Dr. Ravi Kumar Chittoria
Department of Plastic Surgery & Advanced Centre For Microvascular, Maxillofacial & Craniofacial, Laser Surgery, Tertiary Burn Care, Antiaging & Regenerative Medicine, Smile Train, Advanced Wound Care, Telemedicine, Cadaveric Organ & Tissue Transplantation, Skin and Tissue Banking, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), An Institute of National Importance under Ministry of Health & Family Welfare, Govt of India, Pondicherry-605006, India and Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.


ISBN 978-93-91882-36-5 (Print)
ISBN 978-93-91882-43-3 (eBook)
DOI: 10.9734/bpi/idhr/v6

This book covers key areas of health research. The contributions by the authors include ayurvedic categories, cognitive stimulation, brain training, cognitive functions, health perception, complaint of memory, associative memory, managerial innovation, organizational citizenship behaviour, online Learning, medical education, e-learning, E-health, E-nursing, E-learning, nursing education, developing countries,human factors, knowledge of AIDS, assessment of government handling of AIDS, national strategic plan for HIV/AIDS, xenobiotic, Microbiota,tandem repeats, vaccination, SARS-CoV-2,evolution, depression, anxiety, herd immunity, simulation, infectious disease, disease propagation, live kidney, nephrology, donor risk, uninephrectomy, information security, confidentiality integrity, risk management,total quality management, service quality, quality function deployment,antibody response, nasopharyngeal carriage, pneumococcal polysaccharide vaccine, recurrent respiratory infections, mental health, burnout, health communication, management phycology, diabetes,antidiabetic medications. This book contains various materials suitable for students, researchers and academicians in the field of health research.


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Ayurvedic Approach on Memory Stimulation in Guadeloupe: A Pilot Study

Yenkamala Mina Ananda

Issues and Development in Health Research Vol. 6, 5 October 2021, Page 1-15

Background: The necessity to prevent Alzheimer's disease prompted us to offer cognitive stimulation sessions.

Objectives: The goals of our study are to evaluate the effectiveness of cognitive stimulation and also to estimate the influence of the three ayurvedic constitutional categories on the effectiveness of cognitive stimulation over three months.

Methods: We looked at the ayurvedic categories, overall health perceptions, associative memory complaint and evolution in 28 healthy elderly people at T1 and T2 (three months later), as well as 12 healthy controls who weren't stimulated, using self-assessment questionnaires that included Prakriti and memory complaint, as well as several scales of perceived health (cognitive, physical, mental, and well-being/quality of life) and a test of associative memory.

Results: Pitta-Kapha has the highest population representation. The severity of the cognitive and holistic status decreases between the two eras, but not on the physical health. The cognitive and memory issues are weak or non-existent. Regression models allow us to test our health perception and associative memory predictions.

Conclusion: Cognitive stimulation is helpful, and ayurveda categories provide a useful framework for comprehending individual variances of cognitive functioning in healthy aged people.


Objective: In the rapid changes and competitiveness of health care organizations around the world, organizations need to recruit as well as retain talented and innovative nurses who behave like citizens, It is not easy to achieve it without suitable work environment. Work environment is the natural surroundings of the physical and emotional characteristics of a working place that the nurses devote greatest of their working times. Positive work environment is a creative, motivating, pleasurable, and well for managers, staff nurses and patients. It improves patient outcomes, nurses performance and innovation.  The current study aims to investigate the role of work environment on managerial innovation and organizational citizenship behavior at Mansoura University Hospital (MUH) and Elmahala Chest Hospital (ECH).

Materials and Methods: The study was conducted at Main Mansoura University Hospital (MMUH) and Elmahala Chest Hospital (ECH). The total sample was 140 nursing staff. Three tools were employed in this study, Managerial Innovation Questionnaire, Work Environment Questionnaire and Organizational Citizenship Behavior Questionnaire.

