Search results for: Health Outcomes

Authors: James D. Beauchemin

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This study tested whether youth mental health care quality, operationalized as the extent to which youth and families experienced system-of-care principles in service interactions with providers, varied by level of youth need after adjusting for sociodemographic and treatment factors. The relationship of quality to clinical outcomes was also examined. Using administrative data and cross-sectional surveys from a stratified random sample of 1,124 caregivers of youths ages 5 to 20 within a statewide system-of-care, adjusted analyses indicated youths with the most intensive needs were significantly less likely to experience high-quality care (51% vs. 63%, p=0.016), with marked deficits on 6 of 9 items. Receipt of lower-quality care predicted less improvement in youth functioning. Despite considerable effort to develop systems-of-care for youths with the most severe mental health needs, these data suggest quality disparities remain for the most impaired youths. Policy and intervention development may be needed to improve the quality of care for this population.

Keywords: system-of-care, adherence, mental health, youth

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Authors: Rayeheh Khatami, Toktam Hanaei, Mohammad Reza Mansouri Daneshvar

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The growth of the agricultural sector is known as an essential way to achieve development goals in developing countries. Urban agriculture is a way to reduce the vulnerability of urban populations of the world toward global environmental change. It is a sustainable and efficient system to respond to the environmental, social and economic needs of the city, which leads to urban sustainability. Today, many local and national governments are developing urban agriculture as an effective tool in responding to challenges such as poverty, food security, and environmental problems. In this study, we follow a perspective based on urban agriculture literature in order to indicate the urban agriculture’s benefits in environmental planning strategies in non-western countries like Iran. The methodological approach adopted is based on qualitative approach and documentary studies. A total of 35 articles (mixed quantitative and qualitative methods studies) were studied in final analysis, which are published in relevant journals that focus on this subject. Studies show the wide range of positive benefits of urban agriculture on food security, nutrition outcomes, health outcomes, environmental outcomes, and social capital. However, there was no definitive conclusion about the negative effects of urban agriculture. This paper provides a conceptual and theoretical basis to know about urban agriculture and its roles in environmental planning, and also conclude the benefits of urban agriculture for researchers, practitioners, and policymakers who seek to create spaces in cities for implementation urban agriculture in future.

Keywords: urban agriculture, environmental planning, urban planning, literature

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Authors: Sumattana Glangkarn, Vorapoj Promasatayaprot

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Background: Proportion of population ageing in Thailand has been increased rapidly in the past decades according to living longer and the fertility rates have decreased. The most important challenge related to this situation is to consider how to improve quality and years of healthy of life. This study aimed to implement the older persons’ long term care (LTC) system for elderly care by family and community. Method: The Consolidated Framework for Implementation Research (CFIR) was employed for guiding and evaluating an implementation process in ageing care. The CFIR composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Results: most elderly participants were couples, educating primary school and living with children and grandchildren. More than half of them had chronic diseases such as diabetes mellitus and hypertension. Factor analysis revealed factors related to health care of older participants which consisted of exercise, diet, accidental prevention, relaxation, self-care capacity, joyfulness, family relationship, and personal hygiene. A pre-implementation phase showed intervention characteristics included facilities and services of the LTC policy from the Ministry of Public Health. The complexities of the LTC and relative advantages were explained. Community leaders, public health volunteers, care givers and health professionals had participated in the LTC activities. Outer and inner settings consisted of context of community, culture, and readiness. Characteristics of the individuals related to knowledge, self-efficacy, perceptions, and believes. The process consisted of planning, acting, observing, and reflecting. The implementation outcomes and service outcomes had been evaluated during-implementation phase. Conclusion: the participation of caregivers, community leaders, public health volunteers, and health professionals had supported the LTC services. Thus, family and community care could improve quality of life of the ageing.

Keywords: ageing, CFIR, long term care, implementation

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Authors: Luisa Windhagen, Atsumi Hirose, Alex Bottle

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Global urbanization has resulted in the expansion of slums, leaving over 10 million Tanzanians in urban poverty and at risk of poor health. Whilst rural residence has historically been associated with an increased risk of adverse pregnancy outcomes, recent studies found higher perinatal mortality rates in urban Tanzania. This study aims to understand to what extent slum neighborhoods may account for the spatial disparities seen in Tanzania. We generated a slum indicator based on UN-HABITAT criteria to identify slum clusters within the 2015-2016 Tanzania Demographic and Health Survey. Descriptive statistics, disaggregated by urban slum, urban non-slum, and rural areas, were produced. Simple and multivariable logistic regression examined the association between cluster residence type and neonatal mortality and stillbirth. For neonatal mortality, we additionally built a multilevel logistic regression model, adjusting for confounding and clustering. The neonatal mortality ratio was highest in slums (38.3 deaths per 1000 live births); the stillbirth rate was three times higher in slums (32.4 deaths per 1000 births) than in urban non-slums. Neonatal death was more likely to occur in slums than in urban non-slums (aOR=2.15, 95% CI=1.02-4.56) and rural areas (aOR=1.78, 95% CI=1.15-2.77). Odds of stillbirth were over five times higher among rural than urban non-slum residents (aOR=5.25, 95% CI=1.31-20.96). The results suggest that slums contribute to the urban disadvantage in Tanzanian neonatal health. Higher neonatal mortality in slums may be attributable to lack of education, lower socioeconomic status, poor healthcare access, and environmental factors, including indoor and outdoor air pollution and unsanitary conditions from inadequate housing. However, further research is required to ascertain specific causalities as well as significant associations between residence type and other pregnancy outcomes. The high neonatal mortality, stillbirth, and slum formation rates in Tanzania signify that considerable change is necessary to achieve international goals for health and human settlements. Disparities in access to adequate housing, safe water and sanitation, high standard antenatal, intrapartum, and neonatal care, and maternal education need to urgently be addressed. This study highlights the spatial neonatal mortality shift from rural settings to urban informal settlements in Tanzania. Importantly, other low- and middle-income countries experiencing overwhelming urbanization and slum expansion may also be at risk of a reversing trend in residential neonatal health differences.

