The relationship between college health professionals\u27 communicative behaviors, students\u27 satisfaction, and students\u27 perceived quality of healthcare

In this thesis, a Pearson product-moment correlation was performed using SPSS to analyze the associations between college health professionals’ communicative behaviors (instrumental and affective), students’ satisfaction, and students’ perceived quality of healthcare. Results showed that college health professionals’ communicative behaviors positively associated with students’ satisfaction and students’ perceived quality of healthcare. The implication is that college health professionals need to pay careful attention to how they interact with students at student health service because their interactions can potentially cause either high or low patient satisfaction or perception of quality of healthcare among students. Additionally, this thesis used anxiety/uncertainty management (AUM) theory to investigate how students managed their anxiety and uncertainty about their health issues when they interacted with college health professionals at student health service. The thesis found that students reported using trust, relaxation, and information seeking/giving as strategies to deal with their anxiety and uncertainty about their health issues before and during their interactions with college health professionals

Preventive Healthcare Strategies and Impact among the Asante People of the Early Twentieth Century Gold Coast: A Historical Narrative and Lessons for the Present Sanitation Challenge in Kumase

This article focuses on the development of preventive health care of the Asante people of early twentieth century Gold Coast. Attention has been paid to the public health strategies put in place by the Colonial Administration as well as the efforts and collaboration between Traditional Authorities and the British Colonial Administration to prevent diseases in Asante and Kumase in particular. Lessons for the present sanitation challenge learnt from this historical piece gleaned severally from archival and secondary written sources have been discussed

Public Education for Work Zone Safety

This project aims to help improve work zone driver safety in Indiana through driver education and public awareness campaigns. The project focused on two specific objectives: (1) to design a public awareness campaign to increase drivers’ knowledge and influence positive attitudes about work zone driver safety practices; and (2) to prepare educational materials to be incorporated into driver’s education or training curriculum prior to taking driving test and getting a driver’s license issued. The campaign was informed by formative research, conducted using a survey to assess public knowledge and attitudes. Based on these results, campaign messages were designed. The effectiveness of the campaign messages was tested through an online survey which provided feedback to improve the effectiveness of materials and messages. This report concludes with recommendations to INDOT for the successful implementation of the public awareness campaign and educational materials, that might be applicable to other states as well

Design of Educational Material and Public Awareness Campaigns for Improving Work Zone Driver Safety

This project aims to help improve work zone driver safety in Indiana through driver education and public awareness campaigns. The project focused on two specific objectives: (1) to design a public awareness campaign to increase drivers’ knowledge and influence positive attitudes about work zone driver safety practices; and (2) to prepare educational materials to be incorporated into driver’s education or training curriculum prior to taking driving test and getting a driver’s license issued. The campaign was informed by formative research, conducted using a survey to assess public knowledge and attitudes. Based on these results, campaign messages were designed. The team also designed an education curriculum which consists of three modules and fourteen knowledge questions. This report concludes with recommendations to INDOT for the successful implementation of the public awareness campaign and educational materials, that might be applicable to other states as well

Science, Technology and Healthcare Delivery in Ghana: A Historical Perspective = Tudomány, technológia és egészségügyi ellátás Ghánában: Történelmi perspektíva

In the last three decades, a number of studies have been undertaken concerning the impact of science and technological innovations on health sector reforms and responsive healthcare delivery in most countries globally. However, few of these studies are placed in historical context and/or focused particularly on the case of Ghana. In addition, such studies are mostly carried out in the biomedical and physical sciences with very few in the social sciences. Against this background, this paper draws experiences from health professionals in purposively selected institutions in Ghana and supported with critical review of related literature, to answer two central research questions. First, how has science and technological advancement effectively and efficiently supported healthcare delivery system in Ghana? Second, how have post-independence health sector reforms in Ghana been responsive to the needs of patients due to advances in science and technology? Based on empirical results, we argue in this paper that over the last few decades, advances in science and technology have significantly improved Ghana’s health delivery system and promoted responsive healthcare particularly in the area of orthodox medical services. However, the gains from advances in science and technology need to be strengthened by the Ministry of Health, Ghana Health Services and relevant stakeholders to improve health facilities and conditions especially in rural districts in the country

