Dr. Win Myint Oo
Associate Professor,
Faculty of Medicine, Sibu Clinical Campus, SEGi University, Malaysia.

ISBN 978-93-91882-30-3 (Print)
ISBN 978-93-91882-32-7 (eBook)
DOI: 10.9734/bpi/idhr/v5

This book covers key areas of health research. The contributions by the authors include oral pre-malignant lesions, tobacco smoking, carcinogen, anticardiolipin antibody, lupus anticoagulant, antiphospholipid antibody, antithrombin deficiency, prothrombin mutation, nurse administrator, healthcare, facility design, awareness of nurses, eclampsia, pre-eclampsia, hypertension disorder, chronic vascular disease, blood pressure, medical practitioners, foodborne diseases, food handlers, breast cancer, matrix metalloproteinase, all-trans retinoic acid, VO2 and VCO2 rate variability, glucose intolerance, oral glucose tolerance test, glucose metabolism, prehospital care, upper limb fractures, nursing, problem solving, self-directed learning, traditional learning, pandemic preparedness, assessment, social change, multi-stakeholder, lessons learned, large-scale efforts. This book contains various materials suitable for students, researchers and academicians in the field of health research.

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Association of Oral Pre-Malignant Lesions with the Consumption of Tobacco: A Cross-sectional Observational Study

Chinmay Jani, Arpita Joshi, Kushboo Jain, Kanisha Mittal, Harshal Jadav, Divyesh Jetpariya, Omar Al Omari, Harpreet Singh, Umit Tapan, D. V. Bala

Issues and Development in Health Research Vol. 5, 20 September 2021, Page 1-13

Background: Tobacco use is a public health problem globally. It can be consumed by chewing and/or smoking amongst various other ways. It can not only lead to various cancers but can also cause a variety of oral pre-malignant lesions (OPML). These include, oral sub-mucous fibrosis (OSMF), tobacco pouch keratosis (TPK), leukoplakia, erythroplakia, and smoker's palate. The primary aim of this study was to determine the prevalence of tobacco use in workers at high risk of tobacco consumption and addiction and its association with the oral pre-malignant lesions

Methodology: A cross-sectional observational study of workers working in four different industries of Ahmedabad and Gandhinagar was undertaken from March 2014 to October 2014. Out of 909 workers surveyed regarding their current or former tobacco consumption, 28 (3%) were females. Oral examination was done for detecting pre-malignant lesions. The oral cavity findings were evaluated based on tobacco habits, and statistical analysis was performed to determine the significance of the relationships discovered between tobacco usage and lesions.

Result:  Out of 909 participants, 881 were males. Out of 28 females only one had former tobacco chewing history. To remove the gender bias, only males were included in further analysis. Out of 881 male workers 537 (60.9%) consumed tobacco; out of which, 360 (40.9%) were consumers of smokeless tobacco (SLT), and 141 (16%) were smokers. OPML were present in around 52% of the study population exposed to tobacco in the form of smoking or chewing as compared to 2.6% of those without exposure. [Odds ratio 40.58 (20.37 – 80.87)]. The odds of having OPML still remained high even after quitting for 6 months. [17.70 (8.25-38.01)]. However, the risk was significantly reduced by 56% in these former consumers [Odds ratio 0.44 (0.28-0.67)]. Out of the 360 tobacco chewers, 43% had oral lesions, compared to merely 2.6% of workers without an addiction having oral lesions. [Odds ratio 28.14 (14.05 – 56.34)]. A total of 23% of current smokers had smoker's palate, whereas non-addicted workers did not have this lesion.

Conclusion:  Tobacco consumption in any form is hazardous and causes various kinds of oral premalignant lesions. Betel quid exposure causes a more harmful effect that goes unnoticed. Even though tobacco consumption has a long-lasting impact, its cessation can lead to significant risk reduction in having OPML. Awareness should be created about various lesions, and specific steps, should be taken for early diagnosis and treatment.

