Attitudes and intentions of future health care providers regarding termination of pregnancy (TOP) services in South Africa

Includes bibliographical references (leaves 79-84).Voluntary or induced termination of pregnancy (TOP) is a common reproductive health phenomenon worldwide, whether legal or illegal (WHO, 2004; Schenker and Cain, 1999). Although some countries, including South Africa, have liberalized TOP laws to allow legal and safe provision of abortion, many barriers continue to impede successful rollout of services. Key among these are the following: * recruiting and retaining staff to provide such services, * incorporating TOP observation and training into medical training curricula, preventing burnout, * addressing negative attitudes and stigma of health providers, * diminishing professional discrimination and harassment, and * offering more TOP training modules, counselling workshops, and values clarification workshops over a spread of geographic areas (Adamo, 2003). Identifying future health professionals who may be interested in training and eventually providing TOP care has thus been prioritized by the South African Department of Health. Examining the knowledge, attitudes, beliefs, and intentions of medical students in training could make an important contribution to policy initiatives with respect to abortion provision. The current study measured these parameters among medical students in one of the eight medical training institutions in South Africa. With the liberalization of TOP legislation in South Africa, future health professionals' attitudes and intentions towards abortion services is a critical determinant to equity, access, and availability of women's reproductive care and to the successful implementation of TOP law

Microstructural abnormalities in deep and superficial white matter in youths with mild traumatic brain injury

BACKGROUND: Diffusion Tensor Imaging (DTI) studies of traumatic brain injury (TBI) have focused on alterations in microstructural features of deep white matter fibers (DWM), though post-mortem studies have demonstrated that injured axons are often observed at the gray-white matter interface where superficial white matter fibers (SWM) mediate local connectivity. OBJECTIVES: To examine microstructural alterations in SWM and DWM in youths with a history of mild TBI and examine the relationship between white matter alterations and attention. METHODS: Using DTIDWM fractional anisotropy (FA) and SWM FA in youths with mild TBI (TBI, n=63) were compared to typically developing and psychopathology matched control groups (n=63 each). Following tract-based spatial statistics, SWM FA was assessed by applying a probabilistic tractography derived SWM mask, and DWM FA was captured with a white matter fiber tract mask. Voxel-wise z-score calculations were used to derive a count of voxels with abnormally high and low FA for each participant. Analyses examined DWM and SWM FA differences between TBI and control groups, the relationship between attention and DWM and SWM FA and the relative susceptibility of SWM compared to DWM FA to alterations associated with mild TBI. RESULTS: Case-based comparisons revealed more voxels with low FA and fewer voxels with high FA in SWM in youths with mild TBI compared to both control groups. Equivalent comparisons in DWM revealed a similar pattern of results, however, no group differences for low FA in DWM were found between mild TBI and the control group with matched psychopathology. Slower processing speed on the attention task was correlated with the number of voxels with low FA in SWM in youths with mild TBI. CONCLUSIONS: Within a sample of youths with a history of mild TBI, this study identified abnormalities in SWM microstructure associated with processing speed. The majority of DTI studies of TBI have focused on long-range DWM fiber tracts, often overlooking the SWM fiber type

