18 research outputs found
Needs and contents of a customized digital tool for retention in care and medication adherence among pregnant and breastfeeding women living with HIV in Kilimanjaro
Get PDFThis research article was published by Bulletin of the National Research Centre Volume 47, 2023Background
Retention in care and adherence to medication among pregnant and breastfeeding women living
with HIV (PBWLH) are crucial for preventing mother‑to‑child transmission (PMTCT) of HIV. Wide coverage of mobile
phones, digital tools, including internet‑enabled medication dispensers and short message service (SMS), have
been recommended as potential interventions to improve adherence to medication by PBWLH. The main objective
of the study was to understand the needs and contents for a customized digital tool for retention in care and medica‑
tion adherence among PBWLH.
Method
A mixed‑methods study was conducted from September 2021 to March 2022 at five health facilities
in the Kilimanjaro region. We interviewed 142 pregnant and breastfeeding women, receiving PMTCT services, using
a semi‑structured questionnaire. Among the interviewed, twenty breastfeeding women were purposively selected
and enrolled to use an internet‑enabled Wisepill medication dispenser for one month. They received different types
of SMS reminders for one month, and feedback on their adherence patterns was received after one month using
an adherence graph from the Wisepill digital tool. Later, exit and in‑depth interviews were conducted to explore
the needs and contents of a future customized digital adherence tool. Descriptive analyses for quantitative data
and thematic content analyses for qualitative data were also done.
Results
Among 142 women interviewed, 42(30%) were pregnant and 100 (70%) were breastfeeding. Most 136 (95%)
had access to mobile phones and used SMS daily, while 90% were interested in receiving reminder messages. Qualita‑
tive findings revealed more insights into reminders’ content and educational SMS. Most people preferred neutral SMS,
which does not contain the word “medication”. Health educational SMS content was preferred to be on breastfeeding,
opportunistic diseases, nutrition and entrepreneurship education. Overall, SMSs were regarded as helpful to remind
clients of medication time and the medication dispenser provided them with privacy and safe storage for their
medication.
Conclusions
This study’s findings will help construct useful content for future digital adherence tools to support
the health of pregnant and breastfeeding women living with HIV
The Noel Kempff project in Bolivia: gender, power, and decision-making in climate mitigation
No full textA focus on land-use and forests as a means to reduce carbon dioxide levels in the global atmosphere has been at the heart of the international climate change debate since the United Nations Kyoto Protocol was agreed in 1997. This environmental management practice is a process technically referred to as mitigation. These largely technical projects have aimed to provide sustainable development benefits to forest-dependent people, as well as to reduce greenhouse gas emissions. However, these projects have had limited success in achieving these local development objectives. This article argues that this is due in part to the patriarchal underpinnings of the sustainable development and climate-change policy agendas. The author explores this theory by considering how a climate mitigation project in Bolivia has resulted in different outcomes for women and men, and makes links between the global decision-making process and local effects.
This article is hosted by our co-publisher Taylor & Francis. For the full table of contents for this and previous issues of this journal, please visit the Gender and Development website
Developing as an ‘extended’ pedagogic researcher:addressing the ‘three Rs’
No full textBased on selected content from the keynote talk which opened the 2019 University of Brighton Pedagogic Research conference, in introducing what the author calls the ‘three Rs’ of pedagogic research: ‘revelation’, ‘reading’ and ‘rigour’, this article is intended as a highly readable and engaging outline starter guide for pedagogic researchers who want to improve the quality of their research and begin to make names for themselves as serious researchers. Framed within a broader message about the importance of developing as a researcher, the three Rs are identified as the key ingredients of pedagogic research that is taken seriously by the wider educational research community. Adapted from Eric Hoyle’s models, the notion of a continuum of researcher professionality, ranging from ‘restricted’ to ‘extended’, is introduced, and illustrated by indicative characteristics of the restricted and of the extended researcher. With its capacity to propel the researcher along the notional professionality continuum, towards the extended end, mastery of the three Rs is presented as a developmental process, and specific ways of enhancing pedagogic research though revelation, reading and rigour are outlined
Developing as an ‘extended’ pedagogic researcher:addressing the ‘three Rs’
