Necessary Components for Psychological Treatment of Chronic Pain: A Qualitative Comparative Analysis

Overview: The present thesis considers and utilises a relatively new form of meta-analysis, Qualitative Comparative Analysis (QCA), to understand the necessary components of psychological treatment of Chronic Pain (CP). This volume has three parts, a literature review, empirical paper and critical appraisal of the empirical paper. The literature review considers existing research relating to CP models, theory and treatment as well as the background, principles and methods used in QCA. It then explores the empirical use of QCA in Clinical Health Psychology to date which, to date, has been limited. The empirical paper is a QCA identifying some of the necessary components of psychological treatment of Chronic Pain. It suggests that, in general, behavioural methods of CP treatment are necessary to improve distress and disability levels and that an additive effect of offering multiple interventions within one treatment programme for CP cannot be assumed. The critical appraisal reflects on the experience of the author in conducting a relatively new form of meta-analysis in the field of CP, its challenges and benefits

ODA management in the South African health sector: a critical analysis

M.A. Faculty of Humanties, University of the Witwatersrand, 2011The concept of aid effectiveness, which emerged in the 1990s when developed countries realised that the aid they were providing was not leading to intended results , can be described as the extent to which development aid is disbursed and employed in order to meet the development needs in a specific area. The concept is mostly espoused and advocated by the OECD through its 2005 Paris Declaration. There are major debates about the factors affecting the effectiveness of development aid. Similarly, a related question that could be asked is about the appropriateness of the Paris Declaration as the guiding framework for aid effectiveness, especially in middle income countries such as South Africa that are capable of formulating their own policies. Does the declaration, as it is, enhances or inhibits aid effectiveness? The aim of the research study is to find answers to these important questions. The health sector is utilised as a case study because it is the sector that receives more ODA than others. To undertake this analysis, two critical questions are posed, namely, to what extent are the principles of the Paris Declaration being applied in the South African public health care context?, and to what extent is the Paris Declaration relevant as a guiding framework for aid management in South Africa? The thesis looks at some ODA projects as well as South African policies and guidelines in relation to the Paris Declaration. After reviewing ODA overall in the health sector, a case study of GIZ is undertaken to present a more detailed analysis. The study finds that (i) the Paris Declaration is another form of the Good Governance agenda that is imposed on developing countries by developed countries, while they are not prepared to abide by the declaration (ii) although there is some level of alignment between the funding provided and the priorities of the sector, there is a huge donor focus on HIV/AIDS, which is nether entirely appropriate nor efficient, given that there many other problems and constraints and a dysfunctional healthcare system (iii) the fact that most of the HIV/AIDS prevention interventions are not locally created render them less effective (iv) the fact that most of the funding is not budget support but project support contributes to misalignment, while allowing donors to take ownership of projects (v) increased funding does not per se means better aid, and just pumping money into health sectors does not necessarily improve recipient’s health outcomes. (vi) there is insufficient harmonisation of donor activities in the health sector, and insufficient attention is paid to strengthening of health systems. Finally that the Paris Declaration is an adapted tool for improving aid efficiency in the context of a middle income country such as South Africa which has enough capacity to develop its own (owned) health policy, but is too shallow and does not take into account other intricacies related to development planning in a middle income country like South Africa. The study generally recommends a more centralised and stringent ODA management practice in South Africa. This, it is argued will contribute to a more coordinated approach. Moreover, as it is articulated in the recommendations, the implication of the findings is that other priorities, especially those that relate to system building should be taken into account as they have a bearing on the success of other initiatives such as HIV/AIDS treatment and prevention. Lastly, the study calls for local generated HIV/AIDS prevention approaches to be taken into account by donors in their interventions

What Is Moral Distress? Experiences and Responses

The term ‘moral distress’ entered nursing literature in 1984 when Andrew Jameton first described the phenomenon. According to Jameton, moral distress occurs ‘when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’ (Jameton, 1984:p.6). As we shall see, this brief statement has come in for criticism, led to some confusion, and spurred subsequent attempts at refinement. Our aim in this Green Paper is to present a critical review of discussions of moral distress, propose a phenomenologically grounded analysis of the phenomenon, and sketch an array of possible ways of responding to experiences of moral distress as described

Impacts of rainfall and temperature variation on maize (Zea mays L.) yields: A case study of Mbeya Region, Tanzania

Based on the multiple regression model the impacts of rainfall and temperature on maize (Zea mays L.) yields in Mbeya region have been analyzed. Overall, findings revealed that the seven selected variables, that is, January maximum temperature, February maximum temperature, April maximum temperature, Rainfall from February to April, Rainfall during growing season, December rainfall and October maximum temperature influenced maize yields in the region by 65.4%. Diversely, the results showed 34.6% wasn’t explained by the model, meaning that there are other factors apart from temperature and rainfall could be used to explain the variation of maize (Z. mays) yield in the region. Furthermore, taking 1990 -2012 as baseline period, the model projection for a period of 2020-2042 shows that maize (Z. mays) yield may change from 1.5% to 2.3%, 2.6% to 3.6% and 2.4% to 3.5 %, as a result of separate future influence of 10% decrease in rainfall, 10C raise in temperature and combined influence of both temperature and rainfall change, respectively. Nevertheless, the findings from this study, reveals that Mbeya region may still be potential maize (Z. mays) growing region in the prescribed period provided the magnitude change of both future rainfall and temperature hold and other factors not explained by the model do not change significantly. Therefore, the government must focus to conduct more research on uses of appropriate maize (Z. mays) varieties to obtain the maximum maize (Z. mays) crop yield in the region

