Understanding patient and family experiences of critical care in Bangladesh and India: What are the priority actions to promote person-centred care?

Patients' experiences in the intensive care unit (ICU) can enhance or impair their subsequent recovery. Improving patient and family experiences on the ICU is an important part of providing high quality care. There is little evidence to guide how to do this in a South Asian critical care context. This study addresses this gap by exploring the experiences of critically ill patients and their families in ICUs in Bangladesh and India. We elicit suggestions for improvements from patients, families and staff and highlight examples of practices that support person-centred care. This multi-site hospital ethnography was carried out in five ICUs in government hospitals in Bangladesh and India, selected using purposive sampling. Qualitative data were collected using non-participant observation and semi-structured interviews and analysed using reflexive thematic analysis. A total of 108 interviews were conducted with patients, families, and ICU staff. Over 1000 hours of observation were carried out across the five study sites. We identified important mediators of patient and family experience that span many different aspects of care. Factors that promote person-centred care include access to ICU for families, support for family involvement in care delivery, clear communication with patients and families, good symptom management for patients, support for rehabilitation, and measures to address the physical, environmental and financial needs of the family. This study has generated a list of recommendations that can be used by policy makers and practitioners who wish to implement person-centred principles in the ICU.

The Health and Safety Experiences of Precariously Employed Bangladeshi Immigrant Workers in Toronto During the COVID-19 Pandemic.

Racialized immigrants in Canada have been disproportionately impacted by the COVID-19 pandemic. Our qualitative, community-based study with South Asian Women and Immigrants' Services examined the impact of the second and third waves of the pandemic on the work and health of precariously employed Bangladeshi immigrant women and men in Toronto. Our study is based on interviews and focus group discussions with 45 workers, all conducted in Bangla, and 11 key informants. Interviews reveal work transitions, an increase in precarity, work in essential sectors, exposures at work, home and in transit, workplace prevention and management gaps, and an inability to take time off, with significant impacts on workers' physical and mental health. We discuss the implications of our findings for prevention, preparedness, and response by workplaces and governments to decrease the risk and reduce the impact of infectious diseases emergencies in the precarious work sector.

Systemic barriers to reporting work injuries and illnesses in contexts of language barriers.

BACKGROUND: Workers who experience language barriers are at increased risk of work-related injuries and illnesses and face difficulties reporting these health problems to their employer and workers' compensation. In the existing occupational health and safety literature, however, such challenges are often framed in individual-level terms. We identify systemic barriers to reporting among injured workers who experience language barriers within the varying contexts of Ontario and Quebec, Canada. METHODS: This study merges data from two qualitative studies that investigated experiences with workers' compensation and return-to-work, respectively, for injured workers who experience language barriers. We conducted semi-structured interviews with 39 workers and 70 stakeholders in Ontario and Quebec. Audio recordings were transcribed and coded using NVivo software. The data was analysed thematically and iteratively. RESULTS: Almost all workers (34/39) had filed a claim, though most had initially delayed reporting their injuries or illnesses to their employer or to workers' compensation. Workers faced several obstacles to reporting, including confusion surrounding the cause and severity of injuries and illnesses; lack of information, misinformation, and disinformation about workers' compensation; difficulties accessing and interacting with care providers; fear and insecurity linked to precarity; claim suppression by employers; negative perceptions of, and experiences with, workers' compensation; and lack of supports. Language barriers amplified each of these difficulties, resulting in significant negative impacts in economic, health, and claim areas. CONCLUSION: Improving the linguistic and cultural competence of organizations and their representatives is insufficient to address under-reporting among workers who experience language barriers. Efforts to improve timely reporting must tackle the policies and practices that motivate and enable under-reporting for workers, physicians, and employers.

Differences between men and women in their risk of work injury and disability: A systematic review.