Keywords: urban health, slum residence, neonatal mortality, stillbirth, global urbanisation

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Authors: Stephen Grant Atkins

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Radical use of project-based learning (PBL) in a small New Zealand business school provides an opportunity to longitudinally examine its effects over a decade of pre-Covid data. Prior to this business school’s implementation of PBL, starting in 2012, the business pedagogy literature presented just one example of PBL replacing an entire core-set of courses. In that instance, a British business school merged four of its ‘degree Year 3’ accounting courses into one PBL semester. As radical as that would have seemed, to students aged 20-to-22, the PBL experiment conducted in a New Zealand business school was notably more extreme: 41 nationally-approved Learning Outcomes (L.O.s), these deriving from 8 separate core courses, were aggregated into one grand set of L.O.s, and then treated as a ‘full-year’/‘full-time’ single course. The 8 courses in question were all components of this business school’s compulsory ‘degree Year 1’ curriculum. Thus, the students involved were notably younger (…ages 17-to-19…), and no ‘part-time’ enrolments were allowed. Of interest are this PBL experiment’s effects on subsequent performance outcomes in ‘degree Years 2 & 3’ (….which continued to operate in their traditional ways). Of special interest is the quality of ‘group project’ outcomes. This is because traditionally, ‘degree Year 1’ course assessments are only minimally based on group work. This PBL experiment altered that practice radically, such that PBL ‘degree Year 1’ alumni entered their remaining two years of business coursework with far more ‘project group’ experience. Timeline-wise, thus of interest here, firstly, is ‘degree Year 2’ performance outcomes data from years 2010-2012 + 2016-2018, and likewise ‘degree Year 3’ data for years 2011-2013 + 2017-2019. Those years provide a pre-&-post comparative baseline for performance outcomes in students never exposed to this school’s radical PBL experiment. That baseline is then compared to PBL alumni outcomes (2013-2016….including’Student Evaluation of Course Quality’ outcomes…) to clarify ‘radical PBL’ effects.

Keywords: project-based learning, longitudinal mixed-methods, students criticism, effects-on-learning

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Authors: Fahmi Hassan, Noorizan Abdul Aziz, Yahaya Hassan, Hazlinda Abu Hassan

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Sepsis incidence in critical care settings is a major problem in health care. Extended antibiotic infusion is thought to be superior to traditional dosing especially when treating critically ill patients with sepsis. We compared clinical outcomes of critically ill patients with sepsis receiving 30-minute meropenem infusion and three-hour meropenem infusion. A retrospective case-control study was conducted among septic patients treated with meropenem infusion in ICUs of three hospitals. Patients included in the study received either extended or standard meropenem infusion as per the practice of individual settings. Outcomes and clinical data were retrospectively collected from the electronic databases and patients’ files. A total of 108 patients received extended meropenem infusion while another 117 patients received standard meropenem infusion. Patients receiving the extended meropenem infusion were found to have a significantly lower shorter length of hospital and ICU stay. It was also found that among those receiving extended meropenem infusion, 54.7% (64/117) had a reduction of SAPS II score, while only 44% (48/108) of patients receiving standard meropenem infusion had reduced scores. This study will strengthen the evidence in using extended meropenem infusion as a standard practice in critical care settings. As this is the first study of its kind done in Malaysia, it proves that prolonged meropenem infusion may be beneficial to critically ill patients with sepsis. However, randomized clinical trials with large sample size should be carried out in local settings in order to minimize other confounders that may influence with the result of the study.

Keywords: antibiotics, beta lactams, critical care, extended infusion, meropenem

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Authors: Supunmali Ahangama, Danny Chiang Choon Poo

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Health analytics (HA) is used in healthcare systems for effective decision-making, management, and planning of healthcare and related activities. However, user resistance, the unique position of medical data content, and structure (including heterogeneous and unstructured data) and impromptu HA projects have held up the progress in HA applications. Notably, the accuracy of outcomes depends on the skills and the domain knowledge of the data analyst working on the healthcare data. The success of HA depends on having a sound process model, effective project management and availability of supporting tools. Thus, to overcome these challenges through an effective process model, we propose an HA process model with features from the rational unified process (RUP) model and agile methodology.

Keywords: agile methodology, health analytics, unified process model, UML

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Authors: Kaoutar Chbihi, Aziza Menouni, Imane Berni, Tarik Abchouch, Samir El Jaafari

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The unpredictability and ambiguity of a pandemic, combined with the economic impact, sedentary lifestyle, and increased living cost, have the potential to seriously raise the risk of mental health issues among the population. Therefore, this study had the aim to assess the magnitude of mental health outcomes and risk factors among the general population in Morocco in times of the Covid-19 pandemic. This study consisted of a cross-sectional design and was survey-based and region-stratified by collecting demographic data and mental health measurements from 523 participants. The degree of depression, anxiety, and insomnia symptoms were assessed by using the 9-item Patient Health Questionnaire and the 7-items Generalized Anxiety Disorder. The survey was completed by 523 individuals. Results showed that 67.9% were women, and 58.6% were aged 18-30 years. 49% of participants reported depression issues, while 39.8% experienced anxiety. Being a married woman with children was associated with severe symptoms of depression and anxiety. Finally, our findings reported a significant mental health burden among the general population of Morocco, which needs to be tackled by specific co-created interventions and adapted strategies in order to prevent impacts on public health.