Results: Total work environment at main university hospital was higher (37.1%) than Elmahala Chest Hospital (31.4%) Also Agreement of managerial innovation was higher at main university hospital than at Elmahala Chest Hospital (21.0%, 14.3%) respectively the total organizational citizenship behavior highest agreement in Elmahala Chest Hospital (48.6%) rather than Main University hospital (44.8%). Finally There is a strong positive significance relation between total work environment and both total of managerial innovation and citizenship behaviour in both setting (**p<0.01)

Conclusion: There is a possibility of improving managerial innovation and organizational citizenship behaviors through improving their working environment.

Recommendations: Efforts must be made to foster a healthcare environment that nurtures innovation and organizational citizenship behavior. Also involving nurses in setting goals anddecisions of organizations to develop the organizational citizenship behavior.

Online Learning in the 21st Century: Perspectives from the University of Port Harcourt, Nigeria

I. E. Yarhere, I. O. Obuzor, E. Fomsi

Issues and Development in Health Research Vol. 6, 5 October 2021, Page 34-42

Schools in Nigeria were shut down, and lectures stopped altogether at the peak of the COVID 19 pandemic. The capacity of the Nigerian educational environment to carry out online interactions may be stretched thin with many foreseeable challenges.

Objectives: To identify the current familiarity and use of online classroom platforms by medical students and Paediatric residents and identify the barriers to its use for medical education.

Methods: A descriptive comparative study design using a semi-structured online questionnaire Google survey of 128 medical students and residents in training in University of Port Harcourt Teaching Hospital assessing demographics, availability of online learning tools, and application.

Results: Both groups had high familiarity but low use of Google classroom and preferred mobile devices to laptops. There was high familiarity 90.6%, but low use 42.2%, of Google classroom and the ease of using Google classroom for interfacing or interacting between learners and facilitators was affected by Internet availability, Pearson correlation, 0.185, p = 0.037, but not electric power availability, Pearson correlation, 0.135, p = 0.133.

Conclusions: There is an overall high awareness of a range of the Google classroom LMS platforms by medical students and residents. However, constant electric energy supply, availability of the internet, and competence in preparing multimedia presentations and uploading these for assessment may enhance the use of online learning platforms in Nigeria for undergraduate and postgraduate medical education. For online learning to continue without hindrance, the learners must motivate the facilitators by turning in their assignments early.

Determination of Selected Nursing Transcripts for E-health/E-nursing Education

Rasmeh Al-Huneiti, Mohammed Al Masarweh, Ziad Hunaiti, Ebrahim Mansour, Wamadeva Balachanrdan

Issues and Development in Health Research Vol. 6, 5 October 2021, Page 43-50

This paper reports on research concerning the establishment of an E-learning framework to impart E-health education to nurses in developing countries. Nursing and midwifery academic transcripts from several schools of nursing in different developing countries for nurse graduated in the years 2005-2009 were analyzed to evaluate their contents regarding Information Communication Technology (ICT) and E-health/E-nursing courses. Content analysis mechanism for 24 transcripts from eight developing countries were analyzed, this analysis revealed that there was no evidence of the introduction of the concept of E-health/E-nursing as such in any of the transcripts studied; Most of the programs ( 75%) were four years long, the vast majority (87%) of programmes had some kind of ICT- or computer-related modules, mostly concerning basic computer skills and IT fundamentals. The study finding justify the need for integration of E-health/E-nursing learning module in nursing curricula for national nursing institutions, and E-health literacy should be a prerequisite for the registration of general scope nurses/medical students

This is an issue to be addressed in this paper’s analysis section where the prioritization of HIV/AIDS and Health by South Africans are compared. Utilizing the South African sample from the Fourth Round of the Afrobarometer survey, this paper identifies the factors which predicted respondent selection of HIV/AIDS as an important issue for the government to address. The identification of HIV/AIDS as an important governmental problem became the study’s dependent variable. Other possible important factors were whether respondents had personal knowledge of HIV/AIDS, meaning they knew someone who died of AIDS, poverty, and their assessments of the way the government was handling the HIV/AIDS crisis. Respondent background and demographic characteristics were also included in a logistic regression analysis. The results identified three factors that predicted respondent choice of HIV/AIDS: race, especially being a Black South African, the choice of health as a governmental priority, and the rural-urban dimension. The conclusion was that HIV/AIDS, as opposed to health, should be the focus of campaigns designed to mobilize public support of comprehensive HIV/AIDS strategies in South Africa.