BACKGROUND: Health responses associated with occupational exposures can vary between men and women. AIMS: This study reviewed the work injury and disability risks associated with similar types of occupational exposures for men and women within and across occupations. MATERIALS & METHODS: A systematic review was undertaken of observational studies published between 2009 and 2019. Studies were required to empirically compare men and women for associations between occupational exposures and work injury or disability outcomes. Included studies were appraised for methodological quality and medium to high rated studies were compared for risk differences between men and women. RESULTS: Of 14,006 records identified, 440 articles were assessed for methodological quality, and 33 medium to high rated studies were included and reviewed. Among all occupations, the association between physical exposures, job demands, noise, and repetitive tasks, and injury risk were stronger among men. The relationship between repetitive tasks and sickness absence was stronger among women. Most studies examining psychological exposures found no risk differences for men and women across occupations. Men were at higher injury risk in certain occupations in primary and secondary industry sectors involving physical exposures and some chemical/biological exposures. Women were at higher injury risk for the physical demands and repetitive tasks of health care and aluminum production occupations. CONCLUSION: This review found that men and women can have different work injury and disability risks, both across and within the same occupations, for some physical exposures and to a lesser extent for some chemical and biological exposures. These differences might be a result of occupation-specific task differences.

A rapid review of systematic reviews on the effectiveness of synchronous online learning in an occupational context.

BACKGROUND: This study examined the effectiveness of synchronous online learning (SOL) for occupational purposes relative to face-to-face (F2F) learning. METHODS: Seven bibliographic databases were searched, and publications meeting the inclusion criteria were sought. Title and abstract screening, article screening, methodological quality assessment, and data extraction were carried out by two independent reviewers. RESULTS: Three systematic reviews meeting the inclusion criteria were consistent in providing evidence that there was generally no difference between SOL and F2F learning in their effects on knowledge or skills. CONCLUSIONS: Based on the sparse evidence base examined in this review, we conclude that SOL and traditional F2F learning for occupational or career preparation purposes are similarly effective for learners at the undergraduate level or higher. Much caution should be taken with this assumption when delivering content of a more hands-on nature and when adult learners have less educational preparation, since research is lacking in these areas.

Integrating Safety and Health Promotion in Workplaces: A Scoping Review of Facilitators, Barriers, and Recommendations.

BACKGROUND: Growing evidence supports the integration and coordination of occupational health and safety and workplace health promotion activities instead of these coexisting as siloed efforts. Identifying implementation challenges and how these can be overcome is an important step to achieving truly integrated worker health efforts. We conducted a scoping review to identify the barriers and facilitators to integrated worker health approaches and described recommendations for implementing these efforts. METHOD: Peer-reviewed articles and gray literature from 2008 to 2019 were searched from the following electronic databases: EMBASE, Ovid Medline, PsycINFO, and ABI/INFORM. References from relevant articles and key informant suggestions also were collected. Data were extracted from documents if they focused on the occupational health and safety and health promotion of workers and described outcomes associated with integrated worker health approaches or outlined considerations relevant to the implementation of these approaches. RESULTS: Fifty-one documents met the inclusion criteria and were reviewed. Barriers and facilitators to implementing integrated worker health approaches were found at the extraorganizational, organizational, worker, and program levels, with limited resource availability the most reported barrier and support from leadership the most reported facilitator. Ten broad recommendations were identified and highlighted gaining leadership support, demonstrating leadership commitment, developing worker-centric approaches, and building capacity for workers. CONCLUSION: In reviewing the literature, we found clear and consistent recommendations relevant for integrated worker health approaches. Further research is needed to better understand how these recommendations apply to diverse workforces and organizations with varied resources.

Language Accommodations in Workers' Compensation: Comparing Ontario and Quebec.

Workers who experience language barriers are more likely to get injured or sick because of their work and have poorer claim and return-to-work outcomes compared to other workers. To better understand the systemic factors that shape access to compensation in contexts of language barriers, we compared language accommodation policies and practices in the Quebec and Ontario workers' compensation systems. We uncovered gaps limiting access to professional interpreters in both provinces, although gaps were more pronounced in Quebec where workers were responsible for the cost of interpreters. We argue that simply improving the linguistic competence of workers' compensation systems is not sufficient to tackle access barriers and must be accompanied by efforts to address the root causes of social and economic inequities for workers who experience language barriers.

Effects of alternate nostril breathing exercise on cardiorespiratory functions in healthy young adults.

