Toilet Visits Research Articles

Evaluation of Ambient Sensor Systems for the Early Detection of Heart Failure Decompensation in Older Patients Living at Home Alone: Protocol for a Prospective Cohort Study.

The results of telemedicine intervention studies in patients with heart failure (HF) to reduce rehospitalization rate and mortality by early detection of HF decompensation are encouraging. However, the benefits are lower than expected. A possible reason for this could be the fact that vital signs, including blood pressure, heart rate, heart rhythm, and weight changes, may not be ideal indicators of the early stages of HF decompensation but are more sensitive for acute events triggered by ischemic episodes or rhythm disturbances. Preliminary results indicate a potential role of ambient sensor-derived digital biomarkers in this setting. The aim of this study is to identify changes in ambient sensor system-derived digital biomarkers with a high potential for early detection of HF decompensation. This is a prospective interventional cohort study. A total of 24 consecutive patients with HF aged 70 years and older, living alone, and hospitalized for HF decompensation will be included. Physical activity in the apartment and toilet visits are quantified using a commercially available, passive, infrared motion sensing system (DomoHealth SA). Heart rate, respiration rate, and toss-and-turns in bed are recorded by using a commercially available Emfit QS device (Emfit Ltd), which is a contact-free piezoelectric sensor placed under the participant's mattress. Sensor data are visualized on a dedicated dashboard for easy monitoring by health professionals. Digital biomarkers are evaluated for predefined signs of HF decompensation, including particularly decreased physical activity; time spent in bed; increasing numbers of toilet visits at night; and increasing heart rate, respiration rate, and motion in bed at night. When predefined changes in digital biomarkers occur, patients will be called in for clinical evaluation, and N-terminal pro b-type natriuretic peptide measurement (an increase of >30% considered as significant) will be performed. The sensitivity and specificity of the different biomarkers and their combinations for the detection of HF decompensation will be calculated. The study is in the data collection phase. Study recruitment started in February 2024. Data analysis is scheduled to start after all data are collected. As of manuscript submission, 5 patients have been recruited. Results are expected to be published by the end of 2025. The results of this study will add to the current knowledge about opportunities for telemedicine to monitor older patients with HF living at home alone by evaluating the potential of ambient sensor systems for this purpose. Timely recognition of HF decompensation could enable proactive management, potentially reducing health care costs associated with preventable emergency presentations or hospitalizations. ClinicalTrials.gov NCT06126848; https://clinicaltrials.gov/study/NCT06126848. PRR1-10.2196/55953.

The Effect of Control on The Prevention of Online Examination Fraud.

The purpose of this study is to identify the effect of controls and heavy punishment on theprevention of online examination fraud for professional students at one of the universities in Malaysia. The study has listed five potential key factors as follows: (1) identity verification, (2) monitoring, (3) toilet visit procedures, (4) punishment, and (5) embarrassment. The students were given the questionnaire. Correlation and multiple regression analyses were performed on the data collected from the respondent. The results of the analyses have shown that certain controls, such as monitoring and punishment, have a positive impact on the prevention of online examination fraud in the university. Whereas the other controls, which are identity verification, toilet visit procedures, and embarrassment, do not significantly have a positive impact on the prevention of online examination fraud at the university. This study contributes to higher education by providing additional beneficial information that could strengthen their control and also enhance their punishment in preventing the occurrence of online examination fraud. This, in turn, will improve the quality of their graduates and eventually the image of the university.