Inherited and Acquired Thrombophilia and Infertility

Adriana de Góes Soligo, Ricardo Barini

Issues and Development in Health Research Vol. 5, 20 September 2021, Page 14-18

Implantation failure persists as an important challenge in Human Reproduction. Besides, it is useful to avoid adds on for these patients without scientific evidence. The thrombophilic factors play a role in those situation, but the evidence remain uncertainly. Our researches suggest that protein C and anticardiolipin antibody are more frequently in infertile women. Investigation of acquired and inherited thrombophilia should be considered, particularly in recurrent implantation failure. However, prospective population studies are needed to confirm the data presented.

The Role of the Nurse Administrator in Healthcare Services and Healthcare Built Environment in Southern Nigeria was a capstone project. The topic was coined from – Public Health Nursing Management, Research and Nursing Research, and Administration and Management in Nursing. As part of its corporate social responsibility, a federal government organization built a health facility to promote maternal and child health for its host community in Rivers State, Southern Nigeria. Before the opening ceremony in 2018, the Obstetrician engaged, was to confirm its architectural design. He was, however, accompanied by a nurse. The construction team omitted the first stage labour room, sluice room, treatment room, examination room, nurses’ station, and toilet. This spurred this project title. The study aimed to determine the role of the nurse administrator in healthcare services and built environment in Southern Nigeria; to create awareness of this role among nurses as frontline; and to influence the decision in evidence base healthcare built environment. This will improve the safety of patients and healthcare providers, clinical outcome for patients and job satisfaction of nursing staff. The study was descriptive and observational. It was conducted with self- structured questions through, telephone interview method for a cross- section of nurses in the clinical, educational and administrative areas in three states of Southern Nigeria. Total respondents were thirty five (35). Nurses 30 (85.7%) – (28 (93%) females and, 2 (6.7%) males), Medical doctors 3 (8.6%), Civil Engineer 1 (2.9%) and, Architect 1(2.9%) all males. Data collated for healthcare built environment features, revealed that 46.4% do not have specific built nurses’ toilet, 39.2% were without cloak room, 21.4% shared toilet with patients, and 28.6% were without nurses’ station. Only 10.7% were comfortable with the purpose built healthcare environment and, stated how it had affected them positively. For Nurse Administrators’ role, 7.1% represented the nurses and attended meetings, 10.7%   were involved in decision making, 3.6% contributed in healthcare built environment design and 6.7% of the nurses influenced built environment planning design. The concept of healthcare built environment had been underrated which was responsible for deplorable design of most healthcare facilities. The research also showed a strong link between the design of healthcare settings and outcomes experienced by patients, staff, and families. Hence, the need to create awareness and, include nurse administrators and clinical nurses as frontlines to ensure their voices are heard in, influencing decision among other professionals in creating innovative design in healthcare built environment. This will enhance workflow processes, work environment outcome, patient and provider safety and outcome.

A Study on Hypertension in Pregnancy

S. Muthukumar, R. Gayathri, A. Abarnadevika, S. Shalini, Vinesha Ravi

Issues and Development in Health Research Vol. 5, 20 September 2021, Page 42-50

Pre-eclampsia and Eclampsia are collectively called “Hypertensive disorder of pregnancy” and toxaemia of pregnancy. Pre-eclampsia is a medical condition characterized by high blood pressure and significant amounts of protein in the urine of a pregnant women. If left untreated, it can develop into eclampsia, the life-threatening occurrence of seizers during pregnancy. Hypertension, complicating 5% to 7% of all pregnancies, is a leading cause of maternal and fetal morbidity, particularly when the elevated blood pressure (BP) is due to pre-eclampsia, either alone (pure) or superimposed on chronic vascular disease. Pre-eclampsia is a major cause of preterm birth and an early marker for future cardiovascular and metabolic diseases, whereas preterm delivery is associated with immediate neonatal morbidity and has been linked to remote cardiovascular and metabolic disease in the newborn.