No full textBased on selected content from the keynote talk which opened the 2019 University of Brighton Pedagogic Research conference, in introducing what the author calls the ‘three Rs’ of pedagogic research: ‘revelation’, ‘reading’ and ‘rigour’, this article is intended as a highly readable and engaging outline starter guide for pedagogic researchers who want to improve the quality of their research and begin to make names for themselves as serious researchers. Framed within a broader message about the importance of developing as a researcher, the three Rs are identified as the key ingredients of pedagogic research that is taken seriously by the wider educational research community. Adapted from Eric Hoyle’s models, the notion of a continuum of researcher professionality, ranging from ‘restricted’ to ‘extended’, is introduced, and illustrated by indicative characteristics of the restricted and of the extended researcher. With its capacity to propel the researcher along the notional professionality continuum, towards the extended end, mastery of the three Rs is presented as a developmental process, and specific ways of enhancing pedagogic research though revelation, reading and rigour are outlined
The effects of visual art therapy program based on Zentangle™ methods on cognitive and psychological wellbeing of older adults with mild cognitive impairment
No full textPh.D.Background: The world’s rapid population aging increases number of older people who develop dementia. Older people with mild cognitive impairment (MCI), especially the ones with limited literacy residing in developing countries have increased risk of progressing to dementia. This thesis study examined the applicability of visual art therapy (VAT) and its immediate and lasting effects on cognitive functions, psychological wellbeing and instrumental activities of daily living (IADL) functions among older adults with MCI in rural Tanzania.Methods: A single-blinded randomized controlled trial (RCT) approach was adopted to respond to the overall aim of this thesis. Prior implementation of the RCT, two methodological studies were conducted to translate and validate instruments: Montreal Cognitive Assessment-5-minutes protocol for measuring cognitive functions as a primary outcome, and Short-form Geriatric Depression scale and Lawton instrumental activities of daily living (IADL) scale for measuring secondary outcomes respectively. Participants (n =127) were randomized to receive 12 sessions of VAT based on Zentangle™ methods over six weeks (n =62), or 6 weekly health education (HE) sessions on non-brain health topics (n =65). Outcomes including cognitive functions, depressive symptoms, mental wellbeing and IADL functions were measured at baseline, immediately after intervention, and at 3- and 6-months follow ups. Differential changes on the outcomes between VAT and HE groups over time were examined using generalized estimating equation (GEE). As the RCT was first piloted among few older adults (n =39), the group randomized to VAT was included in the focus group discussion to explore their VAT participation experiences to inform the main study. Thematic analysis was used to analyze the qualitative data.Results: The findings on the outcomes indicated that participants of the VAT group demonstrated significantly greater improvement in global cognition than those in HE group immediately after intervention (β =2.562, (95%CI =1.159, 3.966), p <.001), at 3 months (β =2.204, (95%CI = 0.413, 3.995), p =.016) and at 6 months thereafter (β =2.865, (95%CI =0.771, 4.960), p = .007). VAT intervention also showed a greater reduction in depressive symptoms than the health education immediately post intervention (β =-2.010, (95% CI =-3.095, -0.925), p <.001), but not during follow ups. As for mental wellbeing, no significant group*time interaction effects were noted. Greater benefit of VAT on IADL functions was noted at 6 months follow-up (β =0.573, (95%CI =0.011, 1.135), p =.046), although the effect was not significant after adjusting for baseline depression. Taping from the qualitative data obtained during the pilot study, participants expressed challenging experiences at the initial stages of the therapy, however, they identified several factors inherent in the VAT as key aspects that helped them to build confidence and fully participate in the therapy.Conclusion: This study found that VAT can be effective in improving cognitive functions, psychological wellbeing and functional ability of older people with limited literacy in rural settings of Tanzania. Adopting innovative designs to VAT such as using Zentangle™ methods can enable older adults with MCI who have limited literacy to participate in creative therapy for health promotion programs to fight dementia.背景世界人口迅速老化，罹患認知障礙症人數不斷增加。患有輕度認知障礙的長者，尤其是居住在發展中國家、識字能力有限的長者，罹患認知障礙症的風險更高。本研究測試禪繞活動（Zentangle™）對提升坦桑尼亞農村地區的輕度認知障礙患者的認知功能，心理健康和日常獨立活動能力的效用。研究方法研究分為兩個階段進行。 第一階段驗證了斯瓦希里語版本的蒙特利爾認知評估（K-MoCA）、簡短抑鬱症量表（K-GDS-SF）及Lawton 日常獨立活動量表（KLawtonIADL）的信效度，它們將會應用於第二階段硏究，以用作資料搜集。第二階段硏究採用隨機對照試驗，以測試禪繞活動對提升認知功能、心理健康和日常獨立活動能力，以及減輕抑鬱症狀的效用。參與者（n = 127）被隨機分配為介入組（n = 62），或對照組（n = 65）。介入組會接受為期六週，共12 節的禪繞活動，對照組會接受六節的健康教育講座。研究變數包括認知功能，心理健康和日常獨立活動能力。每個參加者均會接受基礎線、介入後，介入後三個月及介入後六個月的測量。在第二階段初期，有39 位介入組的參加者被邀請參與焦點小組討論以分享參與介入的經驗，利用主題分析方法分析收集得的資料，結果為第二階段的研究提供參考。研究結果利用廣義估計方程分析，結果顯示介入組的認知能力相比起對照組，在介入後(β=2.562, (95%CI =1.159, 3.966), p <0.001)，介入後三個月 (β =2.204, (95%CI = 0.413, 3.995),p =0.016) 以及介入後六個月(β =2.865, (95%CI =0.771, 4.960), p =0.007)，均呈現顯著的改善。介入組的抑鬱症狀相比起對照組，只有在介入後有立即的改善 (β =-2.010, (95%CI =-3.095, -0.925), p <0.001)。介入組的日常獨立活動能力相比起對照組，在介入後六個月呈現顯著的改善(β =0.573, (95%CI =0.011, 1.135), p =0.046)。而在心理健康則未能顯示隨時間介入形成的交互影響效果。從焦點小組討論收集的數據指出，參與者認為介入的初期頗具挑戰性及整體上有助提升自信。總結這項研究顯示，禪繞活動可以有效改善坦桑尼亞農村地區的輕度認知障礙患者的認知功能、心理健康及提升日常獨立活動能力。採用創新的禪繞活動，能有助識字能力有限的長者延緩認知退化。Masika, Golden Mwakibo.Thesis Ph.D. Chinese University of Hong Kong 2020.Includes bibliographical references (leaves 316-363).Abstracts also in Chinese; some appendixes also in Swahili.Title from PDF title page (viewed on 10, September 2021)