Keywords: anxiety, COVID-19, depression, mental health, Morocco, pandemic

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Authors: Florence Awde

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In 2023, it was expected 350 parents in Arizona would have a child receive a cancer diagnosis (Welcome Arizona Cancer Foundation For Children, n.d.). The news of a child’s diagnosis with cancer can be overwhelming and confusing, especially for those lucky enough to lack a personal tie to the disease that takes approximately 1800 children’s lives each year in the United States (Deegan et al., n.d.). A parent’s beliefs, attitudes, and understandings surrounding cancer are vital for medical staff to provide adequate and culturally competent care for each patient, especially across cultural and ethnic lines in regions housing multicultural populations. Arizona's cultural/linguistic mosaic houses many White and Latino populations and English and Spanish speakers. Variations in insurance coverage, from those insured through public insurance programs (e.g., Medicaid) or private insurance plans (e.g., employee-sponsored insurance) versus those uninsured, also factor into health-seeking attitudes and behaviors. To further understand parental attitudes, understandings, and beliefs towards childhood cancer, 22 parents (11 of Latino ethnicity, 11 of White ethnicity) were interviewed on these facets of childhood cancer, despite 21 of the 22 never having a child receive a cancer diagnosis. The exploration of these perceptions across ethnic lines revealed a higher report of fear-orientated beliefs amongst Latino parents--hypothesized to be rooted in the starkly contrasting lack of belief in the possibility of recovering for children with cancer, compared to their white counterparts who displayed more optimism in the recovery process. Further, this study’s results lay the foundation for future scholarship to explore avenues of information dispersal to Latino parents that correct misconceptions of health outcomes and enable earlier intervention to be possible, ultimately correlating to better health and treatment outcomes by increasing parental health literacy rates for childhood cancer in the Phoenix Metropolitan.

Keywords: Childhood Cancer, Parental Beliefs, Parental Attitudes, Parental Understandings, Phoenix Metropolitan, Culturally Competent Care, Health Disparities, Health Inequities

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Authors: Mingming Jiang

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This literature review aims to offer an overview of existing research on learning analytics and learning design, the alignment between the two, and how learning analytics has been leveraged to inform learning design in higher education. Current research suggests a need to create more alignment and integration between learning analytics and learning design in order to not only ground learning analytics on learning sciences but also enable data-driven decisions in learning design to improve learning outcomes. In addition, multiple conceptual frameworks have been proposed to enhance the synergy and alignment between learning analytics and learning design. Future research should explore this synergy further in the unique context of higher education, identifying learning analytics metrics in higher education that can offer insight into learning processes, evaluating the effect of learning analytics outcomes on learning design decision-making in higher education, and designing learning environments in higher education that make the capturing and deployment of learning analytics outcomes more efficient.

Keywords: learning analytics, learning design, big data in higher education, online learning environments

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Authors: Yi-Shuan ShaoShao, Yen-An Tsai, Chia-Huang Chang, Kai-Wei Liao, Ming-Song Tsai, Mei-Lien Chen

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Organophosphate pesticides (OPs) is an environmental hormone with proven endocrine-disrupting effects that may affect the growth and development in human. A large amount of organophosphate pesticides (OPs) is used throughout Taiwan, and human may be exposed through dietary intake or residential use. During pregnancy, OPs can be transferred to the blood stream reaching the fetus through the placenta. The aim of this study was to explore the association between maternal OPs exposure levels and fetal developments and birth outcomes. A birth cohort was follow-up. Maternal urine sample were collected at the first, second, and third gestational trimester. Fetal growth characteristics were measured by ultrasonic scan and birth outcomes were assessed by pediatrician. Urinary metabolite of organophosphate pesticides were assessed using gas chromatography-mass spectrometry. The analytes included dimethylphosphate (DMP), dimethylthiophosphate (DMTP), dimethyldithiophosphates (DMDTP), diethylphosphate (DEP), diethylthiophosphate (DETP), and diethyldithiophosphate (DEDTP). We found that all of urine samples in each trimester were detected at least one metabolite for dialkyl phosphate (DAP). The detection rate range of OP urinary metabolites were from the lowest 22% DEDTP to the highest 100% DMP and DMTP. And to compared geometric means (GM) of urinary metabolites with three trimesters, that third trimester had the highest concentration for DMPs, DEPs, and DAPs in pregnant women were 368.01, 169.85 and 543.75 nmol/g creatinine, respectively. We observed that DAPs concentration in first and second trimester were significantly negative association with head circumference. DMPs in first trimester was significantly negative association with thoracic circumference (p=0.05) by spearman correlation. Our results support associations with prenatal OPs exposure with fetal head circumference and thoracic circumference. It provided that maternal OPs exposure might affect birth outcomes. Thus, prenatal exposure to OPs and health risk worthy of attention and concern.

Keywords: DAPs, birth outcomes, organophosphate pesticides, prenatal

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Authors: Jeremy Bekker, Guy Salazar

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Introduction: Nature-exposure interventions on university campuses may serve as an effective addition to overburdened counseling and student support centers. Nature-exposure interventions can work as a preventative well-being enhancement measure on campuses, which can be used adjacently with existing health resources. Specifically, this paper analyzes how spending time in nature impacts psychological well-being, cognitive functioning, and physical health. The poster covers the core findings and recommendations of this paper, which has been previously published in the BYU undergraduate psychology journal Intuition. Research Goals and Method: The goal of this paper was to outline the potential benefits of nature exposure for students’ physical health, mental well-being, and academic success. Another objective of this paper was to outline potential research-based interventions that use campus green spaces to improve student outcomes. Given that the core objective of this paper was to identify and establish research-based nature exposure interventions that could be used on college campuses, a broad literature review focused on these areas. Specifically, the databases Scopus and PsycINFO were used to screen for research focused on psychological well-being, physical health, cognitive functioning, and nature exposure interventions. Outcomes: Nature exposure has been shown to help increase positive affect, life satisfaction, happiness, coping ability and subjective well-being. Further, nature exposure has been shown to decrease negative affect, lower mental distress, reduce cognitive load, and decrease negative psychological symptoms. Finally, nature exposure has been shown to lead to better physical health. Findings and Recommendations: Potential interventions include adding green space to university buildings and grounds, dedicating already natural environments as nature restoration areas, and providing means for outdoor excursions. Potential limitations and suggested areas for future research are also addressed. Many campuses already contain green spaces, defined as any part of an environment that is predominately made of natural elements, and these green spaces comprise an untapped resource that is relatively cheap and simple.

