121 research outputs found

    Losing women along the path to safe motherhood: why is there such a gap between women's use of antenatal care and skilled birth attendance? A mixed methods study in northern Uganda.

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    BACKGROUND: Thousands of women and newborns still die preventable deaths from pregnancy and childbirth-related complications in poor settings. Delivery with a skilled birth attendant is a vital intervention for saving lives. Yet many women, particularly where maternal mortality ratios are highest, do not have a skilled birth attendant at delivery. In Uganda, only 58 % of women deliver in a health facility, despite approximately 95 % of women attending antenatal care (ANC). This study aimed to (1) identify key factors underlying the gap between high rates of antenatal care attendance and much lower rates of health-facility delivery; (2) examine the association between advice during antenatal care to deliver at a health facility and actual place of delivery; (3) investigate whether antenatal care services in a post-conflict district of Northern Uganda actively link women to skilled birth attendant services; and (4) make recommendations for policy- and program-relevant implementation research to enhance use of skilled birth attendance services. METHODS: This study was carried out in Gulu District in 2009. Quantitative and qualitative methods used included: structured antenatal care client entry and exit interviews [n = 139]; semi-structured interviews with women in their homes [n = 36], with health workers [n = 10], and with policymakers [n = 10]; and focus group discussions with women [n = 20], men [n = 20], and traditional birth attendants [n = 20]. RESULTS: Seventy-five percent of antenatal care clients currently pregnant reported they received advice during their last pregnancy to deliver in a health facility, and 58 % of these reported having delivered in a health facility. After adjustment for confounding, women who reported they received advice at antenatal care to deliver at a health facility were significantly more likely (aOR = 2.83 [95 % CI: 1.19-6.75], p = 0.02) to report giving birth in a facility. Despite high antenatal care coverage, a number of demand and supply side barriers deter use of skilled birth attendance services. Primary barriers were: fear of being neglected or maltreated by health workers; long distance and other difficulties in access; poverty, and material requirements for delivery; lack of support from husband/partner; health systems deficiencies such as inadequate staffing/training, work environment, and referral systems; and socio-cultural and gender issues such as preferred birthing position and preference for traditional birth attendants. CONCLUSIONS: Initiatives to improve quality of client-provider interaction and respect for women are essential. Financial barriers must be abolished and emergency transport for referrals improved. Simultaneously, supply-side barriers must be addressed, notably ensuring a sufficient number of health workers providing skilled obstetric care in health facilities and creating habitable conditions and enabling environments for them

    Athletic Trainers and Sport Psychology: Knowledge, Experience and Attitudes

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    titles. Certified athletic trainers (ATCs) play a unique role in sport environments as the primary medical staff available to athletes. Thus, ATCs are well positioned to oversee athletes' physical and psychological well-being. Although sport psychologists (SPs) have been identified as a potential resource for ATCs, previous studies have reported a lack of collaboration between SPs and ATCs. This study aimed to (a) examine ATCs' views regarding professional roles for both ATCs and SPs, (b) explore ATCs' referral behaviors, (c) evaluate ATCs belief in the credibility of sport psychology across demographic (i.e., gender, age) and experiential variables (i.e., access to SPs), and (d) examine ATCs' involvement in sport psychology. Four hundred ninety-six ATCs (265 men, 231 women) completed and returned the questionnaire. ATCs viewed assisting in the psychological recovery of athletes as the most acceptable professional role for fellow ATCs; aiding in the psychological recovery of injured athletes and teach mental skills were identified by ATCs as the most appropriate roles for SPs. In considering an athlete experiencing interpersonal difficulties (e.g., relationship problems), a mixed design ANOVA revealed a ATC sex by referral option interaction; female and male ATCs indicated they would likely refer the athlete to a counselor/therapist, followed by a SP, however, female ATCs reported a greater likelihood of referring to a counselor/therapist than male ATCs whereas male ATCs indicated a greater likelihood of referring to a SP. Further, ATCs' regular access to SPs and completion of formal sport psychology coursework were identified as variables associated with greater belief in the credibility of sport psychology. These results suggest that access and previous experience with SPs remain significant variables associated with ATCs views about, and belief in, the work of SPs. Implications for sport psychology professionals and recommendations for future research are discussed

    Improving public transit accessibility for blind riders by crowdsourcing bus stop landmark locations with Google street view: An extended analysis

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    Low-vision and blind bus riders often rely on known physical landmarks to help locate and verify bus stop locations (e.g., by searching for an expected shelter, bench, or newspaper bin). However, there are currently few, if any, methods to determine this information a priori via computational tools or services. In this article, we introduce and evaluate a new scalable method for collecting bus stop location and landmark descriptions by combining online crowdsourcing and Google Street View (GSV). We conduct and report on three studies: (i) a formative interview study of 18 people with visual impairments to inform the design of our crowdsourcing tool, (ii) a comparative study examining differences between physical bus stop audit data and audits conducted virtually with GSV, and (iii) an online study of 153 crowd workers on Amazon Mechanical Turk to examine the feasibility of crowdsourcing bus stop audits using our custom tool with GSV. Our findings reemphasize the importance of landmarks in nonvisual navigation, demonstrate that GSV is a viable bus stop audit dataset, and show that minimally trained crowd workers can find and identify bus stop landmarks with 82.5% accuracy across 150 bus stop locations (87.3% with simple quality control). </jats:p

