37 research outputs found

    Evaluating the role of community health workers in achieving an integrated health service in developing nations

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    Revolutionary progress in healthcare over the last 100 years has aided humanity in addressing critical vulnerabilities due to infectious and chronic diseases. Developments in pharmaceutics, medical technology, and practice have disproportionately but universally increased the life expectancy of people in all countries. Coupled with improved life expectancy, the exponential trend of population growth has driven encroachment on the habitats of other earth-dwelling species increasing the chances of zoonotic transmission of novel diseases. As population growth has begun to slow and taper, new generations of healthcare professionals entering the field today face the unique challenge of addressing the increasing occurrences of novel disease outbreaks in the context of a disproportionately increasing elderly population as large cohorts of existing generations age past their physiological prime and become increasingly immuno-vulnerable. The current care context focuses on secondary and tertiary levels of care in fragmented supply-chain-driven health systems usually centralized to hospitals or ambulatory health centers known as healthcare “silos”. Such downstream models are unsustainable as it faces well-known capacity issues, most recently demonstrated by the COVID-19 pandemic, and are expensive to scale and maintain, making it especially difficult for developing countries to model and develop. To mitigate capacity issues, improve society’s overall health, and be able to detect and address health emergencies quickly, more emphasis must be placed on primary-level health systems. Integrating these systems at the community level can decentralize the burden of care from “silos” and develop early monitoring, detection, and response systems, significantly improving access to quality care. Primary-level health system models which revolve around the professionalization of community health workers (CHW), an umbrella term used to describe the age-long practice of community-based care by designated healers, have been regaining attention in recent years as innovative health leaders and global health partners have established several successful programs worldwide. CHWs are trusted community members with a deep understanding of their community’s dynamics, language, experiences, and, importantly, their needs. In this capacity, CHWs are very effective in establishing a dynamic relationship between the patient community and healthcare providers essential to better assessing and understanding community needs, constructively strategizing approaches to address these needs, and effectively delivering care to all. As a community-based approach, CHWs decentralize the locus of care from silo facilities and empower communities to take ownership of their stake in the local health ecosystem to improve the access, trust, and quality of care bilaterally, which leads to a more empowered, effective, and sustainable health system level necessary to address the increasing burden of disease. In recognition of the stark disparity in access to quality healthcare globally, the World Health Organization (WHO) focused 16 of 17 Sustainable Development Goals (SDG) on topics, directly and indirectly, related to improving a population’s access to quality healthcare. The third SDG focuses exclusively on improving health and wellbeing for all at all ages, which includes the “Framework on integrated, people-centered health services” (IPCHS), a strategy passed by the Health Assembly in 2016. This strategy is designed to reorient fragmented supply-chain-driven health systems towards a more cross-sectoral health system centered around the people and communities it serves; to provide responsive services both within and beyond hospital settings irrespective of development status (WHO, 2016). The IPCHS presents a detailed framework with a variety of goals in working towards achieving an integrated people-centered health system, which serves as the primary evaluation framework of this thesis. This thesis reviews studies on CHW programs globally, presenting evaluations on how and which IPCHS goals CHWs can attain and how CHW programs can be utilized to achieve a more sustainable integrated people-centered health system

    A Wait-List Controlled Study of a Culturally Adapted Trauma Focused-Adaptation and Development After Persecution and Trauma (ADAPT) Model-Based Anger Therapy (CTF-AAT) for Intermittent Explosive Disorder (IED) in Timor Leste

