251 research outputs found

    Digital solutions for self-monitoring physical health and wellbeing during pregnancy

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    Perinatal disorders were among the top ten causes of global burden of disease in 2019. Better access to perinatal healthcare would help to reduce preventable morbidity. The increase in access to and use of smartphones presents a unique opportunity to transform and improve how women monitor their own health during pregnancy. This thesis aims to investigate the quality and usage of currently available pregnancy digital health tools for self-monitoring and to validate a newly developed, custom-built pregnancy self-monitoring tool. In Chapter 2, the most popular, commercially available pregnancy apps and their monitoring tools were evaluated for their quality by conducting a pregnancy app scoping review. In Chapters 3 and 4, pregnant women and healthcare professionals were surveyed and interviewed to better understand their usage of and attitudes towards digital health, as well as their thoughts about two hypothetical app features (a direct patient-to-healthcare professional communication tool and a novel body measurement tool). In Chapter 5, we test the performance of a first generation, custom-built body measurement tool (which we called BMT-1) by comparing the digital measurements extracted from photos taken on smartphones to physical measurements taken with measuring tape. The performance of BMT-1 was also assessed on a longitudinal set of digitally constructed pregnancy models. Collectively, the findings from Chapters 2, 3 and 4 provide evidence that there is both opportunity and scope for the development of new digital health tools to support and enhance the quality of care during pregnancy. The results from Chapter 5 indicate that BMT-1 successfully extracted body measurements from both photos and digitally constructed pregnancy models, though would require refinement before it could be launched. To finalise, in Chapter 6, I outline how these findings could help to guide the design, development and implementation of new pregnancy digital health tools

    Essays on Digital Healthcare and Inclusion

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    This dissertation consists of two main parts in seven essays: Five essays revolve around digital healthcare, while two additional essays cover teachers’ attitude towards inclusion. The first three essays are about the use of telehealth software in chronic disease treatment, using the case of hemophilia. Essays IV and V discuss the development of a 3D-software prototype to provide medical models to novice surgeons or other practitioners. The last two essays present a study on what impacts a teacher’s attitude towards inclusion in vocational education. Essay I develops the model and hypotheses which are used in essay II. It combines and adopts several existing models to cover factors that could influence a physician’s decision to recommend a telehealth app to a patient. Essay II builds on this work and tests the model with survey data. The results show that physicians are more likely to recommend a software if they use the software themselves and if they perceive the software to improve their workplace processes. Essay III turns the perspective of the first two essays and investigates which factors influence a patient to use a telehealth app. This was researched by creating a model based on a combination of existing models that describe the behavior of software users and models of patient behavior. Its results indicate that hedonic motivation has an influence, meaning that healthcare apps still need to provide some level of engagement. The other significant influence was cues to action from the social environment, which includes physicians. This additionally validates the necessity of the study undertaken in the first two essays, where the reasoning for a physician to give such an advice was analyzed. Essay IV and V show the development of a hardware/software prototype to solve current shortcomings in the field of surgical-adjacent medicine, like soft-tissue fillers. Facial treatments, even for aesthetic purposes, often involve unnecessary patient risk due to treatment by unexperienced practitioners and/or a lack of standardized procedures. The developed prototype focuses on affordability and helps in treatment planning and professional self-development. Essay IV focuses on the architecture of the prototype itself, while essay V adds an exemplary embedding into a treatment process and a test in a live treatment. Essays VI and VII investigate factors influencing vocational teachers’ attitude towards inclusion. Essay VI is the pilot study. The inclusion-related attitudes of teachers are considered to be essential predictors for their pedagogical and inclusion-related perception and action in inclusive lessons as well as for the teaching success. The results show that previous experiences with inclusion, self-efficacy and the understanding of teaching and learning are the main predictors for a teacher’s personal willingness to act in an inclusive environment

    Pediatric Critical Care in Resource Limited Settings-Lessening the Gap Through Ongoing Collaboration, Advancement in Research and Technological Innovations.

