641 research outputs found
Medical Care Capacity for Influenza Outbreaks, Los Angeles
In December 1997, media reported hospital overcrowding and âthe worst [flu epidemic] in the past two decadesâ in Los Angeles County (LAC). We found that rates of pneumonia and influenza deaths, hospitalizations, and claims were substantially higher for the 1997â98 influenza season than the previous six seasons. Hours of emergency medical services (EMS) diversion (when emergency departments could not receive incoming patients) peaked during the influenza seasons studied; the number of EMS diversion hours per season also increased during the seasons 1993â94 to 1997â98, suggesting a decrease in medical care capacity during influenza seasons. Over the seven influenza seasons studied, the number of licensed beds decreased 12%, while the LAC population increased 5%. Our findings suggest that the capacity of health-care systems to handle patient visits during influenza seasons is diminishing
The violence of peace and the role of education: insights from Sierra Leone
Research on peacebuilding has mushroomed over the last decade and there is a growing interest in the role of education in supporting peacebuilding processes. This paper engages with these debates, UN peacebuilding activities and the location of education initiatives therein, through a case study of Sierra Leone. In the first part, we explore the complex and multi-dimensional nature of violence in post-conflict Sierra Leone. In the second, we critically address the role of education in the conflict and post-conflict period, highlighting educationâs centrality as a catalyst to conflict, and then reflect on the failure of the post-conflict reconstruction process to adequately transform the education system into one that could support a process of sustainable peacebuilding. Finally, we conclude by exploring the ways that greater investment and focus, both financial and human, in the education sector might, in the long term, better contribute to a sustainable and socially just peace
The Politics of Seed in Africa's Green Revolution: Alternative Narratives and Competing Pathways
As calls for a âUniquely African Green Revolutionâ gain momentum, a focus on seeds and seed systems is rising up the agricultural policy agenda. Much of the debate stresses the technological or market dimensions, with substantial investments being made in seed improvement and the development of both public and private sector delivery systems. But this misses out the political economy of policy processes behind this agenda: who wins, who loses, and whose interests are being served? Drawing on lessons from country case studies from Ethiopia, Ghana, Kenya, Malawi and Zimbabwe, as well as insights from a set of complementary studies of cross?cutting themes, this article assesses the evolution of seed system research and development programmes and processes across the region. By examining how the contrasting politics and different configurations of interests affect the way cereal seed systems operate, it highlights opportunities for reshaping the terms of the debate and opening up alternative pathways to more sustainable and socially just seed systems
Advanced EFL learners' beliefs about language learning and teaching: a comparison between grammar, pronunciation, and vocabulary
This paper reports on the results of a study exploring learnersâ beliefs on the learning and teaching of English grammar, pronunciation and vocabulary at tertiary level. While the importance of learnersâ beliefs on the acquisition process is generally recognized, few studies have focussed on and compared learnersâ views on different components of the language system. A questionnaire containing semantic scale and Likert scale items probing learnersâ views on grammar, pronunciation and vocabulary was designed and completed by 117 native speakers of Dutch in Flanders, who were studying English at university. The analysis of the responses revealed that (i) vocabulary was considered to be different from grammar and pronunciation, both in the extent to which an incorrect use could lead to communication breakdown and with respect to the learnersâ language learning strategies, (ii) learners believed in the feasibility of achieving a native-like proficiency in all three components, and (iii) in-class grammar, pronunciation and vocabulary exercises were considered to be useful, even at tertiary level. The results are discussed in light of pedagogical approaches to language teaching
Diffusion of e-health innovations in 'post-conflict' settings: a qualitative study on the personal experiences of health workers.