Patient and Care Provider Perspectives on the Management of Fecal Incontinence: A Qualitative Rapid Review

Patient and Care Provider Perspectives on the Management of Fecal Incontinence: A Qualitative Rapid Review

보육교사의 인권 감수성과 권리존중 보육실행과의 관계

The purpose of this study is to examine the relationship between childcare teachers' human rights sensitivity and rights-respecting childcare practices. To this end, data were collected and analyzed for 322 teachers who participated in education for childcare teachers in Chungbuk in 2023. First, the level of human rights sensitivity of childcare teachers was not high, and the perception of results was the highest by sub-factors. In terms of human rights-related items by episode, the right to freedom and safety of the body was the highest, and the right to education of the disabled was the lowest. Second, the overall level of childcare teachers' respect for infant rights was relatively high. By sub-area, toilet visits (basic needs) were the highest in daily work and respect, and special activities were the lowest. Among the best interests of children, respect for intention was the highest and information provision was the lowest. Third, the higher the human rights sensitivity of childcare teachers, the higher the level of child care that respects rights. By sub-area, going to the bathroom (basic desire) showed the highest correlation. Through these research results, it is necessary to prepare and practice measures to improve the human rights sensitivity of childcare teachers in order to have a high level of respect for rights and continuously implement them in the childcare field. This study is meaningful in providing implications for preparing various support measures to improve human rights sensitivity in order to implement childcare with respect for rights.

The prevalence of undernutrition among students attending traditional Ethiopian orthodox Tewahedo church schools in northwest Ethiopia.

Undernutrition is a major public health concern affecting the health, growth, development, and academic performance of adolescents studying in school. During this crucial period, dietary patterns have a vital impact on lifetime nutritional status and health. The problem of undernutrition among particular groups of adolescents attending traditional schools has not previously been studied. Therefore, this study aimed to assess the prevalence of undernutrition and associated factors among adolescents aged 10-19 years attending Orthodox Church schools in northwest Ethiopia. An institution-based, cross-sectional study design was employed, with data collected from March 1 to 30, 2021. A simple random sampling technique was used to recruit a total of 848 male attendees of traditional schools. Data were collected via an interviewer-administered semi-structured questionnaire. The nutritional status of participants was assessed using anthropometric measurements. The WHO Anthroplus software was used for analysis. Both bivariable and multivariable logistic regression analyses were conducted to identify the factors associated with nutritional status. The degree of association between the independent variables and the dependent variable was assessed using odds ratios, reported with 95% confidence intervals, and a threshold of p ≤ 0.05. The prevalence of undernutrition was found to be 61.3% [95% CI: 58.1, 64.6]. The likelihood of developing undernutrition was elevated among those adolescents who were following the traditional school levels of dikuna (AOR = 4.3, 95% CI = 1.3, 13.6), kinne (AOR = 4.5, 95% CI = 1.4, 14.6), aquaquame (AOR = 9.9, 95% CI = 2.5, 39.88), tirguame (AOR = 6.4, 95% CI = 1.6, 25.6), and among those whose mothers had no formal education [AOR = 3.7, 95% CI: 1.2, 12.8]. In contrast, those adolescents who always washed their hands after a toilet visit had lower odds of undernutrition than their counterparts [AOR = 0.7, 95%CI: 0.5, 0.98]. More than three out of five participating male adolescents were undernourished. Thus, to improve the nutritional status of adolescents studying in traditional church schools, extensive health education for these adolescents is essential. Moreover, the establishment of well-resourced traditional religious school, equipped for the provision of an adequate, diversified diet, is important. Developing the habit of handwashing after visiting the toilet and before and after food preparation is also recommended for adolescent students.

Sleep disorders and severity of insomnia in emergency medical personnel

As part of this work, an analysis of the existing scientific literature on the problem of sleep disorders and insomnia in medical personnel was carried out, which showed that the real problem in emergency medical personnel has not been studied enough — basically, the study of insomnia is carried out on patients and hospital staff. The article describes the results of a survey of emergency medical personnel for the presence of insomnia and the factors causing it, sleep disorders and the severity of insomnia in accordance with the Pittsburgh Sleep Disorders Index and the Insomnia Severity Index. The study involved 60 emergency medical personnel aged 23 to 67 years, of which 70 % were women. The main identified factors leading to the development of insomnia, presented in more than 45 % of respondents, are listed in descending order of importance: overload at work, the presence of bad habits, severe stress, the presence of children or relatives who constantly need care, low physical activity. The main factors influencing sleep disorders in 47 % of respondents were also identified: a feeling of pain, cold, a feeling of warmth in 53 %, night awakenings and toilet visits. All of the above factors affect the daily activities and emotional mood of employees, which affected the daily life of 92 % of employees. The data obtained as a result of the study indicate that 93 % of emergency medical personnel have sleep disorders of varying severity, and 21 % of them already have clinically pronounced insomnia.

