No evidence for reduced Simon cost in elderly bilinguals and bidialectals

We explored whether a bilingual advantage in executive control is associated with differences in cultural and ethnic background associated with the bilinguals’ immigrant status, and whether dialect use in monolinguals can also incur such an advantage. Performance on the Simon task in older non-immigrant (Gaelic-English) and immigrant (Bengali, Gujarati, Hindi, Malay, Punjabi, Urdu-English) bilinguals was compared with three groups of older monolingual English speakers, who were either monodialectal users of the same English variety as the bilinguals or were bidialectal users of a local variety of Scots. Results showed no group differences in overall reaction times as well as in the Simon effect thus providing no evidence that an executive control advantage is related to differences in cultural and ethnic background as was found for immigrant compared to non-immigrant bilinguals, nor that executive control may be improved by use of dialect. We suggest the role of interactional contexts and bilingual literacy as potential explanations for inconsistent findings of a bilingual advantage in executive control

Exploring how different modes of governance act across health system levels to influence primary healthcare facility managers' use of information in decisionmaking: experience from Cape Town, South Africa

BACKGROUND: Governance, which includes decision-making at all levels of the health system, and information have been identified as key, interacting levers of health system strengthening. However there is an extensive literature detailing the challenges of supporting health managers to use formal information from health information systems (HISs) in their decision-making. While health information needs differ across levels of the health system there has been surprisingly little empirical work considering what information is actually used by primary healthcare facility managers in managing, and making decisions about, service delivery. This paper, therefore, specifically examines experience from Cape Town, South Africa, asking the question: How is primary healthcare facility managers’ use of information for decision-making influenced by governance across levels of the health system? The research is novel in that it both explores what information these facility managers actually use in decision-making, and considers how wider governance processes influence this information use. METHODS: An academic researcher and four facility managers worked as co-researchers in a multi-case study in which three areas of management were served as the cases. There were iterative cycles of data collection and collaborative analysis with individual and peer reflective learning over a period of three years. RESULTS: Central governance shaped what information and knowledge was valued – and, therefore, generated and used at lower system levels. The central level valued formal health information generated in the district-based HIS which therefore attracted management attention across the levels of the health system in terms of design, funding and implementation. This information was useful in the top-down practices of planning and management of the public health system. However, in facilities at the frontline of service delivery, there was a strong requirement for local, disaggregated information and experiential knowledge to make locally-appropriate and responsive decisions, and to perform the people management tasks required. Despite central level influences, modes of governance operating at the subdistrict level had influence over what information was valued, generated and used locally. CONCLUSIONS: Strengthening local level managers’ ability to create enabling environments is an important leverage point in supporting informed local decision-making, and, in turn, translating national policies and priorities, including equity goals, into appropriate service delivery practices.ISIScopu

Integration of HIV prevention into sexual and reproductive health services in an urban setting in South Africa

Background: The United Nations Political Declaration on HIV and AIDS of 2006 stressed the need to strengthen policy and programme linkages between HIV and Sexual and Reproductive Health (SRH). However, the effectiveness and best practices for strengthening SRH and HIV linkages are poorly researched in the context of family-planning services. In Cape Town, HIV-prevention services have been integrated into family-planning services. There are two models of service configuration: dedicated stand-alone reproductive health clinics and familyplanning services located in comprehensive primary-care facilities. Objective: To describe how reproductive health services are integrating HIV prevention and care strategies and to measure the coverage and quality of these integrated services. Methods: A cross-sectional study was conducted using structured interviews with facility managers; a facility-based checklist; and a patient record review to assess the availability of resources, training, access, quality and integration. Results: Facilities in Cape Town are equipped adequately to offer integrated HIV-prevention and SRH services. Overall there was poor coverage of integrated services with 54% of familyplanning clients having a known HIV status; 47% being screened for a sexually transmitted infection and 55% being offered HIV counselling and testing and receiving condoms. Quality and continuity of care seemed better at the dedicated clinics than at the comprehensive facilities, supported by better training coverage. Conclusion: Engaging middle-level management is crucial with regard to improving integration within a well-resourced setting

