years to 30 years (62%) and B. Pharm (57.8%) and practice experience more than 2 years to 5 years (38.8%) and Training received in pharmacovigilance Yes (42.2%). Assessing pharmacist’s knowledge showed that 74% of community pharmacists know the ADR definition and 39.5% are not know the ADR are preventable to some extent, no association between knowledge and qualification, and there is an association with practice. Assessing pharmacists knowledge toward ADR reporting, 69% of the participant are agree awareness of the national pharmacovigilance program in Sudan revealed no statistically significant association with training in pharmacovigilance, positive attitude of pharmacist toward ADR reporting, 67.8% of the pharmacists believed that the role of the pharmacist in ADR reporting was essential revealed there are statistically significant associations with training in pharmacovigilance, the behaviour of pharmacist toward ADR, 91.9%of participant agrees to ask for the allergy history of the patient before dispensing the medication revealed no statistically significant association with training in pharmacovigilance. Conclusion: Even though most of the pharmacists had knowledge, attitude and behaviour on ADR reporting and related aspects, the number of them did not know drug safety-related aspects of specific drugs. Educational programs have to be generated awareness on how to report ADR and stimulate pharmacists’ more active participation in the pharmacovigilance program. There is a true need to have training programs to improve the knowledge of pharmacists on ADR related aspects that are of benefit daily, which could greatly have an impact on patient safety. Key Policy Messages: The result reflected pharmacists knowledge toward ADR reporting, most of the participant are agree awareness of the national pharmacovigilance program in Sudan revealed no statistically significant association with training in pharmacovigilance, positive attitude of pharmacist toward ADR reporting, most of the pharmacists believed that the role of the pharmacist in ADR reporting was essential revealed there are statistically significant associations with training in pharmacovigilance, the behaviour of pharmacist toward ADR, majority of the participant agrees to ask for the allergy history of the patient before dispensing the medication revealed no statistically significant association with training in pharmacovigilance.
107 Catholic Church Services in Pandemic Coronavirus Disease (Covid-19) in the Diocese Ruteng - Indone , Salesman F* and Tapung MM
The Covid-19 pandemic affected the coastal communities in Manggarai. The bargaining power of fish catches and crop yields in the field has decreased. This situation makes it difficult for them to survive. Concerned about this situation, the Catholic Church of Diossece Ruteng formed a task force as a social worker to provide basic food assistance, medicines, personal protective equipment, and advocate healthy behavior for Catholics in the diocese of Ruteng. Purpose: Exploring the types of basic needs of coastal communities, continued to provide food aid to reduce the suffering of coastal communities affected by Covid-19. Method and Materials: Using a modification of the IPOAFI model (Identifying, Planning, Organizing, Acting, Finding, Impact). Providing social assistance and advocating for health behavioral education. Results: Reducing the suffering of coastal communities of food shortages, increasing knowledge about Covid-19, cultured hand washing, wearing masks, maintaining body immunity by consuming nutritious food, routine health checks. Conclusion. The presence of the Catholic Church in Diossece Ruteng helped the suffering of the people affected by Covid-19.
108 Food Sovereignty as an Alternative to Reduce the Serious Hunger Problem or Food Shortage Worldwide , Ortega-Ibarra E*, Ortega-Ibarra IH, Díaz-Santiago HD, Luna-Hernández JF, Ramírez Díaz MP, Hernández Ramírez G and Marín-Velázquez J
In 1996 Via Campesina launched an initiative claiming that peoples had the right to affordable, nutritious and culturally appropriate food produced using sustainable and ecological processes, as well as the right to define their own management policies related to agriculture, water, fisheries, land, seeds and biodiversity. This initiative, which constitutes a broad framework for the enforcement of the right to food, has emerged as a response and an alternative to the neoliberal model fostering corporate globalization. Also, it is global and provides a framework to understand and transform governance. This concept -consisting of six well-defined pillars (focuses on food for people, values food providers, localizes food systems, puts control locally, develops knowledge and skills, work with nature) can help avoid food poverty, since it aims to guarantee access to healthy and sufficient nutrition for all people, especially the most vulnerable sectors, such as children, pregnant women and older adults, who hardly achieve a proper living. The World Forum on Food Sovereignty, shares objectives and actions to also help through seven areas: trade policies and local markets, knowledge and local technology, access to and control over natural resources, the exchange of territories in all sectors, response to conflicts and natural disasters, migration and production models.
109 Social Skills Development, Attitudes, Ethics and Bioethics , Sánchez-Díaz MR*
The JQHCE authors address important and difficult problems in care giving and seek the development of social skills, attitudes, ethics, bioethics before, during covid-19.
