bluuebunny/crossref_metadata_2025 huggingface dataset:
Postpartum Depression and its Associated Factors: A Community-based Study in Nepal
Authors: Chalise Anisha , Bhandari Tulsi Ram
Published: August 2020

Background: Postpartum depression is a type of mental disorder associated with childbirth during pregnancy or within the first postpartum year. It is reported as a common psychological health problem affecting 10-15% of women worldwide. The duration of postpartum depression frequently depends on its severity and the time of initiation of treatment. This study assessed depression and its associated factors among postpartum period women of Godavari municipality, Lalitpur, Nepal.Methods: A community-based cross-sectional study was conducted using Edinburg Postpartum Depression Scale among 195 mothers who were within six months of the postpartum period. The chi-square and logistic regression were applied to establish the association between postpartum depression and associated factors. Results: Out of the total 195 postpartum women, 37(19%) women suffered from depression and out of those women 2.1% had suicidal thoughts. Among the associated factors, education, occupation, the intent of pregnancy, family support and pregnancy-related problems/complications were found to be significantly associated with Postpartum depression (p<0.05). Conclusions: Nearly one-fifth postpartum women suffered from some type of depression. It is one of the public health concerns which directly or indirectly corresponds to the socio-economic condition of the women. The improved education and economic status of women, intention of pregnancy, family care and support during pregnancy and the postpartum period and early diagnosis and management of health problems could reduce the magnitude of the postpartum depression. Keywords: Associated factors of postpartum depression; edinburg postpartum depression scale; Nepal; postpartum depression.
Knowledge, Attitude and Barrier to Evidence-based Practice among Physiotherapists in Selected Districts of Nepal
Authors: Bajracharya Shristi , Tharu Niraj Singh , Bokalial Doly
Published: August 2020

Background: Evidence-based practice is considered as one of the most accepted practice all over the world. Physiotherapists in Nepal have started evidence-based practice, but there has been no study regarding evidence-based practice in physiotherapy in Nepal.Methods: A cross-sectional study was carried out among 164 physiotherapists working in different clinics and physiotherapy centers of selected districts of Nepal. A self-reported questionnaire was distributed and collected later.Results: It was found that the physiotherapists had a positive attitude towards evidence-based practice with 95.2% agreeing or strongly agreeing that evidence-based practice is necessary forthe practice of physical therapy and an overall total mean score of 34.73(72.35%) out of 48 and an overall mean 2.8 out of 4. It was also found that physiotherapists had moderate knowledge towards evidence-based practice with an overall total mean score of 19.18(68.5%) out of 28 and an overall mean of 2.74 out of 4. It was found that those having a specialization degree had two times greater knowledge than without specialization. The major barriers to evidence-based practice were obtained insufficient time and traditional methods of treatment.Conclusions: Physical therapists of Nepal stated they had a positive attitude towards evidence-based practice with the majority of the physiotherapists interested in learning more about the topic. They believed that they needed to increase the use of evidence in practice. They thought major barrier as insufficient time hence continuous professional development training that incorporate evidence-based practice were of greater importance.Keywords: Attitude; barrier; evidence-based practice; knowledge.
Complete Labial Fusion in a Postmenopausal Woman Presenting with Retention of Urine
Authors: Dangal Ganesh , Tiwari Kenusha Devi , Poudel Rekha , Bajracharya Nishma , Karki Aruna , Pradhan Hema , Shrestha Ranjana , Bhattachan Kabin
Published: August 2020

Complete labial fusion with retention of urine is a rare clinical entity. It occurs when the labia are fused in midline, forming a raphe. It usually develops in postmenopausal women with hypoestrogenism. The usual treatment is with topical estrogen and surgical separation followed by some dilatation. Here we present a case of a 58 years’ postmenopausal,unmarried, nullipara woman who came to our emergency ward with retention of urine.She had history of incomplete voiding and dribbling of urine since six months. General examination and investigations were normal. Her clitoris was normal in size, and the labia majora and anus were visualized well; however, the urethral meatus and vagina were not seen because of fused labia minora.Patient required surgical excision of fused labial folds to relieve the retention.Keywords: Labial fusion; postmenopausal; urinary retention.
Internalized Stigma, Coping and Social Support with Mental Illness in Manipal Teaching Hospital, Pokhara, Nepal
Authors: Shrestha Sandhya
Published: August 2020

Background: There are an increasing number of studies on the subjective experience of stigma amongst mentally ill persons but still few coming from Asian countries, and very few from Nepal. The objective of this study was to look into the experience of internalized stigma in mentally ill persons in Pokhara, Nepal and to compare this with similar studies using ISMI fromother socio-cultural contexts.Methods: A total of 136 patients with mentally ill people attending OPD of Manipal Teaching Hospital, Nepal responded to the Internalized Stigma of Mental Illness Scale. This is a 29-item self-report questionnaire with good psychometric properties.Results: Among the participant, majority 69.1% were 18-39 years age and majority 60.3% were female. Half of the participant 51.5% experienced high level of internalized Stigma. Regarding coping strategies, 86% of the participant response they does not avoid telling the health care professionals that they had a history of mental illness, Most 87.5% response they does not avoid going out with friends after receiving psychiatric treatment. Most 83.1% response they attempt to correct their friends if they hold negative views on people with mental illness. Most 65.44% were having High Social Support with Mental illness.Conclusions: Study findings show half of the participants (51.5%) experienced high level of stigma and more than half of the participant (65.44%) were having high social support with mental illness.Keywords: Coping; internalized stigma; mental illness; social support.
Anatomic Variations of the Right Hepatic Duct: Results and Surgical Implications From a Cadaveric Study
Authors: Kafle Akinchan , Adhikari Bidur , Shrestha Rajani , Ranjit Nirju
Published: August 2020