Evaluation of Nonpharmacologic Interventions and Sleep Outcomes in Hospitalized Medical and Surgical Patients

Inadequate sleep negatively affects patients' physical health, mental well-being, and recovery. Nonpharmacologic interventions are recommended as first-choice treatment. However, studies evaluating the interventions are often of poor quality and show equivocal results. To assess whether the implementation of nonpharmacologic interventions is associated with improved inpatient night sleep. In a nonrandomized controlled trial, patients were recruited on the acute medical unit and medical and surgical wards of a Dutch academic hospital. All adults who spent exactly 1 full night in the hospital were recruited between September 1, 2019, and May 31, 2020 (control group), received usual care. Patients recruited between September 1, 2020, and May 31, 2021, served as the intervention group. The intervention group received earplugs, an eye mask, and aromatherapy. Nurses received sleep-hygiene training, and in the acute medical unit, the morning medication and vital sign measurement rounds were postponed from the night shift to the day shift. All interventions were developed in collaboration with patients, nurses, and physicians. Sleep was measured using actigraphy and the Dutch-Flemish Patient-Reported Outcomes Measurement Information System sleep disturbance item bank. Other outcomes included patient-reported sleep disturbing factors and the use of sleep-enhancing tools. A total of 374 patients were included (222 control, 152 intervention; median age, 65 [IQR, 52-74] years). Of these, 331 were included in the analysis (195 [59%] men). Most patients (138 [77%] control, 127 [84%] intervention) were in the acute medical unit. The total sleep time was 40 minutes longer in the intervention group (control: median, 6 hours and 5 minutes [IQR, 4 hours and 55 minutes to 7 hours and 4 minutes]; intervention: 6 hours and 45 minutes [IQR, 5 hours and 47 minutes to 7 hours and 39 minutes]; P < .001). This was mainly due to a 30-minute delay in final wake time (median clock-time: control, 6:30 am [IQR, 6:00 am to 7:22 am]; intervention, 7:00 am [IQR, 6:30-7:30 am]; P < .001). Sleep quality did not differ significantly between groups. For both groups, the main sleep-disturbing factors were noises, pain, toilet visits, and being awakened by hospital staff. Sleep masks (23 of 147 [16%]) and earplugs (17 of 147 [12%]) were used most. Nightly vital sign checks decreased significantly (control: 54%; intervention: 11%; P < .001). The findings of this study suggest that sleep of hospitalized patients may be significantly improved with nonpharmacologic interventions. Postponement of morning vital sign checks and medication administration rounds from the night to the day shift may be a useful way to achieve this. Netherlands Trial Registry Identifier: NL7995.

Abnormal Perception of Urge to Defecate: An Important Pathophysiological Mechanism in Women With Chronic Constipation.

