Vulnerable Phase Research Articles

A multi-center pediatric to adult care transition intervention program to improve clinic visit adherence and clinical outcomes among adolescents and emerging adults with type 1 diabetes mellitus [PATHWAY]: Protocol for a randomized controlled trial

ObjectiveThis multi-center randomized controlled trial aims to evaluate the effectiveness of a context-specific transition intervention program to improve clinic visit adherence and clinical outcomes among emerging adults with type 1 diabetes mellitus (T1DM) in Delhi, India. MethodsWe will recruit patients with T1DM of duration ≥1 year and age 15–19.5 years from the participating pediatric sites. After a baseline assessment and a “basic introductory session”, which apprises participants about the concept of transition, study participants (proposed sample size =156) will be randomly allocated into an intervention and control arm. Participants in the intervention arm will receive a structured transition program delivered over 15 months. On the other hand, control arm participants will continue to receive usual care from the pediatric site till the time of transfer to the adult site. The study assessments will be done at baseline, at the time of transfer, and at 1 and 2 years following the transfer. The primary outcome is the difference in clinic attendance rate between intervention and control arms at the end of 1 year post-transfer. The secondary outcomes include the difference in clinic attendance rate at the end of 2 years, the difference in proportion of participants with a minimum of 4 visits in the first follow-up year, and process indicators such as diabetes knowledge and self-management skills, diabetes treatment satisfaction, overall quality of life, diabetes-related distress, hospitalization for acute complications and screening for chronic diabetes complications, and HbA1c. ConclusionThis study will provide important new evidence about a potential strategy to improve clinical care among adolescents and emerging adults with T1DM in lower resource contexts during the vulnerable phase of transition from pediatric to adult healthcare.The trial is registered on the Clinical Trials Registry of India (http://ctri.nic.in) under the CTRI registration number CTRI/2020/10/028379.

ProTransition – evaluation of an online-course for professionals to optimize the health care service for young people with mental illness in transition from adolescence to adulthood

IntroductionAdolescent transitions to adulthood are a vulnerable phase for the development of mental illnesses. Additionally, there are often disruptions in psychiatric care delivery during the transition phase, potentially leading to a considerable treatment delay with a high risk of early chronification. Thus, the health care system and professionals in both child and adolescent psychiatry and adult psychiatry should give greater consideration to the transition phase.ObjectivesAn online-course addressing health care professionals was developed to give in-depth knowledge of “transition psychiatry”, practical guidance and to sensitize for the special challenges and needs of young adults with mental illness. Evaluation focuses on the gain of competences, benefit for practical work and user satisfaction.MethodsParticipants´ estimations and opinions on quality of the online-course, on impact of course participation to their practical work and on their competences regarding transition psychiatry are assessed with an online-survey before starting (t1) and after finishing (t2) the online-course. T1-assessment is already completed with 1924 datasets, t2-assessmend will take place 02/2022.ResultsAnalyses of t1-assessment show a high heterogeneity of participants regarding their work background and setting. Special knowledge about mental illnesses during transition and about transition psychiatry, as well as feeling confident in accompanying transition processes is on a medium level. Results of t2-assessment and comparing analyses are expected in March 2022 and will be presented.ConclusionsThere was high interest of the target group in participating in the online-course. Evaluation will show if the online-course is a helpful measure in delievering the necessary education of professionals in transition psychiatry.DisclosureNo significant relationships.

Design of a Remote Coaching Program to Bridge the Gap From Hospital Discharge to Cardiac Rehabilitation: Intervention Mapping Study.