Background: Right hepatic duct, formed by the confluence of the anterior and posterior right sectorial ducts, joins left hepatic duct to form common hepatic duct. This fashion of confluence does not prevail in all cases. The sectorial ducts can aberrantly meet left duct and rest of the ducts from the left lobe of liver. Presence of such variation imposes clinical importance during peri-hilar, split liver transplant surgery or cholecystectomy. Nepalese population has not been explored before disregarding clinical necessity as MRI or cholangiography. Methods: Descriptive cross sectional study was conducted in 107 cases dissecting the main portal fissure separating hemi liver and extrahepatic biliary confluences. Methylene blue dye was injected and bile duct wall was cut open to the study pattern of the confluence. Data analysis was done with Statistical Package for Social Sciences (SPSS) version 17.Results: Normal variant of confluence was found in 72% cases, aberrant right posterior sectorial duct joins left hepatic duct in 9.3% and aberrant right anterior duct or low insertion of the right posterior sectorial duct was found in 1.9%. 9.3% of cases there is no true right hepatic duct often described as triple confluence. 0.9% cases showed no particular pattern of confluence where common hepatic duct is formed by multiple confluence. Quadrate lobe was found to be draining into right anterior sectorial duct in a single case.Conclusions: Right hepatic duct confluence pattern is variable and all the evidence occurs at the main portal fissure. Right sectorial duct may join the left duct avoiding normal confluence pattern. Right posterior sectorial duct may be inserted low in the common bile duct.Keywords: Duct; hepatic; sectorial; variation.
Gene-Xpert: Diagnosis of Pulmonary Tuberculosis in a Sputum Smear Negative Patient
Authors: Pandey Oshna , Paudyal Buddhi , Basnyat Buddha
Published: August 2020

This case report has tried to highlight the ease and benefit of Gene-Xpert testing in difficult to diagnose patient with sputum smear negative pulmonary tuberculosis. Early treatment of tuberculosis is usually delayed by lack of rapid and accurate diagnostic modalities, especially in resource-limited settings like ours. Gene-Xpert is a rapid test based on real time PCR assay and molecular technology for the detection of Mycobacterium tuberculosis. It is highly sensitive tool and enables simultaneous detection of rifampicin resistance within short period of time i,e. <2hrs. It has distinct advantage of providing same-day diagnosis which could potentially limit loss to follow up during diagnostic evaluation of smear negative tuberculosis patients.Keywords: Gene-Xpert; pulmonary tuberculosis; sputum microscopy.
Доктрина міжнародного приватного права в Україні на зламі століть
Authors: ДОВГЕРТ АНАТОЛІЙ
Published: August 2020

Основним чинником переосмислення і розвитку доктрини міжнародного приватного права у сучасній Україні став процес кодифікації його норм. Під час підготовки проєкту кодифікації в середині 1990-х років виявилося, що всі елементи фактично радянської теорії міжнародного приватного права треба було сумлінно “перебрати”, як деталі у двигуні автомобіля. Праця над кодифікацією поста вила питання про зміни насамперед підходів до колізійного вчення. Пізніше це позначилося на формуванні нових наукових уявлень щодо інших аспектів парадигми міжнародного приватного права.
Мета статті полягає у з’ясуванні змісту реконцептуалізації доктрини міжнародного приватного права в Україні на зламі століть унаслідок успішної кодифікації колізійного права (конфлікт законів та юрисдикцій).
Встановлено, що вітчизняна доктрина колізійного права оновлювалася за такими основними напрямами: (і) переведення колізійного права на приватноправові начала; (іі) надання колізійним нормам більшої гнучкості з одночасним збереженням їхньої визначеності; (ііі) “матеріалізація” вибору права; (іv) прийняття одновекторного (unilateral) підходу до вирішення колізійного питання.
Автор доходить висновку, що українська “колізійна” кодифікація на зламі століть сприяла переходу вітчизняної доктрини міжнародного приватного права на теоретичну платформу західно-європейських країн і міжнародних організацій. За допомогою принципу, прив’язки та інших граней найтіснішого зв’язку українське колізійне право було фактично переписане заново. Тепер воно характеризується високою диспозитивністю, регулятивністю та гнучкістю. Сприйнявши модерний багатовекторний (multilateral) метод вибору права, для становлення якого так багато зробив Ф. Савіньї, вітчизняна доктрина міжнародного приватного права не відмовилася від елементів матеріалізації колізійного права (його націлення на матеріальний результат рішення у конкретній справі – material justice) та від одновекторного (unilateral) підходу до вирішення колізійного питання. Сьогодні нова вітчизняна доктрина пропонує також зміст основних напрямів рекодифікації (оновлення) міжнародного приватного права. Важливим завданням оновлення є, на думку автора, повернення кодифікації до структури Цивільного кодексу України у вигляді завершальної книги про міжнародне приватне право.
Міжнародне приватне морське право України: сучасний стан системи колізійних норм
Authors: СТРЕЛЬЦОВА ЄВДОКІЯ
Published: August 2020