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    Pediatric critical care has continued to advance since our last article, "Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned" was written just 3 years ago. In that article, we reviewed the history, current state, and gaps in level of care between low- and middle-income countries (LMICs) and high-income countries (HICs). In this article, we have highlighted recent advancements in pediatric critical care in LMICs in the areas of research, training and education, and technology. We acknowledge how the COVID-19 pandemic has contributed to increasing the speed of some developments. We discuss the advancements, some lessons learned, as well as the ongoing gaps that need to be addressed in the coming decade. Continued understanding of the importance of equitable sustainable partnerships in the bidirectional exchange of knowledge and collaboration in all advancement efforts (research, technology, etc.) remains essential to guide all of us to new frontiers in pediatric critical care

    Effect of a ward-based outreach team and adherence game interventions on retention in care and virological suppression of HIV-infected patients newly initiated on antiretroviral treatment in Tshwane

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    Thesis (PhD (Family Medicine))--University of Pretoria, 2022.This PhD research project was conducted in Tshwane district of Gauteng province, South Africa. This project was subdivided into four different papers. First abstract The aim of this study was to understand potential benefits and barriers to delivering HIV care at the community level in Tshwane district and develop recommendations for improvement. Seven focus group discussions were conducted with 58 participants. While home-based human immunodeficiency virus (HIV) care was seen as a support strategy which could motivate patients to take their medication, the unpredictability of patients’ responses to HIV test results, incorrect addresses (driven by the need for identity documents), fear of stigma through association with ward-based primary health care outreach teams (WBPHCOTs), especially those in uniform, little or no preparation of patients for home-based care, and lack of confidentiality and trust were raised as potential barriers. Second abstract The aim of this study was to assess the acceptability of community-based HIV services offered by community health workers (CHWs). A survey was conducted in 10 clinics across Tshwane district, Gauteng, South Africa. CHWs conducted interviewer-administered standardised questionnaires with 674 adult participants. Overall, 95.5% of participants thought that home-based HIV care is a good initiative and rated screening for illnesses and referral to health facilities highly. Although the vast majority (>94%) were willing to disclose their status to health professionals in clinics, women were more willing to do so. However, only 53.6% of participants were willing to disclose their HIV status to a CHW from the same neighbourhood and 28.8% would find it problematic if CHWs visited them at home with branded cars. Third abstract This 2 x 2 factorial cohort study assessed the effect of two interventions - WBPHCOTs and an adherence game - on 12-month retention in care and virological suppression in participants newly initiated on ART. Clinics were randomized into four comparator arms: WBPHCOT; Game; WBPHCOT-Game in combination; and Control (standard of care). A total of 467 participants were included in the analysis: WBPHCOT (n=72); Games (n=126); WBPHCOT-Games (n=85); and Control (n=184). After 12 months, 340 participants (86.2%) remained in care. The Games group had the highest retention compared to the Control group (96.8% vs 77.8%; relative risk [RR] 1.25; 95% CI 1.13–1.38; p=0.01). While retention was better in the WBPHCOT-containing interventions than in the Control group, the differences were not statistically significant. Younger participants (<35 years) were significantly less likely to remain in care (71% vs 89%; RR 0.80; 95% CI 0.69 – 0.93; p=<0.001). The overall virological suppression rate was 75.3% and was similar across the four arms. Fourth abstract Following the reporting requirements of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, an aggregative narrative synthesis approach was used to summarize the results of qualitative studies published between 1 January 2000 and 6 November 2020. In total, 17 studies met the selection criteria and were included in the analysis. They reported on a range of roles played by CHWs in HIV care, including 1) Education: home visits; health education and promotion; 2) HIV-specific care: HIV testing services; screening for opportunistic infections and acute illness; medication delivery; tracing persons who had defaulted from care; and 3) Support: treatment support; referral; home-based care; and psychosocial support. Many different barriers to community-based HIV care were reported and centred on the following themes: 1) Stigma and non-disclosure: stigma; non-disclosure of HV status; concerns about confidentiality; 2) Inadequate support: lack of resources, inadequate training, lack of support, poor communication, inadequate funding, and inadequate monitoring; and 3) Health care system challenges: patient preference for more frequent visits, and poor integration. Most articles also provided a set of recommendations to mitigate these barriers, most notably: Professionalizing CHW programmes; intensifying health campaigns; strengthening CHW supervision, providing CHWs with the necessary equipment, and improving CHW attitudes. Conclusion The 2 x 2 factorial cohort study was the first to demonstrate that a physical adherence game improved the retention of people living with HIV (PLWHIV) newly initiated on ART and hence has the potential to improve treatment outcomes. In addition, home-based HIV care was largely accepted as an important and positive intervention. To successfully implement effective home-based HIV care in South Africa, it is important to address perceived barriers to such care and involve all stakeholders, from decision makers to CHWs and PLWHIV.South African Medical Research CouncilFamily MedicinePhD (Family Medicine)Unrestricte

    Utilization of District Health Information System 2 by healthcare workers in Lesotho