BackgroundRemote coaching might be suited for providing information and support to patients with coronary artery disease (CAD) in the vulnerable phase between hospital discharge and the start of cardiac rehabilitation (CR).ObjectiveThe goal of the research was to explore and summarize information and support needs of patients with CAD and develop an early remote coaching program providing tailored information and support.MethodsWe used the intervention mapping approach to develop a remote coaching program. Three steps were completed in this study: (1) identification of information and support needs in patients with CAD, using an exploratory literature study and semistructured interviews, (2) definition of program objectives, and (3) selection of theory-based methods and practical intervention strategies.ResultsOur exploratory literature study (n=38) and semistructured interviews (n=17) identified that after hospital discharge, patients with CAD report a need for tailored information and support about CAD itself and the specific treatment procedures, medication and side effects, physical activity, and psychological distress. Based on the preceding steps, we defined the following program objectives: (1) patients gain knowledge on how CAD and revascularization affect their bodies and health, (2) patients gain knowledge about medication and side effects and adhere to their treatment plan, (3) patients know which daily physical activities they can and can’t do safely after hospital discharge and are physically active, and (4) patients know the psychosocial consequences of CAD and know how to discriminate between harmful and harmless body signals. Based on the preceding steps, a remote coaching program was developed with the theory of health behavior change as a theoretical framework with behavioral counseling and video modeling as practical strategies for the program.ConclusionsThis study shows that after (acute) cardiac hospitalization, patients are in need of information and support about CAD and revascularization, medication and side effects, physical activity, and psychological distress. In this study, we present the design of an early remote coaching program based on the needs of patients with CAD. The development of this program constitutes a step in the process of bridging the gap from hospital discharge to start of CR.

Belief that only fair is beautiful and its impact on teenage girls

Background: Young minds are being driven towards wanting fair skin by the quest of only ‘fair is beautiful’. Adolescent girls who are going through this vulnerable phase of puberty are highly prone to fall prey to this mindset they are being exposed to everyday and may develop body image issues, lack of self-esteem and low confidence. Material and methods: This descriptive cross-sectional study was conducted among 500 adolescent girls in 10 senior secondary schools of a rural block of district Rohtak, Haryana from April 2019- Jan 2020. Results: Out of the 500 participants, 138 (27.7%) were not satisfied with their skin color and among them, nearly half (44.6%) were using fairness cream. Among the study subjects who had body image issues, 65% were dissatisfied with their skin color and this association was also found to highly significant. (p=0.000). Association between socio-economic status, age group and skin color satisfaction were also found to be significant. Conclusion: Fairness cream market and social media perpetuates the ideology that being fair will secure you jobs, get you appreciated by the opposite gender and in general make you happy. T

Biomimetic Silk Macroporous Materials for Drug Delivery Obtained via Ice-Templating.

Silk from Bombyx mori is one of the most exciting materials in nature. The apparently simple arrangement of its two major components─two parallel filaments of silk fibroin (SF) coated by a common sericin (SS) sheath─provides a combination of mechanical and surface properties that can protect the moth during its most vulnerable phase, the pupal stage. Here, we recapitulate the topology of native silk fibers but shape them into three-dimensional porous constructs using an unprecedented design strategy. We demonstrate, for the first time, the potential of these macroporous silk foams as dermal patches for wound protection and for the controlled delivery of Rifamycin (Rif), a model antibiotic. The method implies (i) removing SS from silk fibers; (ii) shaping SF solutions into macroporous foams via ice-templating; (iii) stabilizing the SF macroporous foam in a methanolic solution of Rif; and (iv) coating Rif-loaded SF foams with a SS sheath. The resulting SS@SF foams exhibit water wicking capacity and accommodate up to ∼20% deformation without detaching from a skin model. The antibacterial behavior of Rif-loaded SS@SF foams against Staphylococcus aureus on agar plates outperforms that of SF foams (>1 week and 4 days, respectively). The reassembly of natural materials as macroporous foams─illustrated here for the reconstruction of silk-based materials─can be extended to other multicomponent natural materials and may play an important role in applications where controlled release of molecules and fluid transport are pivotal.

Social and Regional Factors Predict the Likelihood of Admission to a Nursing Home After Acute Hospital Stay in Older People With Chronic Health Conditions: A Multilevel Analysis Using Routinely Collected Hospital and Census Data in Switzerland.