Although the association of absent or attenuated "call to stool" with constipation is well-recognized, no studies have systematically evaluated the perception of urge to defecate in a well-defined cohort of patients with chronic constipation (CC). A prospective study of 43 healthy adult women and 140 consecutive adult women attending a tertiary center for investigation of CC. All participants completed a 5-day viscerosensory questionnaire, and all women with CC also underwent anorectal physiologic investigations. Normal urge perception and abnormal urge perception were defined using a Naive Bayes model trained in healthy women (95% having normal urge). In total, 181 toilet visits in healthy women and 595 in women with CC were analyzed. Abnormal urge perception occurred in 70 (50.0%) women with CC. In this group, the urge to defecate was more often experienced as abdominal sensation (69.3% vs 41.4%; P < 0.0001), and the viscerosensory referral area was 81% larger (median pixels anterior: 1,849 vs 1,022; P < 0.0001) compared to women with CC and normal urge perception. Abnormal (vs normal) urge in women with CC was associated with more severe constipation (Cleveland Clinic constipation score: 19 vs 15 P < 0.0001), irritable bowel syndrome (45.7% vs 22.9% P < 0.0001), and a functional evacuation disorder on defecography (31.3% vs 14.3% P = 0.023). A distinct pattern of abnormal urge was found in women with CC and rectal hyposensitivity. Abnormal urge perception was observed in 50% of women with CC and was frequently described as abdominal sensation, supporting the concept that sensory dysfunction makes an important contribution to the pathophysiology of constipation.

A Smartphone App for Supporting the Self-management of Daytime Urinary Incontinence in Adolescents: Development and Formative Evaluation Study of URApp.

BackgroundDaytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes, including depressive symptoms, peer victimization, poor self-image, and problems with peer relationships. The first-line conservative treatment for UI is bladder training (standard urotherapy) that aims to establish a regular fluid intake and a timed schedule for toilet visits. The success of bladder training is strongly dependent on good concordance, which can be challenging for young people.ObjectiveThis paper aims to describe the development of a smartphone app (URApp) that aims to improve concordance with bladder training in young people aged 11 to 19 years.MethodsURApp was designed by using participatory co-design methods and was guided by the person-based approach to intervention design. The core app functions were based on clinical guidance and included setting a daily drinking goal that records fluid intake and toilet visits, setting reminders to drink fluids and go to the toilet, and recording progress toward drinking goals. The development of URApp comprised the following four stages: a review of current smartphone apps for UI, participatory co-design workshops with young people with UI for gathering user requirements and developing wireframes, the development of a URApp prototype, and the user testing of the prototype through qualitative interviews with 23 young people with UI or urgency aged 10 to 19 years and 8 clinicians. The app functions and additional functionalities for supporting concordance and behavior change were iteratively optimized throughout the app development process.ResultsYoung people who tested URApp judged it to be a helpful way of supporting their concordance with a timed schedule for toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms, including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned with the best practice guidelines for bladder training. URApp was deemed age appropriate, with all clinicians reporting that they would use it within their own clinics. Clinicians felt URApp would be of particular benefit to patients whose symptoms were not improving or those who were not engaging with their treatment plans.ConclusionsThe next stage is to evaluate URApp in a range of settings, including pediatric continence clinics, primary care, and schools. This research is needed to test whether URApp is an effective (and cost-effective) solution for improving concordance with bladder training, reducing bladder symptoms, and improving the quality of life.

Intestinal Parasite Infection and Its Association with Undernutrition among Early Adolescents in Hawassa University Technology Village, Southern Ethiopia

Background. Different studies presented negating findings of the association between intestinal parasite infections (IPIs) and undernutrition among early adolescents in Ethiopia. This study was aimed at assessing intestinal parasite infection and its association with undernutrition among early adolescents in four selected districts of the Sidama region. Method. An institution-based cross-sectional study was conducted in October 2020 among 792 early adolescents. The multistage stage sampling was applied to select 16 primary schools. Simple random sampling was applied to select study participants. Trained data collectors administered questionnaires. Stool samples were collected and analyzed. Anthropometric measurements were taken and indices were calculated using AnthroPlus software. Data were entered into and analyzed by SPSS version 25 software. Association between IPI and undernutrition was measured using multivariable analysis. The outputs are presented using an adjusted odds ratio (AOR) with 95% confidence intervals (CIs). Result. The prevalence of IPI, thinness, and stunting was 32% (95% CI: 28.7%, 35.3%), 17.5% (95% CI: 14.8%, 20.2%), and 21.5% (95 CI: 18.6%, 24.4%), respectively. The higher odds of IPIs were observed among adolescents stunted (AOR = 3.61; 95% CI: 2.44–5.33), those who are thin (AOR = 3.07; 95% CI: 2.02–4.66), those who did not wash their hands after toilet (AOR = 1.89; 95% CI: 1.35–2.66), those who ate raw meat (AOR = 1.50; 95% CI: 1.03–2.14), and those whose family did not own toilet (AOR = 1.71; 95% CI: 1.18–2.46). Conclusion. The prevalence of IPI, thinness, and stunting was high and has public health significance in the study area. IPIs were associated with stunting, thinness, lack of toilets, not washing hands after a toilet visit, and eating raw meat. Strengthening nutrition interventions, deworming programs, and health education on personal and environmental hygiene and sanitation are recommended.