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    The purpose of the study was to investigate the utilization of District Health Information System 2 (DHIS2) by healthcare workers in Lesotho. The study was conducted at three specific healthcare facilities in Lesotho and used a quantitative descriptive and cross-sectional design. The population consisted of 291 healthcare workers. Probability stratified random sampling was used. The sample consisted of 93 respondents. Data was collected from the 16th June to 16th July 2021 using self administered questionnaires. Data was analysed using Statistical Package for the Social Science version 26. Descriptive and inferential statistics were used to summarize raw data. The study found that DHIS2 is not effectively used as (76.4%, n=68) respondents often use DHIS2 for data entry only, (71.9%, n=64) encountered challenges on its use and (82.0%, n=73) needed support to resolve challenges encountered. The recommendations include, need for equipment review, refresher trainings, supervision and motivation concerning utilization of DHIS2Health StudiesM. P. H

    Schedule of Visits and Televisits for Routine Antenatal Care : A Systematic Review

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    This report is based on research conducted by the Brown Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 75Q80120D00001). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.Publisher PD

    Reducing under-five mortality in Makonde district’s public healthcare institutions: an exploratory investigation into the potential role of emerging technologies.

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    Doctoral Degree. University of KwaZulu-Natal, Durban.Under-five mortality rate remains unacceptably high globally, with Sub-Saharan Africa being the region with the worst under-five mortality outcomes. The United Nations reported that an average of 15 000 under-fives died daily in 2018, translating to 5.3 million under-fives dying annually. The United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) estimated that up to 5.5 million under-fives died in 2021. The outbreak of the Coronavirus Disease 2019 (COVID-19) worsened the situation for child healthcare in low-resource settings due to overwhelmed and strained healthcare systems. Promoting the health and well-being of under-fives remains a priority of the United Nations and its member states, as evidenced by the setting of under-five mortality goals in both the expired Millennium Development Goals and the current Sustainable Development Goals. Globally, under-five mortality outcomes are meagrely improving, registering a 4 per cent improvement in 18 years. Zimbabwe is one of the countries with high under-five mortality rates, with the Midlands and Mashonaland West provinces having the worst under-five mortality rates, according to the 2019 Multiple Indicator Cluster Survey (MICS) report. Despite the evidence of emerging technologies helping to reduce under-five mortality rates in other regions and countries like the United States of America, the United Kingdom and South-West Nigeria, the potential of such technologies to reduce under-five mortality rates in Zimbabwe’s public healthcare institutions has not been explored. Although Zimbabwe has registered improvements in under-five mortality rates over the years through such programmes as free healthcare for under-fives in public health facilitie s, child immunisation programmes, provision of nutritional supplements and prevention of mother-to-child transmission (PMTCT), the rates are still unacceptably high and above the SDG target of 23 per 1 000 live births, making Zimbabwe ranked amongst the fifty countries with the highest early childhood mortality in the world. The country’s poor under-five mortalit y rates suggest that the existing methods need to be complemented by different approaches. Guided by three theoretical frameworks, the Diffusion of Innovation, the Unified Theory of Acceptance and Use of Technology and the Capabilities Approach, the researcher explored the potential role of emerging technologies in reducing under-five mortality in Makonde District, Zimbabwe. The key deliverables of this study included a framework for the adoption of emerging technologies to reduce under-five mortality in resource-constrained settings like Makonde district. An exploratory sequential mixed-methods design was used, in which 20 healthcare professionals from Makonde public health facilities participated in interviews and a focus group, while 90 healthcare professionals and 391 mothers of under-five children xi responded to questionnaires. The researcher used purposive and snowball sampling to identify interview and focus group participants, where experience and whether one works in the paediatric ward, works with children or pregnant women were critical considerations. Mothers of under-fives were randomly sampled. The study revealed that the participants arguably value under-fives the most and would accept any technology intended to improve their health and wellbeing. They perceive emerging technologies as helpful in areas like improving diagnosis, minimising loss to follow-ups and providing data-driven, evidence-based and personalised paediatrics. The impediments to adoption included the fear of medico-legal hazards, centralisation of digital health decision-making, network problems, resistance to change and demoralised workforce. There is generally poor knowledge of emerging technologies by healthcare professionals in Makonde District. The study proffers recommendations on what needs to be done for emerging technologies to be adopted in Makonde District’s public healthcare institutions to reduce under-five mortality. An adoption framework is also presented.No isiZulu abstract available

    Intellectual property, trade, human rights and access to medicines in Africa: A Reader

