Improving Algebraic Thinking and Productive Desire among a Training Program Based on (TPACK) Model in Jordan

The study aimed to investigate the effectiveness of a training program based on (TPACK- Technological Pedagogical and Content Knowledge) model in improved algebraic thinking and productive disposition among female Primary school teachers. the guide for the training program and study tools was prepared, ensured their validity and stability, an available sample was selected from the schools of Jerash Kasbah of the Directorate of Education of Jerash Governorate, consisted of (36) mathematics teachers, divided into two groups: one experimental consisted of (18) teachers trained according to (TPACK) model, and the other was a control teacher consisted of (18) teachers who did not undergo training. Results showed statistically significant differences on the algebraic thinking test between the members of the control and experimental groups, and in favor of the experimental group that was trained according to the model, also showed that training according to (TPACK) model improved the level of performance of the experimental group mathematics teachers on the productive disposition scale, and raised their performance to an expert level. one of which is need to change the pattern of training programs directed to teachers within specific mathematics content, and apply integrative teaching models that enhance content, pedagogy and enhanced technology

Current Breast Feeding Practices: Are these Compliant with WHO Recommendations?

Background: To study  the current breast feeding practices in mothers who underwent caesarean section and to what extent these comply with the world health organization (WHO) recommendations. Methods: This  cross-sectional study was based on a survey conducted on women delivered by caesarean section .Proforma built for the survey was completed by interviewing of the subjects. Frequencies of the observations were described as means and percentages.  Pearson chi square test was used to find association between early initiation of breast feeding (EIBF) and independent variables. Binary logistic regression was used to investigate association of factors with EIBF independently. Results: EIBF was found in 15% of infant-mother pairs. All other mothers-infant pairs (85 %) started early breast feeding(EBF) i.e.  breast feeding (BF_ between 2 to 24 hours after delivery. Majority of infants were given a drink, other than breast milk, within 24 after delivery. Counselling or assistance for EIBF or exclusive breast feeding was not provided by healthcare workers to any mother. Main factor significantly associated with initiating breastfeeding during 1st hour after caesarean delivery was attendant’s awareness about recommendation of EIBF. Conclusion: There is poor adherence to WHO recommendations for early initiation of breast feeding i.e. during 1st hour after birth. However, EBF was found in all mothers who did not start EIB

An introduction to the 1998-99 Pakistan socioeconomic survey (PSES)

This brief paper is quite focused. It describes the methodology and scope of the household survey carried out by the PIDE between March and July 1999, with an aim to generate nationally representative data to examine the incidence of poverty and distribution of income. It also includes information on household composition, schooling, labour market, sources of income, credit, fertility, child mortality, health, and nutrition. The next section outlines the objectives of the household survey, followed by the design of the survey as proposed in the MIMAP project. The modified design is presented in Section 4, followed by a discussion on the seasonality in Section 5. The contents of the questionnaire are discussed briefly in Section 6. A brief description of the experience of pre-testing the questionnaire is the subject matter of the next section. Nature of the training imparted to field enumerators is reported in Section 8. The processing of data and scope of the survey are discussed respectively in Sections 9 and 10. The sample characteristics are reported in the last section

Evaluation of the uptake and impact of neonatal vitamin A supplementation delivered through the Lady Health Worker programme on neonatal and infant morbidity and mortality in rural Pakistan: an effectiveness trial

Background: Despite evidence for the benefits of vitamin A supplementation (VAS) among children 6 to 59 months of age, the feasibility of introduction and potential benefit of VAS in the neonatal period in public health programmes is uncertain. Objective: The primary objective was to evaluate the feasibility and effectiveness of early neonatal VAS (single dose of 50 000 international units within 48–72 hours after birth) delivered through the public sector Lady Health Worker (LHW) programme in rural Pakistan and to document its association with a reduction in mortality at 6 months of age. Methods: A community-based, cluster randomised, placebo-controlled trial was undertaken in two districts of rural Pakistan. LHWs dispensed vitamin A/placebo in identical capsules to newborn infants within 48–72 hours of birth. Follow-up visits were undertaken at 1 week of age and every 4 weeks thereafter until 6 months of age. Results: Of a total of 15 433 consecutive pregnancies among eligible women of reproductive age, 13 225 pregnancies were registered, 12 218 live births identified and 11 028 newborn infants reached by LHWs. Of these, 5380 (49%) received neonatal VAS and 5648 (51%) placebo. The LHWs successfully delivered the capsules to 79% of newborns within 72 hours of birth with no significant adverse effects. Although the proportion of days observed with symptoms of fever, diarrhoea or rapid breathing were lower with neonatal VAS, these differences were not statistically significant. Mortality rates in the two groups were comparable at 6 months of age. Conclusions: While our study demonstrated that neonatal VAS was safe and could be feasibly delivered by LHWs in Pakistan as part of their early postnatal visits, the overall lack of benefit on neonatal and 6-month morbidity and mortality in our population suggests the need for further evaluation of this intervention in populations at risk

Significance of Hematological Parameters in Patients with Type-2 Diabetes Mellitus and Its Relationship with Disease Complications