Healthcare professionals in COVID-19-intensive care units in Norway: preparedness and working conditions: a cohort study

ObjectiveTo survey the healthcare professionals’ background and experiences from work with patients with COVID-19 in intensive care units (ICUs) during the first wave of the COVID-19 pandemic in Norway.DesignObservational cohort...

CN50 Let’s talk about bowel problems: The needs of rectal cancer survivors towards the healthcare professional

More sphincter saving procedures are being performed for rectal cancer. The majority of patients expects to resume life as from before diagnosis, but the reality turns out to be different when they are confronted with the low anterior resection syndrome (LARS). This is characterized by frequent toilet visits, clustering, urgency, and incontinence. Patients are unsure what to expect after treatment. Healthcare professionals seem to underestimate the impact of LARS on patients’ lives. The aim of our study was to get insight in the needs of patients with major LARS.

The post-diagnosis sleep quality of patients with Parkinson's disease

Background: Addressing the complex factors associated with Parkinson's disease (PD) requires patient interventions to be implemented by nurses and caregivers that consider personality traits and their relationship to sleep quality. Aims: To assess the sleep quality and personality traits of patients with PD pre- and post-diagnosis and determine how these factors affect patients' quality of life. Methods: The authors mailed a self-reporting questionnaire survey to all 822 members of the Japanese PD Association of Tokyo in January 2017. The overall response rate was 48.4%, and the effective response rate was 34.3%. A total of 282 participants (136 men and 146 women) were enrolled. Each patient responded to questions regarding their sex, age and primary symptoms. Participants also provided responses to questions about the hours slept per night and hours spent napping, as well as the number of toilet visits during sleep and outcomes of Type A behavioural tests. Findings: Patients with PD reported a post-diagnosis decrease in sleep time and an increase in napping time. The study subjects also reported becoming tense easily, but they did not report feeling irritated or angry. The subjective assessment indicated a post-diagnosis worsening of sleep quality in patients with PD. Conclusions: Although the underlying mechanisms of PD are not yet fully understood, patients with PD require comprehensive strategies for care that should include actions such as encouragement of patients with PD to participate in society and to perform appropriate activities that enhance sleep quality.

Dissatisfaction with school toilets is associated with bladder and bowel dysfunction.

Poor quality of school toilets is reportedly an issue in many countries and has been correlated with toilet refusal in children. The aim of this study was to evaluate the association between perceived school toilet quality, behaviour regarding toilet visits, and symptoms of bladder and bowel dysfunction (BBD). Pupils in Danish schools were invited to complete online questionnaires regarding toilet behaviour, perception of school toilet standards/quality, and symptoms of BBD. Teachers at the same schools were asked about the quality of the toilets. We recruited 19,577 children from 252 different schools. More than half of the children (50% boys and 60% girls) were dissatisfied with the toilet facilities. One-fourth of the children (28% of girls, 23% of boys) reported avoiding the use of school toilets. We found a strong correlation between being dissatisfied with school toilets, toilet avoidance, and symptoms of BBD.Conclusion: The majority of Danish children are unhappy with their school toilet facilities. Symptoms of BBD are associated with subjective toilet dissatisfaction and toilet visit postponement. Because children spend a significant part of their day at school, access to satisfactory toilet facilities is of utmost importance for their well-being. What is Known • Bladder and bowel dysfunction is common in childhood with urinary incontinence, constipation, and faecal incontinence being cardinal symptoms. • Behaviour regarding toilet visits contributes to the aetiology, and we know that toilet avoidance can lead to abnormal bladder and bowel function. What is New • Most children are not satisfied with their school toilets, and many avoid toilet visits. • Dissatisfaction with the school toilets is related to toilet avoidance and bladder and bowel dysfunction in school children regardless of age and gender.

