Introducing mobile technologies to strengthen the national continuing medical education program in Vietnam

BACKGROUND: In 2009, the Government of the Republic of Vietnam adopted legislation requiring all clinicians to complete continuing medical education (CME) credits in order to maintain licensure. Several CME in-person and distance-based courses have been developed and as of 2015, a national distance-based electronic learning (eLearning) network was being established. However, the uptake of CME courses remained low despite high clinician demand. Vietnam’s high mobile phone ownership rate of 1.4 mobile subscriptions per person presents an opportunity to leverage this for CME. This study investigated how mobile technologies could strengthen delivery of distance-based CME courses and improve national CME program administration. METHODS: A literature and policy review was conducted. Qualitative methods were employed to collect and analyze key informant interviews of 52 global and Vietnamese experts, including selected policy makers. Interviews were supplemented by six focus group discussions with Vietnamese physicians, nurses, midwives and physician assistants. Transcripts were analyzed using an inductive coding methodology. A framework was developed to organize and present results for government consumption. RESULTS: Globally, examples and supporting evidence related to mobile technologies for CME were limited. Experts reported three main use cases for using mobile technology for CME in Vietnam: 1) delivery of CME courses (N=34; 65%); 2) registration and tracking of CME credits (n=28; 54%); and 3) sending alerts and reminders on CME opportunities (n=23; 44%). The national CME policy environment in Vietnam was supportive of introducing mobile technologies within the eLearning network. However, there was a widespread lack of awareness and capacity to design and deliver distance-based CME courses. Mobile phone ownership was high and health workers reported interest in acquiring CME credits via mobile. Financing options to develop and implement distance-based CME courses were limited. CONCLUSION: Despite the paucity of evidence related to mobile technologies for learning, there is potential to innovate and strengthen the evidence base using these technologies for CME in Vietnam. Introducing mobile technologies within the national eLearning network would improve clinicians’ access to CME, particularly in rural areas, and can strengthen national CME program administration. Key recommendations were developed to provide the government with concrete steps for national level adoption

Assessing the Vulnerability of the Human and Natural Systems and Prioritizing Alternatives to Reduce Vulnerability at Mt. Kasigau, Kenya.

The goal of this research was to examine the vulnerability of the human and natural systems to anthropogenic threats and environmental changes at five villages (Kiteghe, Makwasinyi, Jora, Bungule, and Rukanga) in Mt. Kasigau, Kenya. To accomplish this goal, three research objectives were pursued: (1) to assess the vulnerability of the human system, (2) to assess the vulnerability of the natural system, and (3) to assist the community in identifying, evaluating, and prioritizing ways for reducing vulnerability. These three objectives linked together and are structured in three manuscripts in this dissertation.This study adapted a vulnerability framework that conceptualized vulnerability as a function of ‘exposure’, ‘sensitivity’, and ‘adaptive capacity’. The Analytical Hierarchy Process (AHP), which is a multi-criteria decision-making tool is used to structure vulnerability into a hierarchical format and to build a vulnerability assessment and reduction model based upon the benefits, costs, opportunities, and risks criteria in order to evaluate each alternative.Results from this study illustrated that adaptive capacity and exposure played a critical role in determining the social and environmental vulnerability among the five villages. Therefore, measures to reduce vulnerability should emphasize these two components of vulnerability, especially for the most vulnerable village. Additionally, the vulnerability reduction model that was used by the community identified environmental conservation as the most preferred alternative for reducing vulnerability. The information derived from this research can help local policymakers, non-governmental organization, and other practitioners who are interested in developing policies that promote sustainable development.Lastly, this place-based dissertation research contributes to the discipline of geography by emphasizing how vulnerabilities vary across space and time. It also advances the body of knowledge in vulnerability and sustainability studies through bridging the gap between socio-ecological and biophysical dimension of vulnerability. The need to understand the issue of vulnerability was essential if we are to realize sustainable development. Hence, this study advances sustainability literature by identifying the economic, social, and environmental factors of vulnerability that create barriers to sustainable development at the community level (e.g., village). In this regard, this study could play a vital role in creating a platform for scholars who are interested in vulnerability and sustainability studies