Introduction: Alternate nostril breathing (ANB) is an effective breathing exercise with therapeutic benefits on cardiorespiratory functions for healthy and diseased individuals. This study was conducted to assess the effects of ANB exercise on cardiorespiratory tasks in healthy adults. Materials and Methods: This randomized experimental study was conducted in the Department of Physiology, Chittagong Medical College, Chattogram, from July 2017 to June 2018. A total of 100 1st-year students, aged between 18 and 20 years, were included by a random sampling method. Fifty participants (25 males and 25 females) were enrolled in the experimental group, while age- and body mass index-matched another 50 participants (25 males and 25 females) served as the control group. Experimental group participants performed ANB exercise for 4 weeks. Cardiorespiratory parameters (pulse rate, blood pressure, forced vital capacity, forced expiratory volume in 1st s [FEV1], and peak expiratory flow rate [PEFR] were measured. Data were taken at the start and after 4 weeks in both groups. Results: Independent t-test showed no significant differences in the cardiorespiratory functions between the experimental and control groups among the male and female participants, except for the females' PEFR which showed small differences. On the other hand, repeated measure ANOVA shows significant improvement in the experimental groups among males (P < 0.001-0.028) and females (P < 0.001-0.001) in all the cardiorespiratory functions measured, except for the FEV1 and PEFR among males. Conclusion: The results of this study suggest that cardiorespiratory functions were improved after breathing exercise, and therefore, ANB can be recommended for increasing cardiorespiratory efficiency.

RésuméIntroduction: La respiration nasale alternée (ANB) est un exercice de respiration efficace avec des avantages thérapeutiques sur les fonctions cardiorespiratoires pour les individus sains et malades. Cette étude a été menée pour évaluer les effets de l'exercice ANB sur les tâches cardiorespiratoires chez des adultes en bonne santé. Matériels et méthodes: Cette étude expérimentale randomisée a été menée au Département de physiologie, Chittagong Medical College, Chattogram, de juillet 2017 à juin 2018. Un total de 100 étudiants de 1ère année, âgés de 18 à 20 ans, ont été inclus par un échantillonnage aléatoire. méthode. Cinquante participants (25 hommes et 25 femmes) ont été inscrits dans le groupe expérimental, tandis que l'âge et l'indice de masse corporelle correspondaient à 50 autres participants (25 hommes et 25 femmes) servant de groupe témoin. Les participants du groupe expérimental ont effectué des exercices ANB pendant 4 semaines. Les paramètres cardiorespiratoires (fréquence du pouls, pression artérielle, capacité vitale forcée, volume expiratoire forcé en 1ère s [VEMS] et débit expiratoire de pointe [PEFR] ont été mesurés. Les données ont été recueillies au début et après 4 semaines dans les deux groupes. Résultats: Le test t indépendant n'a montré aucune différence significative dans les fonctions cardiorespiratoires entre les groupes expérimentaux et témoins parmi les participants masculins et féminins, à l'exception du PEFR des femmes qui présentait de petites différences.D'autre part, l'ANOVA à mesures répétées montre une amélioration significative dans les groupes expérimentaux chez les hommes (P < 0,001 à 0,028) et les femmes (P < 0,001 à 0,001) dans toutes les fonctions cardiorespiratoires mesurées, à l'exception du VEMS et du DEP chez les hommes Conclusion: Les résultats de cette étude suggèrent que les fonctions cardiorespiratoires ont été améliorées après un exercice respiratoire , et par conséquent, l'ANB peut être recommandé pour augmenter l'efficacité cardiorespiratoire.

Organizational Perspectives on How to Successfully Integrate Health Promotion Activities into Occupational Health and Safety.

OBJECTIVE: There is increasing recognition of the value of integrating efforts to promote worker health with existing occupational health and safety activities. This paper aimed to identify facilitators, barriers and recommendations for implementing integrated worker health approaches. METHODS: Thirteen stakeholders from different job sectors participated in a workshop that targeted key issues underlying integrated worker health approaches in their own and other organizations. Included were participants from human resources, occupational health and safety, government, and unions. Thematic analysis and an online ranking exercise identified recommendation priorities and contributed to a conceptual framework. RESULTS: Participants highlighted the importance of planning phases in addition to implementation and evaluation. Themes highlighted organizational priorities, leadership buy-in, external pressures, training, program promotion and evaluation metrics. CONCLUSIONS: Findings provide practical directions for integrating worker health promotion and safety and implementation steps.