If hospitalization becomes inevitable in the course of a chronic disease, discharge from acute hospital care in older persons is often associated with temporary or persistent frailty, functional limitations and the need for help with daily activities. Thus, acute hospitalization represents a particularly vulnerable phase of transient dependency on social support and health care. This study examines how social and regional inequality affect the decision for an institutionalization after acute hospital discharge in Switzerland. The current analysis uses routinely collected inpatient data from all Swiss acute hospitals that was linked on the individual level with Swiss census data. The study sample included 60,209 patients 75 years old and older living still at a private home and being hospitalized due to a chronic health condition in 199 hospitals between 2010 and 2016. Random intercept multilevel logistic regression was used to assess the impact of social and regional factors on the odds of a nursing home admission after hospital discharge. Results show that 7.8% of all patients were admitted directly to a nursing home after hospital discharge. We found significant effects of education level (compulsory vs. tertiary education OR = 1.16 (95% CI: 1.03–1.30), insurance class (compulsory vs. private insurance OR = 1.24 (95% CI: 1.09–1.41), living alone vs. living with others (OR = 1.64; 95% CI: 1.53–1.76) and language regions (French vs. German speaking part: OR = 0.54; 95% CI: 0.37–0.80) on the odds of nursing home admission in a model adjusted for age, gender, nationality, health status, year of hospitalization and hospital-level variance. The language regions moderated the effect of education and insurance class but not of living alone. This study shows that acute hospital discharge in older age is a critical moment of transient dependency especially for socially disadvantaged patients. Social and health care should work coordinated together to avoid unnecessary institutionalizations.

Vulnerable Phase of Acute Heart Failure and its Association with Hospital Readmissions Reduction Program.

To determine the prevalence, characteristics and association with prognosis of left bundle branch block (LBBB) in 3 different cohorts of patients with acute heart failure (AHF).We retrospectively analyzed 12,950 patients with AHF who were included in the EAHFE (Epidemiology Acute Heart Failure Emergency), RICA (National Heart Failure Registry of the Spanish Internal Medicine Society), and BASEL-V (Basics in Acute Shortness of Breath Evaluation of Switzerland) registries. We independently analyzed the relationship between baseline and clinical characteristics and the presence of LBBB and the potential association of LBBB with 1-year all-cause mortality and a 90-day postdischarge combined endpoint (Emergency Department reconsultation, hospitalization or death). The prevalence of LBBB was 13.5% (95% confidence interval: 12.9%–14.0%). In all registries, patients with LBBB more commonly had coronary artery disease and previous episodes of AHF, were taking chronic spironolactone treatment, had lower left ventricular ejection fraction and systolic blood pressure values and higher NT-proBNP levels. There were no differences in risk for patients with LBBB in any cohort, with adjusted hazard ratios (95% confidence interval) for 1-year mortality in EAHFE/RICA/BASEL-V cohorts of 1.02 (0.89–1.17), 1.15 (0.95–1.38) and 1.32 (0.94–1.86), respectively, and for 90-day postdischarge combined endpoint of 1.00 (0.88–1.14), 1.14 (0.92–1.40) and 1.26 (0.84–1.89). These results were consistent in sensitivity analyses.Less than 20% of patients with AHF present LBBB, which is consistently associated with cardiovascular comorbidities, reduced left ventricular ejection fraction and more severe decompensations. Nonetheless, after taking these factors into account, LBBB in patients with AHF is not associated with worse outcomes.