Drought impacts assessment in Brazil - a remote sensing approach

Climate extremes are becoming more frequent in Brazil; studies project an increase in drought occurrences in many regions of the country. In the south, drought events lead to crop yield losses affecting the value chain and, therefore, the local economy. In the northeast, extended periods of drought lead to potential land degradation, affecting the livelihood and hindering local development. In the southern Amazon, an area that experienced intense land use change (LUC) in the last, the impacts are even more complex, ranging from crop yield loss and forest resilience loss, affecting ecosystem health and putting a threat on the native population traditional way of living. In the studies here we analyzed the drought impacts in these regions during the 2000s, which vary in nature and outcomes. We addressed some of the key problems in each of the three regions: i) for the southern agriculture, we tackled the problem of predicting soybean yield based on within-season remote sensing (RS) data, ii) in the northeast we mapped areas presenting trends of land degradation in the wake of an extended drought and, iii) in southern Amazon, we characterized a complex degradation cycle encompassing LUC, fire occurrence, forest resilience loss, carbon balance, and the interconnectedness of these factors impacting the local climate. Advisor: Brian D. Wardlo

Women\u27s Experiences With Traumatic Childbirth

ABSTRACT WOMEN’S EXPERIENCES WITH TRAUMATIC CHILDBIRTH by TAMARA DENNIS Postpartum Depression (PPD) and posttraumatic stress disorder (PTSD) following childbirth range from 10% to 40% (Beck, 2008a) and 1 to 6% respectively (Ayers 2007; Joseph & Bailham, 2003). These disorders have detrimental effects on the maternal infant dyad and significant implications for women’s future birth choices, child development, and spousal relationships. Although PPD is widely recognized, PTSD, specifically the overlap of depressive symptoms with posttraumatic symptoms, following childbirth has not been as widely investigated. The purpose of this interpretive phenomenological study was to explore the meaning of traumatic childbirth in order to expand the current body of knowledge and gain a deeper understanding of the lived experience of traumatic childbirth. Phenomenology was used to describe the experiences of 20 mothers who reported a traumatic childbirth event. Participants ranged from 24 to 61 years of age at the time of the interviews. Audiotaped, in-depth interviews were conducted for the study. Data analysis was accomplished through the hermeneutic process and following the methodology of van Manen (1990). Three patterns and 10 themes were identified: 1) “Never Being the Same” which had 4 themes of ‘Knowing”, “Losing Control”, “Bearing the Pain”, and “Being Afraid”; 2) “Making a Difference” which had 3 themes of “Knowing What They Are Doing”, “Unnerving to Them”, and “Sharing All That With Me” and 3) “Getting to the Other Side” which included “Praying”, “Being Angry” and “Looking Back”. These patterns and themes defined the meaning of traumatic childbirth for these participants traumatic birth experience. The first pattern highlighted the life changing experience of trauma during childbirth recognizing that bad things can happen to people. The second pattern focused on the important roles of healthcare providers, spouses, family and friends when a mother experiences a traumatic childbirth event. Finally, the third pattern revealed women’s reflection of and resolution with the traumatic childbirth event. The implications of this study included recommendations for education, research, and practice. The study emphasized the need for collaboration among healthcare providers and long term follow-up care for women experiencing a traumatic childbirth

The Making of a Global Health Crisis: Extensively Drug-Resistant Tuberculosis and Global Science in Rural South Africa

This dissertation is a study of the social, scientific, political and rhetorical origins of extensively drug-resistant tuberculosis (XDR-TB) and the ability of a technical medical term, in concert with local clinical and government responses, to influence global biomedical action. XDR-TB, a form of tuberculosis that is resistant to most anti-tuberculosis drugs, was first creatively named and defined in 2005 in the context of a global laboratory survey documenting increasing tuberculosis drug resistance patterns around the world. In 2006, XDR-TB attracted international attention after a deadly cluster of drug-resistant tuberculosis was discovered in the rural South African town of Tugela Ferry, KwaZulu-Natal. International media and global health workers, responding to this news, defined XDR-TB as a critical threat to global health emanating from Southern Africa. As this dissertation shows, the association of XDR-TB with South Africa shaped the global response to XDR-TB, tying it closely to HIV/AIDS and linking it to the well-known history of South African AIDS denialism and public health inaction. The careful scrutiny given to South African XDR-TB by global public health experts profoundly impacted South African government responses to XDR-TB at the national, provincial, and regional levels. This detailed, multifaceted case study of global health knowledge in-the-making is based on nearly two years of fieldwork in South African clinical and community settings and interviews with international and South African tuberculosis researchers, policy makers, clinicians, administrators and patients. Widely circulated representations of XDR-TB are juxtaposed with the personal experience of South African nurses and local government administrators to make the case that responsibility for and control of successful global health interventions is more broadly distributed than common conceptions of global health research imply. In addition, this research uses published documents, unpublished policy literature, and promotional materials to trace how medical, public, and political understandings of XDR-TB in South Africa changed over time and across geographical space. This research changes our understanding of the politics and practices of health interventions in Africa by linking together activities ranging from the crafting of scientific publication, to global policy decision making, local public resource allocation and in-home nursing care