Keywords: nature exposure, preventative care, undergraduate mental health, well-being intervention

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Authors: Andrey Boyko

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Nowadays, there is no consensus about the influence of urethral plate (UP) width on the surgical outcomes after distal hypospadias repair. The purpose of the research was to study the association between UP width and surgical outcomes after distal hypospadias repair in children. Materials and methods: The study included 138 patients with distal hypospadias. The mean age at the time of surgery was 4.6 years (6 months – 16 years). We measured UP width at the “midpoint within the glans” and used the HOSE scale to assess postoperative outcomes. The patients were divided into 2 groups: group 1 – the patients (107) with UP < 8mm, group 2 – patients (31) with UP > 8mm. All boys underwent TIP repair. Preincision means UP width after incision means UP width, and the UP ratio was analyzed. Statistical data were obtained using Statistica 10. Results: The findings were preincision mean UP width - 5.4 mm and 9.4 mm; after incision mean UP width - 13mm and 17.5 mm; UP ratio - 0.41 and 0.53 in group 1 and group 2, respectively. Most postoperative complications (fistula, meatal stenosis, and stricture) happened in patients with UP width < 8 mm versus ≥ 8 mm (7/107 versus 2/31, respectively). HOSE results were 15.77 (group 1), 15.65 (group 2). The follow up lasted up to 12 months. Statistical analysis proved the absence of correlation between UP width and postoperative complications. Conclusions: In conclusion, it should be noted that the success of surgical repair mostly depended on the surgical technique.

Keywords: children, distal hypospadias, tip repair, urethral plate width

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Authors: Rammah Abdlbagi, Similoluwa Biyi, Aakash Pai

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Introduction: Short-term ureteric stents are commonly placed after ureteroscopy procedures. The removal usually entails having a flexible cystoscopy, which entails a further invasive procedure. There are often delays in removing the stent as departments have limited cystoscopy availability. However, if stents with extraction strings are used, the patient or a clinician can remove them. The aim of the study is to assess the safety and effectiveness of the use of a stent with a string. Method: A retrospective, single-institution study was conducted over a three-month period. Twenty consecutive patients had ureteric stents with string insertion. Ten of the patients had a stent removal procedure previously with flexible cystoscopy. A validated questionnaire was used to assess outcomes. Primary outcomes included: dysuria, hematuria, urinary frequency, and disturbance of the patient’s daily activities. Secondary outcomes included pain experience during the stent removal. Result: Fifteen patients (75%) experienced hematuria and frequency. Two patients experienced pain and discomfort during the stent removal (10%). Two patients had experienced a disturbance in their daily activity (10%). All patients who had stent removal before using flexible cystoscopy preferred the removal of the stent using a string. None of the patients had stent displacement. The median stent dwell time was five days. Conclusion: Patient reported outcomes measures for the indwelling period of a stent with extraction string are equivalent to the published data on stents. Extraction strings mean that the stent dwell time can be reduced. The removal of the stent on extraction strings is more tolerable than the conventional stent.

Keywords: ureteric stent, string flexible cystoscopy, stent symptoms, validated questionnaire

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Authors: Ashleigh Hillier, Jody Goldstein, Lauren Tornatore, Emily Byrne

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As individuals with disabilities attend higher education in greater numbers, universities are seeking ways to support the retention and success of these students, beyond the academically based accommodations. Although mentoring programs for this population are being implemented more frequently, there is a lack of empirically validated outcomes which could promote program replication. The research objective of this exploratory study was to examine outcomes for students with disabilities participating in a peer-to-peer mentoring program. Mentees (students with disabilities) met with their mentor (trained upperclassman) once a week for an hour for one semester (14-weeks). Mentors followed a curriculum structured by monthly and weekly goals to guide the sessions. Curriculum topics included socializing on campus, peer pressure, time management, communicating with peers and professors, classroom etiquette, study skills, and seeking help and campus resources. Data was collected over a period of seven semesters resulting in seven separate cohorts (n=46). The impact of the program was measured using quantitative self-report measures as well as qualitative content analysis of focus groups. Academic outcomes (retention, credits earned, and GPA) were compared between those in the mentoring program and a matched group of students registered with Disability Services who did not receive mentoring. In addition, a one-year follow up was conducted to examine the longer term impact of participation. Findings indicated that mentoring had the most impact in knowing how things work at the university, knowing how and where to find opportunities to meet people on campus, and knowing how to access supports. Mentors also provided a supportive relationship to the mentees and helped with social skills. There were no significant differences in academic outcomes between those who were mentored and those in the comparison group. Most mentees reported continuing to benefit from the program one year on, providing support for the retention of knowledge gained and maintenance of positive outcomes over time. In conclusion, while a range of positive outcomes were evidenced, the model was limited in its impact more broadly, particularly with regards to academic success and impacting more complex challenges.

Keywords: mentor, outcomes, students with disabilities, university

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Authors: Daniel Klimovský

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Slovakia belongs to the most fragmented countries if one looks at its local government structure. The Slovak central governments implemented both broad devolution and fiscal decentralization some decades ago. However, neither territorial consolidation nor size categorization of local competences and powers has been implemented yet. Taking this fact into account, it is clear that the local governments are challenged not only by their citizens as customers but also by effectiveness as well as efficiency of delivered services. The paper is focused on behavior of the local governments in Slovakia and their approaches towards other local partners, including other local governments. Analysis of set of interviews shows that inter-municipal cooperation is the most common local partnership in Slovakia, but due to diversity of the local governments, this kind of cooperation leads to both intended and unintended outcomes. While in many cases the local governments are more efficient as well as effective in delivery of local services thanks to inter-municipal cooperation, there are many cases where inter-municipal cooperation fails, and it brings rather questionable or even negative outcomes.