110 Patient Safety and Unplanned Extubation in a Pediatric Intensive Care Unit: A Analytical Observational Study , Ribeiro ER*, Pellis IC, Maranhao JGW, Gennari RL, Simao M and Pamplona RAC
Introduction: Unplanned extubation (UE) is characterized by the removal or displacement of the endotracheal tube (ETT). Objectives: To analyze the incidence of unplanned extubation, characterize the most prevalent cases of unplanned extubation and analyze an extubation protocol. Methodology: This study is characterized as an analytical observational study design, performed in two stages: field research to collect and analyze data from medical records and analysis of the NPE protocol used by a large hospital. Results: In the collected medical records, rates of 7.75 UE/100 days of MV for general and surgical ICU and 4.68 UE/100 days of MV for cardiopediatric ICU were found. The female gender was predominant in the group of patients evaluated and the cause of unknown origin was the most prevalent. We identified 19 unplanned extubations in the general and surgical ICU, and 9 episodes of unplanned extubation in the cardiopediatric ICU, 28 occurrences. For the protocol evaluation the AGREE II instrument was used and the following scores were obtained: domain 1 with 85.19%; domain 2 with 72.22%; domain 3 with 35.42%; domain 4 with 96.30%; domain 5 with 76.39% and domain 6 with 100%. The general score of the protocol evaluation was grade four. Conclusion: The data presented can be of great benefit for prevention, identification and early intervention of UE episodes in pediatric patients with higher risk factors.
111 To Study Appropriateness of Patient Stay in the Emergency Medicine Department of a Tertiary Care Teaching Hospital of North India , Khaliq MAU*, Yatoo GH, Mufti S, Jabeen U, Malik A and Khaliq MIU
Inappropriate hospital stay increases hospital costs, decrease available resources for patients with critical situation and put patients at risk of nosocomial infections. It was observed that 24.3 % cases of hospital stay studied were inappropriate in Medical Side while as 41.38% cases of hospital stay studied were inappropriate in Surgical Side.
112 An Intervention Study on Worm Infestation among School Going Children in Rural Areas of South India , Devagappanavar G*
Background: World Health Organization had estimated that about 1400 million people worldwide are infected with any one of the three kinds of intestinal helminths. They are a roundworm, hookworm and whipworm infestation. In that 200 million children suffer from diseases associated with these infestations. In India, 25 to 30 children’s were positive with hookworm. The poor standard of living includes improper disposal of faecal and other wastes, overcrowding, unhygienic health practices and poor environmental sanitation are the reasons for the worm infestation among the children. The worm infestation will cause due to unhygienic practices that’s why the Government of India started the National deworming day programme in 2015 with yearly two-phased observation to prevent the worm infestation. So in this study, we wanted to assess the knowledge about worm infestation among the service receiving children, servicing providing school teachers and civil society participation and cooperation. Objectives: Assessment of knowledge about worm infestation among School Children, school teachers and General population. To assess the health education impact on the study participants. Materials and Methods: A school-based cross-sectional intervention study was conducted to assessing the knowledge about worm infestation among the children, school teachers and general population using a pre-tested questionnaire. Systematic random sample, Universal sampling and convenient sampling technique were adapted to choose the students, teachers and community people respectively. The knowledge about worm infestation was assessed through pre-test and after providing the health education the Post-test was done using the same questionnaire for the same participants. Results: Among the school children in the pre-test have 51.36% and in the post-test, it is increased to 83.73 %. In the pretest 57.11% and the post-test, it is increased 92.17 % among the school teachers and the general population in the pre-test knowledge was 41.91 % and it increased to 88.16 % in the post-test. Conclusion: Though the government of India started the national deworming day program in 2015, the knowledge about worm infestation is below 60 percent in the studied population. This study proved that health education is the key to improve their knowledge about worm infestation.
113 Exploring Health Technology Management Relevance to Safety and Quality in Hospital Care , Narino AH*
Technology management is a key issue for innovation and quality in health care sector, which, in turn, implies effectiveness and safety considerations. It is valuable, to explore the influence of technology to safety management and quality in health environment, and so to dig into what topics arise from this relationship. The purpose of this study is to explore the relevance of Health Technology Management to safety and quality in health organizations from health professional’s perceptions and scientific evolution perspectives. Methodology and Theoretical Orientation: An exploratory based qualitative study was conducted. A semi-structured interview was administered to health professionals with professional and academic experience in clinical settings in Matanzas territory. There were selected the main issues raised from professional’s opinions. Additionally, there was examined the scientific development of this subject by means of a review of research documents published in Sciencedirect and Scielo databases. Findings: Main views were similar as to technology use, assessment and innovation impact on human errors, how they may condition clinical and therapeutic practices, health recovery as well as a risky care environment for patients and personnel. Conclusion & Significance: It is confirmed the importance of health technology management to safety and quality of health care as well as research.
114 Village Health Volunteers: Facing up to the Covid-19 Challenge , Changsuphan S* and Chaknum P
Village Health Volunteers (VHVs) are a crucial component of primary health care in Thailand. They have applied their role in collaboration with the nation’s public health officials at primary and community hospitals since 1978. The outbreak of the 2019 Coronavirus disease (COVID-19), first recorded in Wuhan, China at the end of 2019, has infected millions of people in almost every country in the world, leading to illness, hospitalization and, in many cases, untimely death. During this time global healthcare systems have been under enormous strain to contain the virus outbreak and treat sick people. COVID-19 first came to the attention of Thailand as a highly infectious disease on 26 February 2020, but the nation has successfully responded to the pandemic by focusing effort and resources on primary healthcare. VHVs have contributed significantly in their central role in preventing and controlling the virus in communities around the country.