Germination Process of Bud Chips of 3 Commercial Sugarcane (Saccharum officinarum L) Varieties at PT. Gunung Madu Plantations

The increase in demand for sugarcane (Saccharum officinarum L) as an industrial raw material is not accompanied by an increase in national sugarcane production. The decline in sugarcane production was due to errors in cultivation. In the growth phase, germination is the most critical and vulnerable phase, resulting in sugarcane cultivation and subsequent sugarcane growth. The purpose of this study was to determine the germination process of bud chips of 3 commercial sugarcane varieties. The experiment was carried out in March-May 2021 at the Research and Development experimental garden of PT. GMP uses a Randomized Block Design. There were 3 varieties observed, namely GMP3, GMP5, and GMP7. Each Bud chip was planted using an individual technique with a spacing of 50 cm and covered with soil. Observations were made until the 30th day after planting. The results showed that the GMP7 and GMP3 varieties included varieties that had the most stable type of germination and relatively fast organ growth stages, while the GMP5 variety had a relatively slow germination type for each organ formation and plant growth.

Investigation of the species composition and harmfulness of dominant phytophages of onions in the Right-Bank Forest-Steppe of Ukraine

The research is aimed at studying the species composition, dynamics of the number and harmfulness of dominant pests, which is extremely important for the development and improvement of elements of the onion protection system. After all, the analysis of literature sources showed insufficient information about the distribution and harmfulness of the main phytophages under modern conditions of growing onions in the Right Bank Forest-Steppe of Ukraine.
 We conducted the monitoring of the phytosanitary condition of onion crops during 2017–2020 and determined the species composition of dominant phytophages. We studied the complex of soil pests: larvae of Melolontha sp., the population density of which over the years of research was 0.8–2.5 specimens/m2, larvae of Elateridae sp., or click beetles (wireworms) – 0.9–2.2 specimens/m2 and Gryllotalpa gryllotalpa L. – 2.5 specimens/m2. Dominant species of phytophages in onion crops included onion fly (Delia Antigua Mg.), onion thrips (Trips tabaci Lind.), and Ceuthorrhynchus jakovlevi Schultze.
 The four most vulnerable phases of growth and development of onions before colonization and damage by major phytophages were identified:
 1) phase of leaf development (a primary shoot) (ВВСН 1–19);
 2) phase of the beginning of thickening of leaf base – bulb formation (ВВСН 41–43);
 3) phase of bulb formation – beginning of leaf splitting (ВВСН 45–47);
 4) phase of the completion of growth and development (state of physiological rest) (ВВСН 48–49)

Impact of diabetes and on-arrival hyperglycemia on short-term outcomes in acute heart failure patients.

The impact of diabetes mellitus (DM) and hyperglycemia on short-term prognosis in patients with acute heart failure (AHF) remains controversial as most data comes from series of hospitalized patients. Our purpose was to analyze outcomes in a nation-wide registry of AHF patients attended in emergency department (ED). ED AHF patients were prospectively enrolled, with the index event and the vulnerable post-discharge phase outcomes recorded. The influence of presenting hyperglycemia (> 180mg/dL) and DM treatment on prognosis were also investigated. All results were adjusted (a) for baseline characteristics. Of 9192 enrolled AHF patients, 4544 (49,4%) were diabetic, with 24% of diabetics and 25.1% of non-diabetic (p = 0.247) directly discharged from the ED also included. Diabetics had higher rates of comorbidities, but were slightly younger and had lower in-hospital and 30day all-cause mortality than non-diabetics (a-OR = 0.827, 95% CI = 0.690-0980; and a-HR = 0.850, 95% CI = 0.814-1.071, respectively). Conversely, hyperglycemia on-arrival was associated with increased in-hospital, and 30day all-cause mortality, in both DM (a-OR = 1.933, 95% CI = 1.378-2.712, and a-HR = 1.590, 95% CI = 1.304-1.938, respectively) and non-DM patients (a-OR = 1.498, 95% CI = 1.175-1.909, and a-HR = 1.719, 95% CI = 1.306-2.264, respectively). However, during the vulnerable phase, diabetics had worse short-term outcomes, with higher rates of ED-revisit and rehospitalization. These worse outcomes seemed to be unrelated to the severity of DM. In patients with AHF attended in ED, diabetes was associated with lower index event case fatality, but higher rates of rehospitalization and re-consultation in the vulnerable post-discharge period. Conversely, hyperglycemia at hospital arrival was strongly associated with early mortality, regardless of diabetes status.

