Background: Worldwide health systems are facing an increasing number of challenges, while governments remain dedicated to searching for cost-effective options to enhance the capacity of national health systems to perform well. Although the relationship between devolution and disparities in access to health care is mixed, most studies do not attribute observed disparities in healthcare use to Devolution. This review was performed to synthesize evidence around this issue. Specifically, the objective was to answer the question: “What are the contribution of devolution in health financing, health leadership, and health information systems?”. Methods: CrossRef, Google Scholar, Academic keys, Open Academic journals index, MEDLINE, Embase, CINAHL, and PsycINFO were searched with terms related to devolution and health. The search included terms related to health financing, health information systems, and health leadership. Findings were presented within a narrative synthesis. Quality of the evidence was evaluated using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Findings: A few studies, all cross-sectional studies, met the selection criteria for this review. Most studies noted the Healthcare is a major element of national budgets worldwide in as much as all levels vary across countries, systems have come under increased pressure to ensure that resources are spent efficiently.

Background: In the past three decades, health reform has become commonplace in most countries. Such that reforms decentralized governance of health systems has been adopted in some countries as a subset of broader health reforms or as a preferred management strategy. This review was performed to synthesize evidence around this issue. Specifically, the objective was to answer the question: “What is the role of devolution in service delivery, health workforce and medical commodities acquisition?”. Methods: CrossRef, Google Scholar, Academic keys, Open Academic journals index, MEDLINE, Embase, CINAHL, and PsycINFO were searched with terms related to devolution and health. The search included terms related to service delivery, health workforce and medical commodities. Findings were presented within a narrative synthesis. Quality of the evidence was evaluated using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Findings: A few studies, all cross-sectional studies, met the selection criteria for this review. Most studies noted the major benefits resulting from devolution in terms of local governance and citizen participation in the health service delivery sector. The UK and India are some of the countries with evidence of how devolution impacts positively from accountability and participation. Some of benefits reaped include developed leadership, effective monitoring, promotion of quick delegation of work and generation of interest among employees. In Kenya, health sector still undergoes significant human resource deficiency, in spite of the government investing over the years from independent and also considering the devolution of health services. Healthcare workers shortage affects how health institutions functions. Studies showed that health workers positively respond to the demands of human resource of a decentralized unit if they look for employment in it, if a post is offered, they accept, and stays in service. Their ability and willingness to act in response to local demands are due to a number of factors. However, there is little literature on the best level of the government in provision of public type medical services. The recent focus has been entirely on the merits of local provision. Local governments are more responsive to their citizens compared to the central government. Conclusions: A universal objective of health systems should be to reduce inequality in health and promote equity, but the impact of Devolution of health system governance on equity has been questioned.

Nurses’ awareness of professional rights and values and how those values affect their behavior is an integral part of nursing care. This study aimed to assess the perception of married nurses regarding women’s rights and obligations and also to assess the family support towards nursing services and professional development in selected tertiary hospital of West Bengal. This descriptive survey was conducted with 103 married nurses employed in North Bengal Medical College and Hospital who were selected by non probability, total enumerative sampling technique. Data were collected using investigator prepared rating scale and the responses were self reported by the participants. The data were analyzed by descriptive statistics, associations between socio demographic variables and mean scores were analyzed by inferential statistics like chi square test. The results revealed that 46% of the nurses had average perception about their professional rights but 73% of them had good perception about their personal rights, 62% of the nurses had good perception about their professional obligations related to patient care and only 16% of the nurses had good family support towards nursing services and professional development. It was also evident that age, duration of service and type of family (χ 2 values = 4.133, 7.433, 7.336 respectively) at 0.05 level of significance were associated with perception of women’s rights and obligations. Family support was associated with professional qualification of nurses, monthly family income, type of family and working hours (χ 2 values = 4.307, 6.26, 7.01, 6.448 respectively) at 0.05 level of significance. Further studies using standardized tools and other reliable and culture specific instruments are recommended.