Hand Hygiene Knowledge, Perception, and Practices among Domestic Visitors to the Prophet's Mosque in Al Madinah City Amid the COVID-19 Pandemic: A Cross-Sectional Study.

This study aimed to assess hand hygiene knowledge, perception, and practices of visitors to the Prophet’s Mosque in Al Madinah City, Saudi Arabia. Using a self-administered electronic questionnaire, a cross-sectional survey was conducted among domestic residents, who visited the mosque between 31 July and 3 August 2020. Participants’ demographic data, hand hygiene knowledge, perception, and practices were collected. Four hundred participants aged 18–65 (median 36) years completed the survey, of which 215 (53.8%) were female. The visitors’ mean knowledge score about hand hygiene was 6.4 (± standard deviation (SD) 1.35) of total 12. Most participants (392, 98%) were aware of the role of hand hygiene in preventing Coronavirus Disease 2019 (COVID-19); nevertheless, 384 (96%) said hand hygiene lowers body immunity and 316 (79%) thought <60% alcohol is sufficient for hand disinfection. Males had a higher knowledge score than females (6.46 (±1.41) vs. 6.14 (±1.27), p = 0.02) and, visitors who had no formal education scored higher than those with post-graduate education (6.88 (±1.45) vs 5.73 (±1.12), p = 0.01). Washing hands with soap and water was the predominant method practiced after a meal (365, 91.7%), after toilet visit (354, 88.5%), after touching a surface (262, 65.7%), after waste disposal (332, 83.2%), and when hands were visibly dirty (357, 89.5%). Al Madinah visitors had moderate knowledge about hand hygiene, but demonstrated some knowledge gaps and negligence in practice that are crucial to curb the spread of COVID-19.

Potential of Ambient Sensor Systems for Early Detection of Health Problems in Older Adults.

Background: Home monitoring sensor systems are increasingly used to monitor seniors in their apartments for detection of emergency situations. The aim of this study was to deliver a proof-of-concept for the use of multimodal sensor systems with pervasive computing technology for the detection of clinically relevant health problems over longer time periods.Methods: Data were collected with a longitudinal home monitoring study in Switzerland (StrongAge Cohort Study) in a cohort of 24 old and oldest-old, community-dwelling adults over a period of 1 to 2 years. Physical activity in the apartment, toilet visits, refrigerator use, and entrance door openings were quantified using a commercially available passive infrared motion sensing system (Domosafety S.A., Switzerland). Heart rate, respiration rate, and sleep quality were recorded with the commercially available EMFIT QS bed sensor device (Emfit Ltd., Finland). Vital signs and contextual data were collected using a wearable sensor on the upper arm (Everion, Biovotion, Switzerland). Sensor data were correlated with health-related data collected from the weekly visits of the seniors by health professionals, including information about physical, psychological, cognitive, and behavior status, health problems, diseases, medication, and medical diagnoses.Results: Twenty of the 24 recruited participants (age 88.9 ± 7.5 years, 79% females) completed the study; two participants had to stop their study participation because of severe health deterioration, whereas two participants died during the course of the study. A history of chronic disease was present in 12/24 seniors, including heart failure, heart rhythm disturbances, pulmonary embolism, severe insulin-dependent diabetes, and Parkinson's disease. In total, 242,232 person-hours were recorded. During the monitoring period, 963 health status records were reported and repeated clinical assessments of aging-relevant indicators and outcomes were performed. Several episodes of health deterioration, including heart failure worsening and heart rhythm disturbances, could be captured by sensor signals from different sources.Conclusions: Our results indicate that monitoring of seniors with a multimodal sensor and pervasive computing system over longer time periods is feasible and well-accepted, with a great potential for detection of health deterioration. Further studies are necessary to evaluate the full range of the clinical potential of these findings.

