Evolution of Health Web certification, through the HONcode experience

Dysphagia, or difficulty swallowing, is estimated to affect between 5 and 72% of people living at home in the community. This figure is expected to increase in the context of a globally ageing population in which people are living longer with more complex and chronic health conditions, and healthcare system changes are targeted at supporting people to remain living at home. Despite the increasing demand for community-based health care, there remains a significant research gap regarding how dysphagia is and should be managed in the community by speech-language pathologists, including what issues clients with dysphagia living at home and their caregivers experience. Gaining a broader and deeper understanding of the nature of community-based speech-language pathology (SLP) dysphagia services and practices may help provide insights into how dysphagia care in the community setting can be optimised now and into the future. The thesis aims were to (1) investigate and explore community-based SLP services and practices provided to adults with dysphagia living at home and (2) explore the lived experience of dysphagia at home from the perspectives of adults with dysphagia and their caregivers. These aims were explored using quantitative and qualitative methods across four research studies. The first thesis aim was addressed by two studies positioned within an explanatory sequential mixed methods design to first quantitatively, then qualitatively, investigate the nature of dysphagia services and practices for people living at home in the community. The first study (Chapter 2) involved an online survey of practice conducted with speech-language pathologists (n = 144) working with adults with dysphagia living at home. Results suggested that SLP dysphagia practices in the community were similar to dysphagia practices in other settings, which are inherently biomedical and may not be optimal for community-based clients with dysphagia and their caregivers. The second study (Chapter 3) sought to elaborate the findings of Chapter 2 and involved semi-structured interviews with 15 practising speech-language pathologists. Data were analysed using content analysis and revealed an overarching theme suggestive that Community commands a different approach, illustrated by three subthemes that highlighted how and why a different approach to dysphagia care in the community setting was necessary: (1) Skills and mindset require adaptation in the community context, (2) Values and approaches are different in the community context, and (3) Organisational influences impact service delivery in the community context. The second thesis aim was addressed by two separate research studies that explored the lived experience of dysphagia at home in the community, first from the perspectives of 15 clients with dysphagia (Chapter 4) and then of 15 caregivers of persons with dysphagia (Chapter 5). Using a qualitative descriptive approach grounded in phenomenology, interviews explored their personal experiences of living with and managing dysphagia at home. Client perspectives revealed an overarching theme outlining a Journey of discovery—learning to live with dysphagia, describing the process of managing dysphagia at home. This theme comprised three subthemes: (1) The story of dysphagia, (2) Engaging with support networks, and (3) Limited community awareness of dysphagia. Clients described living with dysphagia in the context of other health issues and shared experiences of people in their community not knowing about dysphagia, from friends and the public to health professionals and the hospitality industry. Caregiver perspectives revealed an overarching theme of “You do whatever it takes”, describing the caregiver experience of supporting a family member/friend with dysphagia at home. This theme was reflected in three subthemes where caregivers described (1) Being a caregiver, (2) Support networks, and (3) Practicalities of living with dysphagia. Caregivers voiced a range of pertinent issues experienced when caring for a family member/friend with dysphagia, including how their personal attributes and life experiences may influence their approach to caring. Thesis findings highlight the multifaceted impact dysphagia may have on an individual and their caregiver when living at home in the community. Apparent in the findings is that dysphagia is a health condition that has both physical and psychosocial effects. SLP services must evolve to ensure community-based dysphagia care addresses both physical and psychosocial needs of clients and, importantly, caregivers through the delivery of personalised and holistic care. Further, speech-language pathologists must play a role in raising the profile of dysphagia in our communities.

Between April and July 1994, genocide was perpetrated in Rwanda during which more than one million and seventy four thousand (1,074,000) Tutsi were killed. This was a genocide planned and executed by the national authorities; it was also a mass genocide and genocide of proximity. The psycho-traumatic consequences in the population of Tutsi survivors were assessed through a longitudinal study conducted on genocide survivors seeking services at the Psychosocial Consultations Centre based in Kigali, Rwanda, during the period between 2000 and 2008. The research focused on assessment of the evolution of post traumatic stress disorder (PTSD) they were suffering from by reviewing medical records of 55 patients, using the international classification of mental diseases and also interviewing patients as well as clinicians. The study findings reveal that a high intensity traumatic event and the low income level of the family are causes of therapeutic failures. Specifically, dissociative aspects of PTSD experienced by victims of sexual rape are indeed a big challenge to the establishment of a therapeutic relationship. It was also observed that traumatic reactivations for some patients caused chronicity or intermittent apparition of psychopathologic manifestations. Another phenomenon observed concerns the somatic diseases concomitant to PTSD. Indeed, we had patients for whom somatic problems obstructed the manifestations of PTSD, hence delaying their treatment. Finally, a phenomenon of aggravation of PTSD by acute depressive disorders for almost all patients was additionally observed. Overall, the experience of the trauma of the survivors of the Genocide of the Tutsi of Rwanda leads the researcher to the recognition of multiple evolutions. It has been possible to observe a benign evolution and also a remission punctuated by periods of relapses and, finally, an evolution towards severity. Mental health in the context of post mass violence is a major clinical reality. On the one hand, we have plenty of mental health illnesses in a strict sense of the word: chronic evolution PTSD, severe depression, psychosis, etc. Those situations often need an individualized medicopsychological approach, that is, basic mental healthcare. On the other hand, all that which genocide causes such as psychological suffering, sadness and emotional distress in people and communities requires group therapy approaches as well as socio-economic support. Person-centred group and community initiatives, delivered in cooperation with different sectors involved in management of those issues, are indicated.