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    Research background and context: The core focus of my dissertation is the development and assessment of a culturally adapted psychological intervention in response to my community observations during an extended United Nations (UN) assignment in the newly established independent country of Timor Leste. This was combined with an emerging body of research showing high rates of post-conflict chronic anger responses and inter-familial violence amongst trauma-affected communities in Timor-Leste. The structure of the dissertation includes a general introduction (Chapter 1), followed by eight focused research and clinical narrative review chapters that provide the context to the program of empirical research that forms the core of the second half of the dissertation comprising five chapters with a final integrative synthesis (Chapter 15). The review chapters commence with an overview of historical and contemporary approaches to anger and anger conditions including a review of culturally specific understandings of anger and pathological expression of some anger conditions reflected by the inclusion of intermittent explosive disorder (IED) within recent mental health diagnostic systems (Chapter 2). I then reviewed findings from mental health research within postconflict settings developed over the last 4 decades, with most of that research focused on posttraumatic stress disorder (PTSD) and depressive conditions (Chapter 3). Increasingly, posttrauma anger responses have also been documented as an outcome of trauma, initially amongst combat veterans but also amongst conflict exposed communities affected by war and mass violence (Chapter 4). This background narrative review of the key relevant mental health research allowed me to examine the Timor Leste postconflict environment and the particular importance of understanding the association and role of anger with past trauma exposures in the contemporary life of affected Timorese communities (Chapter 5). To identify a clinical framework to assist with understanding posttraumatic anger, I examine a number of prominent trauma models developed to understand the impact of mas conflict and persecution and review in detail the ADAPT theoretical framework proposed by Silove and colleagues, which focuses on five psychosocial pillars (Chapter 6). The pillar of justice in particular guided the conceptualization of the intervention that describes that exposure to injustices; particularly human rights violations (i.e., torture, murder, and rape) committed by state parties during conflicts, if unaddressed by relevant government entities in the postconflict era were bound to play a central role in triggering chronic anger reactions that may perpetuate pathological expressions of anger marked by aggression and violence. I then shift the focus to the role of psychological interventions including contemporary treatment responses for anger syndromes in other population groups, which were dominated by cognitive behavioural treatment (CBT) approaches and clinical trials examining clinical outcomes including the few IED treatment outcome studies (Chapter 7). A particular focus included research with combat veterans, the population with whom most trauma-focused anger studies had been undertaken. Chapter 8 includes a selective review of the efficacy of psychological interventions in treating PTSD and other CMDs in the literature followed by Chapter 9 that presents a literature overview on cultural competence, adaptation frameworks, models and guidelines that informed the creation and the testing of the culturally adapted trauma focused-adaptation and development after persecution and trauma (ADAPT) model based anger therapy (CTF-AAT) for intermittent explosive disorder (IED) in Timor Leste. Research Method and Results: The empirical chapters commence with a detailed description of the process that I used to develop CTF-AAT intervention linked to the experience of the Timor Leste communities. I drew on key developments in the postconflict mental health field particularly the research and conceptual framework of ADAPT of Silove and colleagues, linking postconflict anger and past experiences of injustice, in Timor Leste. This was combined with key informant and stakeholder consultation to assist and refine the CTF-AAT intervention (Chapter 10) and the selection of the key assessment tools to evaluate anger syndromes and symptom change over time in Timor-Leste (Chapter 11). The resulting CTF-AAT intervention developed in partnership with Timorese consultants was examined for community acceptability and feasibility through a small consecutive series pilot study which confirmed the acceptability and perceived value of the psychological intervention (Chapter 12). This led to the formal examination of CTF-AAT (Chapter 13) through the implementation of an assessor-blinded waitlist controlled trial of a CTF-AAT amongst trauma survivors in postconflict Timor Leste. The intention-to-treat sample (n = 78) comprising Timorese nationals (women = 49; men = 29), ages 18 years and older, meeting Diagnostic and Statistical Manual of Mental Disorders (DSM; 4th ed.) criteria for IED, with equal numbers (n = 39 each) being randomized to the treatment group (TG) and waitlist (WL). Assessments were conducted 1 week prior to therapy, immediately at posttreatment, and at 1-month and 1-year follow-up. The study was designed in conformity with the Consolidated Standards of Reporting Trials (CONSORT) extension for nonpharmacologic treatment interventions. The primary measures included an IED diagnosis made according to the East Timor Explosive Anger Measure (ETAM) and the directionality of expression and control of anger assessed by four dimensions of the State-Trait Anger Expression Inventory (STAXI-2). Secondary measures included psychological distress assessed using the Kessler Psychological Distress Scale (K-10), and an index of PTSD assessed using the Harvard Trauma Questionnaire (HTQ). The results after the third assessment (at 1-month follow-up) in the TG demonstrated a decline in IED from 100% to zero. In the WL, more than 70% (of the 100% at baseline) demonstrated persisting IED at second and third assessments. The TG alone showed significant (p 0.80). Psychological distress and PTSD showed substantial reductions in the TG, but not the WL group. The fourth assessment was conducted among n = 26 TG participants after 1 year of the CTF-AAT intervention, where none met the criteria for IED. Improvements in the four anger dimensions of STAXI-2 observed in previous assessments were maintained at 1-year posttherapy. None of the 26 participants met the PTSD threshold of ≥ 2.2 or the K-10 threshold of K10 > 30, which indicates that the positive impacts of the CTF-AAT intervention are sustainable for at least 1-year posttherapy. Conclusion: The findings provide the first evidence in support of the efficacy of CTF-AAT for IED in a culturally diverse, postconflict setting and the first ADAPT-informed specialized mental health treatment outcome study in the world for IED. Considering the rising number of traumatized populations in the world due to war and conflict, IED rates are bound to escalate thus after further testing, the treatment protocol of CTF-AAT has the potential to be adapted and implemented by lay counselors in similar settings worldwide, the aim being to reduce anger, IED and aggression in post-conflict societies across different cultures