Відмінності у правових нормах, що регулюють відносини у сфері торговельного мореплавства, відмінності у змісті понять та інститутів морського приватного права різних країн створюють невизначеність щодо юрисдикції спору, застосовного матеріального права, а також виконання рішень компетентного правозастосовного органу на території іноземної держави, тим самим породжуючи колізійну проблему. Дієвим методом подолання колізій у цій сфері вбачається колізійно-правовий метод, який, проте, має бути здійснений з урахуванням сучасних тенденцій переосмислення його ролі та функцій.
Метою статті є виявлення, на основі комплексного аналізу теоретичних і законодавчих положень, сучасного стану системи колізійних норм міжнародного приватного морського права України для формування уявлення про рівень їхньої ефективності та відповідності сучасним тенденціям розвитку міжнародного приватного права.
Зазначено, що проблема подолання колізій у морському праві частково вирішена через міжнародно-правову уніфікацію матеріальних норм, проте загалом цей процес є напруженим і надто політизованим, може супроводжуватися труднощами теоретичного та практичного характеру, що підштовхує до переосмислення ролі колізійного метода, оновлення, можливо, масиву колізійних норм, застосування комбінованих форм і методів зближення та взаємодії національних правових систем.
Доведено, на основі аналізу теоретичних положень міжнародного приватного права, колізійних норм і принципів, закріплених у національному законодавстві (Кодекс торговельного мореплавства України (КТМ України) і міжнародних договорах України наявність в українському праві великого масиву колізійних норм, які підлягають застосуванню до широкого кола відносин у сфері торговельного мореплавства. Обґрунтовано виокремлення у межах міжнародного приватного права спеціальної підгалузі – міжнародного приватного морського права, що з урахуванням перспективного розвитку морської індустрії України є важливим.
Визначено, що особливості відносин у сфері торговельного мореплавства зумовили і специфіку методів вирішення колізій, що проявилося у виробленні специ-фічних колізійних прив’язок-принципів: закон прапора, різні модифікації закону порту, закон місця зіткнення тощо. Зазначено, що тенденція розвитку колізійних норм проявляється у збільшенні варіативності колізійних норм, у зміні домінуючої ролі односторонніх колізійних прив’язок, у зміні способів регулювання “морських” колізій: від жорстких до гнучких.
Зроблено висновок, що система колізійних норм міжнародного приватного морського права України володіє ефективним інструментарієм подолання колізій і розвивається у дусі сучасних тенденцій розвитку міжнародного приватного права загалом. Обґрунтовано необхідність ревізії КТМ України з метою удосконалення систематизації колізійних норм, запропоновано виокремити спеціальний розділ для об’єднання усіх колізійних норм, бо це забезпечило б більшу чіткість цієї системи та зручність у використанні.
Визнання та виконання іноземних судових рішень із міжнародних сімейних спорів: світовий досвід уніфікації норм права та деякі питання судової практики
Authors: ЧЕРНЯК ЮЛІЯ
Published: August 2020

Практична складність питання визнання та виконання іноземного судо вого рішення полягає у тому, що судове рішення як акт публічної влади однієї держави, прийнятий у межах її юрисдикції, має бути визнано й виконано на території іншої держави, на яку ця публічна влада не поширюється. Сучасні міжнародні правові договори, які уніфікують норми міжнародного цивільного процесу при вирішенні сімейних спорів, втілюють такі два положення: з одного боку, держава бере на себе обов’язок визнавати та виконувати іноземні судові рішення, керуючись при цьому такими мотивами, як необхідність розвитку міжнародних зв’язків та забезпечення прав особи; з другого боку, кожна держава встановлює певні межі такого визнання і виконання, визначаючи перелік можливих підстав для відмови у визнанні і виконанні іноземного судового рішення.
Метою статті є визначення сучасного стану уніфікації норм інституту визнання та виконання іноземних судових рішень із міжнародних сімейних спорів, окреслення кола принципів, які становлять основу цього інституту права. Окрему увагу сконцентровано на тлумаченні та застосуванні принципу взаємності та застереження про публічний порядок на основі аналізу доктрини та судової практики.
Визначено, що на рівні Гаазьких дитячих конвенцій, регламентів Європейського Союзу, з урахуванням практики Європейського суду з прав людини, уніфіковано такі принципи сучасного інституту визнання і виконання іноземних судових рішень із сімейно-правових спорів: остаточність судового рішення (res judicata) і неможливість перегляду його по суті на стадії визнання і виконання у запитуваній державі; взаємність; неможливість перегляду судом запитуваної держави фактичних обставин, якими суд держави походження рішення обґрунтовував свою юрисдикцію; застосування lex fori до процедури визнання і виконання іноземного судового рішення; можливість часткового визнання і виконання іноземного судового рішення; необхідність застосовувати просту і швидку процедуру визнання та ефективні заходи виконання судового рішення; розширене визначення категорії“рішення суду”, що передбачає поширення цієї категорії “рішення суду” також на затверджені судом мирові угоди і договори, укладені сторонами аліментного зобов’язання.
Позитивний ефект положень статей 462 і 471 Цивільного процесуального кодексу України 2017 р. розглянуто з двох позицій: 1) із позиції держави і розвитку міжнародного правового співробітництва, – це відхід від політики ізольованості і намір сприйняти міжнародні та, зокрема, європейські стандарти у сфері забезпечення прав людини; 2) із позиції пересічних громадян України – суб’єктів цивільних, зокре ма й сімейних, відносин, – це розширення можливості визнання в Україні рішень, ухвалених іноземними судами, та можливості ставити питання про визнання і виконання за кордоном рішень українських судів на умовах взаємності.
Конституційне право на свободу мирних зібрань в Україні
Authors: САМБОР МИКОЛА
Published: August 2020