Keywords: local governments, local partnerships, inter-municipal cooperation, delivery of local services

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Authors: Priyanka Patil, Logan Manikam

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Background: The first 1000 days of life are a critical window and can result in adverse health consequences due to inadequate nutrition. South-Asian (SA) communities face significant health disparities, particularly in maternal and child health. Community-based interventions, often employing Participatory-Learning and Action (PLA) approaches, have effectively addressed health inequalities in lower-income nations. The aim of this study was to assess the feasibility of implementing a PLA intervention to improve infant feeding and care practices in SA communities living in London. Methods: Comprehensive analyses were conducted to assess the feasibility/fidelity of this pilot randomized controlled trial. Summary statistics were computed to compare key metrics, including participant consent rates, attendance, retention, intervention support, and perceived effectiveness, against predefined progression rules guiding toward a definitive trial. Secondary outcomes were analyzed, drawing insights from multiple sources, such as The Children’s-Eating-Behaviour Questionnaire (CEBQ), Parental-Feeding-Style Questionnaires (PFSQ), Food-diary, and the Equality-Impact-Assessment (EIA) tool. A video analysis of children's mealtime behavior trends was conducted. Feedback interviews were collected from study participants. Results: Process-outcome measures met predefined progression rules for a definitive trial, which deemed the intervention as feasible and acceptable. The secondary outcomes analysis revealed no significant changes in children's BMI z-scores. This could be attributed to the abbreviated follow-up period of 6 months, reduced from 12 months, due to COVID-19-related delays. CEBQ analysis showed increased food responsiveness, along with decreased emotional over/undereating. A similar trend was observed in PFSQ. The EIA tool found no potential discrimination areas, and video analysis revealed a decrease in force-feeding practices. Participant feedback revealed improved awareness and knowledge sharing. Conclusion: This study demonstrates that a co-adapted PLA intervention is feasible and well-received in optimizing infant-care practices among South-Asian community members in a high-income country. These findings highlight the potential of community-based interventions to enhance health outcomes, promoting health equity.

Keywords: child health, childhood obesity, community-based, infant nutrition

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Authors: Titir Bhattacharya, Tanika Chakraborty, Prabal K. De

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Maternal and child health continue to be a significant policy focus in developing countries, including India. An emerging model in health care is the creation of public and private partnerships. Since the construction of physical infrastructure is costly, governments at various levels have tried to implement social health insurance schemes where a trust calculates insurance premiums and medical payments. Typically, qualifying families get full subsidization of the premium and get access to private hospitals, in addition to low cost public hospitals, for their tertiary care needs. We analyze one such pioneering social insurance scheme in the Indian state of Andhra Pradesh (AP). The Rajiv Aarogyasri program (RA) was introduced by the Government of AP on a pilot basis in 2007 and implemented in 2008. In this paper, we first examine the extent to which access to reproductive health care changed. For example, the RA scheme reimburses hospital deliveries leading us to expect an increase in institutional deliveries, particularly in private hospitals. Second, we expect an increase in institutional deliveries to also improve child health outcomes. Hence, we estimate if the program improved infant and child mortality. We use District Level Health Survey data to create annual birth cohorts from 2000-2015. Since AP was the only state in which such a state insurance program was implemented, the neighboring states constituted a plausible control group. Combined with the policy timing, and the year of birth, we employ a difference-indifference strategy to identify the effects of RA on the residents of AP. We perform several checks against threats to identification, including testing for pre-treatment trends between the treatment and control states. We find that the policy significantly lowered infant and child mortality in AP. We also find that deliveries in private hospitals increased, and government hospitals decreased, showing a substitution effect of the relative price change. Finally, as expected, out-of-pocket costs declined for the treatment group. However, we do not find any significant effects for usual preventive care such as vaccination, showing that benefits of insurance schemes targeted at the tertiary level may not trickle down to the primary care level.

Keywords: public health insurance, maternal and child health, public-private choice

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Authors: Sheillah Hlamalani Mboweni, Lufuno Makhado

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Background: The increasing number of people who tested HIV positive and who demand antiretroviral therapy (ART) prompted the National Department of Health to adopt WHO recommendations of task shifting where Professional Nurses(PNs) initiate ART rather than doctors in the hospital. This resulted in the decentralization of services to primary health care(PHC), generating a need to capacitate PNs on NIMART. After years of training, the impact of NIMART was assessed where it was established that even though there was an increased number who accessed ART, the quality of care is of serious concern. The study aims to answer the following question: What are the challenges influencing NIMART implementation in primary health care. Objectives: This study explores challenges influencing NIMART training and implementation and makes recommendations to improve patient and HIV program outcomes. Methods: A qualitative explorative program evaluation research design. The study was conducted in the rural districts of North West province. Purposive sampling was used to sample PNs trained on NIMART. FGDs were used to collect data with 6-9 participants and data was analysed using ATLAS ti. Results: Five FGDs, n=28 PNs and three program managers were interviewed. The study results revealed two themes: inadequacy in NIMART training and the health care system challenges. Conclusion: The deficiency in NIMART training and health care system challenges is a public health concern as it compromises the quality of HIV management resulting in poor patients’ outcomes and retard the goal of ending the HIV epidemic. These should be dealt with decisively by all stakeholders. Recommendations: The national department of health should improve NIMART training and HIV management: standardization of NIMART training curriculum through the involvement of all relevant stakeholders skilled facilitators, the introduction of pre-service NIMART training in institutions of higher learning, support of PNs by district and program managers, plan on how to deal with the shortage of staff, negative attitude to ensure compliance to guidelines. There is a need to develop a conceptual framework that provides guidance and strengthens NIMART implementation in PHC facilities.

Keywords: antiretroviral therapy, nurse initiated management of retroviral therapy, primary health care, professional nurses

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Authors: Laura C. Dapp, Claudia M. Roebers

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Being physically active has many benefits for children and adolescents. It is crucial for various aspects of physical and mental health, the development of a healthy self-concept, and also positively influences academic performance and school achievement. In addressing the still incomplete understanding of the link between physical activity (PA) and academic achievement, the current study scrutinized the open issue of how PA has to be implemented to positively affect mathematical outcomes in N = 138 fourth graders. Therefore, the current study distinguished between structured PA (formal, organized, adult-led exercise and deliberate sports practice) and unstructured PA (non-formal, playful, peer-led physically active play and sports activities). Results indicated that especially structured PA has the potential to contribute to mathematical outcomes. Although children spent almost twice as much time engaging in unstructured PA as compared to structured PA, only structured PA was significantly related to mathematical achievement as well as to mathematical self-concept. Furthermore, the pending issue concerning the quantity of PA needed to enhance children’s mathematical achievement was addressed. As to that, results indicated that the amount of time spent in structured PA constitutes a critical factor in accounting for mathematical outcomes, since children engaging in PA for two hours or more a week were shown to be both the ones with the highest mathematical self-concept as well as those attaining the highest mathematical achievement scores. Finally, the present study investigated the indirect effect of PA on mathematical achievement by controlling for the mathematical self-concept as a mediating variable. The results of a maximum likelihood mediation analysis with a 2’000 resampling bootstrapping procedure for the 95% confidence intervals revealed a full mediation, indicating that PA improves mathematical self-concept, which, in turn, positively affects mathematical achievement. Thus, engaging in high amounts of structured PA constitutes an advantageous leisure activity for children and adolescents, not only to enhance their physical health but also to foster their self-concept in a way that is favorable and encouraging for promoting their academic achievement. Note: The content of this abstract is partially based on a paper published elswhere by the authors.