Effects of alternate nostril breathing exercise on cardiac functions in healthy young adults leading a stressful lifestyle.

Alternate nostril breathing (ANB) is one of the best and easiest breathing exercises. ANB exercise has beneficial effects on cardiac function in healthy and diseased people. The objectives of this study were to assess the effects of ANB exercise on cardiac physiology among healthy medical students. This was a prospective interventional study that was conducted in the Department of Physiology, Chittagong Medical College (CMC), Chattogram, Bangladesh, from July 2017 to June 2018. A total of 100 research participants (RPs) aged 18-20 years, Year-I medical students of CMC, were selected. A simple random sampling method was adopted. The selection was done after the inclusion and exclusion criteria were applied. The age and body mass index (BMI) of the RPs were analogous in both the control and experimental groups. Cardiac parameters, like pulse and blood pressure (BP), were measured. The initial baseline data were recorded for both groups and after 4 weeks. The research respondents of the experimental group performed ANB exercise for 4 weeks. The mean value pulse and BP were significantly (p < 0.001) changed after breathing exercise, compared to the values before the breathing exercise. The results of this study suggest that cardiac function significantly improves after the breathing exercise. Therefore, ANB can be recommended for increasing cardiac efficiency.

Effects of alternate nostril breathing exercise on respiratory functions in healthy young adults leading stressful lifestyle.

Alternate nostril breathing (ANB) is one of the best and easiest breathing exercises (pranayama) of yoga that are good for health and physical fitness. ANB exercise has beneficial and therapeutic effects on respiratory function in both normal as well as diseased humans. This study was conducted with the objective of assessing the physiological effects of short-term ANB exercise on respiratory function in healthy adult individuals leading a stressful life. This prospective interventional study was conducted in the Department of Physiology, Chittagong Medical College (CMC), Chattogram, Bangladesh from July 2017 to June 2018. A total of 100 participants aged 18-20 years, studying in the first year in CMC, were included by using a simple random sampling method. Among them, 50 participants were enrolled in the experimental group. Age- and BMI-matched 50 participants constituted the control group. Height, weight were measured, and BMI was calculated. The participants of the experimental group performed ANB exercise over 4 weeks for 10 min/day. The control participants were neither trained nor allowed to practice nostril breathing during the whole study period. Respiratory parameters like forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1), and peak expiratory flow rate (PEFR) were measured by using a digital spirometer (Chest graph HI-101, Japan). Readings were taken in a healthy upright sitting posture in the control and experimental group initially and after 4 weeks. Student's t-test was conducted by using SPSS for windows version-23. The mean value of FVC, FEV1, PEFR were significantly (P < 0.001) changed after the ANB exercise when compared to the values before breathing exercise. The results of this study suggest that respiratory function is significantly improved after the ANB exercise. Therefore, ANB can be recommended for increasing respiratory efficiency.

Tool for the Meaningful Consideration of Language Barriers in Qualitative Health Research.

Individuals who experience language barriers are largely excluded as participants from health research, resulting in gaps in knowledge that have implications for the development of equitable policies, tools, and strategies. Drawing on the existing literature and on their collective experience conducting occupational health research in contexts of language barriers, the authors propose a tool to assist qualitative researchers and representatives from funding agencies and ethics review boards with the meaningful consideration of language barriers in research. There remain gaps and debates with respect to the relevant ethical and methodological guidance set forth by funding agencies and institutions and proposed in the scientific literature. This article adds to knowledge in this area by contributing our experiences, observations, and recommendations, including around the issue of conducting research in contexts of more or less linguistic diversity.

Development of a context specific accreditation assessment tool for affirming quality midwifery education in Bangladesh.