    From Arctic communities to the big city: perceiving and communicating climate risk in a rapidly changing world. Experience from Norway.

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    The risk of climate change encompasses an entirely new approach to risk that has never been experienced before; its consequences do not only affect and threaten the people living on the planet now but also future generations. At the forefront of climate change is Longyearbyen, an Arctic settlement on the Norwegian archipelago Svalbard which is viewed as "a living lab" for climate change as it is warming much faster than the global average. Further south, on the northernmost part of the Norwegian mainland, is Nordkapp. A small municipality that, in recent years, has had to take preventive measures to prevent avalanches. In the very south of Norway is Norway's capital, Oslo, which is regarded as more protected against the most harmful effects of climate change. This thesis researched how the public authorities in Longyearbyen, Nordkapp, and Oslo perceive and communicate climate risks. In a world that is getting warmer and where urbanization is expected to increase, public authorities will be a bridge builder between experts and the public. Empirics from qualitative document analysis and semi-structured interviews with three informants from Longyearbyen, Nordkapp and Oslo were discussed using theories on risk, risk perception and risk communication. This study found that climate change's impact on the overall risk affects risk communication strategies and risk perception. In Longyearbyen and Nordkapp, societies this study found climate risks to manifest objectively more significant, prioritized short-term climate disaster handling. In contrast, in Oslo, which is less exposed to the harmful effects of climate change, issues related to climate adaptation were given more awareness. However, the correlation between climate risk and public authority action can be based on more than just risk perception but also resources and priorities. The study also highlights the importance of local knowledge in assessing climate change risks, as experts alone do not provide a comprehensive understanding of how climate risks affect Longyearbyen, Nordkapp and Oslo

    Africa’s March Towards Prosperity Understanding the role of gender equality, human capital and fertility in securing Africa’s promising future