Keywords: Academic Achievement, Mathematical Performance, Physical Activity, Self-Concept

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Authors: Restituto I. Rodelas

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The higher education has adopted the outcomes-based education from K-12. In this approach, the teacher uses any teaching and learning strategies that enable the students to achieve the learning outcomes. The students may be required to exert more effort and figure things out on their own. Hence, outcomes-based students are assumed to be more responsible and more capable of applying the knowledge learned. Another approach that the higher education in the Philippines is starting to adopt from other countries is blended learning. This combination of classroom and fully online instruction and learning is expected to be more effective. Participating in the online sessions, however, is entirely up to the students. Thus, the effect of blended learning on the performance of students in Statistics may be mediated by outcomes-based education. If there is a significant positive mediating effect, then blended learning can be optimized by integrating outcomes-based education. In this study, the sample will consist of four blended learning Statistics classes at Jose Rizal University in the second semester of AY 2015–2016. Two of these classes will be assigned randomly to the experimental group that will be handled using outcomes-based education. The two classes in the control group will be handled using the traditional lecture approach. Prior to the discussion of the first topic, a pre-test will be administered. The same test will be given as posttest after the last topic is covered. In order to establish equality of the groups’ initial knowledge, single factor ANOVA of the pretest scores will be performed. Single factor ANOVA of the posttest-pretest score differences will also be conducted to compare the performance of the experimental and control groups. When a significant difference is obtained in any of these ANOVAs, post hoc analysis will be done using Tukey's honestly significant difference test (HSD). Mediating effect will be evaluated using correlation and regression analyses. The groups’ initial knowledge are equal when the result of pretest scores ANOVA is not significant. If the result of score differences ANOVA is significant and the post hoc test indicates that the classes in the experimental group have significantly different scores from those in the control group, then outcomes-based education has a positive effect. Let blended learning be the independent variable (IV), outcomes-based education be the mediating variable (MV), and score difference be the dependent variable (DV). There is mediating effect when the following requirements are satisfied: significant correlation of IV to DV, significant correlation of IV to MV, significant relationship of MV to DV when both IV and MV are predictors in a regression model, and the absolute value of the coefficient of IV as sole predictor is larger than that when both IV and MV are predictors. With a positive mediating effect of outcomes-base education on the effect of blended learning on student performance, it will be recommended to integrate outcomes-based education into blended learning. This will yield the best learning results.

Keywords: outcome-based teaching, blended learning, face-to-face, student-centered

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Authors: Amal Jmaii, Damien Rousseliere, Besma Belhadj

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We explore the relationship between internal migration and poverty in Tunisia. We present a methodology combining potential outcomes approach with multiple imputation to highlight the effect of internal migration on poverty states. We find that probability of being poor decreases when leaving the poorest regions (the west areas) to the richer regions (greater Tunis and the east regions).

Keywords: internal migration, potential outcomes approach, poverty dynamics, Tunisia

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Authors: Alan S. Weber

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This contribution reviews the current biomedical and qualitative arts research on arts-in-health interventions to improve both individual and population health outcomes. Arts therapies–for example, music therapy with roots in Aristoxenus’s Ἁρμονικὰ στοιχεῖα and the Pythagorean sect–have long been employed in therapeutic contexts. However, the 20th century witnessed the increasing use of the visual and plastic arts (drawing, painting, sculpting), performing arts (drama and dance), and other expressive arts modalities into occupational therapy, well-being medicine, and psychological and psychiatric counselling, diagnosis, and treatment. A significant body of peer-reviewed evidence in the medical and neurological sciences on the role of arts-in-health has developed, and specifically, research on music and art therapy has led to their inclusion within the current biomedical paradigm of evidence-based practice. The arts cannot only aid in public and population health promotion (promoting healthy behaviors and lifestyles, preventing disease onset) but also in addressing psychological issues (regulation of emotion; stress, anxiety, and depression reduction), behavioural issues (basic life skills, coping), and physiological response (immune system function, hormonal regulation, homeostatis). Working as a cross-disciplinary researcher in the arts in an American medical college, the author has developed several successful arts-in-health programs at the national and international level.

Keywords: arts-in-health, evidence based medicine, arts for health, expressive arts therapies

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Authors: Mathieu Hemono, Sophie Puig-Malet, Patrick Zylberman, Avner Bar-Hen, Rainer Sauerborn, Stefanie Schütte, Niamh Herlihi, Antoine Flahault et Anneliese Depoux

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Since the IPCC released its first report in 1990, an increasing number of peer-reviewed publications have reported the health risks associated with climate change. Although there is a large body of evidence supporting the association between climate change and poor health outcomes, the media is inconsistent in the attention it pays to the subject matter. This study aims to analyze the modalities and rhetoric in the media concerning the impact of climate change on health in order to better understand its role in information dissemination. A review was conducted of articles published between 1990 and 2015 in the francophone newspapers Le Monde and Jeune Afrique. A detailed search strategy including specific climate and health terminology was used to search the newspapers’ online databases. 1202 articles were identified as having referenced the terms climate change and health. Inclusion and exclusion criteria were applied to narrow the search to articles referencing the effects of climate change on human health and 160 articles were included in the final analysis. Data was extracted and categorized to create a structured database allowing for further investigation and analysis. The review indicated that although 66% of the selected newspaper articles reference scientific evidence of the impact of climate change on human health, the focus on the topic is limited major political events or is circumstances relating to public health crises. Main findings also include that among the many direct and indirect health outcomes, infectious diseases are the main health outcome highlighted in association with climate change. Lastly, the articles suggest that while developed countries have caused most of the greenhouse effect, the global south is more immediately affected. Overall, the reviewed articles reinforce the need for international cooperation in finding a solution to mitigate the effects of climate change on health. The manner in which scientific results are communicated and disseminated, impact individual and collective perceptions of the topic in the public sphere and affect political will to shape policy. The results of this analysis will underline the modalities of the rhetoric of transparency and provide the basis for a perception study of media discourses. This study is part of an interdisciplinary project called 4CHealth that confronts results of the research done on scientific, political and press literature to better understand how the knowledge on climate changes and health circulates within those different fields and whether and how it is translated to real world change.