Evaluation of how integrated HIV and TB programs are implemented in South Africa and the implications for rural-urban equity

Introduction: In countries such as South Africa with a high prevalence of HIV and TB policy directives support program integration. Operational research suggests this is desirable, at least for increasing coverage of HIV and TB services, but warns that implementation models must take local health service infrastructure into account. Methods: A program evaluation of HIV and TB prevention and therapeutic services was performed at facility level in two purposefully selected districts in South Africa – one deep rural and an urban district – in order to describe integration and how it is implemented. Twenty-six rural and 146 urban public primary-care facilities were evaluated using secondary data generated from two large evaluations of HIV/TB/Sexually Transmitted Infections (STI) programs conducted in December 2008 and May 2009. The data collection tools consisted of a review of data in the routine health information system, a facility manager interview, a checklist for equipment and supplies, register reviews and a series of patient folder (health record) reviews. Data were collected on extent to which clients receive integrated services, as well as the quality of care, and the availability of key resources and system capacity to support quality care. Data were entered into MS Excel spreadsheets and proportions calculated for all indicators, and confidence intervals for proportions. Results: Evidence of integration was found across two dimensions - disease programs and the prevention–therapeutic axis. Integration was enabled in both the rural and urban districts because HIV and TB services were co-located in the extensive network of general primary-care services. Smaller rural facilities did not always have staff trained in all the required services, nurses worked without the support of a doctor and supervision was weaker, threatening quality of care. In the rural district there were instances of clients receiving more integrated services. The quality of care in the TB program was high in both districts. Conclusions: In both the districts evaluated, integration across programs and the prevention-care-rehabilitation axis of services was achieved through co-location at primary-care level. Coupled with health system strengthening, this has the potential to improve access across the HIV/TB/STI cluster of services. The benefit is likely to be greater in rural areas. Quality of care was maintained in the long established TB programs in both settings.Web of Scienc

Cognitive cost of switching between standard and dialect varieties

Switching between languages in picture naming incurs a cost associated with inhibition of the non-target language (Meuter & Allport, 1999).This cost is symmetrical in balanced bilinguals and asymmetrical in unbalanced bilinguals with higher cost associated with switching back into L1 (Costa & Santesteban,2004).We investigated whether cost is incurred in similar ways by bidialectals switching between two dialects.To increase generalisablity, we conducted this experiment in 2 locations: in Scotland using Standard Scottish English and Dundonian-Scots bidialectals) and in Germany using German and Öcher bidialectals).We also investigated differences between active vs. passive, and older vs. younger bidialectals

Can monolinguals be like bilinguals? Evidence from dialect switching

Bilinguals rely on cognitive control mechanisms like selective activation and inhibition of lexical entries to prevent intrusions from the non-target language. We present cross-linguistic evidence that these mechanisms also operate in bidialectals. Thirty-two native German speakers who sometimes use the Öcher Platt dialect, and thirty-two native English speakers who sometimes use the Dundonian Scots dialect completed a dialect-switching task. Naming latencies were higher for switch than for non-switch trials, and lower for cognate compared to non-cognate nouns. Switch costs were symmetrical, regardless of whether participants actively used the dialect or not. In contrast, sixteen monodialectal English speakers, who performed the dialectswitching task after being trained on the Dundonian words, showed asymmetrical switch costs with longer latencies when switching back into Standard English. These results are reminiscent of findings for balanced vs. unbalanced bilinguals, and suggest that monolingual dialect speakers can recruit control mechanisms in similar ways as bilinguals

Between HIV diagnosis and initiation of antiretroviral therapy: Assessing the effectiveness of care for people living with HIV in the public primary care service in Cape Town, South Africa

