Effort-reward imbalance and self-rated health among Gambian healthcare professionals

Questionnaire for the Investigation of Effort-reward Imbalance and Self-rated Health among Gambian Healthcare Professionals. (DOC 616 kb

Sampled-data implementation of derivative-dependent control using artificial delays

We study a sampled-data implementation of linear controllers that depend on the output and its derivatives. First, we consider an LTI system of relative degree $r\ge 2$ that can be stabilized using $r-1$ output derivatives. Then, we consider PID control of a second order system. In both cases, the Euler approximation is used for the derivatives giving rise to a delayed sampled-data controller. Given a derivative-dependent controller that stabilizes the system, we show how to choose the parameters of the delayed sampled-data controller that preserves the stability under fast enough sampling. The maximum sampling period is obtained from LMIs that are derived using the Taylor's expansion of the delayed terms with the remainders compensated by appropriate Lyapunov-Krasovskii functionals. Finally, we introduce the event-triggering mechanism that may reduce the amount of sampled control signals used for stabilization

Hormonal Correlates and Predictors of Nutritional Recovery in Malnourished African Children.

Background: Malnourished children show variable growth responses to nutritional rehabilitation. We aimed to investigate whether these differences could be explained by variations in growth and energy-regulating hormones. Methods: Quasi-experimental study: Children aged 6-24 months in rural Gambia were recruited to controls if weight-for-height z-score (WHZ) > -2 (n = 22), moderate acute malnutrition if WHZ  -3 (n = 18) or severe acute malnutrition if WHZ < -3 (n = 20). Plasma hormone and salivary CRP levels were determined by ELISA. Results: In univariable analyses, increases in weight-for-age z-score (WAZ) in malnourished children were positively correlated with insulin (F-ratio 7.8, p = 0.006), C-peptide (F-ratio 12.2, p < 0.001) and cortisol (F-ratio 5.0, p = 0.03). In multivariable analysis, only baseline C-peptide (F-ratio 7.6, p = 0.009) predicted the changes in WAZ over 28 days of interventions. Conclusion: In rural Gambian, malnourished children, although it cannot be used in isolation, baseline C-peptide was a predictor of future response to rehabilitation

Association between functional antibody against Group B Streptococcus and maternal and infant colonization in a Gambian cohort.

BACKGROUND: Vertical transmission of Group B Streptococcus (GBS) is a prerequisite for early-onset disease and a consequence of maternal GBS colonization. Disease protection is associated with maternally-derived anti-GBS antibody. Using a novel antibody-mediated C3b/iC3b deposition flow cytometry assay which correlates with opsonic killing we developed a model to assess the impact of maternally-derived functional anti-GBS antibody on infant GBS colonization from birth to day 60-89 of life. METHODS: Rectovaginal swabs and cord blood (birth) and infant nasopharyngeal/rectal swabs (birth, day 6 and day 60-89) were obtained from 750 mother/infant pairs. Antibody-mediated C3b/iC3b deposition with cord and infant sera was measured by flow cytometry. RESULTS: We established that as maternally-derived anti-GBS functional antibody increases, infant colonization decreases at birth and up to three months of life, the critical time window for the development of GBS disease. Further, we observed a serotype (ST)-dependent threshold above which no infant was colonized at birth. Functional antibody above the upper 95th confidence interval for the geometric mean concentration was associated with absence of infant GBS colonization at birth for STII (p<0.001), STIII (p=0.01) and STV (p<0.001). Increased functional antibody was also associated with clearance of GBS between birth and day 60-89. CONCLUSIONS: Higher concentrations of maternally-derived antibody-mediated complement deposition are associated with a decreased risk of GBS colonization in infants up to day 60-89 of life. Our findings are of relevance to establish thresholds for protection following vaccination of pregnant women with future GBS vaccines

Psychosocial Working Conditions and Well-being of International Medical Graduates in Australia: Evidence from the MABEL longitudinal survey