A Review on Xenobiotics: The Impact of SARS-CoV-2 on the Evolutionary Development of Human

A. Vladyko, E. Fomina, P. Semizhon

Issues and Development in Health Research Vol. 6, 5 October 2021, Page 59-66

There are many assumptions about the timing of the finish of the COVID-19 coronavirus pandemic. The experience of the development of previously identified coronavirus epidemics in 2002 (SARS) and 2012 (MERS) indicates a 1-2-year duration. However, there are still many questions related to the course of past epidemics and this pandemic. It is known from the literature data that the mortality rate, for example, during the 2002 SARS epidemic, it was about 10%, in MERS – 35%, while in SARS-CoV-2 it is approximately 3-4%. Then why is the SARS-CoV-2 infection declared a pandemic, and SARS 2002 an epidemic? It is still unclear why the vaccine does not reduce the course of the coronavirus pandemic? And can any vaccine developed by traditional technology aimed at neutralizing the pathogen and stopping its circulation in the human population, prevent the spread of the infectious agent? What is the cause or source of the infection? Why are there no vaccines against human immunodeficiency virus and hepatitis C? Why are the biological characteristics of each person ignored during vaccination? When will the SARS-CoV-2 mutations stop? What role does the environment play in the development of the pandemic? Maybe the COVID-19 coronavirus pandemic did not begin in December 2019, but with the appearance of mammals on earth? Who or what is the regulator of the evolution of all living things on the planet?

This message attempts to answer all the questions raised.

Determination Factors Associated with Psychological Outcomes of Healthcare Workers during the COVID-19 Pandemic and its Effects on Quality of Life

Hanin Abdulhameed Shalaby, Nora Baroom, Rawan Anwar Obaid, Enaam Raboe

Issues and Development in Health Research Vol. 6, 5 October 2021, Page 67-83

Purpose: Healthcare workers (HCWs) are exposed to stressful working conditions during the Coronavirus disease 2019 (COVID-19) pandemic, which is affecting their quality of life (QoL). The purpose of the present research is to assess in-depth the main factors associated with psychological outcomes among HCWs in Saudi Arabia during the COVID-19 pandemic and to gauge the effects of these outcomes on the HCWs’ QoL.

Methodology: In this descriptive cross-sectional study, all HCWs working in tertiary hospitals in Saudi Arabia who have direct or indirect contact with COVID-19 cases were invited voluntarily to complete a validated web-based survey during the study period.Between the 1st of June and the 31st of July 2020, 1,182 HCWs from various regions across SA and specialties, including physicians, nurses, pharmacists, health educators, technicians, and others, participated in this study. The Patient Health Questionnaire depression scale and the Generalized Anxiety Disorder (GAD-7) anxiety scale were used to assess psychological risk factors. World Health Organization Quality of Life Questionnaire(WHOQOL) was used to assess QoL. Socio-demographic information was summarised using frequency and percentages. The study participants' overall anxiety, depression, and WHOQOL scores were calculated using mean, standard deviation, and median values.The relationship between socio-demographic factors and anxiety and depression scales was investigated using independent samples t-tests, one-way ANOVA, and the chi-square test (for categorical depression/anxiety variables severe depression/severe anxiety against mild/moderate/moderately severe).While one-way ANOVA was used to examine those factors and WHOQOL domains. The front-line work predictors of depression and anxiety were identified using multivariate analysis.

Findings: Poor QoL scores were found, particularly in the domains of physical and psychological health. Workers who reported higher levels of anxiety and depression had significantly higher QoL in general. Age, gender, living with children and/or older people, occupation, years of experience, and participation in front-line work were all observed as factors affecting psychological health and QoL.

Unique Contribution to Theory, Practice and Policy: In terms of depression, anxiety, and QoL, certain traits of HCWs may operate as protective or risk factors. Targeted interventions could help medical professionals preserve their mental and physical health by reducing the harmful impacts of front-line work. More research is needed to learn more about how the COVID-19 epidemic and front-line work effect the mental and physical health of HCWs.