Field Epidemiology in the Pacific

In this thesis, I present the projects and activities that I undertook to fulfil the competencies required for completion of the MAE Program 2019 - 2020. During my candidature, I was based at Hunter New England (HNE) Population Health in Newcastle, NSW. During this time I completed three major international projects, contributed to the Regional investigation and response to the COVID-19 pandemic, and was involved in a range of other public health investigations and capacity building opportunities both locally in HNE and in the Pacific. I conducted an Epidemiological study to explore the translation of knowledge into action of graduates of the Field Epidemiology Training Program in Papua New Guinea (FETPNG). Whilst many Field Epidemiology Training Programs (FETPs) have conducted quantitative outcome evaluations of their respective Programs, this study aimed to qualitatively explore the impact that graduates have had on the public health system and their communities, and critical success factors and challenges in practically applying skills in the field after training. The results will be used to strengthen the FETPNG curriculum, advocate for greater support of the Program, and provide the basis for an evaluation tool to be used to evaluate the impact of FETPs in other contexts. At the request of Atoifi Adventist Hospital (AAH) in East Kwaio, Solomon Islands, I analysed the routine passive malaria surveillance data from 1 January 2018 - 31 August 2019. Malaria is an important public health issue in Solomon Islands, and laboratory staff had anecdotally noticed an increase in overall case detection, proportion of Plasmodium falciparum infections, and number of people being confirmed with malaria multiple times. This study described current epidemiology of malaria in East Kwaio for the study period in order to support evidence-based clinical and public health decision-making. In-field dissemination of initial results to AAH staff and community leaders resulted in the recommendation of an electronic malaria surveillance system which would provide data to support malaria planning and decision-making of both Hospital and community members. Following this recommendation, I worked with the AAH team and an Australian developer to develop a pilot electronic surveillance system for malaria for AAH. The system was developed to prioritise usefulness, simplicity, acceptability, data quality, stability, flexibility and timeliness. The system facilitates information management of clinically complex malaria cases, informs the Hospital team of the current epidemiological situation in the region to enable appropriate public health planning, and engages community members as active participants in data utilisation for malaria prevention and control. In February 2020 I was deployed to the World Health Organization Western Pacific Regional Office, Philippines, as an Epidemiologist in the Incident Management Support Team (IMST) in responding to the emerging COVID-19 pandemic. I worked with a team of Epidemiologists to collect, descriptively analyse, interpret and present data from Member States to the IMST on a daily basis. We assessed the current level of transmission in each respective country and area, examining the data in relation to enhanced and routine surveillance data and preparedness assessments, and provided recommendations to the IMST on appropriate public health preparedness and response measures. I also present a range of other public health response experiences, highlighting the imperative to centre the human experience in response work. Finally, I present a selection of teaching and capacity building activities that I conducted. This includes presentation of a Lessons from the Field (LFF) on COVID-19 contact tracing in a remote, resource limited, cross-cultural setting, a combined teaching session to First Year MAE Scholars based on my LFF, and additional capacity building activities in HNE, PNG and Solomon Islands

An Exploratory Study of Classroom Diversity and Cultural Competency

This exploratory study compares the effectiveness of multicultural training across two classrooms of counselors-in-training at a predominately white institution—one which was homogenous in class composition; the other which was diverse in class composition. Results indicated that there was a statistically significant difference between classrooms and that individual students demonstrated statistically significant change in perceived multicultural competence. Such findings highlight the need for ongoing research that explores influence of classroom composition on cultural competency training for counseling graduate students

An Exploratory Study of Classroom Diversity and Cultural Competency

This exploratory study compares the effectiveness of multicultural training across two classrooms of counselors-in-training at a predominately white institution—one which was homogenous in class composition; the other which was diverse in class composition. Results indicated that there was a statistically significant difference between classrooms and that individual students demonstrated statistically significant change in perceived multicultural competence. Such findings highlight the need for ongoing research that explores influence of classroom composition on cultural competency training for counseling graduate students

A Closer Look: Health Services Structure and Organization, Health Disparities, and Receipt of High Quality Breast Cancer Treatment