© 2020 Amadou DarboeBackground: Shortages and maldistribution of medical practitioners, particularly in rural and remote areas, are some of the major challenges besetting health systems worldwide. In its primary attempt to offset these problems, Australia, like a range of high-income countries such as Canada, New Zealand, UK, and the USA, has been actively recruiting doctors from overseas to work in underserved areas. These international medical graduates (IMGs) represent an important segment of the Australian medical workforce, accounting for over 30 per cent of the active doctor population, with higher proportions in regional and remote locations. Over the last two decades, Australia has been drawing its IMG workforce from highly diverse source countries e.g. the UK, Ireland, India, Sri Lanka, Bangladesh, China, Egypt, Iran, and Zimbabwe, most of which differ markedly from Australia on the bases of language, culture, epidemiological profile and the quality of medical training and technology. Additionally, Australia has more recently been implementing policies to increase self-sufficiency of the medical workforce, which has implications for the career opportunities for IMGs in Australia. Since the turn of the second millennium, a substantial body of literature has developed on the experiences and migration outcomes of IMGs in Australia and other Organisation for Economic Co-operation and Development (OECD) countries. But within that body of literature, as confirmed in the scoping review presented in Chapter 3 of this thesis, few have attempted to study how IMGs rate the general quality of their lives amidst their changing professional and social circumstances. In that context, the overarching goal of this thesis was to add and extend this scarce literature by investigating the effect of changes in the psychosocial conditions of IMGs on their general life satisfaction (subjective well-being or SWB) in Australia. Within this, the three broad research aims were 1) to investigate the difference in SWB and its drivers between international and domestic medical graduates (DMGs), 2) to examine the effect of changes in working conditions on the SWB of IMGs relative to DMGs and 3) to explore the effect of recent regulatory changes on the SWB of IMGs. Methods: The thesis used eight waves of survey data from the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal study of Australian doctors from 2009 to 2016. It applied standard econometric panel regression models to address the research aims in three separate chapters (i.e. Chapters 4–6). The thesis relied upon the theory of ‘Job Demands-Resource (JD-R)’ model of Demerouti, Bakker et al. (2001) to define and operationalise work-related psychosocial risk factors into components of job demands and job resources. Results: Chapter 4 addressed the first aim of the thesis by examining any subjective well-being (SWB) difference and its drivers between the IMG and DMG groups using the Oaxaca and Ransom’s (1994) linear decomposition method. The results showed that the IMG group was more likely to report lower SWB than DMGs (p-value<0.001). The well-being gap (of 0.101) was small and largely attributable to the groups’ differences in observable characteristics such as psychosocial and demographic factors. Most notably, the IMG group was worse off with respect to self-reported financial security, exposure to work-related psychosocial risk factors, and community integration. These results therefore highlight the importance of the workplace and community context in understanding the well-being difference between IMGs and DMGs. Chapter 5 addressed the second aim of the thesis. Using a fixed effect linear regression analysis, it examined the effect of changes in psychosocial conditions on changes in SWB of IMGs and tested whether the estimated effect sizes differed between IMG and DMG groups, and within IMGs by key subgroups. Results indicated that exposure to high work-related psychosocial risk factors and a low sense of community integration were associated with statistically significant declines in SWB among study participants (p-value10 years) counterparts. Counter-intuitively however, the SWB of relatively advantaged IMGs from majority English-speaking Commonwealth countries (e.g., the UK, Republic of Ireland, Canada) showed stronger declines under low job control (autonomy) than their non-majority English-speaking counterparts. Furthermore, compared to specialist IMGs, the SWB of hospital non-specialists from all socio-linguistic groups was more affected by exposure to excessive psychological and physical workloads. Collectively, these results demonstrate the importance of psychosocial risk factors to the general well-being of medical doctors, with specific IMG cohorts at particular risk. Notably, the results confirmed the importance of addressing the support needs of newly settled IMGs for an extended period, often to date restricted to initial employment in workforce shortage areas of Australia. Chapter 6 addressed the third research aim by examining the impact of a specific policy changes on IMGs’ well-being and labour supply decisions. Using a random effect model with a difference-in-differences (DiD) estimator, this chapter explored the heightened risk of de-registration of recently arrived IMGs when announcements made by the Medical Board of Australia in 2013 reinforced the policy of de-registration if Australian Medical Council (AMC) clinical exams had not been passed within 3 years. Results revealed a statistically significant increase in hours spent on educational activities and an accompanying decline in the level of SWB among limited registrants. These results suggested the relevance of regulatory actions on the behaviour and well-being of IMGs. Thus, while registration decisions in Australia are often made on the basis of public protection, there is a need to closely monitor how such decisions might be impacting the well-being of the targeted professionals. Implications: Overall, the findings provided novel empirical evidence relating to the experiences of IMGs in Australia, measured by their SWB, with important stratifications highlighting the diverse experiences and psychosocial needs of this highly heterogeneous group. Ensuring a conducive psychosocial work environment can be useful in promoting the general well-being of medical practitioners, especially IMGs who still remain an important part of Australia’s medical workforce

Socioeconomic differential in self-assessment of health and happiness in 5 African countries: Finding from World Value Survey.