Simulations of Infectious Disease Propagation II: Herd Immunity Examined

William J. B. Oldham, Jr.

Issues and Development in Health Research Vol. 6, 5 October 2021, Page 84-93

The results of simulations of the propagation of an infectious disease are presented. In managing and controlling the spread of an infectious disease, such as Covid-19, the concept of “Herd Immunity” (HI) is often invoked when the disease’s propagation will dwindle to acceptable level. We have extended a previous work with explicit attention on the usefulness of this concept. The objectives of this research was to track the propagation of an infectious disease as a function of population density and time and to evaluate HI. The population was divided into two groups. One group was protected from the infection. The second group was unprotected. The results are given as a percentage of the unprotected population that is infected as a function of time. We used computer simulation on a person level to follow the progress of the disease’s infection across the population. In the beginning, the people are uniformly distributed in a square. Movement of the people was simulated by each person performing a random walk. Infection rates are given for the unprotected portion of the population as a function of time. The disease was transferred from an infected person to an uninfected person if the two people were closer together than a given distance. These simulations show the unprotected portion of the population was at total risk if proper measures are not taken early. For 400 unprotected people the infection rate was 100% after approximately 100,000 iterations. We give the results from one dual simulation in which protection was afforded for a significant part of the population and carried out until all of the unprotected were infected. In the second part the protection was lifted to see how fast the total population was infected. For the case of 50% protected it took 400,000 iterations to infect the unprotected people. After the restrictions were lifted it took 150,000 to infect the other half. The simulations here are people based which has the advantage of seeing individual personal involvement. Results of infection rates were calculated for 1,000, 2,500, 5,000, and 10,000 people. The propagation of the disease can be fast and depends on population density. Protection is vital to containing the disease. Restrictions must be lifted carefully and slowly or the total population is at risk. According to the results obtained here the concept of HI is not a viable concept in controlling or managing the spread of the disease. We also present some data on how many people one person infected during the simulation.

Objectives:  The authors of this study were doubtful as to whether the risks of live kidney donation had been adequately studied and protected against. The purpose of this study was to look into the rigour and safety of  current live donation process in Israel.

Background: From 2015-2017, 65% of all kidney donations in Israel were live donations.

Methods: The researchers polled 91 Israelis who had given a kidney. The questionnaire inquired about the pre-donation process, including whether and how risks were communicated to donors, post-donation illness/complications, and medical follow-up.Also, whether the donors felt supported, confident and well-advised.

Results: Creatinine levels increased significantly after donation, with the youngest donors (18-29) having the highest levels.None of the donors were followed up on by a nephrologist, but only by their GP, and none had more than two follow-up visits. Despite the elevated creatinine levels, none were referred to a nephrologist for treatment or monitoring.The risk information provided to the donors also reveals gaps and inadequacies.

Conclusions: The authors give suggestions to improve the live donation procedure by making it more rigorous, cautious, well-followed, and research-based. It's also critical to take active steps to increase the number of deceased donations. Each deceased donation equates to one less live donation, resulting in less harm to healthy individuals.  

Study on Security and Privacy in Healthcare Data Mining

E. Kesavulu Reddy

Issues and Development in Health Research Vol. 6, 5 October 2021, Page 108-114

Managing the privacy and security of healthcare information used to mine data by reviewing its fundamentals, components, and principles, as well as applicable laws and regulations. It also includes a literature review on technical issues in privacy assurance, as well as a case study demonstrating some potential pitfalls in data mining of personally identifiable information. Data mining especially when it draws information from multiple sources poses special problems. This paper provided recommendations for medical data miners regarding privacy and security best practises.

Quality management has become an important issue in hospitals during the last couple of decades. The increased attention to quality is due to governmental regulations, influence of customers, and hospital management initiatives. Apparently, there are many difficulties in managing hospitals in a competitive marketplace with a little support from official bodies especially in a developing country like India. The management of the Corporate Hospitals being very keen about delivering quality services is maintaining a quality department. The purpose of this paper is to provide a framework for implementing the total quality management concept that is compatible with the local culture of India. The SERVQUAL model and its application can help the hospitals in achieving satisfaction on both ends - employees’ satisfaction and customer satisfaction. In hospitals, the traditional Indian culture, leadership style, and the mentality of the medical professionals are somehow the barriers to the adoption of the TQM. The suggested integrated framework model of the TQM can be of great help to the hospitals to move out of the barriers and successfully implementing TQM concepts and practices.