Здійснення права на свободу мирних зібрань і його роль в утвердженні демократичних засад, здійснення народовладдя в Україні довели події 2004, 2013–2014 рр., а саме Помаранчева революція та Революція Гідності, які стали наслідком здійснення українцями гарантованого Конституцією України права на свободу мирних зібрань. Зазначені події засвідчили не лише роль права на свободу мирних зібрань у визначенні демократичного курсу розвитку державності та громадянського суспільства, а й продемонстрували вади конституційних норм, перш за все, пов’язані з обмеженнями здійснення права на свободу мирних зібрань і політичної волі владних еліт у застосуванні до суб’єктів здійснення цього права заходів юридичної відповідальності. Тож важливим для людини є не формальне закріплення права у конституційній нормі, а саме дієвість такої норми, спрямована на пряме врегулювання суспільних відносин щодо здійснення права на свободу мирних зібрань. Існування у нормах позитивного права різних формул, які виражають право на свободу мирних зібрань, тягне за собою відсутність чіткості та зрозумілості норм, які регулюють суспільні відносини зі здійснення права на свободу мирних зібрань, що негативно відображається як на самих суспільних відносинах, так і загалом на стані демократії у державі.
Метою статті є дослідження права на свободу мирних зібрань як конституційного права та семантичної відповідності одиниць мови, що використовуються на його позначення, змістові цього права.
У статті окреслено особливості інституціоналізації права на свободу мирних зібрань у нормах Конституції України, досліджено особливості правового регулювання суспільних відносин щодо здійснення права на свободу мирних зібрань за допомогою конституційних норм прямої дії, а також системність розуміння права на свободу мирних зібрань і регулювання його здійснення за допомогою норм галузі конституційного законодавства України.
Конституційна норма, що міститься у ч. 1 ст. 39 Конституції України, потребує змін, які мають стосуватися: лексико-семантичної формули вираження досліджуваного права, а саме, має бути відтворено як “право на свободу мирних зібрань”; суб’єкт здійснення права на свободу мирних зібрань не повинен бути обмежений виключно наявністю у суб’єктів здійснення цього права правового зв’язку з Україною (громадянства), а належати всім без винятку людям, які на законних підставах перебувають в Україні; вказаний шлях розвитку права збиратися мирно має еволюціонувати у право на мирні зібрання, що є істотно ширшим і розлогішим за своєю суттю, а останнє у своїй гносеології має дістатися лексико-семантичної та юридичної формули саме як право на свободу мирних зібрань, яке визнане світовим співтовариством і відображатиме сутнісні властивості цього права.
Views on Workplace Policies and its Impact on Health-Related Quality of Life During Coronavirus Disease (COVID-19) Pandemic: Cross-Sectional Survey of Employees
Authors: Wong Eliza Lai-Yi , Ho Kai-Fai , Wong Samuel Yeung-Shan , Cheung Annie Wai-Ling , Yau Peter Sen-Yung , Dong Dong , Yeoh Eng-Kiong
Published: August 2020

Background: This study explored the degree of views towards supportive workplace policies among employees during coronavirus disease 2019 (COVID-19) pandemic and its association with health-related quality of life (HRQoL) in Hong Kong. Methods: A cross-sectional study was conducted in 1049 employees using online self-administered questionnaire. Views on workplace policies were measured in term of agreement on its comprehensiveness, timeliness and transparency whereas HRQoL was measured using EQ-5D-5L Hong Kong version. Univariate estimates on the impact of HRQoL from views of measures in workplace was done. Qualitative comments on the suggestions to strengthen workplace measures were collected and presented descriptively. Results: Of 1048 respondents, 16% reported that no workplace measures nor guidelines were existed in their company related to the COVID-19 pandemics. Those who reported having workplace policy were not satisfied with the arrangement in term of comprehensiveness (36%), timeliness (38%), and transparency (63%). Regarding to the policy measure, only 68% respondents reported that their workplace supplied face masks to them. The health index was 0897, which was lower than the norm of 0.924. 64% of respondents reported having a health problem in at least 1 of 5 dimension of EQ-5D-5L with the highest proportion of having problem in anxiety/depression (55%). In addition, the workplace policy and measure had a direct effect of 0.131 on health outcome. Perception of infection risk had a direct effect of 0.218 on health outcome and partly mediated the relationship between workplace policy and measure and health outcome (0.066). Conclusion: The study highlighted the workplace policy and measure is an important mean to minimize infection risk at workplace so as to reduce tremendous stress and health outcome caused by a COVID-19 pandemic. Workplace measures related to COVID-19 pandemic should be further strengthen to mitigate the risk of infection and protect employee’s health.
"Not Just a Journal Club – It’s Where the Magic Happens": Knowledge Mobilization through Co-Production for Health System Development in the Western Cape Province, South Africa
Authors: Cape HPSR Journal Club Team The Western
Published: August 2020