Traumatization in the Medical Profession: Initiating Events, Roles and Process Factors

Physicians show an increased prevalence of post-traumatic stress disorder (PTSD). Potentially traumatic events in the medical profession include confrontation with suffering, death, violent experiences, and medical errors. The aim of the present analysis is to record traumatic events (TE) in physicians seeking help and to qualitatively analyze the roles and process factors involved. Using an online questionnaire, physicians who had experienced a traumatic event (TE) were surveyed regarding posttraumatic stress (PCL-5), depression (PHQ-9), alcohol abuse (CAGE test), and suicidality (BSIS). Reports of TEs were qualitatively analyzed using structured content analysis. N=41 physicians described at least one TE. K=54 descriptions of TEs were qualitatively analyzed. In some cases, the physicians were victims of e. g., accidents or violence; in other cases, they were involved as witnesses or helpers. The following themes could be identified: Accompaniment of and confrontation with suffering and dying, negative courses of treatment (especially complications and medical errors), and lack of support (especially lack of error management). 53,7% of physicians had PTSD, and 36,6% showed symptoms of posttraumatic stress. Harmful alcohol use was observed in 24,4% of the sample. Psychotropic medication was taken by 31,7% of the respondents. The results show a high burden of TE in the medical profession. In this context, physicians are affected by traumatization in their role as victims, witnesses, or treatment providers and confronted with the death or dying process of others. Residency presumably represents a particularly vulnerable phase. Easily accessible forms of therapy (e. g., online therapy), structural changes (e. g., adequate support for residents), and programs for functional error management in hospitals could have a positive effect on the mental health of physicians.

Treatment and progression management of acute kidney injury

Acute kidney injury (AKI) represents one of the greatest global health challenges and is associated with high mortality. The often multifactorial etiology and complex pathophysiological mechanisms have so far hampered the development of causal therapeutic options. The treatment should be stage-adapted according to the current KDIGO guideline: avoid nephrotoxicity, optimize volume status and perfusion pressure, monitor serum creatinine, urine output and proteinuria. New insights into the influence of mitochondrial dysfunction and cellular senescence in AKI, well-defined study endpoints, and innovations through nanotechnology may enable targeted drug-based AKI therapy in the future. Especially the weeks following an AKI are a vulnerable phase and crucial for progression management.

Associated mRNAs coordinate biogenesis of functionally related ion channels

Expression of ion channels underlying the heart’s rhythmic beating must be precisely coordinated to fulfill their physiological roles and protect the heart from arrhythmias. How cells determine proper ratios of different ion channels mediating repolarization, the most vulnerable phase of the ventricular action potential, is poorly understood. Analysis of publicly available RNAseq databases revealed hERG1a transcripts are positively correlated with other ion channels, namely SCN5A, CACNA1C, KCNQ1, and KCND2/3 in heart (R=0.91-0.96), but not, e.g., adipose tissue (−0.58-0.26).

Determinants of maternal influenza vaccination in the context of low- and middle-income countries: A systematic review.

Pregnancy and early infancy are considered to be the vulnerable phases for severe influenza infection causing morbidity and mortality. Despite WHO recommendations, influenza is not included in the immunization programs of many low- and middle-income countries. This systematic review is aimed at identifying barriers and facilitators for maternal influenza vaccination amongst the perinatal women and their health care providers in low- and middle-income countries. We selected 11 studies from the 1669 records identified from PubMed, CABI, EMBASE and Global Health databases. Studies related to both pandemic and routine influenza vaccination and studies conducted amongst women in the antenatal as well as postnatal period were included. Both qualitative, quantitative, cross-sectional and interventional studies were included. Knowledge about influenza disease, perception of the disease severity during pregnancy and risk to the foetus/newborn and perceived benefits of influenza vaccination during pregnancy were associated with increased uptake of influenza vaccination during pregnancy. Recommendation by health care provider, vaccination in previous pregnancy and availability of vaccine in public health system facilitated vaccine uptake. High parity, higher education, vaccination in the later months of pregnancy, less than 4 antenatal visits, concerns about vaccine safety and negative publicity in media were identified as barriers for influenza vaccination. Lack of government recommendation, concerns about safety and effectiveness and distrust in manufacturer were the barriers for the healthcare providers to recommend vaccination. While availability of influenza vaccine in public health system can be a key to the success of vaccine implementation program, increasing the awareness about need and benefits of maternal influenza vaccination amongst pregnant women as well as their health care providers is crucial to improve the acceptance of maternal influenza vaccination in low and middle-income countries.

