Prevalence and risk factors for Active Convulsive Epilepsy in Kintampo, Ghana

Introduction: epilepsy is common in sub-Saharan Africa, but there is little data in West Africa, to develop public health measures for epilepsy in this region. Methods: we conducted a three-stage cross-sectional survey to determine the prevalence and risk factors for active convulsive epilepsy (ACE), and estimated the treatment gap in Kintampo situated in the middle of Ghana. Results: 249 people with ACE were identified in a study population of 113,796 individuals. After adjusting for attrition and the sensitivity of the screening method, the prevalence of ACE was 10.1/1000 (95% Confidence Interval (95%CI) 9.5-10.7). In children aged \u3c18 years, risk factors for ACE were: family history of seizures (OR=3.31; 95%CI: 1.83-5.96), abnormal delivery (OR=2.99; 95%CI: 1.07-8.34), problems after birth (OR=3.51; 95%CI: 1.02-12.06), and exposure to Onchocerca volvulus (OR=2.32; 95%CI: 1.12-4.78). In adults, a family history of seizures (OR=1.83; 95%CI: 1.05-3.20), never attended school (OR=11.68; 95%CI: 4.80-28.40), cassava consumption (OR=3.92; 95%CI: 1.14-13.54), pork consumption (OR=1.68; 95%CI: 1.09-2.58), history of snoring at least 3 nights per week (OR=3.40: 95%CI: 1.56-7.41), exposure to Toxoplasma gondii (OR=1.99; 95%CI: 1.15-3.45) and Onchocerca volvulus (OR=2.09: 95%CI: 1.29-3.40) were significant risk factors for the development of ACE. The self-reported treatment gap was 86.9% (95%CI: 83.5%-90.3%). Conclusion: ACE is common within the middle belt of Ghana and could be reduced with improved obstetric care and prevention of parasite infestations such as Onchocerca volvulus and Toxoplasma gondii

THE INFLUENCE OF COCAINE-RELATED IMAGES ON INHIBITORY CONTROL IN COCAINE USERS

Cocaine users display impaired inhibitory control. The influence of cocaine-related stimuli on inhibitory control has not been assessed. The Attentional Bias-Behavioral Activation (ABBA) task uses cocaine and neutral images as cues to determine if drug-related images impair inhibitory control in cocaine users. This dissertation was designed to assess the influence of cocaine images on inhibitory control in cocaine users through the conduct of studies designed to address four aims. The first aim was to demonstrate that cocaine users display impaired inhibitory control following cocaine images compared to neutral images on the ABBA task. This was accomplished through the conduct of two experiments. The first experiment piloted the ABBA task and cocaine users completed the cocaine go (n = 15) or neutral go condition (n = 15) of the task. The second experiment consisted of two studies designed to develop a within-subjects methodology for using the ABBA task. In the first study, cocaine users completed either the cocaine go (n = 20) or neutral go (n = 20) condition of the ABBA task and all participants also completed the Cued Go/No-Go task, with geometric shapes as cues. In the second study, cocaine users (n = 18) completed the cocaine go condition of the ABBA task and a modified version of the ABBA task with all neutral images as cues to further refine a possible within-subjects methodology. The second aim was to demonstrate that inhibitory failures occur most often when cues are presented for short compared to longer durations of time. Data collected during other protocols (n = 91) were combined to investigate the influence of stimulus onset asynchrony (SOA; i.e., the amount of time a cue is presented before a target indicated a response should be executed or withheld) on inhibitory control following cocaine-related and neutral cues on the ABBA task. The third aim was to demonstrate impaired inhibitory control following cocaine images on the ABBA task is specific to cocaine users. Cocaine users (data collected in the second experiment of the first aim) and non-using control participants (n = 16) completed the cocaine go and all neutral conditions of the ABBA task and the Cued Go/No-Go task. The fourth aim was to demonstrate the feasibility and acceptability of inhibitory control training to cocaine-related stimuli with cocaine users. A small pilot clinical trial was conducted and cocaine users were randomly assigned to complete inhibitory control training to cocaine images or geometric shapes. Cocaine images impaired inhibitory control on the ABBA task, as demonstrated by an increased proportion of inhibitory failures in the cocaine go condition compared to the neutral go condition in Experiments 1, 2, and 4. The proportion of inhibitory failures following cocaine images in Experiment 4 was increased at short (i.e., 100, 200) compared to long SOAs. Cocaine images also impaired inhibitory control compared to the Cued Go/No-Go Task in Experiment 2, however there were no differences in the proportion of inhibitory failures between the cocaine go and all neutral conditions of the ABBA task. There were no differences between cocaine users and controls in Experiment 3 for the proportion of inhibitory failures on the ABBA or Cued Go/No-Go tasks, but controls responded faster indicating a speed/accuracy trade off occurred in the control group. Inhibitory control training as an approach to improve treatment outcomes is feasible, as indicated by attendance and accuracy on the training task, and participants rated the overall procedure as satisfactory in Experiment 5. A better understanding of inhibitory control in the presence of cocaine related cues could be crucial to better understand how drug cues contribute to the risk for relapse and the continued use of drugs because both occur in the presence of drug cues