Study on Addressing Shortages of Doctors through Department of Health Bursaries in Selected University of Kwa Zulu Natal Province, South Africa

Bongani Innocent Dlamini, Luther-King Junior Zogli, Mthembeni Mthethwa

Issues and Development in Health Research Vol. 5, 20 September 2021, Page 51-62

In an attempt to address scarcity of medical practitioners in South Africa, the Province of KwaZulu Natal’s Department of Health put in place a strategy to award bursaries to medical students in order to intensify the recruitment and retention of medical practitioners. Students who go through this programme will then have a service obligation to the department. The objective current study is therefore to determine whether the current process of awarding bursaries contributes to the bursary-holders’ satisfaction and loyalty to the Department of Health. It will find out the extent to which the process of awarding bursaries to medical students influences students’ loyalty to the department upon completion, other than the legal obligation which is enforced through a contractual agreement. This study adopted quantitative research design. The findings revealed that that majority of the participants are satisfied with guidance providing when completing bursary forms, response to application, being able to go to their university of choice and the monetary value of the bursary. However, it was noted that the bursary information is not well publicised in some districts. Furthermore, some students did not understand the bursary contract as well as were unaware of the consequences of breach of contract. Finally, most participants alluded to the fact that they are not provided the opportunity to give feedback about their experience of the bursary programme.

Evaluation of Microbial Load in Fast Food Establishments in Kaduna Metropolis: A Descriptive Cross-sectional Study

Suleiman Usman, Opasola O. Afolabi, Lateefat H. Modupe

Issues and Development in Health Research Vol. 5, 20 September 2021, Page 63-71

The increase in human population brings about the proliferation of more food manufacturing and dispensing establishments among which are fast food establishments and food vendors or street hawkers in Nigeria. Fast food establishment’s indiscriminate activities are often associated with frequent food poisoning in developing countries especially in Nigeria. This scenario could be due to the poor state of food safety and general hygiene in these countries. Consequently, large quantities of food produced and distributed get to the consumer in an unwholesome condition. The contamination of food could be due to a variety of microbial pathogens, chemicals, and parasites that may find their way into the food chain at different points during the food preparation and production process. This study evaluates the microbial load in some selected fast food establishments in Kaduna Metropolis, Kaduna state, Nigeria. Thus, five research objectives and questions guided the study. A descriptive cross-sectional study using a multistage sampling technique was adopted to select 174 fast-food establishments. The premises were assessed on the practice of personal hygiene and implementation of Hazard Analysis and Critical Control Point (HACCP) principles during their food preparations. Laboratory analyses were carried out on the samples for bacteriological analyses of 1g of food (Tuwon Shinkafa, Tuwon Masara, Stew, Rice, and Bread). The study found that majority of the selected fast food establishments were observed to have Predominates bacterial isolates that include Pseudomonas spp. (50%), Salmonella spp. (86.7%), Shigella dysenteries (68.7%), Escherichia coli (20.0%) and Staphylococcus aureus (97.3%) respectively. The total number of occurrence of bacteria in all the food sampled was 2,659 cfu/g with Bread having the highest number of 685 cfu/g followed by Tuwon Masara with 629 cfu/g. The study equally found out that Staphylococcus aureus appears the highest in the samples with 700 cfu/g followed by Salmonella with 629 cfu/g. Hence, the predominant occurrence of bacteria in the food samples is due to poor personal hygiene, environmental sanitation and general cleanliness of the eating utensils which was observed during the study. It is recommended that health education of the food handlers on personal hygiene and HACCP implementation should be given more priority in Kaduna metropolis.

Determination of Phytochemicals as Potential Inhibitors of Matrix Metalloproteinases (MMPs) with Special Reference to Breast Cancer

Anirban Roy, Indira Chakraborty, Aniruddha Banerji

Issues and Development in Health Research Vol. 5, 20 September 2021, Page 72-81

Both in India as well as globally, breast cancer is the most common type of cancer in women. The major causes for mortality and poor clinical prognosis in most cancers including breast cancers is metastasis and secondary tumour formation and even with modern methods of treatment, metastasized cancers remain largely untreatable. The matrix metalloproteinases (MMPs), a family of zinc dependant endopeptidase enzymes, play critical roles in the regulation of metastasis and tumour development, making MMPs possible therapeutic targets for preventing metastasis. Treatment with phytochemical compounds has the potential to reduce side effects of treatment and make treatment more affordable. The objective of this article is to analyse the potential of four such phytochemicals resveratrol, theaflavin, curcumin and all-trans retinoic acid as MMP inhibitors with special reference to breast cancers.