Keywords: climate change, health, health impacts, communication, media, rhetoric, awareness, Global South, Africa

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Authors: Alison C. Essary, Victor Trastek

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Introduction: The current state of the health care system in the U.S. is characterized by an unprecedented number of people living with multiple chronic conditions, unsustainable rise in health care costs, inadequate access to care, and wide variation in health outcomes throughout the country. An estimated two-thirds of Americans are living with two or more chronic conditions, contributing to 75% of all health care spending. In 2013, the School for the Science of Health Care Delivery (SHCD) was charged with redesigning the health care system through education and research. Faculty in business, law, and public policy, and thought leaders in health care delivery, administration, public health and health IT created undergraduate, graduate, and executive academic programs to address this pressing need. Faculty and students work across disciplines, and with community partners and employers to improve care delivery and increase value for patients. Methods: Curricula apply content in health care administration and operations within the clinical context. Graduate modules are team-taught by faculty across academic units to model team-based practice. Seminars, team-based assignments, faculty mentoring, and applied projects are integral to student success. Cohort-driven models enhance networking and collaboration. This observational study evaluated two years of admissions data, and one year of graduate data to assess program outcomes and inform the current graduate-level curricula. Descriptive statistics includes means, percentages. Results: Fall 2013, the program received 51 applications. The mean GPA of the entering class of 37 students was 3.38. Ninety-seven percent of the fall 2013 cohort successfully completed the program (n=35). Sixty-six percent are currently employed in the health care industry (n=23). Of the remaining 12 graduates, two successfully matriculated to medical school; one works in the original field of study; four await results on the MCAT or DAT, and five were lost to follow up. Attrition of one student was attributed to non-academic reasons. Fall 2014, the program expanded to include both on-ground and online cohorts. Applications were evenly distributed between on-ground (n=70) and online (n=68). Thirty-eight students enrolled in the on-ground program. The mean GPA was 3.95. Ninety-five percent of students successfully completed the program (n=36). Thirty-six students enrolled in the online program. The mean GPA was 3.85. Graduate outcomes are pending. Discussion: Challenges include demographic variability between online and on-ground students; yet, both profiles are similar in that students intend to become change agents in the health care system. In the past two years, on-ground applications increased by 31%, persistence to graduation is > 95%, mean GPA is 3.67, graduates report admission to six U.S. medical schools, the Mayo Medical School integrates SHCD content within their curricula, and there is national interest in collaborating on industry and academic partnerships. This places SHCD at the forefront of developing innovative curricula in order to improve high-value, patient-centered care.

Keywords: delivery science, education, health care delivery, high-value care, innovation in education, patient-centered

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Authors: Julie Mariam Abraham, G. J. Melendez-Torres

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Background. Maternal mortality is disproportionately higher in low- and middle- income countries (LMICs) compared to other parts of the world. At the current pace of progress, the Sustainable Development Goals for maternal mortality rate will not be achieved by 2030. A variety of factors influence the increased risk of maternal complications in LMICs. These are exacerbated by socio-economic and political factors, including poverty, illiteracy, and gender inequality. This paper aims to use realist synthesis to identify the contexts, mechanisms, and outcomes (CMOs) of maternal health interventions conducted in LMICs to inform evidence-based practice for future maternal health interventions. Methods. In May 2022, we searched four electronic databases for systematic reviews of maternal health interventions in LMICs published in the last five years. We used open and axial coding of CMOs to develop an explanatory framework for intervention effectiveness. Results. After eligibility screening and full-text analysis, 44 papers were included. The intervention strategies and measured outcomes varied within reviews. Healthcare system level contextual factors were the most frequently reported, and infrastructural capacity was the most reported context. The most prevalent mechanism was increased knowledge and awareness. Discussion. Health system infrastructure must be considered in interventions to ensure effective implementation and sustainability. Healthcare-seeking behaviours are embedded within social and cultural norms, environmental conditions, family influences, and provider attitudes. Therefore, effective engagement with communities and families is important to create new norms surrounding pregnancy and delivery. Future research should explore community mobilisation and involvement to enable tailored interventions with optimal contextual fit.

Keywords: maternal mortality, service delivery and organisation, realist synthesis, sustainable development goals, overview of reviews

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Authors: Jin Hun Choi, So Hyun Ahn, Seong Keun Wang, Ik-Seung Chee, Jung Lan Kim, Sun Woo Lee

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Objectives: The purpose of the study is to investigate the effects of day hospital care in hospitalized schizophrenic patients in terms of treatment adherence and treatment outcomes. Methods: Among schizophrenic patients hospitalized between 2011 and 2012, 23 day hospital care patient and 40 control subjects were included in the study. All candidates underwent Beck Cognitive Insight Scale, Drug Attitude Inventory, World Health Organization Quality of Life Assessment and Psychological Well-Being Scale when their symptoms were stabilized during hospitalization, and after being discharged, 23 patients received day hospital care for two months and then changed to out-patient care while 40 patients received out-patient care immediately after discharge. At the point of two months of out-patient care, the treatment adherence of the two groups was evaluated; tracking observation was performed until February, 2013, and survival rates were compared between the two groups. Results: Treatment adherence was higher in the day hospital care group than in the control group. Kaplan-Meier survival analysis showed a higher survival rate for the day hospital care group compared to the control group. Levels of cognitive insight and quality of life were higher after day hospital care than before day hospital care in the day hospital care group. Conclusions: Through the study, it was confirmed that when hospitalized schizophrenic patients received continuous day hospital care after being discharged, they received further out-patient care more faithfully. The study is considered to aid in the understanding regarding schizophrenic patients’ treatment adherence issues and improvement of treatment outcomes.

