Ethische Fragen zur Digitalisierung im Globalen Süden: Perspektiven auf Gerechtigkeit und Gleichberechtigung

Digitalization and information and communications technology (ICT) influence and transform the world economy, our everyday life, politics, and our way of communicating. This entails opportunities and benefits as well as risks, challenges, and difficulties for all actors involved. Especially in the African context, but also in other countries of the Global South, there are important questions and aspects of digitalization which have to be addressed by technology assessment (TA) from an ethical point of view: questions of unequal power relations, neo-colonialism, (digital) illiteracy and language barriers, general barriers to access, and the gender digital divide. To broaden the perspectives of TA in global contexts, these issues should be discussed by different scientific disciplines, equally considering the positions of those affected. The inter- and transdisciplinary approaches in this TATuP special topic make a much-needed contribution to TA of digitalization in a global context.Digitalisierung und Informations- und Kommunikationstechnologien (IKT) beeinflussen und verändern die Weltwirtschaft, unser Alltagsleben, die Politik und unsere Kommunikation. Das birgt Chancen und Vorteile, aber auch Risiken, Herausforderungen und Schwierigkeiten für alle beteiligten Akteur*innen. Besonders im afrikanischen Kontext, aber auch in anderen Ländern des Globalen Südens, gibt es wichtige Fragen und Aspekte der Digitalisierung, die in der Technikfolgenabschätzung (TA) von einem ethischen Standpunkt aus adressiert werden müssen: Fragen zu ungleichen Machtverhältnissen, Neokolonialismus, (digitalem) Analphabetismus und sprachlichen Barrieren sowie zu allgemeinen Zugangsbarrieren und der digitalen Kluft zwischen den Geschlechtern. Um die Perspektive von TA in globalen Kontexten zu erweitern, sollten diese Fragen aus unterschiedlichen wissenschaftlichen Disziplinen heraus diskutiert und die Perspektive derjenigen miteinbezogen werden, die im konkreten Fall betroffen sind. Die inter- und transdisziplinären Ansätze in diesem TATuP-Thema leisten einen wichtigen Beitrag zur TA der Digitalisierung im globalen Kontext

Digitalization in the Global South

What are opportunities and risks of ICT in a global context from an ethical and interdisciplinary point of view? This TATuP special topic addresses often neglected issues, like unequal power relations, neo-colonialism, (digital) illiteracy, general barriers to access, or the gender digital divide. Editors: J. Heesen, L. Schelenz, K. Schopp and M. PawelecWhat are opportunities and risks of ICT in a global context from an ethical and interdisciplinary point of view? This TATuP special topic addresses often neglected issues, like unequal power relations, neo-colonialism, (digital) illiteracy, general barriers to access, or the gender digital divide. Editors: J. Heesen, L. Schelenz, K. Schopp and M. Pawele

Emerging from the shadows: Intrinsic and extrinsic factors facing community health workers in Western Cape, South Africa

Community health workers (CHWs) have been identified as a key component of the health workforce in South Africa. However, the efficacy of CHW programs continues to be limited by a poor understanding of facilitators and barriers to CHW engagement. This study explores intrinsic and extrinsic factors that CHWs face. We conducted in-depth interviews with 20 CHWs in order to understand the challenges they may face as they implement their duties linked to the primary health care strategy in the Western Cape, South Africa

A Self-Management Training Intervention: Perceptions and Practices of Community Health Workers in South Africa

Background. While community health workers (CHWs) are increasingly being used as a strategy for increasing health care access, particularly in rural communities, interventions are needed to improve their skill sets in inspiring health behavior change, both for themselves and among their community clients. Self-management (SM) education interventions have shown to improve health behaviors and wellbeing. Purpose

Challenges experienced by community health workers and their motivation to attend a self-management programme

Community health workers (CHWs) are change agents expected to assist in decreasing the global burden of disease in the communities they serve. However, they themselves have health risk behaviours, which predispose them to non-communicable diseases and thus need to be empowered to make better health choices. There is a gap in literature detailing the challenges faced by CHWs in addressing their own health risk behaviours.: This study aimed to explore the challenges experienced by CHWs in carrying out their daily duties and the motivating factors to join a self-management programme