Objective: To determine the association of haematological parameters with disease complications in patients with type 2 Diabetes Mellitus. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology, Rawalpindi Pakistan from Feb to Aug 2019. Methodology: In this study, 200 Patients were selected and divided into four groups, 1) Anaemia without Diabetes 2) Diabetes with Anaemia 3) Diabetes without Anaemia 4) Healthy Control Group. All the patients were assessed because of their clinical history and laboratory evidence. The patients' clinical details, type of anaemia, laboratory investigations and complications related to diabetes were recorded on a specially designed proforma. Results: Diabetes-related complications were highest in diabetes with anaemia Group. It was recorded that diabetes with anaemia Group, 36 patients (50.0%) had microvascular complications and 32 patients (47.8%) had macrovascular complications. In the healthy control group, 8 patients (11.1%) had microvascular complications, and nine patients (13.4 %) had macrovascular complications. Conclusion: Patients with type 2 Diabetes Mellitus should be evaluated and treated for anaemia routinely to prevent complication

Evaluation the effectiveness of abridged IMNCI (7-Day) course v standard (11-Day) course in Pakistan

Background: The conventional IMCI training for healthcare providers is delivered in 11 days, which can be expensive and disruptive to the normal clinical routines of the providers. An equally effective, shorter training course may address these challenges.Methods: We conducted a quasi-experimental study in two provinces (Sindh and Punjab) of Pakistan. 104 healthcare providers were conveniently selected to receive either the abridged (7-day) or the standard (11-day) training. Knowledge and clinical skills of the participants were assessed before, immediately on conclusion of, and six months after the training.Results: The improvement in mean knowledge scores of the 7-day and 11-day training groups was 31.6 (95% CI 24.3, 38.8) and 29.4 (95% CI 23.9, 34.9) respectively, p = 0.630 while the improvement in mean clinical skills scores of the 7-day and 11-day training groups was 23.8 (95% CI: 19.3, 28.2) and 23.0 (95% CI 18.9, 27.0) respectively, p = 0.784. The decline in mean knowledge scores six months after the training was - 12.4 (95% CI - 18.5, - 6.4) and - 6.4 (95% CI - 10.5, - 2.3) in the 7-day and 11-day groups respectively, p = 0.094. The decline in mean clinical skills scores six months after the training was - 6.3 (95% CI - 11.3, - 1.3) in the 7-day training group and - 9.1 (95% CI - 11.5, - 6.6) in the 11-day group, p = 0.308.Conclusion: An abridged IMNCI training is equally effective as the standard training. However, training for certain illnesses may be better delivered by the standard course

Evaluation of health workforce competence in maternal and neonatal issues in public health sector of Pakistan: an Assessment of their training needs

<p>Abstract</p> <p>Background</p> <p>More than 450 newborns die every hour worldwide, before they reach the age of four weeks (neonatal period) and over 500,000 women die from complications related to childbirth. The major direct causes of neonatal death are infections (36%), Prematurity (28%) and Asphyxia (23%). Pakistan has one of the highest perinatal and neonatal mortality rates in the region and contributes significantly to global neonatal mortality. The high mortality rates are partially attributable to scarcity of trained skilled birth attendants and paucity of resources. Empowerment of health care providers with adequate knowledge and skills can serve as instrument of change.</p> <p>Methods</p> <p>We carried out training needs assessment analysis in the public health sector of Pakistan to recognize gaps in the processes and quality of MNCH care provided. An assessment of Knowledge, Attitude, and Practices of Health Care Providers on key aspects was evaluated through a standardized pragmatic approach. Meticulously designed tools were tested on three tiers of health care personnel providing MNCH in the community and across the public health care system. The Lady Health Workers (LHWs) form the first tier of trained cadre that provides MNCH at primary care level (BHU) and in the community. The Lady Health Visitor (LHVs), Nurses, midwives) cadre follow next and provide facility based MNCH care at secondary and tertiary level (RHCs, Taluka/Tehsil, and DHQ Hospitals). The physician/doctor is the specialized cadre that forms the third tier of health care providers positioned in secondary and tertiary care hospitals (Taluka/Tehsil and DHQ Hospitals). The evaluation tools were designed to provide quantitative estimates across various domains of knowledge and skills. A priori thresholds were established for performance rating.</p> <p>Results</p> <p>The performance of LHWs in knowledge of MNCH was good with 30% scoring more than 70%. The Medical officers (MOs), in comparison, performed poorly in their knowledge of MNCH with only 6% scoring more than 70%. All three cadres of health care providers performed poorly in the resuscitation skill and only 50% were able to demonstrate steps of immediate newborn care. The MOs performed far better in counselling skills compare to the LHWs. Only 50 per cent of LHWs could secure competency scale in this critical component of skills assessment.</p> <p>Conclusions</p> <p>All three cadres of health care providers performed well below competency levels for MNCH knowledge and skills. Standardized training and counselling modules, tailored to the needs and resources at district level need to be developed and implemented. This evaluation highlighted the need for periodic assessment of health worker training and skills to address gaps and develop targeted continuing education modules. To achieve MDG4 and 5 goals, it is imperative that such deficiencies are identified and addressed.</p

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care