OBJECTIVE: using the International Confederation of Midwives (ICM) Global Standards for Midwifery Education as a conceptual framework, the aim of this study was to explore and describe important 'must haves' for inclusion in a context-specific accreditation assessment tool in Bangladesh. DESIGN: A questionnaire study was conducted using a Likert rating scale and 111 closed-response single items on adherence to accreditation-related statements, ending with an open-ended question. The ICM Global Standards guided data collection, deductive content analysis and description of the quantitative results. SETTING: twenty-five public institutes/colleges (out of 38 in Bangladesh), covering seven out of eight geographical divisions in the country. PARTICIPANTS: one hundred and twenty-three nursing educators teaching the 3-year diploma midwifery education programme. FINDINGS: this study provides insight into the development of a context-specific accreditation assessment tool for Bangladesh. Important components to be included in this accreditation tool are presented under the following categories and domains: 'organization and administration', 'midwifery faculty', 'student body', 'curriculum content', 'resources, facilities and services' and 'assessment strategies'. The identified components were a prerequisite to ensure that midwifery students achieve the intended learning outcomes of the midwifery curriculum, and hence contribute to a strong midwifery workforce. The components further ensure well-prepared teachers and a standardized curriculum supported at policy level to enable effective deployment of professional midwives in the existing health system. KEY CONCLUSIONS: as part of developing an accreditation assessment tool, it is imperative to build ownership and capacity when translating the ICM Global Standards for Midwifery Education into the national context. IMPLICATIONS FOR PRACTICE: this initiative can be used as lessons learned from Bangladesh to develop a context-specific accreditation assessment tool in line with national priorities, supporting the development of national policies.

It's not only what you say, it's also how you say it: communicating nipah virus prevention messages during an outbreak in Bangladesh.

BACKGROUND: During a fatal Nipah virus (NiV) outbreak in Bangladesh, residents rejected biomedical explanations of NiV transmission and treatment and lost trust in the public healthcare system. Field anthropologists developed and communicated a prevention strategy to bridge the gap between the biomedical and local explanation of the outbreak. METHODS: We explored residents' beliefs and perceptions about the illness and care-seeking practices and explained prevention messages following an interactive strategy with the aid of photos showed the types of contact that can lead to NiV transmission from bats to humans by drinking raw date palm sap and from person-to-person. RESULTS: The residents initially believed that the outbreak was caused by supernatural forces and continued drinking raw date palm sap despite messages from local health authorities to stop. Participants in community meetings stated that the initial messages did not explain that bats were the source of this virus. After our intervention, participants responded that they now understood how NiV could be transmitted and would abstain from raw sap consumption and maintain safer behaviours while caring for patients. CONCLUSIONS: During outbreaks, one-way behaviour change communication without meaningful causal explanations is unlikely to be effective. Based on the cultural context, interactive communication strategies in lay language with supporting evidence can make biomedical prevention messages credible in affected communities, even among those who initially invoke supernatural causal explanations.

Antioxidant capacity and total phenolic contents in hydrophilic extracts of selected Bangladeshi medicinal plants.

OBJECTIVE: To evaluate hydrophilic extracts from edible portions of fifteen plants for total phenolic content (TPC) and anti-oxidant capacity (AC) as an effort to find possible sources for future novel antioxidants. METHODS: Folin-Ciocalteau and DPPH radical scavenging assays were employed to determine TPC and AC, respectively. RESULTS: Among the assayed plants, TPC (mean±SD), expressed as gallic acid equivalent, varied from 0.04±0.01 (Amaranthus spinosus) to 6.01±0.04 (Zanthoxylum rhetsa) mg gallic acid equivalent/g fresh weight. AC (mean±SD), expressed as trolox equivalent, ranged from 0.14±0.00 (Alternanthera philoxeroides) to 7.54±0.00 (Zanthoxylum rhetsa) µmol trolox equivalent/g fresh weight. A significant and positive linear relationship (R(2)=0.99) was observed between TPC and AC of Zanthoxylum rhetsa, Oxalis corymbosa, and Alternanthera sessilis. CONCLUSIONS: The results of the present study implies that the analyzed plants possess varying degree of antioxidant capacity and, therefore, the antioxidant potency of these underused plants may be utilized to prevent oxidative damage and oxidative stress related disorders.

A preliminary observation on water quality and plankton of an earthen fish pond in Bangladesh: recommendations for future studies.

