Youth Volunteerism and Civic Service in Latin America and the Caribbean: A Potential Strategy for Social and Economic Development

Youth Volunteerism and Civic Service in Latin America and the Caribbean: A Potential Strategy for Social and Economic Developmen

eHealth Conversations : using information management, dialogue, and knowledge exchange to move toward universal

The publication of eHealth Conversations, developed with the support of the Spanish Agency for International Development Cooperation (AECID), represents a major step forward for the PAHO/WHO Strategy, since it explores ways of implementing regional mechanisms with free and equitable access to information and knowledge sharing. These initiatives aim to advance the goals of more informed, equitable, competitive, and democratic societies, where access to health information is considered a basic right. This publication is one of the instruments used by PAHO/WHO to develop the initiatives outlined in the Strategy, which coincides with the global eHealth strategy. One of the fundamental needs for the improvement of eHealth is the dissemination of information, and PAHO/WHO is assuming a leading role in this effort. The development of this new electronic publication is a key step in disseminating information that will be useful for decision makers on applying these technologies for the health of the Americas. This electronic book is one of the products of PAHO/WHO’s project: “eHealth Conversations: Using Information Management, Dialogue, and Knowledge Exchange to Move Toward Universal Access to Health.” Participants in these conversations included experts on electronic health and other specialties. Through virtual dialogues, the experts contributed with knowledge and reflections on the present and the future of eHealth in the Americas, analyzed the situation, and made recommendations for the implementation of electronic health initiatives. These recommendations are not only intended for PAHO/ WHO, but also for governments and the private sector. The aim of the project is to guarantee the convergence of local, national, and regional initiatives regarding the adoption and application of ICTs for public health, with special attention on critical issues in this field. It also intends to strengthen individual and collective capacities of health workers and institutions, connecting them in a network of on-line health networks, as well as to reinforce the PAHO/WHO eHealth program.Acknowledge the Spanish Agency for International Development Cooperation (AECID) for its financial support in preparing this publication and developing the project titled “eHealth Conversations: Using Information Management, Dialogue, and Knowledge Exchange to Move Toward Universal Access to Health;

HEALTH SYSTEM ANALYSIS OF THE BARRIERS TO ACCESS, AVAILABILITY, UTILISATION AND READINESS OF SEXUAL AND REPRODUCTIVE HEALTH SERVICES IN COVID-19 AFFECTED AREAS: DEVELOPMENT AND VALIDATION OF A DATA COLLECTION SYSTEM TO BE APPLIED FOR FUTURE HEALTH PANDEMICS

Background: The Coronavirus Disease 19 (COVID-19) pandemic has severely impacted sexual health service provision with consequences at both individual and public health level. The collection of real-time high-quality data is of utmost importance to monitor the impact on service delivery and disruption in case of future health emergencies. Aims: This is a 3-year study, implemented in the framework of a broader collaboration between World Health Organization (WHO) Department of Sexual and Reproductive Health Research and University of Brighton (UOB) with the University Hospital Verona (UHVR). The overarching study aim was to develop and pilot a secure, standardised, web-based electronic case report form (eCRF), via Research Electronic Data Capture (REDCap) system, for sexually transmitted infection (STIs) and HIV clinical data management. The eCRF constituted the basis for a research infrastructure aimed at conducting multi-centric implementation studies able to answer selected research questions and guide decision making processes. Methods: The eCRF construction required a multidisciplinary approach (9 study experts from UHVR and UOB with different backgrounds) and consisted of a series of distinct steps: i) identification of a minimum set of standardised HIV-STIs core variables required to increase study consistency; ii) design of the eCRF framework according to literature key-principles with particular focus on a structure based on modularity, longitudinal mode, flexibility, intuitive workflow, and compliance with the General Data Protection Regulation; iii) set up of a series of quality checks at different levels to minimise errors and ensure data integrity at time of data entry; iv) eCRF piloting by 12 healthcare providers external to the study, who were asked to assess and provide feedback on key eCRF aspects; v) testing of entry procedure and quality checks efficiency using clinical routine data on HIV-Pre-Exposure Prophylaxis (PrEP) users accessing UHVR Centro MISTRA from January 2108 to September 2022. Mixed manual and automatic entry processes (with import of a pre-existing Excel sheet) were performed for checking feasibility of both tasks. The tool usability was evaluated via an implementation study which tested data entry system (data reconciliation) and data processing through exploratory statistical analyses, which focused on the assessment of COVID-19 impact on PrEP users in pre-pandemic, pandemic, and post-pandemic periods. Results: Four instruments were developed (Demographics, Past Medical History, Standard Visits, Antimicrobial Prescription) hosting 7 modules. The modular approach was used to test the current set of instruments and, in the future, to add further functionalities allowing an interchangeable, dynamic, and independent modules development without impacting the overall eCRF frame. The repeatable Standard Visit instrument (including sexual behaviour, PrEP intake, signs & symptoms, and laboratory assessment modules) is the eCRF core. Given the longitudinal mode, baseline instrument is populated only at enrolment and then can be further filled in at various time points (patient follow-up visits), if needed. The core eCRF feature is the possibility of completing visits based on patients’ needs with little burden for physician or data collector. The reconciliation process uploading already collected data into the eCRF was straightforward with 95% of successful import without need of further review. Exploratory analyses were conducted on 256 PrEP users and 1595 visits. Main findings showed significant decrease in visits number and increase in PrEP discontinuation during pandemic period. Conclusion: The study led to the implementation of an easy-to-use eCRF able to host standardised, real-time, high-quality data. The eCRF suggests a wide range of applicability in both research and clinical areas to be adopted in case of future health emergencies, potentially useful to guide clinical decision-making and support healthcare practice with telehealth implementation

