1,366 research outputs found

    Effects of municipal smoke-free ordinances on secondhand smoke exposure in the Republic of Korea

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    ObjectiveTo reduce premature deaths due to secondhand smoke (SHS) exposure among non-smokers, the Republic of Korea (ROK) adopted changes to the National Health Promotion Act, which allowed local governments to enact municipal ordinances to strengthen their authority to designate smoke-free areas and levy penalty fines. In this study, we examined national trends in SHS exposure after the introduction of these municipal ordinances at the city level in 2010.MethodsWe used interrupted time series analysis to assess whether the trends of SHS exposure in the workplace and at home, and the primary cigarette smoking rate changed following the policy adjustment in the national legislation in ROK. Population-standardized data for selected variables were retrieved from a nationally representative survey dataset and used to study the policy action’s effectiveness.ResultsFollowing the change in the legislation, SHS exposure in the workplace reversed course from an increasing (18% per year) trend prior to the introduction of these smoke-free ordinances to a decreasing (−10% per year) trend after adoption and enforcement of these laws (β2 = 0.18, p-value = 0.07; β3 = −0.10, p-value = 0.02). SHS exposure at home (β2 = 0.10, p-value = 0.09; β3 = −0.03, p-value = 0.14) and the primary cigarette smoking rate (β2 = 0.03, p-value = 0.10; β3 = 0.008, p-value = 0.15) showed no significant changes in the sampled period. Although analyses stratified by sex showed that the allowance of municipal ordinances resulted in reduced SHS exposure in the workplace for both males and females, they did not affect the primary cigarette smoking rate as much, especially among females.ConclusionStrengthening the role of local governments by giving them the authority to enact and enforce penalties on SHS exposure violation helped ROK to reduce SHS exposure in the workplace. However, smoking behaviors and related activities seemed to shift to less restrictive areas such as on the streets and in apartment hallways, negating some of the effects due to these ordinances. Future studies should investigate how smoke-free policies beyond public places can further reduce the SHS exposure in ROK

    The Elusive Pursuit of Justice: Sexual Assault Survivors' Speak About Redress in the Aftermath of Violence

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    The struggle of survivors to obtain justice after they have been sexually assaulted has been a much discussed topic in recent years. Significant attention and resources are being directed towards this issue, making academic research particularly valuable at this time. However, instead of asking how legal processes can theoretically be made better, as is the case in most of the literature on this topic, my focus has been on asking why survivors want to engage in a legal process at all. What do they get from reporting their assaults and does what the legal system offers them respond to what survivors are looking for from justice? This project starts this conversation by asking survivors what they think justice should be in the aftermath of a sexual assault. Using feminist standpoint epistemology and grounded theory, I interviewed sixteen survivors and seven lawyers to explore what justice means for survivors in the aftermath of an assault. From the data, I identified four major themes including: harms and healing, accountability, punishment, and restorative justice. I found that survivors were not satisfied with the justice they could obtain under criminal law. They stated that it was difficult, financially and emotionally, to engage in criminal proceedings that were unlikely to resolve in a way that made them feel as if justice was done. While other forms of legal justice are also available, survivors often found these to be inaccessible as well, or they were unaware of the existence of these alternative options. The survivors I spoke with imagined an expansive ideal of justice. To most of the women I interviewed with, justice involved the prevention of future violence, something they did not think the legal system was currently equipped to deal with. They were curious, though conflicted, about restorative models, but appreciated their focus on attempting to reform offender behaviour. They also stressed the importance of being supported in their attempts to recover from sexual assault, highlighting that financial compensation was crucial for any survivor to heal

    Exploring the role of socio-economic and cultural factors influencing the occurrence of VVF in Northern Nigeria