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    Intellectual property, trade, human rights and access to medicines in Africa: A reader by Atangcho N Akonumbo explores the current debates and conflicts pertaining to intellectual property (IP), trade and access to medicines in Africa as a public health issue, in a public health context. The Reader has a broad focus running across fourteen chapters. It examines the complex web of access to medicines, while introducing major concepts pertaining to access to medicines such as IP, trade, medicine and human rights, and provides a historical overview of the nexus between IP and human rights. It establishes the link between human rights, IP and access to medicines within the context of developing countries broadly and Africa in particular. The Reader discusses key flexibilities within the international IP framework championed by the TRIPS Agreement to enhance access to medicines, including compulsory licensing and parallel importation, while addressing impediments therein which provoked the Doha Declaration and arrangements thereafter. Also, it examines issues such as the implications of data exclusivity and linkage techniques; the role of anti-counterfeiting and competition laws in checking the effect of IP regimes; current threats to access to medicines at the international, regional and national levels such as the influence of regional or bilateral trade agreements; and research and development in respect of medicines for neglected and (re)emerging infectious diseases. It discusses the contributions of naturopathic and traditional medicines as parallel and complementary systems to modern medicine in the access to medicines landscape in the African context. The Reader further addresses the implications of the difficulty of access to medicines for women, children and other social minorities such as disabled persons and Lesbian, Gay, Bisexual, and Transgender (LGBT) persons. This Reader comes at a critical time, and potentially, a turning point in the history of public health crisis in Africa – when concerns about access to medicines have been heightened in the face of (re)emerging diseases and today the Covid-19 pandemic – a situation which has revealed gross lapses in public health governance. It is written in a simple language, making its content accessible to a wide audience. It contains informative and useful graphs, text boxes and illustrative excerpts from various primary and secondary sources. The Reader is likely to become an invaluable tool for a wide range of persons and institutions, including academics, students, legal practitioners, health professionals, drug procurement agencies, civil society organisations and the public at large, involved or interested in the access to medicines discourse.PublishedIntellectual property, trade, human rights and access to medicines in Africa: A reader by Atangcho N Akonumbo explores the current debates and conflicts pertaining to intellectual property (IP), trade and access to medicines in Africa as a public health issue, in a public health context. The Reader has a broad focus running across fourteen chapters. It examines the complex web of access to medicines, while introducing major concepts pertaining to access to medicines such as IP, trade, medicine and human rights, and provides a historical overview of the nexus between IP and human rights. It establishes the link between human rights, IP and access to medicines within the context of developing countries broadly and Africa in particular. The Reader discusses key flexibilities within the international IP framework championed by the TRIPS Agreement to enhance access to medicines, including compulsory licensing and parallel importation, while addressing impediments therein which provoked the Doha Declaration and arrangements thereafter. Also, it examines issues such as the implications of data exclusivity and linkage techniques; the role of anti-counterfeiting and competition laws in checking the effect of IP regimes; current threats to access to medicines at the international, regional and national levels such as the influence of regional or bilateral trade agreements; and research and development in respect of medicines for neglected and (re)emerging infectious diseases. It discusses the contributions of naturopathic and traditional medicines as parallel and complementary systems to modern medicine in the access to medicines landscape in the African context. The Reader further addresses the implications of the difficulty of access to medicines for women, children and other social minorities such as disabled persons and Lesbian, Gay, Bisexual, and Transgender (LGBT) persons. This Reader comes at a critical time, and potentially, a turning point in the history of public health crisis in Africa – when concerns about access to medicines have been heightened in the face of (re)emerging diseases and today the Covid-19 pandemic – a situation which has revealed gross lapses in public health governance. It is written in a simple language, making its content accessible to a wide audience. It contains informative and useful graphs, text boxes and illustrative excerpts from various primary and secondary sources. The Reader is likely to become an invaluable tool for a wide range of persons and institutions, including academics, students, legal practitioners, health professionals, drug procurement agencies, civil society organisations and the public at large, involved or interested in the access to medicines discourse

    2022 NSU Fact Book

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    The 30th edition of the Nova Southeastern University (NSU) Fact Book provides perspective on the university’s character, growth, and accomplishments. The 2022 Fact Book includes narrative, numeric, and graphic representation of the university, including history, characteristics, and development of the institution. Data are presented in both tabular and graphic formats to provide pertinent detail, and general trends are highlighted. Like all previous editions of the Fact Book, this edition is a snapshot of the university during the academic year that concludes in the year of its publication. Therefore, the 2022 Fact Book represents NSU from fall 2021 through spring 2022, unless otherwise noted.https://nsuworks.nova.edu/nsudigital_factbook/1031/thumbnail.jp
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