BACKGROUND: Technological innovations have the potential to strengthen human resources for health and improve access and quality of care in challenging 'post-conflict' contexts. However, analyses on the adoption of technology for health (that is, 'e-health') and whether and how e-health can strengthen a health workforce in these settings have been limited so far. This study explores the personal experiences of health workers using e-health innovations in selected post-conflict situations. METHODS: This study had a cross-sectional qualitative design. Telephone interviews were conducted with 12 health workers, from a variety of cadres and stages in their careers, from four post-conflict settings (Liberia, West Bank and Gaza, Sierra Leone and Somaliland) in 2012. Everett Roger's diffusion of innovation-decision model (that is, knowledge, persuasion, decision, implementation, contemplation) guided the thematic analysis. RESULTS: All health workers interviewed held positive perceptions of e-health, related to their beliefs that e-health can help them to access information and communicate with other health workers. However, understanding of the scope of e-health was generally limited, and often based on innovations that health workers have been introduced through by their international partners. Health workers reported a range of engagement with e-health innovations, mostly for communication (for example, email) and educational purposes (for example, online learning platforms). Poor, unreliable and unaffordable Internet was a commonly mentioned barrier to e-health use. Scaling-up existing e-health partnerships and innovations were suggested starting points to increase e-health innovation dissemination. CONCLUSIONS: Results from this study showed ICT based e-health innovations can relieve information and communication needs of health workers in post-conflict settings. However, more efforts and investments, preferably driven by healthcare workers within the post-conflict context, are needed to make e-health more widespread and sustainable. Increased awareness is necessary among health professionals, even among current e-health users, and physical and financial access barriers need to be addressed. Future e-health initiatives are likely to increase their impact if based on perceived health information needs of intended users
The Improving Rural Cancer Outcomes (IRCO) Trial: A factorial clusterrandomised controlled trial of a complex intervention to reduce time to diagnosis in rural patients with cancer in Western Australia: A study protocol
Introduction: While overall survival for most common cancers in Australia is improving, the rural-urban differential has been widening, with significant excess deaths due to lung, colorectal, breast and prostate cancer in regional Australia. Internationally a major focus on understanding variations in cancer outcomes has been later presentation to healthcare and later diagnosis. Approaches to reducing time to diagnosis of symptomatic cancer include public symptom awareness campaigns and interventions in primary care to improve early cancer detection. This paper reports the protocol of a factorial cluster-randomised trial of community and general practice (GP) level interventions to reduce the time to diagnosis of cancer in rural Western Australia (WA). Methods and analysis: The community intervention is a symptom awareness campaign tailored for rural Australians delivered through a community engagement model. The GP intervention includes a resource card with symptom risk assessment charts and local referral pathways implemented through multiple academic detailing visits and case studies. Participants are eligible if recently diagnosed with breast, colorectal, lung or prostate cancer who reside in specific regions of rural WA with a planned sample size of 1350. The primary outcome is the Total Diagnostic Interval, defined as the duration from first symptom (or date of cancer screening test) to cancer diagnosis. Secondary outcomes include cancer stage, healthcare utilisation, disease-free status, survival at 2 and 5 years and cost-effectiveness. Ethics and dissemination: Ethics approval has been granted by the University of Western Australia and from all relevant hospital recruitment sites in WA. Results: Results of this trial will be reported in peerreviewed publications and in conference presentations. Trial registration number: Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12610000872033
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The HumanâNature Relationship and Its Impact on Health: A Critical Review
Within the past four decades, research has been increasingly drawn toward understanding whether there is a link between the changing humanânature relationship and its impact on peopleâs health. However, to examine whether there is a link requires research of its breadth and underlying mechanisms from an interdisciplinary approach. This article begins by reviewing the debates concerning the humanânature relationship, which are then critiqued and redefined from an interdisciplinary perspective. The concept and chronological history of âhealthâ is then explored, based on the World Health Organizationâs definition. Combining these concepts, the humanânature relationship and its impact on humanâs health are then explored through a developing conceptual model. It is argued that using an interdisciplinary perspective can facilitate a deeper understanding of the complexities involved for attaining optimal health at the humanâenvironmental interface
Can Healthcare Assistant Training (CHAT) improve the relational care of older people? A developmental and feasibility study of a complex intervention
Background: Older people account for an increasing proportion of those receiving NHS acute care. The quality of healthcare delivered to older people has come under increased scrutiny. Healthcare assistants (HCAs) provide much of the direct care of older people in hospital. Patientsâ experience of care tends to be based on the relational aspects of that care including dignity, empathy and emotional support.
