The effect of cochlear implant usage duration on the Cantonese phonological development of hearing impaired children

Thesis (B.Sc)--University of Hong Kong, 2007.Also available in print.A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, June 30, 2007.published_or_final_versionSpeech and Hearing SciencesBachelorBachelor of Science in Speech and Hearing Science

Hostility in the context of depression: Testing the relevance of perceived social ranking

Theoretical positions (Sloman & Gilbert, 2000), current research (Robbins & Tanck, 1997) and clinical observations (APA, 1994) have generally concluded that depressed populations tend to demonstrate an elevated level of hostility. Based on the premises of the Social Rank Theory (SRT; Sloman & Gilbert, 2000), the current study explores the purported etiological underpinnings of the co-occurrence between depression and hostility. The SRT regards depression as a state of inferiority resulting from a drop in social rank and hostility as stemming from a sense of injustice over this inferiority. To test this idea, measures of perceived social rank, depression, trait anger, anger expression and perceived injustice were administered to 97 university students at two time points, one month apart. Long-term rank change was measured retrospectively at Time 1 and short-term rank change was measured prospectively by sampling at Time 1 and Time 2. Three hypotheses were advanced: 1) social rank would be negatively associated with depression; 2) unfavourable rank change would predict greater levels of depression; and 3) unfavourable rank change from an initially superior rank would predict greater levels of anger and perceived injustice. Results were partially supportive of the hypotheses. As expected, social rank was negatively associated with depression. As well, a long-term change in social rank predicted greater levels of anger suppression. Results were discussed with respect to their consistency with the SRT. Potential weaknesses of the methodology and future directions of this line of inquiry were also presented

Stress and Anxiety Among Correctional Health Care Professionals in a U.S. State Prison System During COVID-19

Since prisons were an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, the experience of correctional health care professionals (HCPs) may differ from HCPs in other settings. This cross-sectional descriptive study assessed stress, anxiety, and burnout levels in home and work environments among HCPs employed by one U.S. state prison system during the period of initial COVID-19 vaccine rollout. Participants (N = 444) were invited to voluntarily participate in an anonymous questionnaire distributed by prison administration from March 1 through May 17, 2021. Measures were adapted from a prior study of noncorrectional HCPs during the COVID-19 pandemic. Descriptive statistics (mean; standard deviation; 25th, 50th, and 75th percentiles), ranking measures that could alleviate anxiety and stress related to the pandemic, and qualitative responses were analyzed. Responses from 43% of HCPs (192) revealed that correctional HCPs experienced high levels of stress and anxiety at work and at home during the pandemic, with particularly high levels among females and registered nurses. Understanding and addressing these stressors will be of critical importance as prison systems work to avoid turnover of experienced HCPs in such specialized settings and also help inform human resource planning at state prison systems for future public health responses

Antibiotic overuse in the primary health care setting: A secondary data analysis of standardised patient studies from India, China and Kenya

INTRODUCTION: Determining whether antibiotic prescriptions are inappropriate requires knowledge of patients\u27 underlying conditions. In low-income and middle-income countries (LMICs), where misdiagnoses are frequent, this is challenging. Additionally, such details are often unavailable for prescription audits. Recent studies using standardised patients (SPs) offer a unique opportunity to generate unbiased prevalence estimates of antibiotic overuse, as the research design involves patients with predefined conditions. METHODS: Secondary analyses of data from nine SP studies were performed to estimate the proportion of SP-provider interactions resulting in inappropriate antibiotic prescribing across primary care settings in three LMICs (China, India and Kenya). In all studies, SPs portrayed conditions for which antibiotics are unnecessary (watery diarrhoea, presumptive tuberculosis (TB), angina and asthma). We conducted descriptive analyses reporting overall prevalence of antibiotic overprescribing by healthcare sector, location, provider qualification and case. The WHO Access-Watch-Reserve framework was used to categorise antibiotics based on their potential for selecting resistance. As richer data were available from India, we examined factors associated with antibiotic overuse in that country through hierarchical Poisson models. RESULTS: Across health facilities, antibiotics were given inappropriately in 2392/4798 (49.9%, 95% CI 40.8% to 54.5%) interactions in India, 83/166 (50.0%, 95% CI 42.2% to 57.8%) in Kenya and 259/899 (28.8%, 95% CI 17.8% to 50.8%) in China. Prevalence ratios of antibiotic overuse in India were significantly lower in urban versus rural areas (adjusted prevalence ratio (aPR) 0.70, 95% CI 0.52 to 0.96) and higher for qualified versus non-qualified providers (aPR 1.55, 95% CI 1.42 to 1.70), and for presumptive TB cases versus other conditions (aPR 1.19, 95% CI 1.07 to 1.33). Access antibiotics were predominantly used in Kenya (85%), but Watch antibiotics (mainly quinolones and cephalosporins) were highly prescribed in India (47.6%) and China (32.9%). CONCLUSION: Good-quality SP data indicate alarmingly high levels of antibiotic overprescription for key conditions across primary care settings in India, China and Kenya, with broad-spectrum agents being excessively used in India and China