Retinal nerve fiber layer thickness (RNFLT) is affected in several ocular and systemic conditions, most commonly glaucoma and diabetic retinopathy. This cross sectional study was done to compare the RNFLT in 180 eyes of 90 patients. A total of 90 patients were assigned to 3 groups of 30 patients each of primary open angle glaucoma (POAG), type 2 diabetes mellitus (T2DM) and POAG with T2DM (POAG/T2DM). The RNFLT was measured with spectral-domain OCT. Readings from all the areas of retina were measured in both eyes. Presence of T2DM in patients of POAG significantly affected the RNFLT as compared to patients of POAG or T2DM individually. The RNFLT was negatively correlated with the duration of glaucoma, duration of diabetes and HBA1c levels. Hence, care should be taken in interpreting optical coherence tomography readings in patients of POAG/T2 DM. The changes in RNFLT can be used to monitor the progression of diseases affecting RNFLT and efficacy of treatment modalities.

Background: Auditory reaction time (ART) and visual reaction time (VRT) are non-invasive techniques used to assess the capability of the CNS to integrate sensory and motor activities based on the level of CNS arousal and alertness. There is a lacuna for studying the impact of nicotine in smokeless tobacco users, therefore this study aimed to estimate and compare ART and VRT of smokers and dipping tobacco users with non-tobacco users in different age groups. Methods: Total 612 apparently healthy male subjects were divided equally on the basis of habit into three groups namely smokers, dipping tobacco users and control (non- tobacco user) with 204 subjects in each group. They were divided further on the basis of age into 4 sub groups like 11-20 years, 21-30 years, 31-40 years and 41-50 years with having 51 subjects in each group. RTM-608 (Medicaid system) apparatus was used to measure audio-visual reaction time under strict precautions and standard protocols to minimize the effect of other variables on reaction times. Data was analyzed using one way analysis of variance in each group. Results: All age groups differ significantly from each other for ART and VRT (ANOVA; p<0.05). Significant reduction was found for ART & VRT for dipping tobacco users as compared to control and smokers (p <0.05). ART and VRT increases with age in each group of control, smokers and dipping tobacco users. Conclusion: The audio and visual reaction time was significantly higher in older individuals. Reduction in ART and VRT were observed in the dipping tobacco users and smoker which shows acceleration of the response to stimulus

Perinatal asphyxia leading to Hypoxic Ischemic Encephalopathy (HIE) is a major concern in newborn morbidity and mortality in India. In this study we have done transcranial USG and MRI brain of both term and preterm newborns to detect the HIE related changes in neonatal brain and also evaluated wheather MRI is better than USG in detecting the lesions.This cross sectional analytical study was conducted at Calcutta National Medical College and Hospital, Kolkata with 57 newborns (26 preterm,31 term) for a period of one year. Cranial USG was done on day 5 to day 7 of the baby and MRI brain of the same baby after 24 hrs of doing USG. We found that cerebral oedema, lesions of basal Ganglia, thalamus and parasagittal subcortical white matter injury were more common in term babies, whereas Germinal Matrix Haemorrage (GMH), IntraVentricular Haemorrage (IVH) and PeriVentricular Leucomalacia (PVL) were common in preterms.When we compared USG and MRI findings we found statistically significant difference in relation to detection of abnormal findings(49 by MRI,33 by USG},deep grey matter insult of basal ganglia, thalamus (22 by MRI, 8 by USG), parasagittal subcortical white matter injury (6 by MRI,0 by USG) with p value less than 0.05.Detection of GMH and IVH was 15 by MRI and 9 by USG. In conclusion, though USG is a less expensive initial screening tool in detecting HIE related lesions and it can detect IVH, GMH very effectively, but MRI brain should be the final investigation of choice to detect both central and peripheral cortical injuries in newborn with perinatal asphyxia.

Communication climate influences quality of work environment as it contributes to the effectiveness and success of an organization. Organizations with positive communication climate have good employee relationships that in turn improve staff empowerment and career growth. Aim: The current study aims to determine the impact of communication climate on nurses’ organizational career growth and empowerment. Research design: Quasi-experimental research design has been carried out. Setting: The study conducted in (General medical and surgical departments) at Qena and Sohag University Hospitals. Sample: All available nurses working in the designated sites 98. Tools: three tools were used, communication climate questionnaire, organizational career growth scale, and conditions of work effectiveness questionnaire II. Results: The present study findings that there were highly statistical significance differences of communication climate, organizational career growth, and structural empowerment between the two hospitals X2 = 16.843, 18.18 and 30.247 respectively & P<0.01. Regarding means and standard deviations it was 54.20±9.35 & 41.39±13.47 for communication climate, 47.02±8.60 & 37.69±10.05 for organizational career growth, and 55.20±9.39 & 41.04±11.60 for structural empowerment at Qena and Sohag University Hospitals respectively. Conclusion: The improvement in the communication climate results in higher levels of organizational career growth and structural empowerment. Recommendations: Management should develop and maintain communication climate that enables free expression of ideas and exchange of opinions among staff. Managers should encourage nurses’ empowerment for effective organizational performance. Nurses’ organizational career growth and continuing education are important for improving staff performance and skills.