The Effect of Progesterone Only Contraception on the Accuracy of Cervical Cytologic interpretation

Abstract Introduction: Papanicolaou screening is the standard of care for the detection of abnormal cervical cells. Early detection and treatment of cervical neoplasia depends on the accurate interpretation of the cytologic sample. Diagnosis of dysplasia is made by histology interpretation to confirm the results of cytology screening. Cervical cells are susceptible to change as a result of hormonal exposure, and this has the potential to affect cytologic interpretation. Cervical cells may be exposed to exogenous progesterone if the woman uses injectable depot medroxyprogesterone acetate or a progesterone intrauterine device. Previous study results have been inconsistent regarding the effect of progesterone on relationship between cytology and histology interpretation. The purpose of this exploratory study was to examine the accuracy of cervical cytologic findings in women who were using either one of two forms of progesterone only contraception, depot medroxyprogesterone acetate injection or the progesterone IUD, as compared to women who either used a non-hormonal form of contraception or no contraception. Accuracy, for the purposes of this study, was defined as the association between cytology interpretation and histology interpretation. A secondary purpose of the exploratory study was to investigate whether the length of time of progesterone exposure had an effect on the association between cytologic and histologic findings. Methods: A de-identified synthetic derivative database was used for this study in which cytology and histology results from 180 women were analyzed. Three groups were mined from the database: a group using the progesterone releasing intrauterine device (IUD, N = 35), a group using the injectable depot medroxyprogesterone (N = 73), and a control group of women who used either no contraception or non-hormonal contraception (N = 72). Cytology and histology were analyzed for associations as well as for sensitivity and specificity. Chi square analysis and logistic regression were the statistical methods used to test the associations. Results: Cytology and histology results were collapsed into low grade/high grade categories. There was a significant association between cytology and histology findings (p = .008) among the total group (N = 180). Among subgroups analyzed from low grade/high grade perspective, a significant relationship was found between cytology and histology among women who had no progesterone exposure (p = .019) and those using the progesterone IUD (p = .019). However, there was not a significant association between cytology and histology findings in progesterone injection users (p = .790). Thus a new outcome variable was then applied for more precise analysis in which each cytology/histology relationship was labeled as agree, false negative or false positive. Using the new outcome variable (false negative, false positive or agree) there was no difference in the association of cytology and histology by progesterone exposure. Logistic regression revealed no relationship between length of time of progesterone exposure and accuracy of cytologic interpretation. Conclusion: Although our exploratory study was significantly underpowered, findings suggest that the subjects in this study who used either the progesterone IUD or injection had no difference in association of their cytology to histology findings compared to women who had no progesterone exposure. What can be derived from the study is a basis for comparing varied progesterone delivery systems, as well as format for repetition of a similar study in a multi center, multi site study. There are several other forms of progesterone (implant and oral progesterone formulations) which were not included in this study which may affect the association between cytology and histology results. Further investigation is warranted

Digital Research Cycles: How Attitudes Toward Content, Culture And Technology Affect Web Development.

It has been estimated that one third of the world\u27s population does not have access to adequate health care. Some 1.6 billion people live in countries experiencing concentrated acquired immune deficiency syndrome (AIDS) epidemics. Many countries in Africa--and other low-income countries--are in dire need of help providing adequate health care services to their citizens. They require more hands-on care from Western health workers--and training so more African health workers can eventually care for their own citizens. But these countries also need assistance acquiring and implementing both texts--the body of medical information potentially available to them--and technology--the means by which that information can be conveyed. This dissertation looks at these issues and others from a multi-faceted approach. It combines a survey of the developers of Web sites designed for use by health workers in low-income countries and a proposal for a novel approach to communication theory, which could help improve health communication and other social marketing practices. It also includes an extensive review of literature regarding a number of topics related to these issues. To improve healthcare services in low-income countries, several things should occur. First, more health workers--and others--could visit African countries and other places to provide free, hands-on medical care, as this researcher\u27s group did in Uganda. Such trips are ideal occasions for studying the cultural differences between mzungu (white man) and the Ugandan people. A number of useful medical texts have been written for health workers in low-income countries. Others will be published as new health information becomes available. But on what medium will they be published? Computers? Personal digital assistants? During the past 10 years the Internet became an ideal venue for conveying information. Unfortunately, people in target countries such as Uganda encounter cultural differences when such new technologies are diffused. This dissertation looks at cultural and technological difficulties encountered by people in low-income countries who attempt to diffuse information and communication technologies (ICT). Once a technology has been successfully adopted, someone will look for ways to use it to help others. There are hundreds of sites on the Internet--built by Web developers in Western countries--that are designed for use by health workers in low-income countries. However, these Web developers also experience cultural and technological differences, based on their knowledge of and attitudes toward best practices in their field. This research includes a survey of Web developers which determined their attitudes toward best practices in their field and tested this researcher\u27s hypothesis that there is no significant difference among the developers\u27 attitudes toward the content on their sites, their audience\u27s cultural needs and the various technological needs their audience has. It was found that the Web developers agree with 17 of 18 perceived best practices and that there is a significant difference between Web developers\u27 attitudes toward their audience\u27s technological needs and their attitudes toward quality content and the audience\u27s cultural needs. Creation of the survey herein resulted in this researcher generating a new way of thinking about communication theory--called digital research cycles. The survey was based on a review of literature and is rooted in the belief that any successful communication of a computer-mediated message in the information age is a behavior which is influenced by the senders\u27 and receivers\u27 attitudes and knowledge about textual style, the audience, technology and the subject matter to which the message pertains