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    Background Access to a range of adequate care, and support during pregnancy and after delivery is required to prevent maternal morbidity, however, difficulties accessing appropriate healthcare by pregnant women is a significant problem in low- and middle-income countries, especially in Nigeria. Though there are multiple, significant, maternal morbidities or complications, obstructed fistula was identified as the one that impacts most women especially, in sub-Saharan Africa. There are two major kinds of obstructed fistula common in developing countries, namely, Vesico Vaginal Fistula (VVF) and Recto Vaginal Fistula (RVF) (Tebeu et al., 2012). This study focuses on vesicovaginal fistula because it has the most debilitating impact and is most prevalent in developing countries, especially Nigeria, where it is also increasing in prevalence in the Northern Nigeria geopolitical zones (Ijaya et al., 2010). VVF is an avertible tragedy, and a preventable complication of pregnancy resulting in an abnormal passage or channel between the vagina and the bladder. The impacts include stillbirth, physical and psychological trauma for the victim. Maternal healthcare has been jeopardised especially in low- and middle-income countries giving rise to occurrence of VVF. While the quality of available healthcare is a concern, socioeconomic and cultural factors has been identified as critical factors leading to its occurrence. The literature review identified evidence gaps including, a lack of in-depth exploration of the individual's risk of being at risk (due to socio-economic/cultural factors), the experiences of VVF women, influence on practitioners’ service delivery, available interventions, and the challenges in delivering VVF services. Aims This study aimed to (1) explore the socio-economic and cultural factors influencing VVF occurrence among women in Northern Nigeria and (2) Identify potential interventions to address the increasing prevalence of VVF in Northern Nigeria. Methods A critical interpretivist approach and purposive sampling was used to explore participant experiences of VVF. A 1:1 semi-structured interview was conducted with twenty-two VVF patients and ten VVF practitioners from across the three geopolitical zones of Northern Nigeria. The interviews were transcribed, and thematic analysis of the data completed guided by Braun and Clarke (2006). Findings The findings of this study produced three overarching themes which are: Socioeconomic and inter-connections with cultural factors influencing the prevalence of VVF. Occurrence of VVF and challenges hindering access to healthcare. Potential solutions to reduce the prevalence of VVF. The findings indicate the negative impact of multiple, inter-related socio economic and cultural factors on women’s health outcomes and experiences, specifically in relation to their perceived value and role in society, associated risk of VVF and access to preventative and treatment services. Conclusions Reducing VVF prevalence may not be realistic without in-depth exploration and adequate prevention of the risk of being at its risk. VVF may continue to thrive where there is no improvement in maternal healthcare services, poverty, poor quality of education status or access to education and dominance of predisposing cultural practices. This study identified causes and suggested strategies for preventing VVF occurrence, resulting in specific recommendations for future policy, practice, and research, whilst also highlighting the implications of leaving these unaddressed, for economic recovery and achieving Sustainable Development Goals (SDGs) among women in Northern Nigeria

    30th European Congress on Obesity (ECO 2023)

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    This is the abstract book of 30th European Congress on Obesity (ECO 2023

    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

    Breastfeeding, motherhood and employment: the experience of breastfeeding mothers returning to work in Qatar