Needs and contents of a customized digital tool for retention in care and medication adherence among pregnant and breastfeeding women living with HIV in Kilimanjaro
No full textAbstract Background Retention in care and adherence to medication among pregnant and breastfeeding women living with HIV (PBWLH) are crucial for preventing mother-to-child transmission (PMTCT) of HIV. Wide coverage of mobile phones, digital tools, including internet-enabled medication dispensers and short message service (SMS), have been recommended as potential interventions to improve adherence to medication by PBWLH. The main objective of the study was to understand the needs and contents for a customized digital tool for retention in care and medication adherence among PBWLH. Method A mixed-methods study was conducted from September 2021 to March 2022 at five health facilities in the Kilimanjaro region. We interviewed 142 pregnant and breastfeeding women, receiving PMTCT services, using a semi-structured questionnaire. Among the interviewed, twenty breastfeeding women were purposively selected and enrolled to use an internet-enabled Wisepill medication dispenser for one month. They received different types of SMS reminders for one month, and feedback on their adherence patterns was received after one month using an adherence graph from the Wisepill digital tool. Later, exit and in-depth interviews were conducted to explore the needs and contents of a future customized digital adherence tool. Descriptive analyses for quantitative data and thematic content analyses for qualitative data were also done. Results Among 142 women interviewed, 42(30%) were pregnant and 100 (70%) were breastfeeding. Most 136 (95%) had access to mobile phones and used SMS daily, while 90% were interested in receiving reminder messages. Qualitative findings revealed more insights into reminders’ content and educational SMS. Most people preferred neutral SMS, which does not contain the word “medication”. Health educational SMS content was preferred to be on breastfeeding, opportunistic diseases, nutrition and entrepreneurship education. Overall, SMSs were regarded as helpful to remind clients of medication time and the medication dispenser provided them with privacy and safe storage for their medication. Conclusions This study's findings will help construct useful content for future digital adherence tools to support the health of pregnant and breastfeeding women living with HIV
Adaptive management of the climate change problem: bridging the gap between research and public policy
Get PDFThere are important differences between adaptation to normal climate and adaptation to climate change. One scientific community is organized to address extreme probabilities in current distributions, and their disaster potential. Another scientific community addresses the longer-term changes in the climate system. There are important differences between natural hazard (extreme and unpredictable events) and disaster as natural hazard with disastrous economic and social consequences as a matter of enormous concern. Finally, disaster management means a forecast for the real disaster events and after these disasters occurred, a post disaster attitude is necessary to ameliorate the situation and to take measures for rapid recovery. In this paper the author tries to address the description, understanding and prediction of extreme events in the weather system and their impact across a range of natural and socio-economic phenomena. Other goals of the paper are to present the weather and climate characteristics, the statistics of extreme events and to evaluate their impact on economy. Thus one major task of the work is to address the management of natural disasters caused by weather: the management of event forecast, risk assessment for various regions, and disaster management after the event occur. At the intersection between Economics, Management and Science of Weather Processes, this interdisciplinary study will provide the reader with insight and tools to address contemporary climate and weather hazard management problems.weather disasters, natural hazard, human vulnerability, extreme events, statistics and impact, management of event forecast, regional risk assessment, post disaster management
Can Visual Art Therapy Be Implemented With Illiterate Older Adults With Mild Cognitive Impairment? A Pilot Mixed-Method Randomized Controlled Trial