Background: The field of Health Policy and Systems Research (HPSR) views researchers as active participants in processes of knowledge mobilization, learning and action. Yet few studies examine how such processes are institutionalized or consider their health system or wider impacts. This paper aims to contribute insights by presenting a South African experience: the Western Cape (WC) HPSR Journal Club (JC). Methods: The paper draws on collective reflection by its authorial team, who are managerial and academic JC participants; reflective discussions with a wider range of people; and external evaluation reports. The analysis has been validated through rounds of collective engagement among authors, and through comparison with the wider sets of data, documentation and international literature. It considers impacts using a framework drawn from the co-production literature. Results: Since 2012, the JC has brought together provincial and local government health system managers and academics to discuss complex systems’ and social science perspectives on health system development. The JC impacts encompass the trusting relationships (group micro-level) that have not only strengthened personal confidence and leadership skills (individual micro level), but also led to organizational impacts (meso level), such as practice and policy changes (practitioner organizations) and strengthened research and post-graduate teaching programs (academic organizations). Macro-societal impacts are, finally, judged likely to have resulted from new health system practices and policies and from academic post-graduate training activities. This set of impacts has been enabled by: the context of the JC; aspects of the JC design that underpin trusting relationships and mutual learning; the sustained participation of senior health system managers and academic managers who are able to translate new ideas into practice in their own organizational environments; and our individual and collective motivations – including the shared goal of health system development for social justice. Our challenges include risks and costs to ourselves, and the potential exclusion of challenging voices. Conclusion: The principles and practice of the JC approach, rather than the JC as a model, offer ideas for others wishing to mobilize knowledge for health system development through embedded and co-production processes. It demonstrates the potential for productive human interactions to seed long-lasting systemic change.
Engaging Knowledge Users with Mental Health Experience in a Mixed-Methods Systematic Review of Post-secondary Students with Psychosis: Reflections and Lessons Learned from a Master’s Thesis
Authors: Sanderson Victoria , Vandyk Amanda , Jacob Jean Daniel , Graham Ian D.
Published: August 2020

Engaging knowledge users (KUs) as research team members throughout the research process helps generate relevant knowledge and may improve uptake of research results. The purpose of this article is to describe how an integrated knowledge translation (iKT) approach was embedded within a master’s thesis project comprising a mixed-methods systematic review. KUs were engaged in four distinct phases of the systematic review process, including (1) proposal development; (2) development of the research question and approach; (3) creation of an advisory panel; and (4) an end of study meeting to interpret findings and plan dissemination of findings. The extent of each KU’s engagement on the research team fluctuated during the study. Challenges included maintaining the same KUs throughout the project and maintaining the scope of the project to align with a master’s thesis. Our suggestions for optimizing graduate student iKT projects include having regular team meetings and periodically checking in with team members to encourage reflection on overall engagement and progress of the project. Overall, KUs helped create a research project designed to address their needs and provided input on how results might translate into implications for clinical practice, education, academic policy, and future research within their respective contexts.
Why Do They Leave? Challenges to Retention of Surgical Clinical Officers in District Hospitals in Malawi
Authors: Gajewski Jakub , Wallace Marisa , Pittalis Chiara , Mwapasa Gerald , Borgstein Eric , Bijlmakers Leon , Brugha Ruairi
Published: August 2020

Background: Low- and middle-income countries (LMICs) are the worst affected by a lack of safe and affordable access to safe surgery. The significant unmet surgical need can be in part attributed to surgical workforce shortages that disproportionately affect rural areas of these countries. To combat this, Malawi has introduced a cadre of non-physician clinicians (NPCs) called clinical officers (COs), trained to the level of a Bachelor of Science (BSc) in Surgery. This study explored the barriers and enablers to their retention in rural district hospitals (DHs), as perceived by the first cohort of COs trained to BSc in Surgery level in Malawi. Methods: A longitudinal qualitative research approach was used based on interviews with 16 COs, practicing at DHs, during their BSc training (2015); and again with 15 of them after their graduation (2019). Data from both time points were analysed and compared using a top-down thematic analysis approach. Results: Of the 16 COs interviewed in 2015, 11 intended to take up a post at a DH following graduation; however, only 6 subsequently did so. The major barriers to remaining in a DH post as perceived by these COs were lack of promotion, a more attractive salary elsewhere; and unclear, stagnant career progression within surgery. For those who remained working in DH posts, the main enablers are a willingness to accept a low salary, to generate greater opportunities to engage in additional earning opportunities; the hope of promotional opportunities within the government system; and greater responsibility and recognition of their surgical knowledge and skills as a BSc-holder at the district level. Conclusion: The sustainability of surgically trained NPCs in Malawi is not assured and further work is required to develop and implement successful retention strategies, which will require a multi-sector approach. This paper provides insights into barriers and enablers to retention of this newly-introduced cadre and has important lessons for policy-makers in Malawi and other countries employing NPCs to deliver essential surgery.
Evidence-Informed Deliberative Processes for HTA Around the Globe: Exploring the Next Frontiers of HTA and Best Practices Comment on "Use of Evidence-informed Deliberative Processes by Health Technology Assessment Agencies Around the Globe"
Authors: Gopinathan Unni , Ottersen Trygve , Cyr Pascale-Renée , Chalkidou Kalipso
Published: August 2020