Using provider performance incentives to increase HIV testing and counseling services in Rwanda

Paying for performance provides financial rewards to medical care providers for improvements in performance measured by specific utilization and quality of care indicators. In 2006, Rwanda began a paying for performance scheme to improve health services delivery, including HIV/AIDS services. This study examines the scheme's impact on individual and couples HIV testing and counseling and using data from a prospective quasi-experimental design. The study finds a positive impact of paying for performance with an increase of 6.1 percentage points in the probability of individuals having ever been tested. This positive impact is stronger for married individuals: 10.2 percentage points. The results also indicate larger impacts of paying for performance on the likelihood that the respondent reports both partners have ever been tested, especially among discordant couples (14.7 percentage point increase) in which only one of the partners is HIV positive

The integration of health equity into policy to reduce disparities: Lessons from California during the COVID-19 pandemic.

Racial and ethnic minoritized groups and socioeconomically disadvantaged communities experience longstanding health-related disparities in the United States and were disproportionately affected throughout the COVID-19 pandemic. How departments of public health can explicitly address these disparities and their underlying determinants remains less understood. To inform future public health responses, this paper details how California strategically placed health equity at the core of its COVID-19 reopening and response policy, known as the Blueprint for a Safer Economy. In effect from August 2020 to June 2021, the Blueprint employed the use of the California Healthy Places Index (HPI), a place-based summary measure of 25 determinants of health constructed at the census tract level, to guide activities. Using Californias approach, we categorized the state population by HPI quartiles at the state and within-county levels (HPIQ1 representing the least advantaged, HPIQ4, the most advantaged) from HPI data available to demonstrate how the state monitored crude COVID-19 test, case, mortality, and vaccine rates and unadjusted rate ratios (RR) using equity metrics developed for the Blueprint. Notable patterns emerged. Testing disparities disappeared during the summer and winter surges but resurfaced between surges. Monthly case RR peaked in May 2020 for HPIQ1 compared to HPIQ4 (RR 6.61, 95%CI: 6.41-6.81), followed by mortality RR peaking in June 2020 (RR 5.06, 95% CI: 4.34-5.91). As the pandemic wore on, disparities in unadjusted case and mortality RRs between lower HPI quartiles relative to HPIQ4 reduced but remained. Utilizing a place-based index, such as HPI, enabled a data-driven approach that used a determinants of health lens to identify priority communities, allocate resources, and monitor outcomes based on need during a large-scale public health emergency

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

How to do (or not to do) … using the standardized patient method to measure clinical quality of care in LMIC health facilities.

Standardized patients (SPs), i.e. mystery shoppers for healthcare providers, are increasingly used as a tool to measure quality of clinical care, particularly in low- and middle-income countries where medical record abstraction is unlikely to be feasible. The SP method allows care to be observed without the provider's knowledge, removing concerns about the Hawthorne effect, and means that providers can be directly compared against each other. However, their undercover nature means that there are methodological and ethical challenges beyond those found in normal fieldwork. We draw on a systematic review and our own experience of implementing such studies to discuss six key steps in designing and executing SP studies in healthcare facilities, which are more complex than those in retail settings. Researchers must carefully choose the symptoms or conditions the SPs will present in order to minimize potential harm to fieldworkers, reduce the risk of detection and ensure that there is a meaningful measure of clinical care. They must carefully define the types of outcomes to be documented, develop the study scripts and questionnaires, and adopt an appropriate sampling strategy. Particular attention is required to ethical considerations and to assessing detection by providers. Such studies require thorough planning, piloting and training, and a dedicated and engaged field team. With sufficient effort, SP studies can provide uniquely rich data, giving insights into how care is provided which is of great value to both researchers and policymakers