The present study provides a characterization of water quality and plankton samples in earthen fish pond in Rajshahi, Bangladesh. Sampling was done over a period of six months, running from October, 2004 through March, 2005. All the water quality parameters were within the optimal ranges for plankton productivity. Temperatures varied from 19.75 to 27.25 degrees C; transparency, 24.75-29.50 cm; pH, 6.62-7.85; Dissolved Oxygen (DO), 3.87-5.85 mg L(-1); free CO2 5.25-7.25 mg L(-1) and bicarbonate (HCO3) alkalinity, 81.25-147.5 mg L(-1). Analyses of plankton samples recorded a total of 5 classes phytoplankton viz.; Bacillariophyceae, Chlorophyceae, Cyanophyceae, Dinophyceae, Euglenophyceae and 2 classes of zooplankton; Crustacea and Rotifera. The phytoplankton population was comprised of 17 genera belonging to Cyanophyceae (5 classes, 34.47%), Bacillariophyceae (3, 13.87%), Cyanophyceae (3, 34.48%), Euglenophyceae (3, 10.68%) and 1 to Dinophyceae (6.50%). The zooplankton population consisted of 10 genera belonging to Rotifera (4, 40.13%) and Crustacea (6, 59.87%). Phytoplankton and zooplankton abundance varied from 60800 to 239400 units/l and 7620 to 12160 units/l, respectively. It is concluded that the phytoplankton groups provide the main support for earthen pond aquaculture in the pond compared to zooplankton classes. The information provides for more research to compare water quality and pond plankton characteristics in earthen aquaculture systems with and without fish stocking. Further studies on the seasonal changes of water quality parameters and its effects on plankton production in the fish ponds and all year extended monitoring is recommended in future studies.

Effects of iso-nutrient fertilization on plankton production in earthen ponds of Bangladesh.

The experiment was conducted to evaluate the effects of iso-nutrients fertilization on fertilizer combinations, containing a similar amount of nitrogen (N) and phosphorus (P) were the production of plankton in earthen ponds for a period of eight weeks. Two different were tested in triplicate using six earthen ponds of 100 m2 each. The fertilizer combinations of cow manure, urea and Triple Super Phosphate (TSP) at the rate 5000, 125 and 100 kg ha(-1), respectively, containing approximately 102 kg N and 65 kg P was used for treatment-1 (T-l). Another combination of poultry-manure, urea and TSP at the rate of 2000, 125 and 100 kg ha(-1), respectively, was considered as the treatment-2 (T-2). The application rate of poultry manure was adjusted to make the nutrient (N and P) content of fertilizer combination in T-2 similar to that in T-1. Four groups of phytoplankton namely, Bacillariophyceae, Chlorophyceae, Cyanophyceae and Euglenophyceae and two groups of zooplankton namely, Crustacea and Rotifera were identified. The mean abundance of both phytoplankton (78.25 +/- 6.33 x 10(4) cells L(-1)) and zooplankton (57.63 +/- 4.59 x 10(4) cells L(-1)), were significantly higher (p < 0.05) in earthen ponds which treated with poultry manure. The result showed that despite iso-nutrients content, the nutrient status of poultry manure proved to be superior to cow manure.

Role of aromatase inhibitor in ovulation induction in patients with poor response to clomiphene citrate.

AIM: To examine the efficacy of aromatase inhibitor in the induction of ovulation. METHODS: This prospective clinical trial in patients with infertility and poor response to clomiphene citrate (CC) was undertaken in a tertiary referral infertility clinic. Thirty-five infertile patients, who were treated by clomiphene citrate for several cycles and referred to the infertility clinic, were the target population. Initially, the response of CC was assessed by same dose of CC that the patient had in her last cycle. The patients who did not respond adequately were treated by aromatase inhibitor 2.5-5 mg/day from day 3-7 of the menstrual cycle. The main outcome measures were the number of mature follicles, ovulation rate, endometrial thickness and pregnancy rate. RESULTS: Twenty-seven (90%) patients developed mature follicles by day 12. The majority (77.77%) developed single follicle. Except for one cycle of one patient, the follicles of all patients were ruptured in all cycles and seven (25.94%) got pregnant. CONCLUSION: The aromatase inhibitor letrozole is effective for ovulation induction in anovulatory infertility in patients that failed to ovulate by CC.