Investigating the Association of VO2 and VCO2 Rate Variability with Serum Glucose, Insulin and Glucose Intolerance

Julián Satué-Rodríguez, José D. Méndez

Issues and Development in Health Research Vol. 5, 20 September 2021, Page 82-90

Objective: To measure the changes in the cellular metabolism evaluated by the variability of oxygen consumption (VO2) and carbon dioxide production (VCO2) as well as the association of serum glucose and insulin to energy spectral density (ESD) of VO2 and VCO2.

Materials and Methods: Ten non-glucose intolerant and ten glucose intolerant subjects between the ages of 21 and 70 were included in the study. Glucose and insulin levels, as well as VO2 and VCO2 levels, were measured every 10 minutes for 3 hours. The ESD of VO2 and VCO2 were calculated and related to glucose and insulin concentrations.

Results: There was statistical significance in glucose levels, insulin, and ESD of VO2 and VCO2 among non-glucose intolerant subjects, and glucose and insulin among glucose intolerance subjects, at post-load glucose state compared to basal state. Furthermore, for both the basal and post-load glucose states, glucose levels were significantly higher in glucose intolerance subjects than in non-glucose intolerant subjects.

Conclusions: These findings show an increase in ESD of VO2 and VCO2 at the post-load glucose state in non-glucose intolerant subjects, implying that their measurement may be a key indicator of the variability of cellular metabolic activity and contribute to the confirmation of glucose metabolism disturbances.  More research is needed to understand the precise behaviour of ESD of VO2 and VCO2 in a larger population that includes diabetic subjects.

Injuries are the number one cause for morbidity and mortality among adolescents. Adolescent fractures are a hidden public health problem in Sri Lanka. Injury to upper limb will affect all the activities of the adolescent in this new era as risk factors of upper limb fractures are common with highly commercialized society. Prevention of adolescent injuries is an investment for the country as they belong to economically productive age group. To ease the burden on the state, attention should be given for prehospital care.

Objective of the Study: The objective of the study was to describe the sociodemographic factors of adolescents with upper limb fractures in a district in Sri Lanka and associated prehospital care.

Methods: A hospital based descriptive cross-sectional study was conducted on a sample of 1090 newly diagnosed adolescents with upper limb fractures aged 10 to 19 years treated from higher-level hospitals in the district of Colombo. Descriptive statistics were used to describe sociodemographic details and the prehospital care methods.

Results of the Sample: The mean age of the sample was 12.45 years (SD=2.59). The majority were males (n = 892; 81.8%). Adolescent’s residence (n=518, 47.5%) was the commonest place of injury. Most of the adolescents (n=855, 78.5%) sustained upper limb fractures following a fall. The majority used three-wheeler taxi as transportation method to reach the hospital (n= 687; 63%). Out of the participants, only 29.5% (n= 322, CI: 26.8-32.3) received any kind of prehospital care.

Conclusion: Most of the adolescents had not received any kind of prehospital care and their transportation method to a health care setting was three-wheeler taxis. Adolescents belong to a productive age group and are in the transition period from childhood to adulthood, so conducting awareness programs among school children, their parents, and teachers will benefit the country.

Background: Although there is much literature on Problem-Based Learning (PBL) in medical and nursing education, there is little from the cultural perspective. Therefore, the study objective was to investigate the outcome abilities including critical thinking, problem-solving, and self-directed learning of nursing students receiving PBL vs. traditional lecture. PBL is a student-centered outcome-based learning and has become very crucial for higher learning and proven to improve the quality of learning among students at all levels and in various disciplines.

Methods:  A randomized controlled trial (RCT) design was used with 85 undergraduate students who studied in level seven and were enrolled to a psychiatric nursing course. Four instruments were used including: 20-items self-report PBL Evaluation Questionnaire (PBLEQ). The Self-assessment Scale on Active Learning and Critical Thinking (SSACT) scale consists of 14 items of two domains “active learning” and “critical thinking.” All scales had good reliability with coefficient alpha >0.8.

Results: the survey response rates were 100%, the study results revealed that the experimental group was considered PBL is effective in their learning process (t=3.568; p\(\le\)0.05). The overall SSACT also showed a significant difference in experimental group at pre and post intervention (t=6.413; p\(\le\)0.05). There was also a significantly different percentage score between experimental and control group in pretest (t=2.374 p\(\le\)0.05).