115 Health in All Policies: Management Model for the Comprehensive Transformation of the System , Mandl Stangl J*
The essay explores the components of the approach health in all policies as a management model based on primary health care and its basic principles for health promotion described in the Ottawa Charter and the Adelaide Declaration: citizen participation and community empowerment, intersectorality, personal skills development, timely technologies and governance processes on social determinants of health. In this sense, we propose the transformation of the health system based on the construction of a comprehensive program for the strengthening of the organization through mechanisms of collaboration between the State and the Society, privileging equity and justice in defense of human rights. The document collects lessons learned from practices on the development and strengthening of “Sistemas Locales de Salud” and the Project “Municipios Hacia la Salud” in Venezuela (1989-2000), as well as experiences in other countries. The proposal is presented as a management model for the design, implementation, and governance of redistributive policies with a perspective of multisectoral strategic plan. We conclude that to be effective and efficient, these initiatives need better processes of political and functional decentralization, strong political and executive leadership, inclusive citizen participation, integrality between health and social goals and objectives, consensual planning between society and governments and; continuous accompaniment, monitoring and evaluation.
116 Virtual Reality: A Tool for Managing and Mitigating the Nursing Fatigue , Sohayb ABU TAPANJEH, Mahmoud Al-Masaeed and Muhammad Alqudah*
Background and Aim: Nurses' fatigue risks are on the rise. The implications include a rise in nurse's dissatisfaction, a decline in nurses' health, and a rise in the risk of medical errors. There is a need to counter fatigue by either coping with it or eliminating the risks involved. One of the emerging alternatives to handling nursing fatigue is virtual reality (VR) technology. The review examines the existing literature on the use of VR in managing nurses' fatigue. Methods: The review adopts an ILR approach. This includes collecting relevant literature online and critically examining it for patterns and trends on the topic. The required literature is collected from four databases, CINAHL, Google Scholar, Scopus, and Medline. An electronic search strategy for the Scopus database is duplicated across the other three databases. The findings result in MEDLINE (16), Google Scholar (41), SCOPUS (33), and CINAHL (19). After screening through the PRISMA Equator tool and a GRADE model on the articles' quality and reliability, 21 articles were used in the study analysis. Findings and Conclusion: The review findings indicate three broad areas of VR application in managing nurses' fatigue. They are (i) VR in encouraging nurses' rest, (ii) VR in promoting nurses' psychological well-being, and (iii) VR in nurses' fatigue mitigation training. The overall review conclusion is that VR is emerging as a complementary tool in managing nurses' fatigue. Institutions should invest in VR tools and infrastructure to complement their current nurses' fatigue mitigation and coping strategies.
117 Achievements in Reducing the Hospitalization Rate of Home Care Patients in a Regional Hospital in Taiwan , Chia-Li H, Yuan-Yi C, Shin-Ping H, Mung-Ting L and Li-Chen S*
This article provides practical experience of cross-field integration and cooperation in hospitals in a certain region of Taiwan from 2018 to 2019 to reduce the hospitalization rate of home care, reduce the care load of caregivers, improve the quality of care and reduce medical expenses.
118 Development of the Covid-19 Epidemic Model: Calculations for a Mutating Virus , Below D, Mairanowski J and Mairanowski F*
Our previously developed simple analytical model for calculating the epidemic spread of COVID 19 is further developed. We propose a calculation method for analyzing the spread of the two-strain virus system. Comparison of the calculation results with statistical data on the example of the United Kingdom, the United States and South Africa shows their satisfactory agreement. A methodology for calculating epidemic growth under conditions of abrupt changes in lockdown conditions is proposed. It is shown that both empirical coefficients included in the model can be calculated on the basis of information on population size and quarantine conditions during the epidemic. Preliminary recommendations for determining these coefficients are given. Reliable calculation of the model coefficients will make it possible to transform the proposed calculation methodology into a higher class of models for operational and long-term forecasting of epidemic spread depending on the conditions determining this process. A method for calculating epidemic growth under conditions of simultaneous action of several virus strains is proposed. Comparison of calculation results on proposed ratios for countries with intensive recurrent epidemic growth due to virus mutation is in satisfactory agreement with statistical data. The method of calculation of epidemic growth under sharp changes of lockdown conditions is developed. To confirm the possibility of using this method it is necessary to compare the results of calculations with the data of statistics. When the results of the calculations are compared with statistical data, a systematic bias is observed from late February and early March onwards. For countries where vaccination is intensively carried out, this deviation can be explained by a decrease in the proportion of the population that can be infected by contact with infected persons. However, such differences for South Africa, where intensive vaccination is not carried out, require further investigation.