This study was carried out in 388 premature babies for incidence of retinopathy of prematurity, foetal and maternal risk factors to design an effective screening program for ROP. Further, the efficacy of mode of treatment was evaluated. Preterm neonates with birth weight ≤ 1500 grams and/or gestation age ≤ 32 weeks; and selected patients with birth weight between 1500 to 2000 grams or gestational age > 32 weeks but ≤ 35 weeks with unstable clinical course were included in the study. The incidence of any stage of ROP in this study was 23.70%. Majority of patients (88.64%) developed mild forms of ROP (stage 1 and 2). On univariate analysis, the significant risk factors predisposing to ROP were low gestation age, low birth weight, respiratory distress, unmonitored oxygen supplementation, sepsis, blood transfusion, surfactant use and metabolic acidosis. Significant maternal risk factor was pregnancy-induced hypertension. On multivariate logistic regression, low gestational age, unmonitored oxygen supplementation, use of surfactant and pregnancy induced hypertension were found to be independent risk factors. The majority of cases (70.65%) of ROP of stage 1 and 2 without plus disease regressed without any treatment. Rest 29.35% cases needed treatment, and were treated with Diode laser photocoagulation to avascular retina. Regression occurred in all the cases.

Introduction: Breast cancer is the furthermost typically identified life-threatening most cancers in female and the foremost motive of most cancers loss of life among women. Aims and Objectives: Due to the absence of information involving breast cancer in Jouf region, KSA. Our study was directed to discover out the level of their knowledge about breast cancer and practice of breast self-examination amid the study population. Material and Methods: Descriptive study including 755 Saudi volunteers living in Al- Qurrayat, Northern Saudi Arabia. Only for women agreeing to take part in the breast self-examination workshop had been blanketed and completed items of a scale assessing the knowledge level, attitudes regarding breast self-examination. Results: A total of 618/755 (81.9%) participant (622 females and 133 males), successfully completed the data. the majority of the participant about 34.7% were between 26-35 year. the level of knowledge in the participants about breast cancer perception according to their education is 16.6% of the respondents had no knowledge, about 5.7% of them complete the university. Also, 65.4% of the respondents had little and moderate knowledge and only about 17.4% had a good knowledge of breast cancer. In addition, 14.4% of female and 0.3 % of the male population had no knowledge about breast self-examination. Furthermore, 345 out of 755(45.7%) study population interested to get information about breast cancer were university educated. Conclusion: breast self-examination necessities to be taught to all women, irrespective of their education level

The study included more of booked cases compared to unbooked. In booked cases most of them belonged to group to whom magnesium sulphate was not given (70% not given vs 59% given) and while in unbooked cases most of them were in group who received magnesium indicating poor control of blood pressure in unbooked cases. This confirms the high incidence of pre eclampsia in primigravida (69%given and 66% not given), more common in young women. The inclusion of more of preterm pregnancies represents the fact that termination of pregnancy is definitive treatment of pre eclampsia. Among the vaginal deliveries the instrumental delivery was significantly more in magnesium sulphate given group representing the tocolytic effect of magnesium sulphate. The complications of severe preeclampsia like eclampsia, pulmonary oedema and renal failure occurred more in group not given magnesium sulphate (2%,1%,1% given vs 11%, 3%, 4% not given) respectively and incidence of abruption and DIC in is almost similar in both groups (4% and 1% Vs 3%and 1%). Eclampsia is a grave complication of severe preeclampsia occurred more in the group not given magnesium sulphate compared to group given magnesium sulphate (11% vs 2%) indicating that intervention with magnesium sulphate has better maternal out come when given to women with severe pre eclampsia. The symptoms of toxicity like loss of deep tendon reflexes, oliguria and other side effects like nausea, head ache, flushing and vomiting had higher incidence in magnesium sulphate administered group. Nearly 40%-50% of new borns from both groups had good Apgar of 7-10 (40% given and 46% not given) respectively. Women with 3-6 Apgar were more in magnesium sulphate administered group (32% vs 10%) respectively in given and not given groups. Both groups had equal NICU admissions. When new born of more than 32 weeks, the salvageable neonates admitted to NICU were considered, the outcome was better in group given magnesium sulphate with no deaths pointing towards role of magnesium sulphate in improving fetal survival.