Conclusion: This study offers information on student’s perspective regarding the effectiveness of PBL in constructing professional knowledge, developing problem solving skills, developing self-directed learning, and improving motivation. Moreover, it promotes effective group collaboration and enhances active learning and critical thinking. Therefore, PBL is easily considered as an alternative method of teaching nursing students since, it helps students act as professionals in clinical situations with insufficient information and encourages them to think not only deeply, but also rigorously while developing lifelong learning skills.

Study on Functional Outcomes of Adolescents after Initial Treatment of Upper Limb Fractures in a Selected District in Sri Lanka

Hemali Jayasekera, Samitha Siritunga, Upul Senarath, Paramjit Gill

Issues and Development in Health Research Vol. 5, 20 September 2021, Page 121-126

Background: Adolescents are most likely to suffer from injuries, which are the leading cause of morbidity and mortality.  Fractures have been identified as a major consequence of injuries and fractures of the limbs significantly limit their functional capacity. It can lead to reduced productivity and quality of life of adolescent. As adolescents are among the most economically productive age groups, preventing adolescent-related injuries is an investment for a country. During the first three months after treatment, 59.5 percent of upper limb fracture patients admitted to the National Hospital in Sri Lanka struggled to conduct daily activities.

Objective: To evaluate the functional outcomes of adolescents aged 10 to 19 years after receiving first treatment for upper limb fractures at government hospitals in Colombo district in Sri Lanka.

Methodology:  A follow-up research was conducted on 400 randomly selected adolescent victims who had upper limb fractures as a result of their injuries. After initial treatment, they were recruited from six main hospitals in Colombo district and followed up for six weeks. At six weeks, while attending follow-up clinics at their respective hospitals or at their homes, a validated and culturally accepted new tool was employed to measure their functional outcomes using a Likert scale.

Results: After six weeks of treatment, 33.2 percent of 400 sufferers had good functional outcomes. Adolescents' highest mean score was for performing specific activities, such as playing, sports or recreational activities, or sewing, and this was their primary functional disability (Mean score 865.5 with standard deviation of 23.97).

Conclusions and Recommendations: Adolescent fracture sufferers' rehabilitation care must be improved for them to recover quickly, as they are the country's future generation.

Pandemic Preparedness and What have We Really Learned from COVID-19 So Far?

Erika Wichro

Issues and Development in Health Research Vol. 5, 20 September 2021, Page 127-135

Background: The COVID-19 pandemic in its second year has shown that current systems are vastly challenged by the complexity and intersectoral affects around the globe. Quick fixes and problem-solving in a fractioned, comparted way do no longer serve. And still, there seem to be the notion that doing the same things repeatedly will lead to different results.

Purpose: To review selected assessments’ best practices, lessons learnt, and progress made. At the same time this is to appreciate the efforts so far in Pandemic Preparedness and to highlight the possibility to consider a different, system theory approach – the concept of social change 2.0 of David Gershon.
Findings: As the pandemic progresses into various phases, the complexity for sectors, systems and countries worldwide is unprecedented. Various documents were put together to ensure that progress is made in this context. Even more assessments to identify best practices and gaps were scheduled to support the governments in their tasks to provide safety for their population and to contribute to global health security. Apart from some categories being the same or similar, however, there is a growing variety of instruments supposed to help countries to get an oversight of ongoing pandemic preparedness efforts. The assessment reports revealed that every single assessment contained different indicators and functionalities. While the focus was on identifying gaps, little is available on the progress made and where potential overlaps might occur. Nethertheless, there is a lot of good intention and a huge amount of efforts and resources being put onto these assessments. Interoperability, connecting the dots seemed to be superseded by an intersectional activism where different entities need to leave a footprint with single-sided solutions instead of a collaborative (behavior driven), systematic, holistic and integrated approach in form of integrated programs.
Conclusion: The huge efforts of everyone involved in pandemic preparedness and management, particularly of the frontline workers, are acknowledged. Drawing from various assessments’ best practices and lessons learnt, fractioned approaches continue to occur and do suggest a mindset change to drop the assumption that insufficient structures and systems can serve as solid baseline. Identifying gaps is no longer enough. Pandemic preparedness is suggested to be an integrated part of systems theory, in particular the social change 2.0 concept.