Benefits of Health Insurance among the poor insured people of Balochistan

The Province of Balochistan is the poorest province of Pakistan with very limited resources of healthcare facilities mostly in respect of healthcare providers due to which the population is suffering with lack of healthcare services throughout the region. The Government of Pakistan initiated a health insurance program for the people living with less than 2 dollar per day income to provide healthcare services to such people who are not able to have the healthcare services through their own income and mostly were pushed towards death due to unaffordability in respect of out of pocket expenditures. The five districts among 33 districts were selected in the initial phase of this program to insure such people from the province of Balochistan in 2016. The state life corporation of Pakistan (Insurance Company) was awarded the mandate by the federal government for the health insurance services. Articles reviewed regarding health insurance schemes in different developing countries for knowledge attitude where it has come to knowledge that the health insurance has well resulted in many countries among the insured people who availed the benefits of insurance policy, some studies expressed that people were not aware of benefits of health insurance system due to lack of knowledge about insurance plans and some even didn’t knew about the health insurance system. The awareness plays a vital role to such people to get the benefits of insurance schemes. The secondary data obtained from the Health Department Government of Balochistan for this study and analyzed via Microsoft Excel 2010 and SPSS. The measures found the percentages of the insured people among the population and the people who got treatments against the health insurance. The data included all of those people who were inpatients in the same district hospital and other district hospitals as well. It has been found that the head of the families (card holder) had the treatment with 65.2%, the wives 20.5%, the child with 8.5%, son/daughter 5.6% and the husbands with 0.2 % among the beneficiaries. This health insurance for poor people was a good initiative, the ratio of beneficiaries who were facilitated and availed of treatments through insurance companies among the insured population was very low, and the stakeholders said that lack of awareness was the main cause of the low ratio of treated people within the insured population. The delay in payments of premiums from the federal government to the insurance company also played a role for fewer beneficiaries, this caused the delay payments to healthcare providers and the health care providers lost the interest to provide services to the insured people. Private hospitals do not take interest in special care treatments to the insured. The same disappointed the insured people and avoided treatment against the insurance scheme. The decisions were centralized at federal level and lack of coordination also found in between federal and provincial level. The Health Insurance schemes are highly helpful for developing and low income countries where the health services provision is very difficult due to financial hardship as well as lack of skilled human resource, communications, and proper referral system. The Province of Balochistan is needed to implement health insurance in the entire province to provide healthcare services to the scattered population. The pilot phase gave low results but there is an opportunity to increase the beneficiaries of the health insurance scheme with proper awareness of communities and with good governance to save many lives who can suffer due to non-availability of services.open석

Joint Shear Deformation and Beam Rotation in RC Beam-Column Eccentric Connections

This paper discusses joint shear deformation and beam rotation for RC beam-column eccentric connections. Two eccentric connections were designed according to ACI 318-14 and ACI-352 and their half scaled models were constructed sequentially to introduce a cold joint at the beam column interface. Specimen having eccentricity equal to bc/8 (12.5% of column width) and bc/4 (25% of column width) were named as specimen 1 and specimen 2 respectively. The specimens were tested under quasi static full cyclic loading. The results are presented in the form of beam rotation versus drift and beam rotation versus lateral load plots. In addition, joint shear deformation versus drift is also plotted for both specimens. Careful observation of the damage pattern revealed that bond slip occurred at 2.5% drift in both specimens with no yielding of beam longitudinal bars in the joint core due to the presence of construction joint. An increase in out of plane rotation was observed with increase in eccentricity. However, in plane rotation was more in specimen 1 as compared to specimen 2, primarily due to negligible out of plane rotations. Furthermore, joint shear deformation increased with increase in eccentricity. However, it was negligible due to slab contribution as well as bond slippage with minimum load transfer to the joint core. It is concluded that bond slippage is the principal failure pattern whereas out of plan rotation increases with eccentricity without significant contribution to the final failure pattern. Doi: 10.28991/cej-2021-03091650 Full Text: PD

THE IMPACT OF BEHAVIORAL FACTORS ON ENVIRONMENTAL ISSUES REGARDING INDIVIDUAL INVESTOR’S DECISION MAKING: EMPIRICAL EVIDENCE FROM PAKISTAN’S STOCK MARKET

The behavioural biases impact the decision-making of individual investor in the stock market, hence, modern finance theories presumed that investor does not make a rational decision. This research paper aims to examine the impact of behavioral factors on environmental issues regarding individual investor’s decision-making in the Stock Market of Pakistan. The data was collected from five provinces of Pakistan through adapted questionnaires; a sample size of 421 individual investors of the Pakistan stock market. This study applied the Structural Equation Model (SEM) using SmartPLS to analyze the influence of individual investor’s behavioural factors on environmental issues. This study finding showed that overconfidence, loss aversion, mental accounting, and herding biases of individual investors positively affect investment decisions on environmental issues. This study attempts to fulfill the gap by analyzing behavioral factors and environmental issues in the Pakistan stock market. However, the current study contributes to the existing literature on behavioral finance and environmental issues in the Pakistan stock market. Furthermore, the current study will be useful for financial professionals, regulatory authorities, or investment advisors, academia as well as practitioners