Purpose: The aim of this study was to evaluate the effects of various drinks and toothbrushing on the color changes of esthetic restorative materials used in dentistry. Materials and Methods: Forty specimens were prepared from each of four restorative materials (nano-hybrid composite [IPS EMPRESS Direct ivoclar] composite resin [Tetric N-Ceram Bulk Fill,ivoclar], glass ionomer cement [Vivaglass CEM PL ivoclar ], composite resin [Tetric N-Ceram cavifil,ivoclar]). Specimens were divided into four groups for immersion in five different staining solutions (cola, chocolate milk, coffee, 7up and cherry juice). Each group was subdivided into brushing and non-brushing groups. The specimens in the brushing subgroups were brushed with toothpaste once a day using toothbrush. Color was measured using a Digital Shade Matching System DSMS, and color changes were calculated between baseline and 21 days, 1, 2, 3, 4, 5, 6 months. Results: All the solutions evaluated yielded color changes after 21 days, and these changes were significantly greater for glass ionomer cement than IPSS EMPRESS, composite bulkfill and composite resin (p < 0.006). Brushing no significantly difference for the color changes of restorative materials (p > 0.004). Conclusion: Chance for staining the esthetic restorative materials in a short period is low except GIC, and the brushing has no significant effect to prevent any discoloration for the esthetic restorations in a short period approximate one month.

This study aims to shed light on the extent to which the accused’s right in Islamic jurisprudence is in harmony with the conventional law. The accused may be exposed to some harmful acts during his trial which may entirely affect his rights which will give him the entitlement to defend himself. The researcher pays attention to explaining the rights of the accused person in Islamic jurisprudence compared to the conventional law. The study adopts inductive approach to gather information written in Islamic jurisprudence, and adopts comparative approach in order to make comparisons between the views of ancient and contemporary jurists in question under discussion, and transfer ideas of Shariah experts to the legal studies field in order to compare the approach and benefit and vice versa. The study concludes that the conventional law does not differ much from the Islamic jurisprudence in terms of providing personal rights to the accused; both Islamic jurisprudence and conventional law agree on the principle that the accused is innocent until proven guilty.

There are many short and long term consequences for Pakistan in joining the U.S. - led alliance against terrorism. The alliance helped Pakistan overcome sanctions, gain financial and military support, and end its global isolation. Pakistan, on the other hand, is giving a big price in the area of social strategy. It has suffered vast losses in the global war on terror. Counterterrorism against terrorists and domestic militancy added institutional uncertainty and elevated social issues that stayed compatible with assault society. Therefore, Pakistan is regarded to be one of the worldwide system’s financial and strategic losers that have developed since 9/11.

There have been many accidents which result in deaths due to motor accidents which is the majority or hunting or Jihad or other things that result in crime. We find that a lot of people are unaware of the provisions of manslaughter and that the blood money is paid by Aqilah and this is something unknown to some people. Thus, I explained the reality of Aqilah and the important issues that may be hidden to many people. And here lies the importance of this research, and also to know its provisions and conditions through the extrapolation of the views of the four Schools, and to analyse, discuss and clarify the points of agreement and disagreement between them. Moreover, it looked into the views of contemporary scholars to choose the provisions that fit the development of the current era. Through the study, we reached to some important results, most important of which if the offender has no Aqilah, or he has but the Aqilah is unable to pay the blood money (diyyah) for him, it should be paid from the Baitulmal or its representative.

A suitable selection system will lead to a prospective, responsible and competent public officials. Therefore, in carrying out the selection it is necessary to look at the motivation possessed by the officials. This article aims to show how prospective public officials motivate themselves in a selection system as a basis for deciding whether the candidate is prospective and promising to hold the position. This study used a qualitative research design. The results obtained were goal achievement, intelligence, as well as transparent, open, and objective job auction system contribute to the motivation of the candidate in the selection of prospective officials.