Objective(s): We aimed to: understand the relational care training needs of HCAs caring for older people; design a relational care training intervention for HCAs; and assess the feasibility of a cluster-randomised controlled trial to test the new intervention against HCA training as usual.
Design: (1) Telephone survey of all NHS hospital Trusts in England to assess current HCA training provision; (2) focus groups of older people and carers and (3) semi-structured interviews with HCAs and other care staff to establish training needs and inform intervention development; (4) feasibility cluster-randomised controlled trial.
Setting: (1) All acute NHS hospital Trusts in England; (2,3,4) Three acute NHS hospital Trusts in England and the populations they serve.
Participants: (1) 113 of 161 (70.2%) Trusts took part in the telephone survey; (2) 29 older people or carer participants of three focus groups; (3) 30 HCA and 24 âother staffâ interviewees; (4) 12 wards (four per Trust); 112 HCAs; 92 patients during the pre-randomisation period and 67 patients during the post-randomisation period.
Interventions: For the feasibility trial a training intervention (Older Peopleâs Shoes) for HCAs developed as part of the study was compared with HCA training as usual.
Main outcome measures: Patient level outcomes were the experience of emotional care and quality of life during their hospital stay as measured by the Patient Evaluation of Emotional Care during Hospitalisation (PEECH) and the European Quality of Life (EQ-5D) questionnaires. HCA outcomes were empathy measured by the Toronto Empathy Questionnaire (TEQ) and attitudes towards older people measured by the Age Group Evaluation and Description (AGED) Inventory. Ward level outcomes were the quality of HCA/patient interaction measured by the Quality of Interaction Scale (QUIS).
Results: (1) A third of Trust telephone survey participants reported HCA training content that we considered to be ârelational careâ. Training for HCAs is variable across Trusts and focused on new recruits. The biggest challenge for HCA training is getting HCAs released from ward duties. (2) Older people and carers are aware of the pressures ward staff are under but good relationships with care staff determines whether the experience of hospital is positive. (3) HCAs have training needs related to âdifficult conversationsâ with patients and relatives; they have particular preferences for learning styles that are not always reflected in available training. (4) In the feasibility trial 187 of the 192 planned ward observation sessions were completed; response to HCA questionnaires at baseline, eight and 12 weeks post-randomisation was 64.2%, 46.4% and 35.7% respectively; 57.2% of eligible patients returned completed questionnaires.
Limitations: This was an intervention development and feasibility study so no conclusions can be drawn about the effectiveness of the intervention.
Conclusions: The intervention had high acceptability among nurse trainers and HCA learners. Viability of a definitive trial is conditional on overcoming specific methodological (patient recruitment processes) and contextual (involvement of wider ward team) challenges.
Future work: Methods to ease the burden of questionnaire completion without compromising ethics or methodological rigour need to be explored.
Study registration: ISRCTN1038579
"Physical education", "health and physical education", "physical literacy" and "health literacy": Global nomenclature confusion.
The title âphysical educationâ (PE) is the traditional taxonomy used to represent the education discipline. Health and physical education (HPE) is regarded to be an all-encompassing health-dimensional title that has been recently embraced by various education systems around the world. Hence, it can be argued that PE and HPE are often used interchangeably by educationalists, portraying a similar meaning and understanding. This can be regarded as internationally confusing, as historically PE and HPE have represented different and at times paradoxical discourses and ideologies. Amongst the ambiguity of which title to use, PE or HPE, new terms of branding such as âphysical literacyâ and âhealth literacyâ have re/emerged. The purpose of this interpretivist study is to identify if associated terms used for the original PE label are a help or hindrance to practitioners? Participants were asked an open-ended question relating to PE nomenclatures. The data gathered were analysed and findings confirmed that practitioner confusion does exist. It is suggested that children are first and foremost âphysically educatedâ; therefore a strong, clear and comprehensive grounding in quality PE is essential for teachers and students
Supplemental Information 1: The final alignment of the obtained sequences of the 16S rRNAâ12S rRNA fragment of Siamophryne troglodytes
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