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    Participation of women in employment in Qatar has increased significantly over the past 10 years, from 12.4% in 2011 to 37% in 2020, with 64.1% of working women also being married (Planning and Statistics Authority, Qatar). Their professional commitments notwithstanding, most of these women are also mothers, with many breastfeeding. The Quran demands that mothers breastfeed their children for the first two years of their lives. This thesis explores this tension between a rapid increase in mothers entering the labour market, and the specific historic, cultural and religious expectations upon mothers in Qatar, which create challenges for mothers, employers and policy makers that are different from those of working mothers in the Global North and need further consideration. This thesis employed a qualitative research methodology in which a total of 50 breastfeeding, professional, working mothers in the public and private sectors of Qatar were interviewed. The thesis adopts a multifaceted theoretical framing. First, matricentric feminism (O’Reilly, 2016) and Hay’s concept of intensive mothering are considered in terms of their applicability, and expanded upon in seeking to make sense of the tensions and challenges the women experienced as they returned to work following birth and a relatively short maternity leave of only 50 and 60 days, in the private and public sectors respectively, within this particular context in the Global South. Second, the theory of the gendered institution, as proposed by Acker in 1990, posits that breastfeeding mothers cannot embody the ‘ideal worker’ construct due to considerations such as the roles they can handle, interpersonal interactions, self-efficacy, and culture. Third, under maternal bodies at work theory by Gatrell, Cooper and Kossek's (2017), breastfeeding mothers are perceived as social pollutants. According to this theory, women's experiences are influenced by the perspective that maternal bodies belong in the private sphere and that their presence in the workplace is repugnant to other workers. Finally, the experiences of breastfeeding women are analysed from the perspective of their embeddedness in multiple layers of contexts, in line with the theorisation of Lewis and Den Dulk (2008). There are four layers of contexts taken into account the global, national/regional and institutional layers. Under this theoretical position, the thesis appreciates the reality that different factors interact to produce magnified or suppressed effects. Through the lens of this multifaceted theoretical framework, the findings from the interviews are analysed through thematic analysis.This thesis therefore significantly contributes to the literature on working mothers through its location in an Islamic country, and through its orientation and exploration of the significance of the religious context at the intersection of gender and employment in particular, which remains underexplored. The findings show how the mothers’ return to work is complicated by the ways in which employment policies on pregnancy, maternity and breastfeeding are not aligned with Islamic doctrine on what is expected of women seeking to conform to ideas of being a ‘good Muslim mother’ In line with matricentric feminism, the findings show that Qatari women have displayed increased propensity to seek opportunities under professional employment as a way of advancing their interests as women and mothers, while also taking care of their families. The participation of women in the workplace has magnified the effects of intensive mothering, whereby women are expected to pursue professional acheivements in the workplace, while also being a good mother in accordance with the guidelines by Islam. These guidelines impose two years breastfeeding period after the birth of a baby, in addition to other domestic responsibilities. However, the novel work-related responsibilities have made fulfilling this mandate challenging for these women. The limitations arise from circumstances that can be explained through elements of the gendered organisation since most workplaces are not set up to facilitate breastfeeding. Similarly, women are found not to fit the ‘ideal worker’ image, thus limiting the extent to which they can exercise agency. It is also apparent from the resrach findings that the maternal body of the Qatari breastfeeding women in the study is perceived as a pollutant and repugnant in most workplaces and public spaces. While providing breastfeeding facilities in the workplace and accommodating breastfeeding activities could solve some of these challenges, most of the workplaces where the women interviewed work have not taken such measures. Finally, there is evidence that most breastfeeding mothers' experiences can be linked to multiple factors based on layers of contexts, starting with the global, national/regional and finally at the institutional level. The effects of the failure by Qatar to ratify the Maternity Protection Convention, 2000 (No. 183) has played a role in subsequent actions such as the provision of insufficient leave days. Furthermore, institutions have not been mandated to accommodate the interests of breastfeeding mothers by providing the necessary facilities, such as private rooms for breastfeeding or for the expression of milk. These circumstances function to cause and magnify the challenges that breastfeeding mothers experience in practice upon their return to work. It also highlights the different ways they sought to overcome these challenges. It highlights how women in Qatar find themselves in a situation in which they are compelled to adhere to religious guidelines and organisational policies that are in conflict with each other. The implications of these findings for theory, policy and practice are explored from a feminist perspective in the final discussion and conclusion. The proposal for policy changes focus on adjustments to the limited maternal leave days to provide breastfeeding mothers with more time to take care of the infant. Changes to Human Rresources policies in the workplace such as job-sharing can also provide stop-gap measures to accommodate the interests of breastfeeding mothers. For practice, it is necessary for a multi-stakeholders and multi-sector approach to developing solutions to the challenges that contribute to the negative experiences of Qatari mothers who breastfeed at work

    Health Leadership and Management Practices That Support Accountability for Results

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    Although leaders are expected to nurture and sustain a culture of accountability for results, little is known about how health leaders in developing countries perceive, interpret, demonstrate, and promote accountability in their day-to-day practices. The purpose of this generic qualitative study was to explore the management and leadership practices that leaders of public and non-profit health support organizations in Uganda utilize to embody and support accountability for key stakeholders’ results. Data from in-depths interviews with 13 participants at the governance, senior management, and middle management levels were analysed using thematic data analysis. Riggio\u27s conceptualization of using multiple perspectives and disciplines to understand leadership guided the study. The findings indicate that the combination of management and leadership practices that promote accountability results are motivated and sustained by the leaders’ ethical and moral values, character and soft skills; majorly driven by task, relations, change, and externally-oriented leadership behavior; aligned with the leaders’ perceived primary management and leadership roles and responsibilities; and focus on enabling others to identify the right problem to address, recognize and navigate the eclectic ecosystem-wide interests, and mandates. These findings add to knowledge on managing and leading accountability in low-income settings. Implications for positive social change included understanding how to identify, select, develop, promote, and retain managers and staff with the relevant skills, enduring positive intrapersonal accountability motives and practices; this results in building effective organization systems that shape, strengthen, and sustain a culture of accountability for results
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