Racial/ethnic disparities in breast cancer outcomes have been well documented; however, the reasons why certain groups have widely different health experiences are not well understood. Recognizing that variation in quality of cancer care may correlate with socio-demographic and health system characteristics, the overall objectives of this dissertation were (1) to investigate the relationships between race/ethnicity and structural/organizational aspects of health services in terms of post-operative receipt and timing of initiation of radiation therapy and adjuvant chemotherapy, and (2) to determine whether timing of adjuvant therapy initiation affects mortality. This dissertation used population-based SEER-Medicare data to examine these issues in female Medicare beneficiaries ages 65 and older diagnosed with primary breast cancer in the years 1994 to 2002. Structural/organizational variables examined included characteristics of the surgical facility (i.e., type/ownership, teaching status, size, institutional affiliations, and presence of on-site radiation services), distance traveled to surgical facilities, distance to nearest radiation therapy provider, and distance to nearest chemotherapy provider. Racial/ethnic groups examined included non-Hispanic white, non-Hispanic black, and Hispanic patients. We found significant racial/ethnic disparities in terms of receipt and timing of initiation of radiation therapy, as well as all-cause and breast cancer specific mortality, whereas we found no evidence of racial/ethnic disparities in adjuvant chemotherapy. We also found evidence that certain health services characteristics, including type/ownership and size of surgical facility, presence of on-site radiation at surgical facility, and distance from patient residence to adjuvant therapy providers, were associated with quality of care received, suggesting that health care systems or policies may be designed in such a way to improve outcomes for all breast cancer patients, and particularly, among minority women at risk for undertreatment. Finally, we found evidence that earlier initiation of radiation therapy and adjuvant chemotherapy may correspond to better health outcomes. This study documents the important role that health services characteristics may play in determining quality of care. Additionally, considering that black women are more likely to be diagnosed with aggressive, advanced stage cancers and more likely to die from breast cancer, this study suggests that earlier initiation of treatment may help minimize racial disparities in breast cancer mortality

The Enfreakment of Language: Disability, Eugenics, and Rhetoric

This project is motivated by the presence of eugenics in our dominant approaches to meaning-making: what does it look like, and why should we care? To begin to answer these questions, this dissertation works from two concepts: enfreakment – the identification of elements that are desirable or wanted – and eugenicist logics, the removal of what is not wanted or deemed necessary for the desired outcome, or alternatively, the replication of the elements that are considered useful. To observe the interaction between the logic of eugenics and enfreakment within ableist systems, this dissertation develops the enfreakment of language, a term that encompasses both the process of enfreakment and the heuristic that allows us to see that process in action. The enfreakment of language uncovers how particular modes of Western and Euro-American meaning-making depend on the logic of eugenics, a dependency that is detrimental to the bodies that become subjected to the power gained through this logic. Focusing on some of the implications of the overlap and interaction between the logics of eugenics and enfreakment within ableist systems, this project demonstrates the operation of eugenics as a logic that motivates discourses around human variation. I offer three examples of representations of disability and eugenics in America to illustrate reproductions of the freak show and eugenicist practices within the production and consumption of the “abnormal” body. I first show how a system based on eugenicist logic operates by examining how eugenicist logic in the language of U.S. Ugly Laws is mirrored in Nazi euthanasia practices. Next, I illustrate the collapse of a system based on eradication through an examination of representations of Anne Frank, demonstrating how eugenicist logics of Nazi programs dis/able her as the “face of the Holocaust.” Finally, I look at the attempts to create an alternate, anti-eugenicist system in contemporary public rhetorics through an analysis of Lady Gaga’s references to Nazi eugenics and disability in her work. Ultimately, this dissertation argues that Disability Studies is essential if the academy is to account for the bodies and practices that have been erased in the attempt to define categories of “abnormal.

MidExDB: A database of Drosophila CNS midline cell gene expression

<p>Abstract</p> <p>Background</p> <p>The <it>Drosophila </it>CNS midline cells are an excellent model system to study neuronal and glial development because of their diversity of cell types and the relative ease in identifying and studying the function of midline-expressed genes. In situ hybridization experiments generated a large dataset of midline gene expression patterns. To help synthesize these data and make them available to the scientific community, we developed a web-accessible database.</p> <p>Description</p> <p>MidExDB (<it>Drosophila </it>CNS Midline Gene Expression Database) is comprised of images and data from our in situ hybridization experiments that examined midline gene expression. Multiple search tools are available to allow each type of data to be viewed and compared. Descriptions of each midline cell type and their development are included as background information.</p> <p>Conclusion</p> <p>MidExDB integrates large-scale gene expression data with the ability to identify individual cell types providing the foundation for detailed genetic, molecular, and biochemical studies of CNS midline cell neuronal and glial development and function. This information has general relevance for the study of nervous system development in other organisms, and also provides insight into transcriptional regulation.</p