6,111 research outputs found

    Implementing screening and brief Interventions for excessive alcohol consumption in primary health care

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    O consumo de bebidas alcoólicas é um dos principais fatores de risco da morbilidade e mortalidade prematura a nível mundial. As pessoas que consomem este género de bebidas têm um risco aumentado de vir a desenvolver mais de 200 problemas de saúde diferentes. A maioria do impacto do consumo de álcool na saúde humana é determinado por duas dimensões: o volume total de álcool consumido e o padrão de consumo. Existem várias medidas com comprovada eficácia que podem ser empregues para reduzir o risco associado ao consumo de álcool, entre as quais se encontra a deteção precoce e intervenção breve ao nível dos Cuidados de Saúde Primários. A maioria dos profissionais de saúde neste nível de cuidados considera o consumo de álcool como um importante problema de saúde e manifesta o seu apoio a medidas que visem reduzir o seu impacto. No entanto, poucos são os profissionais dos Cuidados de Saúde Primários que de forma sistemática identificam e aconselham os seus doentes relativamente aos seus hábitos etílicos. Como tal, o objetivo geral desta tese foi investigar como implementar a deteção precoce e intervenção breve no consumo excessivo de álcool nos Cuidados de Saúde Primários. Foi realizada uma revisão sistemática das barreiras e facilitadores à implementação da deteção precoce e intervenção breve no consumo excessivo de álcool nos Cuidados de Saúde Primários. As barreiras e facilitadores identificados nesta revisão foram analisados à luz da teoria de modificação comportamental para compreender a ligação destes fatores aos determinantes da mudança de comportamento, e para identificar as estratégias conceptualmente mais eficazes para abordar as barreiras e facilitadores à mudança de comportamento dos profissionais dos Cuidados de Saúde Primários no sentido de aumentar as taxas de deteção precoce e intervenção breve no consumo excessivo de álcool. Esta metodologia foi utilizada para desenhar um programa de implementação com base em pressupostos teóricos que foi testado num estudo experimental randomizado e controlado em clusters. Esta tese identificou diversas barreiras à implementação, ligadas a todos os domínios teóricos da mudança comportamental. As barreiras mais frequentemente mencionadas pelos profissionais foram: preocupação sobre as suas competências e eficácia para realizar a deteção precoce e intervenção breve; falta de conhecimento específico sobre o consumo de álcool; falta de tempo; falta de materiais; falta de apoio; e atitudes para com o doente com consumos excessivos de álcool. Esta tese mostrou também a existência de dois grupos distintos de médicos de família com base nas suas atitudes para com estes doentes, um com atitudes mais positivas, o outro com atitudes mais negativas. Esta tese mostrou ainda que um programa de implementação da deteção precoce e intervenção breve, desenhado com base em pressupostos teóricos de modificação comportamental, adaptado às barreiras e facilitadores da implementação, aumenta de forma significativa as taxas de identificação precoce dos consumos de álcool. Esta tese contribui para aumentar o conhecimento atual no sentido em que põe à disposição dos investigadores evidência prática sobre como abordar os fatores com influência na implementação da identificação precoce e intervenção breve para o consumo de álcool ao nível dos Cuidados de Saúde Primários. Esta tese contribui também para um melhor entendimento dos mecanismos subjacentes à resistência e à mudança de comportamento dos profissionais dos Cuidados de Saúde Primários no que respeita à implementação da deteção precoce e intervenção breve do consumo de álcool. Os resultados desta tese poderão ser usados por investigadores e decisores políticos para desenhar novos programas de implementação tendo como objetivo modificar esta prática clínica ao nível dos Cuidados de Saúde Primários.Alcohol use is among the leading risk factors for the global burden of disease and premature death. People who drink alcoholic beverages are at risk of developing more than 200 diseases and injury conditions. Most of the impact of alcohol consumption on human health and well-being is determined by two dimensions of drinking: the total volume of alcohol consumed and the pattern of drinking. Several effective strategies exist to reduce the harmful use of alcohol, which includes screening and brief interventions for excessive alcohol use in primary health care. The majority of primary health care providers agree that the excessive consumption of alcohol is an important health issue and express their support to policies for reducing the impact of alcohol on the health of their patients. Notwithstanding, implementation of screening and brief interventions is low at the primary health care level. Therefore, the overall aim of this thesis is to investigate how to implement screening and brief interventions for excessive alcohol consumption in primary health care. This thesis reviewed the barriers of, and facilitators for, the implementation of alcohol screening and brief interventions in primary health care. Behaviour change theory was used to understand how these factors linked to the determinants of behaviour change and how they could be addressed in order to change primary health care providers’ behaviour, i.e. to increase the delivery of alcohol screening and brief interventions. A comprehensive theory-based implementation programme was designed and tested in a cluster randomized controlled trial. This thesis identified several barriers to implementation which were mapped to all the theoretical domains of behaviour change. Primary health care providers concerns about their ability to deliver alcohol screening and brief interventions and to help patients to cut down, lack of alcohol-related knowledge, lack of time, lack of materials and support, and providers’ attitudes towards at-risk drinkers were among the most commonly cited barriers. This thesis found evidence that the attitudes of family physicians could be used to divide practitioners into two distinct groups, one with more positive and the other with more negative attitudes towards at-risk drinkers. This thesis also found that a behaviour change theory-based programme, tailored to the barriers for, and facilitators of, the implementation of screening and brief intervention in primary health care is effective in increasing alcohol screening rates. This thesis contributed to the evidence base by providing researchers with practical evidence on how to address the factors influencing the implementation of screening and brief interventions in primary health care. This thesis also provides researchers with insight into the behavioural mechanisms mediating primary health care providers’ decision to deliver alcohol screening and brief interventions. The results of this thesis could be used by researchers and policymakers to inform the design of novel theory-oriented interventions to support the implementation of alcohol screening and brief interventions in primary health care

