Symptom burden in individuals with inflammatory bowel disease: a mixed methods study

To investigate the symptom burden experiences of individuals with inflammatory bowel disease (IBD). An explanatory sequential mixed methods study was conducted. A cross-sectional, correlational survey was first undertaken. Symptom burden was measured using a modified disease specific version of the Memorial Symptom Assessment Scale, which was administered to a consecutive sample of individuals with IBD (n = 247) at an IBD Outpatients department in one urban teaching hospital in Ireland. Disease activity was determined using clinical disease activity indices, which were completed by the consulting physician. A sequential qualitative, descriptive study was then conducted aimed at explaining noteworthy quantitative findings. A criterion-related purposeful sample of seven participants from the quantitative study was recruited. Semi-structured face to face interviews were conducted using an interview guide and data were analysed using content analysis. Findings revealed that participants experienced a median of 10 symptoms during the last week, however as many as 16 symptoms were experienced during active disease. The most burdensome symptoms were lack of energy, bowel urgency, diarrhoea, feeling bloated, flatulence and worry. Total symptom burden was found to be low with a mean score of 0.56 identified out of a possible range from 0 to 4. Participants with active disease (M = 0.81, SD = 0.48; n = 68) had almost double mean total symptom burden scores than participants with inactive disease (M = 0.46, SD = 0.43; n = 166) (p < 0.001). Mean total psychological symptom burden was found to be significantly greater than mean total physical symptom burden (rho = 0.73, n = 247, p < 0.001). Self-reported disease control, gender, number of flare ups in the last two years, and smoking status was found to be significant predictors of total symptom burden, with self-reported disease control identified as the strongest predictor. Qualitative data revealed tiredness, pain, bowel symptoms, worry and fear as being burdensome. Furthermore, symptom burden experiences were described in terms of its impact on restricting aspects of daily activities, which accumulated into restrictions on general life events. Psychological symptom burden was revealed as more problematic than physical symptom burden due to its constant nature, with physical and psychological symptoms described to occur in a cyclical manner. Participants revealed that disease control was evaluated not only in terms of symptoms, but also in terms of their abilities to control the impact of symptoms on their lives. This study highlights the considerable number of symptoms and the most burdensome symptoms experienced by individuals with IBD, both during active and inactive disease. This study has important implications on symptom assessment in terms of the need to encompass both physical and psychological symptoms. In addition, greater attention needs to be placed on psychological aspects of IBD care.

Repairing wireless sensor network connectivity in damaged environments

A wireless sensor network can become partitioned due to node failure, requiring the deployment of additional relay nodes in order to restore network connectivity. This introduces an optimisation problem involving a tradeoff between the number of additional nodes that are required and the costs of moving through the sensor field for the purpose of node placement. This tradeoff is application-dependent, influenced for example by the relative urgency of network restoration. In addition, minimising the number of relay nodes might lead to long routing paths to the sink, which may cause problems of data latency. This data latency is extremely important in wireless sensor network applications such as battlefield surveillance, intrusion detection, disaster rescue, highway traffic coordination, etc. where they must not violate the real-time constraints. Therefore, we also consider the problem of deploying multiple sinks in order to improve the network performance. Previous research has only parts of this problem in isolation, and has not properly considered the problems of moving through a constrained environment or discovering changes to that environment during the repair or network quality after the restoration. In this thesis, we firstly consider a base problem in which we assume the exploration tasks have already been completed, and so our aim is to optimise our use of resources in the static fully observed problem. In the real world, we would not know the radio and physical environments after damage, and this creates a dynamic problem where damage must be discovered. Therefore, we extend to the dynamic problem in which the network repair problem considers both exploration and restoration. We then add a hop-count constraint for network quality in which the desired locations can talk to a sink within a hop count limit after the network is restored. For each new problem of the network repair, we have proposed different solutions (heuristics and/or complete algorithms) which prioritise different objectives. We evaluate our solutions based on simulation, assessing the quality of solutions (node cost, movement cost, computation time, and total restoration time) by varying the problem types and the capability of the agent that makes the repair. We show that the relative importance of the objectives influences the choice of algorithm, and different speeds of movement for the repairing agent have a significant impact on performance, and must be taken into account when selecting the algorithm. In particular, the node-based approaches are the best in the node cost, and the path-based approaches are the best in the mobility cost. For the total restoration time, the node-based approaches are the best with a fast moving agent while the path-based approaches are the best with a slow moving agent. For a medium speed moving agent, the total restoration time of the node-based approaches and that of the path-based approaches are almost balanced.