This comment reflects on an article by Oortwijn, Jansen, and Baltussen about the use and features of ‘evidence-informed deliberative processes’ (EDPs) among health technology assessment (HTA) agencies around the world and the need for more guidance. First, we highlight procedural aspects that are relevant across key steps of EDP, focusing on conflict of interest, the different roles of stakeholders throughout a HTA and public justification of decisions. Second, we discuss new knowledge and models needed to maximize the value of deliberative processes at the expanding frontiers of HTA, paying special attention to when HTA is applied in primary care, employed for public health interventions, and is produced through international collaboration.
Visible dust and asbestos: what does it suggest regarding asbestos exposures?
Authors: Petty Stephen E.
Published: August 2020

Courts in asbestos litigation in the past decade have increasingly required quantitation of asbestos exposures beyond arguments that the exposures exceeded de minimis or background levels. Exposure levels for those in the past were often either not measured or minimally measured. Similar Exposure Groups (SEGs) methods can be considered, however i) the available data to be used for comparison may not well reflect the exposures of the individual of interest and ii) past data/standards were taken in units of million particles per cubic foot of air (mppcf) as opposed to fibers per cubic centimeter (f/cc).1 The purpose of this work was to research these two issues to determine if exposure to visible dust created from asbestos-containing materials (ACM) (>1% asbestos) likely exceeds recommended asbestos exposure limits. This was accomplished by posing and answering the following three questions regarding asbestos exposures: 1) Was the American Conference of Governmental Industrial Hygienists’ (ACGIH) 5 million particles per cubic foot (mppcf) of air threshold limit value, in effect for many years, a total dust standard? 2) Does the presence of visible dust indicate the presence of more than 5 mppcf of dust in the air? 3) Would the presence of visible asbestos-containing dust demonstrate a potential health hazard? The author conducted a review of the available literature to determine the answers to these questions. The author also extensively researched and analyzed the conversion factor or ratio between exposures in units of mppcf and f/cc. The results indicate that: i) the 5 mppcf asbestos standard was based on total dust, not just asbestos dust; ii) the presence of visible dust from ACM operations is likely greater than 5 mppcf; and iii) that the presence of visible asbestos-containing dust likely results in levels above the American Conference of Governmental Industrial Hygienists’ (ACGIH) and the Occupational Safety & Health Administration’s (OSHA) standards. These results have implications for individuals performing retrospective asbestos exposure analysis.
Plasticized Chitosan / aloe biofilms for cell regeneration
Authors: Calixto-Olalde Ma. Elena , García-Contreras René , Zamorano-Hernández Julio , Louvier-Hernández José Francisco
Published: August 2020

The objective of the present work was to evaluate the effect of the incorporation of plasticizing agents; Glycerin and PVA, as well as the incorporation of aloe extract on the regeneration and / or cellular recovery capacity of plasticized chitosan. The preparation of the biofilms consisted of mixing, low molecular weight chitosan (0.5, 1 and 1.25%), polyvinyl alcohol (1 and 1.5%) and glycerin (3.5, 5 and 7%). Aloe extract was incorporated in 1% together with glycerin. The drying of the films was carried out in an incubator at 28 ° C for 24 hours, using the method of slow evaporation or casting. Stress tests to determine their mechanical properties, DSC compatibility, water vapor permeability tests and through a cytotoxic activity test of biofilms using human gingival fibroblasts (HGF), the viability of the use of these biofilms in regeneration was determined mobile. A combination of chitosan / PVA / glycerin was found that exhibits good elastic properties. The DSC showed that there is a good incorporation of the components. The permeability is acceptable for the application and the cell viability tests indicate an increase thereof due to the presence of the aloe extract, as well as the plasticizers with respect to the chitosan without plasticizers.
Market research to identify commercial viability of buccal tablets based on white clay
Authors: González-Vázquez Isidro , Ángel-García Martha Patricia , Arteaga-Iturrarán Raul
Published: August 2020

About a billion tubes of toothpaste are discarded in landfills every year. It becomes a real environmental problem considering that the package is composed of 75% plastic and 25% aluminum. Aware of this, new green brands go on the market with the will to eradicate such waste. The idea is to validate the developing of a toothpaste that is a pill that is used for cleaning teeth that will be mainly clay combined with coconut oil. Making this toothpaste will result on a better dental health as well as taking care of the environment, helping to eliminate plastics. Using clay and coconut oil has prove to destroy of all types of microbes, viruses, bacteria, many of which harm our oral hygiene. Helping to solve the problem of caries that affects 60 to 90 percent of the population by improving their dental hygiene. Survey in a simple of 383 inhabitans was taken in order to Identify areas of commercial opportunity and the willingness of the consumer to purchase oral cleaning tablets.
Neuromarketing from the perspective of a micro business
Authors: Romero-Zarate Reyna , López-De La Cruz Mario , Ríos-Cardenas Martín Raymundo
Published: August 2020