Assessment of risk factors for Non-Communicable diseases among a cohort of community health workers in Western Cape, South Africa

Community Health Workers (CHWs) have been identified as the key health professionals to drive the agenda of the prevention of health risk behaviours, linked to noncommunicable diseases (NCDs) in South Africa. They are regarded as the agents of change, who will provide impetus to the achievement of the health behaviour goals, set out by the South African National Department of Health1 . However, this cohort, may suffer from an array of NCDs. There are various risk factors that influence the health of individuals and contribute to NCDs, including modifiable and non-modifiable risk factors, which cannot be changed, or altered by an intervention, such as age, family history, gender and ethnicity2,3. Modifiable risk factors have been classified as behavioural, physical, and biological4 . Globally, NCDs are responsible for 80% of premature deaths in LMICs5,6. In response to the NCD pandemic, the World Health Organisation (WHO) set a global target in 2012, which was aimed at reducing premature deaths, caused by NCDs, by 25%, by the year 20257 . However, this goal will require drastic, immediate, and targeted approaches that address the root causes of NCDs. South Africa has followed the global trend, and evidence depicts an increase in NCDs8 , with a 27% probability of dying between the ages of 30 and 70 years, as a result of cardiovascular diseases (CVDs), diabetes, cancers, or chronic respiratory conditions7,9. This is similar to other countries such as India (26%), Philippines (28%), Democratic People’s Republic of Korea (27%), Mali (26%), Russian Federation (30%), Ukraine (28%) , Tajikistan (29%), Fiji (31%), Afghanistan (31%) and Armenia (31%)9 In the Western Cape, the prevalence of chronic diseases of lifestyle raises major concerns about the communities’ health risk behaviour. The Burden of Disease Survey for the Western Cape, which was released on 24 April 2017, reported that NCDs contributed to 61% of deaths in the Western Province1

Emerging from the Shadows: Intrinsic and Extrinsic Factors Facing Community Health Workers in Western Cape, South Africa

Community health workers (CHWs) have been identified as a key component of the health workforce in South Africa. However, the efficacy of CHW programs continues to be limited by a poor understanding of facilitators and barriers to CHW engagement. This study explores intrinsic and extrinsic factors that CHWs face. We conducted in-depth interviews with 20 CHWs in order to understand the challenges they may face as they implement their duties linked to the primary health care strategy in the Western Cape, South Africa. All interviews were audiotaped, transcribed verbatim, coded and analyzed using NVivo 12. Drawing on narratives of CHWs, we illustrate the complex issues surrounding CHW outreach in poor rural communities. The CHWs identified five key areas of challenges with respect to personal health, gender issues, poor community understanding of CHWs roles, environmental challenges and lack of patient adherence. These all hinder the ability of CHWs to meet their personal and familial needs, as well as those of the community members they support. There is a need to address the intrinsic needs of CHWs in order to ensure their emotional and physical well-being, as well as a need to create an awareness of the roles of CHWs

TREK1 channel activation as a new analgesic strategy devoid of opioid adverse effects

International audienceBackground and Purpose: Opioids are effective painkillers. However, their risk-benefit ratio is dampened by numerous adverse effects and opioid misuse has led to a public health crisis. Safer alternatives are required, but isolating the antinociceptive effect of opioids from their adverse effects is a pharmacological challenge because activation of the μ opioid receptor triggers both the antinociceptive and adverse effects of opioids. Experimental Approach: The TREK1 potassium channel is activated downstream of μ receptor and involved in the antinociceptive activity of morphine but not in its adverse effects. Bypassing the μ opioid receptor to directly activate TREK1 could therefore be a safer analgesic strategy. Key Results: We developed a selective TREK1 activator, RNE28, with antinociceptive activity in naive rodents and in models of inflammatory and neuropathic pain. This activity was lost in TREK1 knockout mice or wild-type mice treated with the TREK1 blocker spadin, showing that TREK1 is required for the antinociceptive activity of RNE28. RNE28 did not induce respiratory depression, constipation, rewarding effects, or sedation at the analgesic doses tested. Conclusion and Implications: This proof-of-concept study shows that TREK1 activators could constitute a novel class of painkillers, inspired by the mechanism of action of opioids but devoid of their adverse effects