Starting at Birth: An Integrative, State-of-the-Science Framework for Optimizing Infant Neuromotor Health.

Numerous conditions and circumstances place infants at risk for poor neuromotor health, yet many are unable to receive treatment until a definitive diagnosis is made, sometimes several years later. In this integrative perspective, we describe an extensive team science effort to develop a transdiagnostic approach to neuromotor health interventions designed to leverage the heightened neuroplasticity of the first year of life. We undertook the following processes: (1) conducted a review of the literature to extract common principles and strategies underlying effective neuromotor health interventions; (2) hosted a series of expert scientific exchange panels to discuss common principles, as well as practical considerations and/or lessons learned from application in the field; and (3) gathered feedback and input from diverse stakeholders including infant caregivers and healthcare providers. The resultant framework was a pragmatic, evidence-based, transdiagnostic approach to optimize neuromotor health for high-risk infants based on four principles: (a) active learning, (b) environmental enrichment, (c) caregiver engagement, and (d) strength-based approaches. In this perspective paper, we delineate these principles and their potential applications. Innovations include: engagement of multiple caregivers as critical drivers of the intervention; promoting neuromotor health in the vulnerability phase, rather than waiting to treat neuromotor disease; integrating best practices from adjacent fields; and employing a strengths-based approach. This framework holds promise for implementation as it is scalable, pragmatic, and holistically addresses both the needs of the infant and their family.

Associations of Wellbeing Levels, Changes, and Within-Person Variability With Late-Life All-Cause Mortality Across 12 Years: Contrasting Hedonic vs. Eudaimonic Wellbeing Among Very Old Adults.

Advanced old age has been characterized as a biologically highly vulnerable life phase. Biological, morbidity-, and cognitive impairment-related factors play an important role as mortality predictors among very old adults. However, it is largely unknown whether previous findings confirming the role of different wellbeing domains for mortality translate to survival among the oldest-old individuals. Moreover, the distinction established in the wellbeing literature between hedonic and eudaimonic wellbeing as well as the consideration of within-person variability of potentially relevant mortality predictors has not sufficiently been addressed in prior mortality research. In this study, we examined a broad set of hedonic and eudaimonic wellbeing indicators, including their levels, their changes, as well as their within-person variability, as predictors of all-cause mortality in a sample of very old individuals. We used data from the LateLine study, a 7-year longitudinal study based on a sample of n = 124 individuals who were living alone and who were aged 87–97 years (M = 90.6, SD = 2.9) at baseline. Study participants provided up to 16 measurement occasions (mean number of measurement occasions per individual = 5.50, SD = 4.79) between 2009 and 2016. Dates of death were available for 118 individuals (95.2%) who had deceased between 2009 and 2021. We ran longitudinal multilevel structural equation models and specified between-person level differences, within-person long-term linear change trends, as well as the “detrended” within-person variability in three indicators of hedonic (i.e., life satisfaction and positive and negative affect) and four indicators of eudaimonic wellbeing (i.e., purpose in life, autonomy, environmental mastery, and self-acceptance) as all-cause mortality predictors. Controlling for age, gender, education, and physical condition and testing our sets of hedonic and eudaimonic indictors separately in terms of their mortality impact, solely one eudaimonic wellbeing indicator, namely, autonomy, showed significant effects on survival. Surprisingly, autonomy appeared “paradoxically” related with mortality, with high individual levels and intraindividual highly stable perceptions of autonomy being associated with a shorter residual lifetime. Thus, it seems plausible that accepting dependency and changing perceptions of autonomy over time in accordance with objectively remaining capabilities might become adaptive for survival in very old age.