N30 Experience of living with intestinal failure: a systematic review of qualitative studies

Abstract Background Intestinal failure (IF) affects about 2000 people with Crohn’s disease (CD) in the UK. It is a result of the most severe phenotype of CD where an individual can no longer obtain sufficient nutrients from their gut to sustain life without supplementation in the form of parenteral nutrition (PN) or fluids intravenously and most have a stoma. Many cannot tolerate any food and very little drink by mouth. Such individuals usually need a permanent central venous catheter and must have an infusion of PN overnight, all or most nights in the week, often for 10–12 h at the time. Complications such as infection or thrombosis of the central line are a constant risk. This treatment must often continue for life. This systematic review aimed to explore the experience of people living with IF and the impact of the condition on their daily lives. Methods The following databases were searched in July 2019: MEDLINE, PubMed, PsychINFO, Web of Science and Global Health Scopus. Search terms included ‘intestinal failure’, ‘short bowel syndrome’, ‘quality of life’ (QoL) and terms relating to psychosocial functioning. English language articles were retrieved and screened by one reviewer at title and abstract, ratified by a second reviewer. The resulting articles selected at abstract were screened at full text by 3 reviewers. Results Eight papers, based on 7 studies, were included with a total of 97 participants: 36 male, 61 female. The age range of adults was 28–83. One study was conducted in children, with age range of 7–17. In 5 studies, all participants were on HPN. In 2 studies, 4/6 and 7/10 participants were on HPN respectively. There was one overarching theme: ‘Complications and challenges of living with IF’, with three specific themes that reflect the patients’ experience: (1) ‘Eating for survival’ encompasses the perpetual need to eat in order to make up for the large quantities of nutrients lost due to malabsorption (2) ‘Life with HPN: nutritional safety net at a price’ describes relief from the pressure to eat for survival but with drawbacks such as restrictions on social activities and risk of catheter line infections. (3) ‘Benefits and pitfalls of having a stoma’ relates to benefits of having a stoma, such as reduced frequency of toilet visits, and the accompanying inconvenience of leaks, high output and negative body image. Conclusion Living with IF has many challenges. Patients struggle with retaining enough nutrients and the physical and technical difficulties with having HPN and/or a stoma. The psychosocial well-being in these patients is affected by these challenges, as a result. Overall, QoL is poor and currently very little is being done to improve this.

The Influence of Prolongation of Interruptions of Preoperative Posturing and Other Clinical Factors on the Progress of Macula-On Retinal Detachment

To evaluate whether prolongation of interruptions of preoperative posturing by sitting upright influences retinal detachment (RD) progression. The secondary objective was to find clinical factors to identify patients with a high risk for RD progression. Prospective cohort study. One hundred ninety-eight patients divided among 3 cohorts of patients with macula-on RD were included. Inclusion criteria were volume OCT scans of sufficient quality and smallest distance from the fovea to the detachment border of at least 1.25 mm. In the second and third cohort, 50 patients with only superior temporal RD were included. Patients were admitted to the ward in anticipation of surgery. Preoperative bed rest and positioning were prescribed. The position of the RD border was determined based on OCT imaging performed at baseline, before and after the usual interruptions for meals or toilet visits. The duration of interruptions was prolonged with sitting upright for 20 minutes in cohort 2 and for 40 minutes in cohort 3. Various secondary outcome measures were defined, such as the baseline area of subretinal fluid (SRF) as measured on ultrasound images in the third cohort. The RD border displacement was determined. The worst RD progression from baseline was given by the shortest distance to the fovea in any of the OCT scans during follow-up. The worst relative RD progression from baseline was defined as the worst RD progression from baseline as a percentage of the baseline distance between RD border and fovea. The median duration of interruptions was 22, 41, and 58 minutes in cohorts 1, 2, and 3, respectively. The median RD border displacement during interruptions in patients with superior temporal RD was not significantly different among the cohorts (P= 0.28). The correlation coefficient between the SRF area at baseline and worst relative RD progression from baseline was 0.37 (95% confidence interval, 0.04-0.66; P= 0.009). We did not find a significant increase in RD progression after prolongation of interruptions by sitting upright. Patients with a larger area of SRF on ultrasound showed more RD progression from baseline.