BACKGROUND: While much is written about the scale up of HIV counselling and testing (HCT) and antiretroviral therapy (ART), little research has been done on the expansion of routine preART HIV care. OBJECTIVE: To assess the quality of preART care in Cape Town and its continuity with HCT and ART. METHODS: The scale up of the HCT, preART and ART service platform and programmatic support in Cape Town is described. Data from the August 2010 routine annual HIV/TB/STI evaluation, from interviews with 133 facility managers and a folder review of 634 HCT s who tested positive and 1115 clients receiving preART HIV care are analysed. RESULTS: Historically the implementation and management of preART care has been relatively neglected compared with the scale-up of HCT and ART. The CD4 count was done on 77.5% positive HCT clients and 46.6% were clinically staged - crucial steps that determine the care path. There were: gaps in quality of care - 32.2% of women had a PAP smear; missed opportunities for integrated care - 67% were symptomatically screened for tuberculosis; and positive prevention - 48.3% had contraceptive needs assessed. Breaks in the continuity of care of preART clients occurred with only 47.2% of eligible clients referred appropriately to the ARV service. CONCLUSION: While a package of preART care has been clearly defined in Cape Town, it has not been fully implemented. There are weaknesses in the continuity and quality service delivered that undermine the programme objectives of provision of positive prevention and timeous access to ART

Critiquing the response to the Ebola epidemic through a primary health care approach

BACKGROUND: The 2014/2015 West Africa Ebola epidemic has caused the global public health community to engage in difficult self-reflection. First, it must consider the part it played in relation to an important public health question: why did this epidemic take hold and spread in this unprecedented manner? Second, it must use the lessons learnt to answer the subsequent question: what can be done now to prevent further such outbreaks in the future? These questions remain relevant, even as scientists announce that the Guinea Phase III efficacy vaccine trial shows that rVSV-EBOV (Merck, Sharp & Dohme) is highly efficacious in individuals. This is a major breakthrough in the fight against Ebola virus disease (EVD). It does not replace but may be a powerful adjunct to current strategies of EVD management and control. DISCUSSION: We contribute to the current self-reflection by presenting an analysis using a Primary Health Care (PHC) approach. This approach is appropriate as African countries in the region affected by EVD have recommitted themselves to PHC as a framework for organising health systems and the delivery of health services. The approach suggests that, in an epidemic made complex by weak pre-existing health systems, lack of trust in authorities and mobile populations, a broader approach is required to engage affected communities. In the medium-term health system development with attention to primary level services and community-based programmes to address the major disease burden of malaria, diarrhoeal disease, meningitis, tuberculosis and malnutrition is needed. This requires the development of local management and an investment in human resources for health. Crucially this has to be developed ahead of, and not in parallel with, future outbreaks. In the longer-term a commitment is required to address the underlying social determinants which make these countries so vulnerable, and limit their capacity to respond effectively to, epidemics such as EVD. CONCLUSION: The PHC approach offers an insightful critique of the global and regional factors which have compromised the response of health systems in Guinea, Liberia and Sierra Leone as well as suggesting what a strengthened EVD response might involve in the short, medium and long-term.Web of Scienc

Knowledge, attitude and practice study of HIV in female adolescents presenting for contraceptive services in a rural health district in the north-east of Namibia

Background: Namibia bears a large burden of Human Immunodeficiency Virus (HIV), and the youth are disproportionately affected. Objectives: To explore the current knowledge, attitudes and behaviour of female adolescents attending family planning to HIV prevention. Methods: A cross-sectional study design was used on a sample 251 unmarried female adolescents aged from 13 years to 19 years accessing primary care services for contraception using an interviewer-administered questionnaire. Data were analysed using Epi Info 2002. Crude associations were assessed using cross-tabulations of knowledge, attitude and behaviour scores against demographic variables. Chi-square tests and odds ratios were used to assess associations from the cross-tabulations. All p-values < 0.05 were considered statistically significant. Results: A quarter of sexually active teenagers attending the family-planning services did not have adequate knowledge of HIV prevention strategies. Less than a quarter (23.9%) always used a condom. Most respondents (83.3%) started sexual intercourse when older than 16 years, but only 38.6% used a condom at their sexual debut. The older the girls were at sexual debut, the more likely they were to use a condom for the event (8% did so at age 13 years and 100% at age 19 years). Conclusions: Knowledge of condom use as an HIV prevention strategy did not translate into consistent condom use. One alternate approach in family-planning facilities may be to encourage condom use as a dual protection method. Delayed onset of sexual activity and consistent use of condoms should be encouraged amongst schoolchildren, in the school setting.Department of HE and Training approved lis