The impact of first pregnancy and delivery on pelvic floor dysfunction

Background: The first childbirth has the greatest impact on a woman’s pelvic floor when major changes occur. The aim of this study was to comprehensively describe pelvic floor dysfunction (PFD) in young nulliparous women, and its correlation with postnatal pathology. Methods: A prospective study was performed at Cork University Maternity Hospital, Ireland. Initially 1484 nulliparous women completed the validated Australian Pelvic Floor Questionnaire at 15 weeks’ gestation and repeatedly at one year postnatally (N=872). In the second phase, at least one year postnatally, 202 participants without subsequent pregnancies attended the clinical follow up which included: pelvic organ prolapse quantification, a 3D-Transperineal ultrasound scan and collagen level assessment. Results: A high pre-pregnancy prevalence of various types of PFD was detected, which in the majority of cases persisted postnatally and included multiple types of PFD. The first birth had a negative impact on severity of pre-pregnancy symptoms in <15% of cases. Apart from prolapse, vaginal delivery, including instrumental delivery did not increase the risk of PFD symptoms, where as Caesarean section was protective for all types of PFD. The first birth had a bigger impact on pre-existing symptoms of overactive bladder compared to stress urinary incontinence. Pelvic organ prolapse is extremely prevalent in young primiparous women, however usually it is low grade and asymptomatic. Congenital factors and high collagen type III levels play an important role in the aetiology of pelvic organs prolapse. Levator ani trauma is present in one in three women after the first pregnancy and delivery. Conclusion: The main damage to the pelvic floor most likely occurs due to an undiagnosed congenital intrinsic weakness of the pelvic floor structures. PFD is highly associated with first childbirth, however it seems that pregnancy and delivery are contributing factors only which unmask the congenital intrinsic weakness of the pelvic floor support.

Study on street children in four selected towns of Ethiopia

The child is the most precious asset and the focal point of development for any country. However, unless children are brought up in a stimulating and conducive environment getting the best possible care and protection, their physical, mental, emotional and social development is susceptible to permanent damage. Ethiopia, being one of the least developed countries of the world due to interrelated and complex socio-economic factors including man-made and natural calamities, a large portion of our population - especially children - are victimized by social evils like famine, disease, poverty, mass displacement, lack of education and family instability. Owing to the fact that children are the most vulnerable group among the whole society and also because they constitute half of the population it is evident that a considerable number of Ethiopian children are living under difficult circumstances. Therefore, as in a number of other third world countries there are many poor, displaced, unaccompanied and orphaned children in our country. A considerable proportion of these children work on the street with some even totally living on the street without any adult care and protection. These children are forced to the streets in their tight for survival. They supplement their parents meagre income or support themselves with the small incomes they earn doing menial jobs. In doing this, street children face the danger of getting into accidents and violence, they get exploited and abused, many are forced to drop out of school or never get the chance to be enroled at all and some drift into begging or petty crime. This study is undertaken mainly for updating the findings of previous studies, monitoring changing trends, examining new facts of the problem and getting a better understanding of the phenomenon in the country by covering at least some of the major centres where the problem is acute. Thus, the outcome of this research can be useful in the formation of the social welfare programme of the country. Finally, in recognition of the urgency of the problem and the limited resources available, the Ministry of Labour and Social Affairs expresses appreciation to all agencies engaged in the rehabilitation of street children and prevention of the problem. The Ministry also calls for more co-operation and support between concerned governmental and non-governmental organizations in their efforts for improving the situation of street children and in curbing the overwhelming nature of the problem.