Experiences of powerlessness and the limits of control in healthcare

To what extent are experiences of powerlessness explained as involving a loss of control, and to what extent are attempts to increase patients’ control suitable as means of addressing these experiences? In this paper, I present some findings from a recent project in the phenomenology of powerlessness to argue that in response to experiences of powerlessness, the ideal of control has limited use in either a diagnostic or therapeutic function

Addiction, Identity, and Disempowerment

Supposing that addicts choose to act as they do, rather than being compelled to behave in particular ways, what explains the choices that they make? Hannah Pickard has recently pointed out that we can go a long way to answering this question if we can make sense of why addicts value the ends they pursue. She argues that addiction is a social identity that gives purpose and structure to life and that the choices that addicts make are valuable to them as ways of sustaining this social identity. But if addicts freely make choices towards ends that they perceive as valuable in terms of a social identity to which they contribute, and therefore if addiction involves the deployment of quite considerable agential apparatus, how are we to hold on to the natural assumption that addictions are disempowering? In this paper I present an answer to this question. Drawing on the resources of the phenomenological tradition, I argue that some social identities give purpose and structure to life in a way that inhibits, rather than enables, the exercise of a capacity that is central to our form of life. I elaborate the hypothesis that paradigmatic cases of addiction involve this sort of disempowering social identity

Estimated HIV Trends and Program Effects in Botswana

Background: This study uses surveillance, survey and program data to estimate past trends and current levels of HIV in Botswana and the effects of treatment and prevention programs. Methods/Principal Findings: Data from sentinel surveillance at antenatal clinics and a national population survey were used to estimate the trend of adult HIV prevalence from 1980 to 2007. Using the prevalence trend we estimated the number of new adult infections, the transmission from mothers to children, the need for treatment and the effects of antiretroviral therapy (ART) and adult and child deaths. Prevalence has declined slowly in urban areas since 2000 and has remained stable in rural areas. National prevalence is estimated at 26 % (25–27%) in 2007. About 330,000 (318,000–335,000) people are infected with HIV including 20,000 children. The number of new adult infections has been stable for several years at about 20,000 annually (12,000–26,000). The number of new child infections has declined from 4600 in 1999 to about 890 (810–980) today due to nearly complete coverage of an effective program to prevent mother-to-child transmission (PMTCT). The annual number of adult deaths has declined from a peak of over 15,500 in 2003 to under 7400 (5000–11,000) today due to coverage of ART that reaches over 80 % in need. The need for ART will increase by 60 % by 2016. Conclusions: Botswana’s PMTCT and treatment programs have achieved significant results in preventing new child infections and deaths among adults and children. The number of new adult infections continues at a high level. More effective prevention efforts are urgently needed

Economics of seawater desalination in Cyprus

Thesis (M.Eng.)--Massachusetts Institute of Technology, Dept. of Civil and Environmental Engineering, 1999.Includes bibliographical references (p. 48-52).The Republic of Cyprus is currently suffering from severe drought conditions. This is not uncommon to Cyprus, as they frequently experience three to four year droughts every decade. They are currently in the middle of their fourth year of drought. Some Cypriots believe that the main reason for water shortages is due only to low levels of rainfall (average rainfall in Cyprus is 500 mm per year, and less than 400 mm per year is considered a drought year). It is not disputed that this is part of the problem. However, my belief, along with many Cypriots is that the biggest part of the problem is one of water allocation. Agriculture in Cyprus contributes approximately 5% to the GDP, yet consumes 75% of available water in Cyprus. The remainder of water is left for the sector of the economy that produces the remaining 95% of the GDP, of which municipal, industrial and tourist uses are of greatest importance. One may ask why this is so. According to some Cypriots, it is because Cypriot farmers are thought to be a politically influential group, and that they farm more as a way of life, rather than to earn a living directly. Others discount this "way of life" theory. What is important, however is that farming is using a lot of water and is contributing very little to the GDP of Cyprus. For example, Citrus crops grown within the Southern Conveyor System (a large network of water conveyance pipes stretching for over 100 km in the southern part of the island) (see Figure 3, page 16) uses approximately 21% of all available water available in Cyprus, and without Government subsidies would not show profitability. Although there may be some aesthetic value in citrus groves one must ask if it is economically and environmentally justified to continue farming citrus. To do so means building seawater desalination plants that contribute 5.0 to 6.0 kg of CO 2, a greenhouse gas, to the atmosphere per m3 of water produced by desalination, along with the cost of the water nearing one US dollar per m3 . Desalination is a painful solution to Cyprus' water shortage that could be otherwise be addressed with a proper water allocation scheme.by Mark P. Batho.M.Eng