The status and influencing factors of sleep quality for home-care colostomy patients with colorectal cancer

Objective To investigate the level and influence factors of sleep quality for home-care colostomy patients with colorectal cancer. Methods The Pittsburgh sleep quality index were administered on 170 patients with colorectal cancer. Results The score of global Pittsburgh Sleep Quality Index (PSQI) was 7.193±4.355, which was significantly higher than 3.88±2.52 of the norm. And 37.3% (62/166) of colostomy patients with colorectal cancer reported poor sleep quality. 37.3% (62/166) of patients didn′t get 6 hours' sleep every night. The major reasons for sleep disturbance were night toilet visits, 22.3% (37/166) of patients went to night toilet more than 3 times per week. Logistic regression analysis showed that the type of colostomy (OR=1.969, P=0.012) and discharge time (OR=2.092, P=0.000) were influencing factors of sleep quality. Conclusion The sleep quality of colostomy patients with colorectal cancer were worse than normal people, and their sleep time were prevalent. The type of colostomy and discharge time were major influencing factors of sleep quality. Key words: Colorectal neoplasms; Ostomy; Sleep hygiene; Influencing factors

The sources of water supply, sanitation facilities and hygiene practices in oil producing communities in central senatorial district of Bayelsa state, Nigeria

Background: It has been estimated that 100million Nigerians still lack basic sanitation facilities and 63 million also do not have access to portable drinking water and as many as 80% of all diseases worldwide are related to unsafe water as well as poor environmental hygiene. Most infectious, diseases are caused by living organisms, such as bacteria, viruses, or parasitic worms, and a disease is transmitted by the passing of these organisms from one person's body to another or through intermediate hosts. The World Bank reports that 30% of the total disease burden in developing countries results from contamination at the household level and that 75% of life years lost within this 30% are due to lack of good water supply and sanitation and the prevalence of risky hygiene behaviour. This study aimed to assess the sources of water supply, sanitation facilities and hygiene practices in oil producing communities in Central Senatorial District of Bayelsa State. Materials and method: The study designs adopted for this research work were quantitative analysis and descriptive research method. The study population covered all housing units in the randomly selected communities in the central senatorial district of Bayelsa state. The 400 sample size for housing units was determined using the Taro Yamane formula, and systematic sampling method was used with a sampling interval of three. A 26-item administered closed-ended structured questionnaire was used. Data was collected from 296 out of 400 questionnaires and analysed using descriptive statistics with frequency counts and simple percentages using SPSS. Results: The result identified multiple sources of water supply which includes rain, river/stream, pipe borne, borehole and hand-dug well with borehole being the major source (91%). The major toilet facility used was the flush toilet (45%) and majority of residents clean their toilet once weekly (60%), however, about half of the residents (51%) practice unsafe excreta disposal. Hygiene practices such as bathing occurred among all resident at least once daily and hand washing was frequent after toilet visit (73%) but not before eating (35%). Conclusion: Water supply was seen to be relatively adequate, but its quality was poor, necessitating treatment. Unsafe excreta disposal is still widely practiced. Critical hand washing practice was still poor amongst residents. The State and Local Government including Oil companies in oil producing communities in Central Senatorial District should provide adequate portable water and sanitation facilities in public places with hygiene enlightenment campaign.