    A Multi-level Analysis on Implementation of Low-Cost IVF in Sub-Saharan Africa: A Case Study of Uganda.

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    Introduction: Globally, infertility is a major reproductive disease that affects an estimated 186 million people worldwide. In Sub-Saharan Africa, the burden of infertility is considerably high, affecting one in every four couples of reproductive age. Furthermore, infertility in this context has severe psychosocial, emotional, economic and health consequences. Absence of affordable fertility services in Sub-Saharan Africa has been justified by overpopulation and limited resources, resulting in inequitable access to infertility treatment compared to developed countries. Therefore, low-cost IVF (LCIVF) initiatives have been developed to simplify IVF-related treatment, reduce costs, and improve access to treatment for individuals in low-resource contexts. However, there is a gap between the development of LCIVF initiatives and their implementation in Sub-Saharan Africa. Uganda is the first country in East and Central Africa to undergo implementation of LCIVF initiatives within its public health system at Mulago Women’s Hospital. Methods: This was an exploratory, qualitative, single, case study conducted at Mulago Women’s Hospital in Kampala, Uganda. The objective of this study was to explore how LCIVF initiatives have been implemented within the public health system of Uganda at the macro-, meso- and micro-level. Primary qualitative data was collected using semi-structured interviews, hospital observations informal conversations, and document review. Using purposive and snowball sampling, a total of twenty-three key informants were interviewed including government officials, clinicians (doctors, nurses, technicians), hospital management, implementers, patient advocacy representatives, private sector practitioners, international organizational representatives, educational institution, and professional medical associations. Sources of secondary data included government and non-government reports, hospital records, organizational briefs, and press outputs. Using a multi-level data analysis approach, this study undertook a hybrid inductive/deductive thematic analysis, with the deductive analysis guided by the Consolidated Framework for Implementation Research (CFIR). Findings: Factors facilitating implementation included international recognition of infertility as a reproductive disease, strong political advocacy and oversight, patient needs & advocacy, government funding, inter-organizational collaboration, tension to change, competition in the private sector, intervention adaptability & trialability, relative priority, motivation &advocacy of fertility providers and specialist training. While barriers included scarcity of embryologists, intervention complexity, insufficient knowledge, evidence strength & quality of intervention, inadequate leadership engagement & hospital autonomy, poor public knowledge, limited engagement with traditional, cultural, and religious leaders, lack of salary incentives and concerns of revenue loss associated with low-cost options. Research contributions: This study contributes to knowledge of factors salient to implementation of LCIVF initiatives in a Sub-Saharan context. Effective implementation of these initiatives requires (1) sustained political support and favourable policy & legislation, (2) public sensitization and engagement of traditional, cultural, and religious leaders (3) strengthening local innovation and capacity building of fertility health workers, in particular embryologists (4) sustained implementor leadership engagement and inter-organizational collaboration and (5) proven clinical evidence and utilization of LCIVF initiatives in innovator countries. It also adds to the literature on the applicability of the CFIR framework in explaining factors that influence successful implementation in developing countries and offer opportunities for comparisons across studies

    Resilience and food security in a food systems context

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    This open access book compiles a series of chapters written by internationally recognized experts known for their in-depth but critical views on questions of resilience and food security. The book assesses rigorously and critically the contribution of the concept of resilience in advancing our understanding and ability to design and implement development interventions in relation to food security and humanitarian crises. For this, the book departs from the narrow beaten tracks of agriculture and trade, which have influenced the mainstream debate on food security for nearly 60 years, and adopts instead a wider, more holistic perspective, framed around food systems. The foundation for this new approach is the recognition that in the current post-globalization era, the food and nutritional security of the world’s population no longer depends just on the performance of agriculture and policies on trade, but rather on the capacity of the entire (food) system to produce, process, transport and distribute safe, affordable and nutritious food for all, in ways that remain environmentally sustainable. In that context, adopting a food system perspective provides a more appropriate frame as it incites to broaden the conventional thinking and to acknowledge the systemic nature of the different processes and actors involved. This book is written for a large audience, from academics to policymakers, students to practitioners

    The Association between Psychotic Symptoms and Romantic Relationship Quality among Young Adult Ethnic Minorites