The micro-business are small enterprises which ones are characterized because they have 10 workers limited invoicing, due to low income, nevertheless, it´s been calculated that in 2002 the 50% of the population in “Ciudad Nezahualcóyotl”, México, was included in order to get economical resources in daily basis. The micro-enterprises in many occasions do not take into account to perform a marketing research to identify the characteristics (like real and trustable preference) of shoppers-costumers thinking it´s irrelevant. The main purpose of this research was to aid the micro-entrepreneur to improve when taking decisions when buying supplies, applying, neuroscience and marketing technical analysis which ones have been refered in neuromarketing research.
Respuestas fisiológicas de Zea mays durante la infección por Ustilago maydis bajo diferentes concentraciones de humus en suelo
Authors: Méndez-Morán Lucila , Meza-Canales Iván David , Robles-Murguía Celia , Loza-Llamas América
Published: August 2020

The available resources during plant development, sometimes plant can be limited due to energy used during physiological plant defense to pathogens attacks. The main of this work was the physiological analysis of Zea mays plants development under different sustainable fertilization systems, as the earthworm-humus, and their relation with the response to Ustilago maydis infection, a biotrophyc fungus that causes the disease known as common coal or cuitlacoche in corn. Mize seedlings developed with different % of humus/soil under greenhouse conditions were inoculated with U. maydis (T1), and plants not inoculated as control (T0). Physiological and growth measurements in T1 showed a significant effect on the plant, the best was a 25%. After infection, the plants growth was lower as a result in decrease in photosynthesis activity, however, the presence of humus partially counteracts the fungus infection. High concentrations of humus reflected a negative effect on plant growth. In the future, the studies in the field will serve to deduce the importance of these agricultural practices in plant-fungus responses.
Peran Pendampingan Warga Peduli AIDS terhadap Kualitas Hidup Orang Dengan HIV-AIDS di Kecamatan Alak Kota Kupang
Authors: Kale Chintya G. , Regaletha Tadeus A. L. , Sir Amelya B.
Published: August 2020

HIV-AIDS still be the global healthy problem which has higer number of morbidity and mortability cases. PLWA (People Live With AIDS) have often being denied by the others so the HIV-AIDS problem sometimes is undetected in the society, also give the influence towards the quality of PLWA’s life.  The quality of life is the important component of life and welfare evaluation of the PLWA. Based on the data of Alak districst in 2018, the higest case was 185 cases of HIV-AIDS in which the HIV infectants were 102 cases, while people with AIDS were 83 cases.  This research is purposed to describe the quality of life of People Live With HIV-AIDS in Alak district in 2019 whose got accompaniment from the WPA ( PCWA : People Who Care With AIDS) companions. This research was done by using descriptive qualitative method. The main informants of this research were two WPA (PCWA) companions and five PLWA whose got the accompaniment also supported by three triangulation informants. The technique of data collection of this research was indeep interview whith three steps of interactive analitical models which are Reduction, Data Presentation and conclusion drawing. The result of this research shows that the implementation of the role of the PCWA as the mentors of taking medication, social supporter, and health service access support was successful and gave the impact towards PLWA’s Life. It’s shown by looking to the improvement of physical aspect, psychological aspect, independency, social relationship, sociaty aspect and spiritual aspect. This accompaniment had occured for almost 4 years towards the PLWA. It was expected for the other people to participate helping the PCWA companions in order to support and conducive towards the PLWA so, they have better quality of life.
Indeks Kepuasan Masyarakat (IKM) terhadap Kualitas Pelayanan Publik di Puskesmas Oepoi Kota Kupang
Authors: Nesimnasi Vivi , Romeo Petrus , Ndoen Enjelita M.
Published: August 2020

The Public Satisfaction Index (IKM) is one of the methods used to determine the quality of public services through public perception. Public services provided by the Kupang City Oepoi Community Health Center (Puskesmas Oepoi) have not met yet community expectations. The preliminary observations found several problems regarding health services rendered by Puskesmas Oepoi, such as inadequate facilities and infrastructure, limited service time, insufficient human resources, and unsatisfying handling complaints and suggestions. These, consequently, could reduce public satisfaction, which will ultimately lead to a decline in the quality of Puskesmas Oepoi public services. This study aimed to determine the IKM toward the quality of public services in Puskesmas Oepoi Kupang City. The study used a quantitative descriptive survey approach. The number of samples was 96 respondents obtained by accidental sampling technique. The data analysis technique used the guidelines of Community Satisfaction Survey consisting of nine IKM indicators. The results showed that the satisfaction level and quality of services provided by Puskesmas Oepoi Kupang City in 2019 were at the "Good" category with a total conversion value of the nine elements of IKM was 76.62. Puskesmas Oepoi should improve the IKM elements that are at the “poor” category as well as maintain the IKM elements that are at the “good” category so that the public remains satisfied with the service performance provided by Puskesmas Oepoi.
Hubungan Faktor Risiko Individu dan Ergonomi dengan Kejadian Nyeri Punggung Bawah (Low Back Pain) pada Pengguna Game Online
Authors: Koteng Manda Sub Jakaria , Ratu Jacob M , Berek Noorce Christiani
Published: August 2020