Factors that contribute to wealth related inequalities in self-rated health (SRH) and happiness remains unclear most especially in sub-Saharan countries (SSA). This study aims to explore and compare socioeconomic differentials in SRH and happiness in five SSA countries.Using the 2010/2014 World Values Survey (WVS), we obtained a sample of 9,869 participants of age 16 and above from five SSA countries (Nigeria, Ghana, South Africa, Rwanda and Zimbabwe). Socioeconomic inequalities were quantified using the concentration index. The contribution of each predictor to concentration index's magnitude was obtained by means of regression based decomposition analysis.Poor SRH ranges from approximately 9% in Nigeria to 20% in Zimbabwe, whereas unhappiness was lower in Rwanda (9.5%) and higher in South Africa (23.3%). Concentration index was negative for both outcomes in all countries, which implies that poor SRH and unhappiness are excessively concentrated among the poorest socioeconomic strata. Although magnitudes differ across countries, however, the major contributor to wealth-related inequality in poor SRH is satisfaction with financial situation whereas for unhappiness the major contributors are level of income and satisfaction with financial situation.This study underscores an association between wealth related inequalities and poor SRH and unhappiness in the context of SSA. Improving equity in health, as suggested by the commission of social determinants of health may be useful in fighting against the unfair distribution of resources. Thus, knowledge about the self-rating of health and happiness can serve as proxy estimates for understanding the distribution of health care access and economic resources needed for well-being in resident countries

Critical assessment of refugees’ needs in post-emergency context: the case of Malian war refugees settled in Northern Burkina Faso

Abstract Background Empirically assessing the needs of refugees in camps is critical to the improvement of existing policies and programs that aim at enhancing their well-being. By neglecting the needs of refugees, interventions may fail to capture the complex patterns of refugees’ daily lives within camps. This paper provides a comprehensive assessment of the needs of encamped Malian refugees in Northern Burkina Faso following the 2012-armed conflict. In addition to assessing the needs of Malian refugees, the study aimed to critically assess from an upstream perspective the degree of their involvement in policies and practices that are targeted towards improving their livelihood. Methods We took an “upstream” view on the lives of Malian refugees to identify their unmet needs. A purposive sampling strategy was employed to collect data from various media sources, including data aggregated from the website of the United Nations High Commissioner for Refugees (UNHCR). The most populous refugee camp (Mentao) was visited in September 2012 and in-depth group discussion and interviews were conducted with key informants, including nine camp representatives and four officials from the central and decentralized administrations. Results Media canvass combined with the UNHCR level 2 census revealed a flawed headcount of refugees, which was 205.4% higher than the real number in Burkina Faso. Although refugees live harmoniously with the natives and their security has been assured, they strongly complained about the number of unused food items distributed. Camps were distributed among humanitarian organizations leading to differential advantage and resources from one camp to another. Additionally, idleness, lack of classrooms facilities for pre-school children and lack of continuous healthcare services were major concerns raised. Further, refugees expressed limited involvement in the planning and implementation of programs that are related to their welfare. Conclusion This study revealed that refugees’ voices were not taken into consideration in making tailor-made programs. This calls for more comprehensive surge capacity to deal with refugees’ basic needs. Further, a strong leadership from hoststate should be encouraged to offer equal opportunities to refugees regardless of their camps. Finally, an innovative strategy is needed to build a reliable database that could enhance the design, implementation, monitoring and evaluation of policies and programs

Factors contributing to regional inequalities in acute respiratory infections symptoms among under-five children in Nigeria: a decomposition analysis

Abstract Background Acute respiratory infections (ARI) are major causes of morbidity and mortality in many low-income countries. Although factors associated with ARI symptoms in children under 5 years of age have been identified; however, variation in their prevalence resulting from regional-specific proximate determinants has received little attention. Therefore, we aim to investigate the specific regional determinants of overall and wealth-related inequality in children having ARI in Nigeria over a decade. Methods We analyzed trends in development of ARI symptoms among children under 5 years of age in Nigeria using nationally representative cross sectional surveys carried out in 2003, 2008 and 2013. Overall- and household wealth index based- inequality in the distribution of prevalence of ARI symptoms were estimated by region using Gini index and Concentration Index, respectively. Multivariate logistic regressions for complex survey and decomposition analysis for both indexes were used to calculate percentual contribution. Results We found a decreasing trend in development of ARI symptoms over the decade between regions. Children in South Western region had reduced likelihood of developing the symptoms. Concentration index (CI) for the prevalence of ARI symptoms over the years and across regions had negative values (all p < 0.05). Gini index (GI) varies from 0.21 in North East to 0.62 in South Western region. Furthermore, the mapping showed that the extent at which both inequalities contribute to ARI symptoms prevalence in each region is different. The four major sources of wealth-related inequalities were poor households, no maternal education, biomass cooking, and rural area. The major contributors to overall inequalities were having a child aged 6 to 23 months, having no maternal education, having no vaccination card, and having a high birth order/short birth interval. Conclusions Although ARI prevalence decreased over the decade, it has remained unequally distributed between regions and over the time. The sources of those inequalities are context sensitive. Thus, in future health promotion initiatives, it is imperative to account for regional variations in the distribution of ARI

Logistic regression models demographic and socioeconomic characteristics with feeling of unhappiness.

<p>Logistic regression models demographic and socioeconomic characteristics with feeling of unhappiness.</p