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    Developing countries are often at risk of falling into a poverty trap, whereby economic growth and prosperity is thwarted due to both endogenous and exogenous factors, including limited access to capital, poor infrastructure, low education levels, corruption, and many others. This is particularly true for many African nations that are now emerging from centuries of colonial rule and are attempting to find a path forward to obtain peace, economic growth, and overall prosperity. The goal of this dissertation is to identify the principal factors of what can assist poorer nations in becoming more prosperous. Based on the neoclassical economic growth model (Barro & Lee, 2015) ), I developed a model to account for the effect of multidimensional factors of gender equality, fertility rate and Africa’s specific opportunity to economic growth. The model will be helpful to explain how gender equality, human capital, and fertility rates serve as essential factors in economic growth and prosperity for African states. Based on this model, I attempt to provide a path forward for African countries to allocate resources to those components that will maximise their chances of success in achieving overall prosperity. Based on this model, gender equality and a high fertility rate provide an opportunity for prosperous African countries. I also offer an in- depth analysis of cases of Rwanda, Uganda, Ethiopia, and Zambia in qualitative support for my argument

    Shortest Route at Dynamic Location with Node Combination-Dijkstra Algorithm

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    Abstract— Online transportation has become a basic requirement of the general public in support of all activities to go to work, school or vacation to the sights. Public transportation services compete to provide the best service so that consumers feel comfortable using the services offered, so that all activities are noticed, one of them is the search for the shortest route in picking the buyer or delivering to the destination. Node Combination method can minimize memory usage and this methode is more optimal when compared to A* and Ant Colony in the shortest route search like Dijkstra algorithm, but can’t store the history node that has been passed. Therefore, using node combination algorithm is very good in searching the shortest distance is not the shortest route. This paper is structured to modify the node combination algorithm to solve the problem of finding the shortest route at the dynamic location obtained from the transport fleet by displaying the nodes that have the shortest distance and will be implemented in the geographic information system in the form of map to facilitate the use of the system. Keywords— Shortest Path, Algorithm Dijkstra, Node Combination, Dynamic Location (key words

    Drawing on parents’ experiences to explore how to prevent high-risk primary school children developing antisocial and criminal behaviour

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    Much evidence links early childhood factors to later antisocial and criminal behaviour. However, many ‘at-risk’ children do not develop such behaviours. Some families are subject to intensive intervention from services including social, health, criminal justice and special education services, yet little is known about what aspects of support are useful for the most vulnerable families in the longer term. This mixed methods study investigates parents’ experiences of the full range of services with which they and their children are involved during middle childhood. The major component is a longitudinal five-year qualitative interview study of eleven families, including practitioners parents nominated as helpful. Children were at-risk because of their difficult behaviour and additional family risk factors. Inductive thematic analysis suggested factors which appeared important in changing child behaviour and family functioning. A subset of these factors were further investigated using quantitative longitudinal analysis of a large cohort data set, the Avon Longitudinal Study of Parents and Children (ALSPAC), to examine associations with antisocial and criminal behaviour at ages 16–21. The original contribution to knowledge is identification and explanation of factors influencing how families benefit, or fail to benefit, from intervention. These include the conflicting roles of services tasked with support, reform and surveillance of families. Some parents are skilfully supported to make lasting changes in their parenting behaviour, but non-familial influences such as peers, neighbourhood and school experiences mean improvements in parent-child relationships do not necessarily translate to improvements in the child’s behaviour and wellbeing outside the family. In addition, the study contributes analyses linking middle childhood factors to lower chance of future antisocial and criminal behaviour. These factors include changes in maternal hostility and depression, financial circumstances and children’s relationships with teachers. Findings suggest families could be helped by easier-to-access, on-call, non-judgemental support and, in schools, attention to consistent, supportive relationships

    Principles and criteria for assessing urban energy resilience: A literature review