Nasopharyngeal carriage of Streptococcus pneumoniae in asymptomatic patients plays an essential role in pneumococcal transmission and generally precedes invasive pneumococcal disease (IPD). The influence of nasopharyngeal pneumococcal carriage on antibody response to pneumococcal vaccine has not been well defined.

Objective: To study the impact of the nasopharyngeal carriage of pneumococcus on the antibody response to pneumococcal polysaccharide vaccine in a pediatric group.

Methods: Prospective study that included 20 pediatric patients with recurrent respiratory infections from an outpatient Immunology clinic in Santiago (Chile). All patients underwent a previous immunological study. The nasopharyngeal carriage of Streptococcus pneumoniae was investigated in a nasal and pharyngeal swab sample, and bacteriological culture and serotyping were performed for 10 pneumococcal serotypes. At the inclusion visit, all children received 23-valent pneumococcal polysaccharide vaccine (Pneumo-23®, Sanofi Pasteur). Pneumococcal anti-polysaccharide IgG class antibodies for 10 serotypes were measured in a blood sample at study entry, at 45-60 days and at 12 months after vaccination. The groups were compared according to nasopharyngeal carriage and antibody response to the vaccine.

Results: Ten patients had nasopharyngeal carriage (5 women, mean age 9, range 4-14 years) (group 1) and 10 patients did not carry the pneumococcus (group 2 control). The isolated serotypes (S) were S1 = 4, S5 = 3, S6B, S14 and S19A, one each. There were no differences in IgG levels before vaccination between the group with nasopharyngeal carriage of pneumococcus with respect to the group that did not carry pneumococcus in any of the 10 serotypes evaluated. In contrast, specific IgG levels were significantly higher for S1 (p <0.05), S5 (p <0.05) and S9 (p <0.02) at 45-60 days post vaccination and for S1 (p<0.05) and for S5 (p<0.05) at 12 months post-vaccination in the groupwith positive carriage of pneumococcus in nasopharyngeal secretion compared to group  2.

Conclusions: In this series of children older than 4 years with recurrent respiratory infections without immunodeficiencies, nasopharyngeal carriage of Streptococcus pneumonia did not affect the IgG antibody response induced by the 23-valent pneumococcal polysaccharide vaccine. Carriage was detected in 50% of the included cases and the most frequent serotypes isolated were S1 and S5. It is likely that the carriage of these two serotypes has a favorable effect on a better response to the vaccine.

Objectives: To measure the prevalence and causes of burnout among Health Care Professionals (HCPs) in four hospitals in Saudi Arabia.

Background: Burnout is a mental illness caused by the failure of coping techniques that people often employ to deal with work stress, as a result of prolonged exposure to psychological factors. Burnout has the potential to be costly to employees, patients, and healthcare systems. Burnout has been linked to indices of personal suffering since the 1980s, including physical tiredness, insomnia, an increase in marriage and family problems, and even an increase in the use of alcohol and other drugs.

Methodology: We used the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). It assesses the four components of burnout; Emotional Execution (EE), Depersonalization (DP), low Personal Accomplishment (PA) and involvement. The total score was calculated by method 1 in Maslach Burnout inventory, 4th edition for medicine subgroup.

Results: The main findings of this study show that doctors and nurses have the highest risk of experiencing burnout and that burnout more prevalent among those who work in emergency care and inpatient wards. Saudi and married physicians scored higher burnout while young and inexperienced nurses were more inclined to report emotional execution and low involvement in the work. Also, the study showed that physicians and men were not able to practice adaptive stress-coping strategies.

Conclusion: the study emphasized the importance of work environment factors and suggested that the lack of involvement in work is an alarming predictor of burnout in public hospitals. Hospitals management should consider reducing demanding tasks and increasing rewards with a coaching leadership style, including instructional and emotional support.