Construction and Initial Structure of Sexual Dysfunctions Tendencies Measure

Disclosure of sexual dysfunctions is difficult due to shame and social stigma. The instruments to measure sexual dysfunctions so far were quite backdated and lengthy. Moreover, there was no specific instrument available that could evaluate all the sexual dysfunctions on the Diagnostic and Statistical Manual of Mental Disorders’ criteria in a single scale; separate for men and women. The objective to develop the scale was to provide the non-clinical population with a short and straight-forward measure in English which could help them in deciding about seeking professional help. The constructed scale comprised of 7 items for males and 7 for females and employed 6-points Likert scale for responses. The study involved 79 men and 105 women (N=184; Kaiser-Meyer-Olkin Measure of Sample Adequacy=0.682 for males and 0.618 for females). The inclusion criteria were the practical involvement of the participants in sexual practices and ability to respond to a questionnaire in English. Exploratory Factor Analysis was conducted to measure the reliability and validity of the scale. While employing Principal Component Analysis for extraction and Oblimin with Kaiser Normalization as Rotation, Exploratory Factor Analysis was conducted on 7 items for males and 7 items for females separately. Sampling adequacy was found good and the adequacy of correlations between items and was found highly significant. The Cronbach’s Alpha reliability was satisfactory. 4 factors were extracted for males with 78.65% variance explained. 3 factors were extracted for females with 66.57% variance explained. The communalities for all the 14 items ranged between 0.554 to 0.937. The study established that Sexual Dysfunctions Tendencies Measure is a valid and reliable tool to measure sexual dysfunctions with the criteria of the Diagnostic and Statistical Manual of Mental Disorders

Late Morbidity Among Survivors of Childhood Cancers; Experience at Tertiary Care Cancer Hospital

Background: Long-term survivors of childhood malignancies are at increased risk of experiencing treatment-related morbidities. Survival into late adulthood in these children provides ample time for the acquisition of long-term sequelae. This study aimed to determine late adverse effects among long-term survivors of childhood cancer from a low-income country perspective. Methods: Data were retrospectively collected from review of charts of patients aged under 18 years at the time of their primary diagnosis between January 1, 1995, to December 31, 2008, and who survived for at least 5 years after completion of their treatment. Analyzed data included demographics, cancer type, treatment modality, types of chemotherapy agents administered and specific late morbidities including frequency of azoospermia, oligospermia, endocrine abnormalities, hearing and pulmonary function impairment, and cardiac dysfunction among the long-term survivors of cancer. Results: The total number of patients was 300 with a mean age of 18 ± 2 years. The male to female ratio was 2.7:1. Median follow up duration was 18 years (range: 5-25 years). Seventy-seven percent of patients were from Punjab, 20% were from Khyber Pakhtunkhwa and 3% were from other provinces. Fifty percent had a diagnosis of Hodgkin Lymphoma, 17% Acute Lymphoblastic Leukemia, 13% Non-Hodgkin Lymphoma, 10% Germ cell tumors and 10% had other tumors. Fifty-seven percent received chemotherapy, 23% chemotherapy and radiotherapy, 15% chemotherapy and surgery, 3% chemotherapy, surgery and radiotherapy and 2% had only surgery. Notable long-term documented sequelae were; azoospermia/oligospermia in 64%, endocrine abnormalities in 25% with hypothyroidism in 13.5% and follicle-stimulating hormone and luteinizing hormone abnormalities in 11.5%, ototoxicity in 6.5%, impaired pulmonary function tests in 4.6%, cardiotoxicity in 2.4% and second malignancies (acute myeloid Leukemia and myelodysplastic syndrome)  in 1%. Conclusion: Childhood cancer survivors are at increased risk of adverse treatment-related sequelae and a long-term follow-up plan should be in place in centers where they receive treatment for their primary disease

In Vitro, Ex Vivo, and In Vivo Evaluation of Nanoparticle-Based Topical Formulation Against Candida albicans Infection

Ketoconazole is commonly used in the treatment of topical fungal infections. The therapy requires frequent application for several weeks. Systemic side effects, allergic reactions, and prolonged treatment are often associated with non-compliance and therapy failure. Hence, we developed an optimized topical antifungal gel that can prolong the release of drug, reduce systemic absorption, enhance its therapeutic effect, and improve patient compliance. Ketoconazole-loaded PLGA nanoparticles were prepared by the emulsion/ solvent evaporation method and were characterized with respect to colloidal properties, surface morphology, and drug entrapment efficiency. The optimized ketoconazole-loaded PLGA nanoparticles and commercially available silver nanoparticles were incorporated into a Carbopol 934P-NF gel base. This arrangement was characterized and compared with commercially available 2% ketoconazole cream to assess physical characteristics of the gel, in vitro drug release, ex vivo skin permeation and retention, and in vivo studies on Wister male albino rats. The results showed that polymeric PLGA nanoparticles were very effective in extending the release of ketoconazole in our optimized formulation. Nanoparticles were smooth, spherical in shape, and below 200 nm in size which is consistent with the data obtained from light scattering and SEM images. The ex vivo data showed that our gel formulation could strongly reduce drug permeation through the skin, and more than 60% of the drug was retained on the upper surface of the skin in contrast to 38.42% of the commercial cream. The in vivo studies showed that gel formulation could effectively treat the infection. This study demonstrates that our topical gel could be effective in sustaining the release of drug and suggests its potential use as a possible strategy to combat antifungal-resistant Candida albicans