The Effects of Analgesics on the Migration of Pancreatic Cancer Cells.

Adenocarcinoma of the pancreas is one of the most aggressive malignant diseases in humans. Characteristics of this tumour type are poor response to radiotherapy and chemotherapeutic agents as well as metastasis in the absence of an organ capsule. The best therapeutic option is surgical removal of the tumour followed by chemotherapy or radiotherapy. Yet, even after surgical R0-resection, the 5-year survival probability is only about 20% because of the high recurrence rate of this tumour and complications due to metastases. Furthermore, recent studies have shown that the perioperative period is a particularly vulnerable phase, during which tumour progression and metastasis may be facilitated. The effects of analgesics administered during the perioperative period are still unknown. The present work investigated the effects of analgesics on pancreatic cancer cell migration in vitro. The migratory potential of pancreatic cancer cells was analysed using a Cell Migration Assay Kit with a Boyden chamber, in which cells migrate through a semi-permeable membrane under different stimuli. Cell concentration was measured by reading fluorescence (Ex/Em=530/590 nm) in a plate reader. Migration in PANC-1 pancreatic cancer cells was significantly decreased after 24 h stimulation with 100 μM of ropivacaine, 100 nM of sufentanil, 1,000 μM of ropivacaine and 1,000 nM of sufentanil. In the PaTu 8988t cell line, incubation with 10 μM of ropivacaine caused a slight but statistically significant increase in migration, whereas lidocaine, metamizole and paracetamol did not significantly affect migration. The risk of tumour progression and metastasis seems to be increased during major oncological surgical interventions. The recent advances in the molecular and biological understanding of pathogenesis of pancreatic cancer have not yet significantly improved patient outcome. Therefore, further studies are needed to identify the underlying mechanisms of this aggressive tumour and establish new therapeutic options for the future.

AN EVALUATION OF GOVERNMENT SUPPORT SERVICES FOR SMMEs IN THOHOYANDOU, SOUTH AFRICA

Small, Medium, and Micro Enterprises (SMMEs) possess attributes akin to entrepreneurship that make them indispensable tools for economic growth and development. While SMMEs have a direct impact on economic growth in advanced economies, these enterprises have a high failure rate due to a variety of reasons, especially during the start-up and growth phases. Government support schemes have been availed to SMMEs to assist them to survive the vulnerable phases of their existence. This study investigates the role of government support services towards the development and growth of SMMEs in South Africa. The quantitative research design used the survey method to collect data from a sample of one hundred (100) SMMEs in Thohoyandou, South Africa. The Statistical Package for Social Sciences (SPSS) was used to analyse the data, and presentation used descriptive analysis. The main study revealed that despite the government support schemes and initiatives, the failure rate of SMMEs remains high. The major factors affecting the uptake of government support schemes and initiatives included the lack of information and access to the financial assistance offered to most SMMEs through the government schemes. Despite the support schemes and initiatives, further challenges include the proliferating myriad of rules and regulations in the regulatory environment curtailing the operations and survival of SMMEs. Study findings indicated that despite the existence of the growth and development-oriented government support schemes, most SMMEs are unaware of their existence while other enterprises find them ineffective. The main conclusions point to the information deficit and needs analysis that would tailor-make and accommodate the specific requirements of different enterprises.