Prescribing Pattern of Antidiabetic Drugs amongst Pre-obese Diabetic Patients in a Tertiary Care Hospital, India

Sougata Sarkar, Vartika Srivastava, Adrija Roy, Manjushree Mohanty

Issues and Development in Health Research Vol. 6, 5 October 2021, Page 149-162

Background: In order to improve the prescription quality and rational prescribing pattern promotion there is an inevitable need to investigate the factors that affect doctors' prescription patterns. Defining drug prescription and consumption pattern provides advantageous feedback to prescribers in order to improve their prescribing behaviour. Diabetes is a common non communicable disease. It leads to high morbidity and mortality due to the disease itself and its diverse complications like CAD, hypertension, renal complication, retinal damage, neurological disorders, generalised infections etc. With such multifactorial background of high prevalence, progressive nature of the disease, availability of multiple therapeutic regimens prescribed on trial and error basis, the treatment is individualised and neither complete nor satisfactory.

Objectives: This study was undertaken to analyse the current prescribing pattern in pre-obese patients of type 2 diabetes mellitus with regard to drug/drugs per prescription, dose, duration of treatment and frequency of change of drugs.

Methods: This is a prospective,parallel group, comparative observational study, performed in the department of pharmacology and Endocrinology in KIMS Bhubaneswar, between 2014 to 2016. The enrolled pre-obese patients were divided as a)New diabetic b)Old diabetic(<3 years duration).Each category was further divided into four subgroups according to the treatment recieved a)Monotherapy-Metforminb)Combination therapy-Metformin+another antidiabetic groups,preferably sulfonylureas, alphaglucosidase inhibitors or DPP 4 inhibitors c)Triple therapy( Metformin+SU+Voglibose or Gliptins or Glitazones) d)Insulin with other oral hypoglycemic drugs.

Results: In the study of prescribing pattern, it was observed that most prescriptions in this tertiary care hospital were found to be in compliance with the ADA guidelines. Metformin monotherapy was prescribed as initial treatment. Sulphonylureas/Gliptins/Alpha glucosidase inhibitors/thiazolidinediones were used as second line therapy, in addition to metformin or as monotherapy according to patient requirement, tolerability and cost.

Conclusions: The antidiabetic medications prescribed in this hospital, were found to be in compliance with ADA guidelines.

Depression, Anxiety, and Stress among Health Science Students Belonging to Non-affluent Families

Kartheek R. Balapala, Balakrishnan Subramanian

Issues and Development in Health Research Vol. 6, 5 October 2021, Page 163-171

Introduction: In due course of training, the health science students confront significant stress in psychological, academic, and existential domains. Coping strategies may be needed for a medical student placed in a new school with a new teaching schedule.

Objective: To study depression, anxiety and stress (DAS) levels and their associated factors among the health science students belonging to academic years 1 to 5 of the University Tunku Abdul Rahman in Malaysia.

Methods: Undergraduate Health Science students learning medicine, traditional Chinese medicine, and physiotherapy courses were selected for a questionnaire-based descriptive correlational study. DAS scale questionnaire 21 (DASS 21) was used for analyzing the levels of stress and other parameters, and General health questionnaire 12 (GHQ 12) was used for the assessment of general health among 134 students on a week before their periodical examinations.

Results: Severe depression was found in 9.7% of students learning health science courses. About 42% of students showed combined effects of depression and anxiety. The three domains of DAS were significantly correlated. Depression was found significantly among female students (38%) more than male students (18%). DAS levels were significantly high among the first-year students as compared to the final year graduating students in the MBBS course. Depression and stress levels and their associations were found high among students those who were encountered adverse life events in the recent past 1 year before the study. GHQ scores for 134 participants of all health science courses were >6 in 39.55%, equal to 6 in 9.7%, and others in 50.75% of student participants.

Conclusion: A significant number of students learning health sciences were having higher levels of DAS and were associated with several important factors. There is a need to adopt better counselling and mentoring techniques among university staff with better connectivity among health science students. Proactive steps must be implemented at the community level for the amelioration of the drawbacks.