    Improving public transit accessibility for blind riders by crowdsourcing bus stop landmark locations with Google street view

    Get PDF
    Low-vision and blind bus riders often rely on known physical landmarks to help locate and verify bus stop locations (e.g., by searching for a shelter, bench, newspaper bin). However, there are currently few, if any, methods to determine this information a priori via computational tools or services. In this paper, we introduce and evaluate a new scalable method for collecting bus stop location and landmark descriptions by combining online crowdsourcing and Google Street View (GSV). We conduct and report on three studies in particular: (i) a formative interview study of 18 people with visual impairments to inform the design of our crowdsourcing tool; (ii) a comparative study examining differences between physical bus stop audit data and audits conducted virtually with GSV; and (iii) an online study of 153 crowd workers on Amazon Mechanical Turk to examine the feasibility of crowdsourcing bus stop audits using our custom tool with GSV. Our findings reemphasize the importance of landmarks in non-visual navigation, demonstrate that GSV is a viable bus stop audit dataset, and show that minimally trained crowd workers can find and identify bus stop landmarks with 82.5 % accuracy across 150 bus stop locations (87.3 % with simple quality control)

    Recommendations for the use of common outcome measures in pediatric traumatic brain injury research

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    This article addresses the need for age-relevant outcome measures for traumatic brain injury (TBI) research and summarizes the recommendations by the inter-agency Pediatric TBI Outcomes Workgroup. The Pediatric Workgroup\u27s recommendations address primary clinical research objectives including characterizing course of recovery from TBI, prediction of later outcome, measurement of treatment effects, and comparison of outcomes across studies. Consistent with other Common Data Elements (CDE) Workgroups, the Pediatric TBI Outcomes Workgroup adopted the standard three-tier system in its selection of measures. In the first tier, core measures included valid, robust, and widely applicable outcome measures with proven utility in pediatric TBI from each identified domain including academics, adaptive and daily living skills, family and environment, global outcome, health-related quality of life, infant and toddler measures, language and communication, neuropsychological impairment, physical functioning, psychiatric and psychological functioning, recovery of consciousness, social role participation and social competence, social cognition, and TBI-related symptoms. In the second tier, supplemental measures were recommended for consideration in TBI research focusing on specific topics or populations. In the third tier, emerging measures included important instruments currently under development, in the process of validation, or nearing the point of published findings that have significant potential to be superior to measures in the core and supplemental lists and may eventually replace them as evidence for their utility emerges

    Assessment of a Program for SARS-CoV-2 Screening and Environmental Monitoring in an Urban Public School District

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    Importance: Scalable programs for school-based SARS-CoV-2 testing and surveillance are needed to guide in-person learning practices and inform risk assessments in kindergarten through 12th grade settings. Objectives: To characterize SARS-CoV-2 infections in staff and students in an urban public school setting and evaluate test-based strategies to support ongoing risk assessment and mitigation for kindergarten through 12th grade in-person learning. Design, Setting, and Participants: This pilot quality improvement program engaged 3 schools in Omaha, Nebraska, for weekly saliva polymerase chain reaction testing of staff and students participating in in-person learning over a 5-week period from November 9 to December 11, 2020. Wastewater, air, and surface samples were collected weekly and tested for SARS-CoV-2 RNA to evaluate surrogacy for case detection and interrogate transmission risk of in-building activities. Main Outcomes and Measures: SARS-CoV-2 detection in saliva and environmental samples and risk factors for SARS-CoV-2 infection. Results: A total of 2885 supervised, self-collected saliva samples were tested from 458 asymptomatic staff members (mean [SD] age, 42.9 [12.4] years; 303 women [66.2%]; 25 Black or African American [5.5%], 83 Hispanic [18.1%], 312 White [68.1%], and 35 other or not provided [7.6%]) and 315 students (mean age, 14.2 [0.7] years; 151 female students [48%]; 20 Black or African American [6.3%], 201 Hispanic [63.8%], 75 White [23.8%], and 19 other race or not provided [6.0%]). A total of 46 cases of SARS-CoV-2 (22 students and 24 staff members) were detected, representing an increase in cumulative case detection rates from 1.2% (12 of 1000) to 7.0% (70 of 1000) among students and from 2.1% (21 of 1000) to 5.3% (53 of 1000) among staff compared with conventional reporting mechanisms during the pilot period. SARS-CoV-2 RNA was detected in wastewater samples from all pilot schools as well as in air samples collected from 2 choir rooms. Sequencing of 21 viral genomes in saliva specimens demonstrated minimal clustering associated with 1 school. Geographical analysis of SARS-CoV-2 cases reported district-wide demonstrated higher community risk in zip codes proximal to the pilot schools. Conclusions and Relevance: In this study of staff and students in 3 urban public schools in Omaha, Nebraska, weekly screening of asymptomatic staff and students by saliva polymerase chain reaction testing was associated with increased SARS-CoV-2 case detection, exceeding infection rates reported at the county level. Experiences differed among schools, and virus sequencing and geographical analyses suggested a dynamic interplay of school-based and community-derived transmission risk. Collectively, these findings provide insight into the performance and community value of test-based SARS-CoV-2 screening and surveillance strategies in the kindergarten through 12th grade educational setting
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