Semantic discovery and reuse of business process patterns

Patterns currently play an important role in modern information systems (IS) development and their use has mainly been restricted to the design and implementation phases of the development lifecycle. Given the increasing significance of business modelling in IS development, patterns have the potential of providing a viable solution for promoting reusability of recurrent generalized models in the very early stages of development. As a statement of research-in-progress this paper focuses on business process patterns and proposes an initial methodological framework for the discovery and reuse of business process patterns within the IS development lifecycle. The framework borrows ideas from the domain engineering literature and proposes the use of semantics to drive both the discovery of patterns as well as their reuse

Holistic System Design for Distributed National eHealth Services

publishedVersio

Understanding the social determinants of non-communicable diseases in Nepal : a systems perspective : a thesis presented in the partial fulfilment of the requirements for the degree of Doctor of Philosophy (PhD) in Health Sciences at Massey University, Wellington Campus, New Zealand

Figures are re-used with permission.Non-communicable diseases (NCDs) constitute more than half of the total disease burden in Nepal. Global evidence indicates the problem of NCDs is influenced by the complex interaction of social determinants including behavioural, socio-economic and environmental. These determinants are the focus of global prevention strategies for tackling NCDs. The health system of Nepal, however, is yet to adopt this comprehensive prevention strategies. The main objective of this research was to understand the social determinants of NCDs in Nepal and identify leverage points for systemic actions in Nepal. The study utilized a systems thinking methodology which enabled a creative combination of case study methods and qualitative causal loop diagramming. In each of the two selected case districts (Bhaktapur and Morang), semi-structured interviews (n=39) and focus group discussions (n=12) were conducted with key stakeholders and community members. These case studies were informed by policy level interviews (n=24). Thematic analysis, guided by the adapted social determinants of health framework, helped to identify key themes and develop causal loop diagrams (CLDs). The findings of the thematic analysis, and CLDs, were then validated through local and policy sense-making workshops. The analysis showed four key interlinked thematic areas, each of which is being published as separate papers. The first paper describes the community and stakeholders’ perception and experience of the rising burden of NCDs. The social experience of NCDs metabolic risks such as hypertension and diabetes were shown to be normalised. Moreover, differences in social experience were observed based on gender and socio-economic circumstances. The second paper described the critical role played by tobacco and alcohol in the interaction of social determinants of NCDs. The analysis indicates that socio-economic circumstances was root cause of changing, and damaging alcohol and tobacco practices, and increased the vulnerability to exploitation by industries. The third paper revealed that poor dietary practices and physical inactivity were resulting due to changes in social practices shaped by worsening dietary and physical environment. Socio-economic circumstances, urbanisation and migration all contributed to the population being exposed to an obesogenic environment. While all three papers discussed specific health system challenges, the fourth paper elaborated on health sector challenges, including the curative focus and limited capacity of the health system both at district and policy or national level to prevent NCDs in Nepal. Three key leverage points for health system action on the social determinant of NCDs were identified by viewing the final CLD through the lens of Donella Meadows’ framework for identifying key health system action on the social determinants of health. These leverage points indicated that the health sector should focus on the development of a robust prevention system for effective NCDs action. Overall, the study highlighted the interactions of socio-economic, gender, commercial and health system determinants driving the NCDs problem in Nepal. The leverage analysis indicated that the health sector should focus on the development of a robust prevention system for effective action on complex problem like NCDs. The Ministry of Health could play a proactive role in creating the prevention system that could effectively guide all sectors towards collective action to impacting social and commercial determinants of health