Low Back Pain (LBP) is the pain experienced in the lower back muscles region. Sitting for a long time as that of online game users may cause such complaints. Other risk factors such as age, sex, BMI, and a longer time to play the game theoretically have a relationship with the incidence of LBP. This study aims to determine the relationship of individual factors and ergonomic factors to the incidence of LBP on the use of online games in Kupang. The study design was cross-sectional. The sample consisted of 38 online game users in Kupang and selected by using accidental sampling technique. Data analyzed by Chi-Square test with the significance of 95%. Result research indicated that individual factors that were age (p = 0.497), gender (p = 0.198), smoking (p = 0.547), and body mass index (p = 0.554) had no association with the incidence of LBP, while the ergonomic factors namely the duration of playing games (p = 0.007) and sitting position (p = 0.004) were related with LBP. Therefore, online game users should consider the duration of the game and sitting position applied in order to reduce LBP.
Analisis Faktor-faktor yang Mempengaruhi Perilaku Ibu untuk Melakukan Kunjungan ANC (K4) di Wilayah Kerja Centro Saúade Comunitaria Letefoho Posto Administrativo Letefoho Municipio Ermera Timor Leste
Authors: Oliveira Felisbela A. O.
Published: August 2020

Antenatal Care (ANC) visit is a visit by pregnant women to health professional in order to receive ANC services. ANC visits are very important for a pregnant woman, to ensure the quality of ANCservices, there needs to be an indicator stating the visit of pregnant women with coverage of K1 and K4, where K1 is the first contact of pregnant women with health workers and K4 is the fourth contact of pregnant women or more with health workers. The purpose of this study was to determine the factors influencing maternal behavior to conduct ANC (K4) visits at Centro Saúde Comunitaria Letefoho. This research method was observational analytic with cross-sectional approach. The sample in this study consisted of 136 mothers and determined by using systematic random sampling techniques. Data were collected by using questionnaires and were analyzed by applying descriptive and bivariate using SPSS version 21. The results showed suggested that maternal education (p = 0.956), mother's knowledge (p = 0.420), mother's attitude (p = 0.817) and social culture (p = 0.618) had no association with ANC visit while the husband support (p = 0.032) and distance to health services (p = 0,000) were found to be correlated to ANC visits.
Faktor Penentu Kejadian Stunting pada Anak Balita di Wilayah Kerja Puskesmas Alak Kota Kupang
Authors: Lobo Welmince Ina , Talahatu Anna Henny , Riwu Rut Rosina
Published: August 2020

Stunting is a chronic nutritional problem that can give an idea of the failure of growth accumulated since before and after birth resulting from inadequate intake of nutrients. Alak Health Center has 137 children stunting toddlers, and the working area of Alak Health Center is one of the villages that are included in the priorities of the stunting treatment in Kupang city. This research aims to determine of stunting incidence in children in the working area of Alak health center of Kupang City. This type of research is analytical surveys with a case-control research draft. The number of Samples of 110 infants selected systematic random sampling. Data retrieval is conducted using field measurements and structured interviews using questionnaires. Data analysis was conducted with a Chi-square test (bivariable) and double logistic regression (multivariable) with α = 0.05. The result of bivariable analysis with a value of P < 0.25 is the level of maternal education, parental income level, maternal nutritional knowledge level, large family, feeding practice, the practice of hygiene and environmental sanitation, care of children in pain, foster pattern, energy sufficiency level, and protein adequacy rate. The results of multivariable analyses showed the practice of environmental hygiene and sanitation, protein adequacy levels, and maternal nutritional knowledge level. It was concluded that the determining factor of stunting in children of toddlers in the workplace of health centers Alak Kupang City is the most dominant is the practice of environmental Hygiene and sanitation (OR = 7,986), the level of protein adequacy (OR = 4,132) and the level of maternal nutritional knowledge (OR = 2,553).
Survei Jentik Nyamuk Anopheles di Desa Maukeli Kecamatan Mauponggo
Authors: Ndiki Helen , Adu Apris A. , Limbu Ribka
Published: August 2020

Malaria is an infectious disease caused by the parasitic plasmodium protozoan parasite. This disease is transmitted through female Anopheles sp mosquito bites. Anopheles mosquito breeding sites can be in the form of fresh water or salt water, ponds that are overgrown with aquatic plants or those that do not plant, rice fields, river mouths where the flow is not swift and small pools filled with rainwater. Maukeli Village is a village that has a lot of rice fields. The purpose of this study was to determine the density of Anopheles mosquito larvae at various breeding places in Maukeli Village, Mauponggo District in 2018. This type of research design was a descriptive survey with a population of all Anopheles sp. existing in the breeding places and breeding places of mosquito larvae Anopheles sp. The samples in this study were all Anopheles mosquito larvae from the results of abduction at breeding places in Maukeli Village. Sampling was carried out accidentally (ie Anopheles mosquito larvae which happened to be available or available to be sampled. The results showed that there were 4 breeding places, namely paddy fields with average density of Anopheles mosquito larvae (12 tail/ cut), river mouths with average density of Anopheles mosquito larvae (8 tail/ cud), pools with average density of mosquito larvae Anopheles (3 tail/ cud) and the lagoon with average density of Anopheles mosquito larvae (5 tail/ cud) while permanent breeding sites are river mouths and temporary breeding sites, such as river mouths, pools and lagoon.