Cigarette smoking during breastfeeding in Papua New Guinea: Prevalence and demographic and socio-economic predictors

Background Cigarette smoking during breastfeeding is reported to contribute to significant changes in the composition of breast milk not only by reducing its protective features but also affecting infants' response to breastfeeding and breast milk. However, studies on the prevalence of cigarette smoking and associated factors during breastfeeding are limited in Papua New Guinea (PNG). This study estimates the prevalence of cigarette smoking and its association with demographic and economic factors among breastfeeding women in PNG. Methods We used weighted survey data from the 2016-2018 PNG Demographic and Health Survey (PNGDHS). A weighted sample of 3, 822 women who were breastfeeding during the survey were included in the study. The outcome variable in the present study is current cigarette smoking. A multiple logistic regression analysis was used to estimate the association between current cigarette smoking status and socio-demographic and economic variables of breastfeeding women. The regression analysis results were reported using adjusted odds ratios (aOR) with their respective 95% confidence intervals (CIs). Results From the weighted sample, the prevalence of cigarette smoking among breastfeeding women was 21.9%; of which 60.8% smoked daily. The mean number of cigarettes smoked in the last 24 hours preceding the survey was 6.05(SD = 5.99). Multiple logistic regression analysis revealed that breastfeeding women who were from the Momase (aOR: 2.337, CI: 1.786-3.058, p<0.001) and Highlands (AOR: 1.589, CI: 1.213-2.082, p = 0.001), had no religious affiliation (aOR: 3.665, CI: 1.235-10.877, p = 0.019), and households with daughters as household heads (aOR: 1.901, CI: 1.231-2.935, p = 0.004) and being in more than one union (aOR: 2.374, CI: 1.805-3.123, p<0.001) were significantly more likely to smoke cigarette compared to women from southern region, those affiliated to Anglican church, those with husband as household heads, and being in one union respectively. Conclusion Cigarette smoking among breastfeeding women in PNG is relatively high, and region of residence, religion, relationship to household head, and the number of unions remain independent predictors. Interventions should target the individual socio-economic and cultural contexts within which breastfeeding occurs

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Effects of Tailored Messaging on Cell Phone Use Avoidance While Driving Through Highway Work Zones: Application of the Risk Perception Attitude Framework

Cell phone use while driving is one of the commonest distracted driving behaviors that causes fatal crashes, and drivers are more likely to use their cell phones in work zones because of slow-moving traffic. The road safety campaign literature suggests that persuasive messages can positively influence safe driving behaviors leading to a reduction in crashes. Thus, this dissertation, guided by the risk perception attitude (RPA) framework, sought to examine how tailored messaging could serve as an effective communication strategy to promote positive attitudes and behavioral intentions in the context of cell phone use avoidance while driving through highway work zones. Findings from two studies, using a college student sample and a national sample of US young adults between 18 and 24 years old, revealed that the RPA framework likely does not serve as a useful audience segmentation strategy in this context because an overwhelming majority of participants (about 87%) belonged to the responsive group. A tailored messaging approach did not influence cell phone use avoidance while driving attitudes and intentions among the young adults because the majority of participants (70%) felt the messages were not designed uniquely for them and might not be personally relevant to them. However, the majority of participants (62%) reported that highway work zone safety was an important topic they would want to receive future messaging about because messages about this topic would help to save lives and protect public safety, drastically reduce crashes in highway work zones, and promote safe driving behaviors in highway work zones. Participants who were aware of the existence of state laws banning cell phone use while driving reported slightly higher attitudes toward and intentions to engage in safe driving behaviors compared to those who were not aware of the existence of such state laws. This dissertation suggests that instead of creating messages to raise risk perceptions and enhance efficacy perceptions, informing the young adult population in the US about the existence of laws banning cell phone use while driving might be an effective means to discourage them from using their cell phones while driving through highway work zones. By extending the RPA framework as an audience segmentation strategy, this dissertation also proposes a responsive group classification framework which could serve as a useful audience segmentation strategy in this study context to classify audiences into four groups to effectively tailor messages to them