Keywords: schizophrenia, day hospital care, adherence, outcomes

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Authors: Rhoda N. Kayongo

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As behavior analysts in education continue to debate on how higher institutions can continue to benefit from their social and academic related programs, higher education is facing challenges in the area of character development. This is manifested in the percentages of college completion rates, teen pregnancies, drug abuse, sexual abuse, suicide, plagiarism, lack of academic integrity, and violence among their students. Attending college is a perceived opportunity to positively influence the actions and behaviors of the next generation of society; thus colleges and universities have to provide opportunities to develop students’ values and behaviors. Prior studies were mainly conducted in private institutions and more so in developed countries. However, with the complexity of the nature of student body currently due to the changing world, a multidimensional approach combining multiple factors that enhance character development outcomes is needed to suit the changing trends. The main purpose of this study was to identify opportunities in colleges and develop a model for predicting character development outcomes. A survey questionnaire composed of 7 scales including in-classroom interaction, out-of-classroom interaction, school climate, personal lifestyle, home environment, and peer influence as independent variables and character development outcomes as the dependent variable was administered to a total of five hundred and one students of 3rd and 4th year level in selected public colleges and universities in the Philippines and Rwanda. Using structural equation modelling, a predictive model explained 57% of the variance in character development outcomes. Findings from the results of the analysis showed that in-classroom interactions have a substantial direct influence on character development outcomes of the students (r = .75, p < .05). In addition, out-of-classroom interaction, school climate, and home environment contributed to students’ character development outcomes but in an indirect way. The study concluded that in the classroom are many opportunities for teachers to teach, model and integrate character development among their students. Thus, suggestions are made to public colleges and universities to deliberately boost and implement experiences that cultivate character within the classroom. These may contribute tremendously to the students' character development outcomes and hence render effective models of behaviour analysis in higher education.

Keywords: character development, tertiary institutions, predictive model, behavior analysis

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Authors: Wynne De Jong, Robert Miller, Ross Riggs

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Beyond the number of nurses providing care for patients, having nurses with the right skills, experience and education is essential to ensure the best possible outcomes for patients. Research studies continue to link nurse staffing and skill mix with nurse-sensitive patient outcomes; numerous studies clearly show that superior patient outcomes are associated with higher levels of regulated staff. Due to the limited number of tools and processes available to assist nurse leaders with staffing models of care, nurse leaders are constantly faced with the ongoing challenge to ensure their staffing models of care best suit their patient population. In 2009, several hospitals in Ontario, Canada participated in a research study to develop and evaluate an RN/RPN utilization toolkit. The purpose of this study was to develop and evaluate a toolkit for Registered Nurses/Registered Practical Nurses Staff mix decision-making based on the College of Nurses of Ontario, Canada practice standards for the utilization of RNs and RPNs. This paper will highlight how an organization has further developed the Patient Care Needs Assessment (PCNA) questionnaire, a major component of the toolkit. Moreover, it will demonstrate how it has utilized the information from PCNA to clearly identify patient and family care needs, thus providing evidence-based results to assist leaders with matching the best staffing skill mix to their patients.

Keywords: nurse staffing models of care, skill mix, nursing health human resources, patient safety

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Authors: Aryati Yashadhana, Ted Fields Jnr., Wendy Fernando, Kelvin Brown, Godfrey Blitner, Francis Hayes, Ruby Stanley, Brian Donnelly, Bridgette Jerrard, Anthea Burnett, Anthony B. Zwi

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Indigenous Australians experience some of the worst health outcomes globally, with life expectancy being significantly poorer than those of non-Indigenous Australians. This is largely attributed to preventable diseases such as diabetes (prevalence 39% in Indigenous Australian adults > 55 years), which is attributed to a raised risk of diabetic visual impairment and cataract among Indigenous adults. Our study aims to explore the interface between structural and sociocultural determinants and human agency, in order to understand how they impact (1) accessibility of eye health and chronic disease services and (2) the potential for Indigenous patients to achieve positive clinical eye health outcomes. We used Participatory Action Research methods, and aimed to privilege the voices of Indigenous people through community collaboration. Semi-structured interviews (n=82) and patient focus groups (n=8) were conducted by Indigenous Community-Based Researchers (CBRs) with diabetic Indigenous adults (> 40 years) in four remote communities in Australia. Interviews (n=25) and focus groups (n=4) with primary health care clinicians in each community were also conducted. Data were audio recorded, transcribed verbatim, and analysed thematically using grounded theory, comparative analysis and Nvivo 10. Preliminary analysis occurred in tandem with data collection to determine theoretical saturation. The principal investigator (AY) led analysis sessions with CBRs, fostering cultural and contextual appropriateness to interpreting responses, knowledge exchange and capacity building. Identified themes were conceptualised into three spheres of influence: structural (health services, government), sociocultural (Indigenous cultural values, distrust of the health system, ongoing effects of colonialism and dispossession) and individual (health beliefs/perceptions, patient phenomenology). Permeating these spheres of influence were three core determinants: economic disadvantage, health literacy/education, and cultural marginalisation. These core determinants affected accessibility of services, and the potential for patients to achieve positive clinical outcomes at every level of care (primary, secondary, tertiary). Our findings highlight the clinical realities of institutionalised and structural inequities, illustrated through the lived experiences of Indigenous patients and primary care clinicians in the four sampled communities. The complex determinants surrounding inequity in health for Indigenous Australians, are entrenched through a longstanding experience of cultural discrimination and ostracism. Secure and long term funding of Aboriginal Community Controlled Health Services will be valuable, but are insufficient to address issues of inequity. Rather, working collaboratively with communities to build trust, and identify needs and solutions at the grassroots level, while leveraging community voices to drive change at the systemic/policy level are recommended.

Keywords: indigenous, Australia, culture, public health, eye health, diabetes, social determinants of health, sociology, anthropology, health equity, aboriginal and Torres strait islander, primary care

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