Exclusive breastfeeding until 6 months postpartum in Lebanon - a systematic review and an online survey

Breastfeeding is the ultimate food source for infants and it is highly valuable for both mothers and children’s health. The WHO recommends exclusive breastfeeding (EBF) until six months postpartum. In Lebanon, the EBF rates until six months postpartum are amongst the lowest worldwide, and the factors affecting EBF have been rarely investigated. A systematic review to determine the associations between socio-cultural-demographic factors and EBF at six months postpartum in middle-income countries was conducted. The review has shown that the most frequently reported determinant of EBF was maternal employment, followed by maternal education and maternal age. This study was the first in Lebanon to explore the association between certain demographic, social and cultural factors with EBF for the six months postpartum of mothers residing across Lebanon. The study employed social media to recruit 593 mothers to complete an online questionnaire. Data analysis consisted of bivariate analysis and multivariate logistic regressions. The findings show that EBF until six months postpartum is not associated with the housekeeper presence, positively associated with having a prenatal plan to breastfeed, the mother disagreeing that free formula samples should be distributed to the mothers after delivery at the hospital, having the baby’s crib kept by the mother’s bed side at the hospital, not being offered a free formula sample at the hospital, the mother’s partner perceiving breastfeeding as very important, not having the mother’s father living in the same household besides the partner and children when the child was between zero and six months and being non-Lebanese. It is the first study conducted in low and middle-income countries to explore the maternal attitudes and opinions regarding feeding practices and their association with EBF until six months. This study shows that ensuring appropriate systems, services and support for mothers, while applying the social-ecological model, should be a priority for the stakeholders to improve maternal and child health

2006 - 2007 University Catalog

Volume 96, Number 1, June 30, 2006 Published once a year June 30, 2006https://scholarsrepository.llu.edu/univcatalog/1009/thumbnail.jp

Experience matters: women's experience of care during facility-based childbirth. A mixed-methods study on postpartum outcomes

Background: The poor treatment women are receiving during facility-based childbirth is an escalating global issue with potentially adverse postnatal consequences. My thesis aims to enhance understanding of these consequences, with a focus on postnatal care-seeking behaviour, maternal mental health and breastfeeding patterns in Tucumán, Argentina. / Objective: I sought to investigate the impact of mistreatment during childbirth (MDC) on postnatal outcomes and explore the influence of individual, interpersonal and societal factors on this relationship. / Methods: Employing a pragmatic epistemological framework, I adopted a mixed-methods approach. First, a systematic review of existing literature on mistreatment and its postnatal effects provided a comprehensive foundation for my research. Subsequently, I conducted semi-structured interviews and focus group discussions with women from an underserved community in Tucumán to gain qualitative insights. To complement this, I carried out a prospective cohort study with women who delivered in a public maternity hospital. Data analysis involved using the capability, opportunity, motivation, and behaviour (COM-B) model, directed acyclic graphs, and factor analysis to examine behavioural impacts, association pathways, and operationalisation of MDC. Multivariable models were applied to measure the association between MDC and postnatal outcomes. / Results: The study revealed that MDC should not be operationalised as a single construct, as women perceive breaches of quality of care differently from direct physical or verbal abuse. Health literacy, social support and self-esteem were identified as psychosocial confounders in the relationship between mistreatment and postnatal outcomes. Only 26% of women in the cohort study in Tucumán accessed postnatal care, with incidences of postpartum depression and anxiety of 67% and 21%, respectively. No statistically significant association was found between MDC and care seeking behaviour, although a possible trend emerged suggesting the women experiencing physical or verbal MDC could be more likely to seek care than those who were not mistreated. / Conclusion: Several exploratory hypotheses are presented to explain the trend suggesting that women who are verbally or physically mistreated are more prone to seek care after birth. Additionally, three concrete contributions emerged from this work: 1) the need to differentiate the conceptualisation of MDC from its operationalisation when assessing postnatal effects; 2) the importance of integrating psychosocial factors into the theory of change when designing effective interventions, and 3) the urgency of enhancing postnatal care access to improve maternal and newborn health outcomes, regardless of women’s childbirth experiences