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    This study aimed to examine the association between psychotic symptoms and the quality of romantic relationships amongst ethnic minority young adults. Approximately 10.4 million people, which represents 4.2% of the adult population in the U.S, are currently diagnosed with severe mental illnesses, including psychotic disorders. Prior research found that ethnic minorities, in general, have an increased risk of developing psychotic disorders such as schizophrenia. People with SMI generally have issues being and maintaining romantic relationships. However, being in positive romantic relationships is associated with better physical and mental well-being. The final sample size for the study consisted of 411 young adult ethnic minorities. The results showed that while controlling for perceived stress levels, psychotic symptoms were only a significant predictor of romantic relationship quality: relationship satisfaction. Psychotic symptoms did not significantly predict the other relationship quality factors such as relationship trust, relationship commitment, and relationship communication. Study results can direct both future research and clinical practice towards symptom management and incorporating the experience of sexuality and romantic relationships among young adult ethnic minorities with psychosis or SMI

    Vitalism and Its Legacy in Twentieth Century Life Sciences and Philosophy

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    This Open Access book combines philosophical and historical analysis of various forms of alternatives to mechanism and mechanistic explanation, focusing on the 19th century to the present. It addresses vitalism, organicism and responses to materialism and its relevance to current biological science. In doing so, it promotes dialogue and discussion about the historical and philosophical importance of vitalism and other non-mechanistic conceptions of life. It points towards the integration of genomic science into the broader history of biology. It details a broad engagement with a variety of nineteenth, twentieth and twenty-first century vitalisms and conceptions of life. In addition, it discusses important threads in the history of concepts in the United States and Europe, including charting new reception histories in eastern and south-eastern Europe. While vitalism, organicism and similar epistemologies are often the concern of specialists in the history and philosophy of biology and of historians of ideas, the range of the contributions as well as the geographical and temporal scope of the volume allows for it to appeal to the historian of science and the historian of biology generally

    Bridging formalisation and expert judgement in searches for studies for systematic reviews

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    Systematic reviews aim to use pre-specified and explicitly described methods. This entails an element of formalisation in which methods are described according to a fixed structure. However, qualitative studies show that too much emphasis on formalisation can obscure how expert judgement is required even after clearly defined methods are established. Thus, there is a gap between how systematic review methods are formalised in guidance and reported in systematic reviews, and how they are carried out in practice using undisclosed expert judgement. The aim of this thesis is to describe and bridge the gap between formalisation and expert judgement with respect to searching for studies for systematic reviews, with a particular focus on forward citation searching and web searching. Forward citation searching and web searching are useful search methods to consider due to observed variability in both if and how they are used in systematic reviews, in contrast to searches of bibliographic databases which are routine in almost all systematic reviews. To this end, the thesis seeks to fulfil three objectives: first, to formalise the conduct and reporting of forward citation searching and web searching in systematic reviews; secondly, to describe and evaluate the conduct and reporting of forward citation searching and web searching in systematic reviews; thirdly, to explore the role of expert judgement when using forward citation searching and web searching. Both aggregative and configurative review types are considered throughout. The findings show that formalised approaches to searching are apparent in guidance to different degrees. However, systematic reviews do not always reflect formalised guidance. Qualitative investigation describes hitherto hidden practical knowledge which underpins searching decisions. The thesis draws these findings together and proposes that guidance on searching for studies should be framed in terms of the practical understanding which informs how searching is undertaken rather than limited to describing recommended processes

    USING HANDS-ON NUTRITION EDUCATION TO IMPROVE READING PROFICIENCY AMONG STUDENTS IN DURHAM PUBLIC SCHOOLS, NC

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    The Education domain of the social determinants of health (SDOH) impacts length of life and general health over an individual’s lifetime (Healthy People 2030). Early childhood reading proficiency is an aspect of education in the public school system that can influence the academic, emotional, and social wellbeing of children (Reading Foundation, 2023). In Durham County, North Carolina, the reading proficiency test scores for elementary students are lower than that for the state of North Carolina, with a further disparity observed in Black and Hispanic students compared to white students in Durham Public Schools (Durham Public Schools, 2023). Nutrition status is an indicator of a child’s overall health, which is associated with their attentiveness and receptiveness to school lessons (Cadiz-Gabjan & Quirino, 2021). Dietary habits formed in childhood influence the habits continued into adulthood, which consequently influences overall health (Chaudhary et al., 2020). Poor nutrition will also negatively influence school attendance, which leads to decreased academic performance (Virginia Commonwealth, 2015). This proposal aims to create a program designed for Durham County Public Schools integrating various school subjects into hands-on nutrition lessons aiming to increase attendance rates and standardized test scores in mathematics, reading, and science among Black and Hispanic students in Durham Public Schools. Keywords: Social determinant of health, reading proficiency, nutrition education, Durham County, North CarolinaMaster of Public Healt

    2023-2024 Boise State University Undergraduate Catalog

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    This catalog is primarily for and directed at students. However, it serves many audiences, such as high school counselors, academic advisors, and the public. In this catalog you will find an overview of Boise State University and information on admission, registration, grades, tuition and fees, financial aid, housing, student services, and other important policies and procedures. However, most of this catalog is devoted to describing the various programs and courses offered at Boise State
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