A study of prevalence and psychological correlates of premenstrual syndrome and premenstrual dysphoric disorder

Background: The premenstrual period is a vulnerable phase for prevalence of bodily and psychological signs and symptoms named the premenstrual syndrome (PMS). There is a paucity of Indian work in this area. Aim: The aim was to study the prevalence and psychological correlates of PMS and premenstrual dysphoric disorder (PMDD). Materials and Methods: This cross-sectional study was carried out in a tertiary care hospital after obtaining the institute ethics committee clearance. Written informed consent was obtained from participants. By purposive sampling, 587 females from urban areas of Pimpri and Alandi were interviewed and subjected to the sociodemographic pro forma and the Premenstrual Symptoms Screening Tool, Menstrual Symptom Questionnaire, Pittsburgh Sleep Quality Index, and Depression Anxiety Stress Scale-21. From this sample, 140 subjects meeting diagnostic criteria of PMS or PMDD were included in the study group. An equal number of age-matched healthy controls with no known psychiatric disorders after clinical interview were included in the control group. All the questionnaires were scored as per the test manuals. Statistical analysis was performed using the SPSS. Results: It was observed that 63.57% of the total cases are moderate PMS, 30.71% are severe PMS, and 5.71% are PMDD. Overall, the more common type of dysmenorrhea was the spasmodic type, but among the PMS/PMDD cases, the more common type of dysmenorrhea was the congestive type. There is significantly higher stress, anxiety, and depression and poorer sleep quality in the cases of PMS and PMDD as compared to the controls. Stress, anxiety, and depression have a significant positive correlation with poor sleep quality. Conclusions: The prevalence of PMS was 22.49% and that of PMDD was 1.36%. Congestive kind of dysmenorrhea was more frequently seen in cases of PMS. There is significantly higher stress, anxiety, depression, and disturbed sleep in females suffering from PMS and PMDD as compared to the controls.

Giant Tumors of the Breast in Adolescence: Clinical Algorithm for Reconstruction of Young Patients in Thelarche

Introduction: Breast tumors such as cystosarcoma phylloides and fibroadenoma may show rapid growth and occur early in thelarche. In adolescents, tumor growth often remains unnoticed due to a lack of breast awareness or a sense of shame in these young girls. The necessity for surgical intervention may interfere with the normal development of the breast, however in certain cases has to be performed due to the threat of deformation of the growing breast or the malignant potential of some tumors like cystosarcoma phylloides. However, visible scars have to be avoided at any price in these young girls, as they are still in their pre-marital and psychologically vulnerable phase. The presumed size of the breast after completion of all Tanner stages of breast development has to be taken into consideration while planning the immediate or deferred reconstruction. Methods: We report on three young girls, 13, 14 and 16 years of age, who presented with a giant cystosarcoma phylloides of 9,6 cm (190 grams), a giant fibroadenoma of 14 cm (287 grams) and a giant PASH-tumor of 16,3 cm (957 grams). All patients were in their thelarche. The extension of the tumor was almost to the whole circumference of the breast with close borders to the skin envelope, resulting in a marked anisomastia due to the giant tumor size. We are proposing here scar-sparing procedures adapted to the form of the breast and the BMI of the patients. For access to the tumor, in two cases, we chose the anterior axillary line to avoid visible scars on the surface of the breast - one with autologous and one with heterologous, implant-based reconstruction. In the third case, the patient had a marked anisomastia with a massively ptotic breast with a huge broadening of the nipple-areolar-complex due to the growth of the tumor. Here we selected a tumor-size adapted, inferior-pedicled reduction mammaplasty according to Ribeiro in the modification of Rezai with a skin reduction and shortening of the diameter of the areola. Patient reported-outcome has been measured by validated Breast-Q-questionnaires. Results: We present three different types of access for the removal of giant tumors and three options for the reconstruction of patients in their thelarche. Two tumors were removed through axillary access to the breast to avoid scars in the developing breast. We achieved free margins at first surgical intervention in all three cases. One reconstruction was performed by autologous tissue through lateral thoracic wall advancement mammaplasty. Another patient had an implant-based reconstruction. The third patient – who presented with a macromastia with marked enlargement of the nipple-areola-complex was treated with a tumor-adapted reduction mammaplasty. All three young patients have reported a high degree of satisfaction in validated Breast QoL questionnaires with the outcome of the procedures.