No full text© The Author(s) 2020. Older adults with mild cognitive impairment (MCI) with no literacy are at increased risk of progression to dementia. Whether it is feasible to engage this population in visual art therapy (VAT) and yield effects on cognition and depression remained unclear. A pilot mixed-method single-blinded randomized controlled trial was conducted in a sample of community-dwelling older adults with MCI. The experimental group (n = 21) was assigned to 12 sessions of VAT over 6 weeks, and the control group (n = 18) was assigned to 6 weekly health education (HE) on nonbrain health topics. Participants were evaluated at baseline using Montreal Cognitive Assessment–5-minute protocol (MoCA-5-min) and Geriatric Depression Scale Short Form (GDS-SF). A focus group discussion (FGD) was also conducted to the experimental group to explore their experiences of participating in the VAT. Findings indicated that both VAT and HE groups had significant improvement in MoCA-5-min scores and depressed mood over time; however, the significant group × time interaction effect was noted only for the psychological outcome. Findings from the FGD indicated that participants had challenging experiences at the beginning of the therapy, but later, they were able to cope and found that the VAT was relevant and beneficial for their cognitive and psychosocial health. This pilot study provided initial evidence about the potential benefit of VAT in improving cognitive and psychological well-being of older adults with MCI and low literacy and provided insights on how to better engage them in this cognitive stimulating intervention. A full-scale trial is recommended for a stringent evaluation.link_to_subscribed_fulltex
Development of a prediction model for child maltreatment recurrence in Japan: A historical cohort study using data from a Child Guidance Center
No full textAbstractTo develop a prediction model for the first recurrence of child maltreatment within the first year after the initial report, we carried out a historical cohort study using administrative data from 716 incident cases of child maltreatment (physical abuse, psychological abuse, or neglect) not receiving support services, reported between April 1, 1996 through March 31, 2011 to Shiga Central Child Guidance Center, Japan. In total, 23 items related to characteristics of the child, the maltreatment, the offender, household, and other related factors were selected as predictive variables and analyzed by multivariate logistic regression model for association with first recurrence of maltreatment. According to the stepwise selection procedure six factors were identified that include 9–13year age of child (AOR=3.43/95%CI=1.52−7.72), <40year age of the offender (AOR=1.65/95%CI=1.09−2.51), offender’s history of maltreatment during childhood (AOR=2.56/95%CI=1.31−4.99), household financial instability or poverty (AOR=1.64/95%CI=1.10−2.45), absence of someone in the community who could watch over the child (AOR=1.68/95%CI=1.16−2.44), and the organization as the referral source (AOR=2.21/95%CI=1.24−3.93). Using these six predictors, we generated a linear prediction model with a sensitivity and specificity of 45.2% and 82.4%, respectively. The model may be useful to assess the risk of further maltreatment and help the child and family welfare administrations to develop preventive strategies for recurrence
Forgetting to Take Medication, Treatment Adherence and Their Relationship with Viral Load Suppression Among People Living with HIV in the Kilimanjaro Region, Tanzania
No full textBackground: Antiretroviral therapy (ART) adherence is crucial for virological suppression and positive treatment outcomes among people living with HIV (PLHIV), but remains a challenge in ensuring patients achieve and sustain viral load suppression. Despite the recommended use of digital tools medications uptake reminders, the contribution of forgetting to take medication is unknown. This study investigated the contribution of forgetting to take medication on the total missed medication and its effects on detectable viral load (VL). Methods: This mixed-method research was conducted among children, adolescents, pregnant, and breastfeeding women living with HIV on ART in northern Tanzania. Forgetting to take medication constituted reporting to have missed medication due to forgetfulness. A multivariable logistic regression model was used to estimate the adjusted odds ratio (AOR) with a 95% confidence interval (CI) to determine the contribution of forgetting medication intakes on total missed medication and other factors associated with having a detectable VL. Results: Of 427 respondents, 33.3% were children, 33.4% adolescents, and 33.3% pregnant and breastfeeding women, whose median age (interquartile range) was 9 (7–12), 18 (16–18), and 31 (27–36) years, respectively. Ninety-two (22.3%) reported missing medication over the past month, of which 72 (17.9%) was due to forgetting. Forgetting to take medication (AOR: 1.75 95% CI: 1.01–3.06) and being on second-line regimen (AOR: 2.89 95% CI: 1.50–5.55) increased the chances of a detectable VL, while females had lower chances of detectable VL (AOR: 0.62 95% CI: 0.41–0.98). The themes on the reasons for forgetting to take medication from qualitative results included being busy with work and the importance of reminders. Conclusion: Forgetting to take medication is common among PLHIV and an important predictor of a detectable VL. This calls for the use of automated short message services (SMS) reminders or Digital Adherence Tools with reminders to improve and promote good ART adherence among PLHIV