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    AbstractBetween 60% and 80% of global energy is consumed in urban areas and given the projected increase in world׳s urban population, this share is expected to further increase in the future. Continuity of energy supply in cities is affected by climate change and a growing array of other threats such as cyber attacks, terrorism, technical deficiencies, and market volatility. Determined efforts, acknowledging the interactions and interlinkages between energy and other sectors, are needed to avoid adverse consequences of disruption in energy supply. Resilience thinking is an approach to management of socio-ecological systems that aims to develop an integrated framework for bringing together the (often) fragmented, diverse research on disaster risk management. The literature on urban resilience is immense and still growing. This paper reviews literature related to energy resilience to develop a conceptual framework for assessing urban energy resilience, identify planning and design criteria that can be used for assessing urban energy resilience, and examine the relationship of these criteria with the underlying components of the conceptual framework. In the conceptual framework, it is proposed that in order to be resilient, urban energy system needs to be capable of “planning and preparing for”, “absorbing”, “recovering from”, and “adapting” to any adverse events that may happen in the future. Integrating these four abilities into the system would enable it to continuously address “availability”, “accessibility”, “affordability”, and “acceptability” as the four sustainability-related dimensions of energy. The paper explains different resilience principles associated with these abilities and sustainability dimensions. Also, different planning and design criteria were extracted from the literature and categorized into five themes: infrastructure; resources; land use, urban geometry and morphology; governance; and socio-demographic aspects and human behavior. Examination of the relationship of these criteria with the underlying components of the conceptual framework highlighted the complexity and multi-faceted nature of energy resilience. Exploration of the relevance of the identified criteria to climate change mitigation and adaptation revealed that most of the identified criteria can provide both mitigation and adaptation benefits

    Understanding leadership development for young people: creating a multi-dimensional and holistic framework for emerging high-school students as future leaders in KSA

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    This thesis concerned with understanding what makes young people as future leaders. It sets out to explore leadership development for secondary school students (12-to-18-year), focussing on what makes young leaders and how they become future leaders. The fundamental purpose of this explanatory and exploratory qualitative study was to investigate leadership development at the age of adolescence. There are three key objectives for this study: (1) to explore and investigate what contributes to forming young people as future leaders; (2) to clarify and understand how young people become future leaders; and (3) to create a multidimensional and holistic framework for developing secondary students as future leaders. These aims were achieved via conducting qualitative in-depth interviews (N=46) with established leaders (N=19) and university professors (N=27) in both the UK and the kingdom of Saudi Arabia (KSA). Additionally, as this study focuses on adolescence, it was important to conduct three focus groups with secondary school students in KSA (N=27). Succinctly this study aims to deepen our understanding of the issue of developing young people as future leaders. This study used multi-levels of analysis and multi-domains of purposive sampling via using maximal variation sampling, both leaders and academics are categorised into six domains (business, education, social, voluntary sector, YLD programmes directors, and developmental psychologists). The secondary school students were selected from government school, private school, and gifted students. Due to the extensive sample gathered (46 interviews and 3 focus groups) and significant data generated (287.000 words), the author’s study produces both emergent themes and abundant numerical results. However, these large quantities can encourage various quantitative studies in the future. There are several key contributions of value in this study; (1) creating and conceptually testing a comprehensive framework to develop young people as future leaders; (2) the theoretical contribution as the qualitative analysis has generated massive number of new emergent themes related to the research questions; (3) analysis of the empirical contributions revealed lots of variables, factors, criteria, tools; (4) a cross-cultural YLD which verify that there are both differences and similarities between the UK and KSA; (5) the findings proved that leadership for young people is learnable to a great extent; that adolescence is a critical period for developing leaders; that sparking the motivation to lead is important at this age; there are serious obstacles facing YLD; generic leadership is more applicable for YLD; and finally, one of the significant contributions of this study is its focussing of attention on a long-term approach for young people leadership development. The further contribution of this study is creating a multi-dimensional and holistic framework for YLD based on theories of adult leadership and intensively reviewing the literature review on YLD. It has been developed via pilot study and finally developed and validated throughout a cohort of stablished leaders and university professors (N=41). This study’s findings can benefit policy and practice to a great extent since it focuses on the secondary school students; as they are the future leaders, this study can be of significant help to the strategic planning of policy makers in the Ministry of Education, Youth Ministry, and generally within the political context, family business. This study inspires me to establish a leadership-based academy, which focuses on high-school students and develops them as national leaders
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