Background. Most countries that have based their healthcare systems on primary care enjoy better population health, lower health disparities, more equitable access to care, and lower costs. Iranian primary health care (PHC) has achieved population health indices similar to that of the best in the region during the past two decades. Despite this, the system showed itself to be both inadequate in meeting the evolving health needs of the population and unaffordable by many. To address these shortages, in 2005 it was decided to implement a new system, called family medicine (FM), together with Behbar (rural insurance for all) in rural areas and in urban areas of less than 20,000 population. The aim of this thesis was to identify facilitators of and barriers to the implementation of FM in Iran. Methods. Qualitative methods were used, particularly individual semi-structured interviews with stakeholders at three levels: national (19 interviews), provincial (9), and local (43). In addition, three focus groups, document analysis, and observations in health centres were used. The framework approach was employed as the main method for analysis, while remaining open to accommodate emerging themes. The analysis was based on a modified fourfold framework consist of administration, bargaining, interpretation and institutional structuring components, originally introduced by Harrison (2004). Results. The study revealed four interdependent factors that influenced implementation: aspects of the policy; the existing environment; the experience of implementation; and attitudes and perceptions of local practitioners and the public. Making the policy in the 'organized anarchies' of the health system, where ambiguity is prevalent, few people involved and imposing it on others was at the heart of problems with implementation. The policy that was conceptually welcomed because of its innovation and incentive for cooperation, was badly put into practice. The core barrier was the merger of two diverse policies, implemented concurrently by two hostile organizations (MOH & MIO). Conclusions. The thesis revealed the dynamic model of health policy analysis. The policy was essentially adopted on the basis of idealistic views rather than a real solution to existing problems. Implementation was an attempt by two organizations with different aims. Despite some efforts to reduce practical difficulties, the underlying divergence between Behbar and FM was too fundamental to be overcome. Parliament's attempt to separate the purchaser from the provider resulted in great mistrust between the two and to some extent undermined the essence of FM.

Balancing it out: the process by which midwifery students provide care to women following stillbirth in Papua New Guinea

Introduction Sweden, Denmark and Norway are the world leaders in the implementation of e-prescription models. Their first efforts to utilize computer support for the process of administrating and managing medication prescriptions date from the 1980s. Different models of electronic prescribing continued to be tested in the next thirty years. The priority was set on the patient’s personal medical record rather than the electronic prescription. Nowadays in Denmark over 88% of medical prescriptions are generated and transferred electroni-cally and almost 100% of general practitioners use an electronic patient record. Both patients and practitio-ners benefit heavily from using the e-prescription. Aim The aim of this study is to elicit the main characteristics of the electronic prescription models used in Scandinavian countries and analyze the specifics that made the extreme evolution of e-health in these countries possible. Materials and Methods We have conducted a systematic analysis of the e-health prescription practices in Scandinavian countries and summarized the data in specific figures, tables and charts. Results Our current study focuses on the similarities and differences, advantages and obstacles of the e-prescription models applied in the Scandinavian countries. Following the modification of the system historically, the study displays the circumstances, under which the implementation of the e-prescription has happened in each of the analyzed countries. It becomes clear that the fast-paced progress of the online e-prescription system in Scandinavian countries is to a great extend present due to the chain of constant adoption of experience and successful studies that is built between the three countries. Conclusion The experience of Sweden, Denmark and Norway proves that the implementation of the e-prescription systems is a solution to many technological, economic and social issues. The digitalization of health leads to the reduction of costs as well as better health care and greater satisfaction to all involved in the system.

The Health and Safety of Migrant workers in the Garment industry in Vietnam: Key issues and potential strategies

Community psychiatry in Mozambique – a transcultural journey

This exegesis reports on nine case studies of university-led work-integrated learning (WIL) in journalism at Griffith University (GU), undertaken from 2014–2018. While WIL has a relatively long history in journalism education in terms of internships and cadetships, they have some limitations in terms of access and equity. Students may lack the capacity to fulfil the requirements of internships because of disadvantage, the number of available placements may be limited and/or students may have varied experiences with placements. This exegesis enunciates the varied dimensions and faces of a ‘wise practice’ approach to university-led WIL in journalism education and addresses the central research questions: What are the dimensions of inclusive, quality WIL and what are the challenges to its implementation? To address these questions, I draw on data from participant observation as well as from interviews and focus groups with students, academics and industry partners. Each set of data formed a case study. This multiple case study analysis has led me to identify three distinct yet interrelated models of university-led WIL in journalism education – I have called these Flipped WIL, Event WIL and Purpose WIL. The development and delivery of each of the case studies were informed by the teaching philosophy of university-led WIL as wise practice, which emphasises context, diversity, inclusion and community. University-led WIL occurs within a hybridised space created within a university context outside the internship/placement model. Students obtain practical experience, usually in conjunction with a professional organisation, and this goes beyond simply providing ‘scholarly problematizing by students of their practice experiences’ (Cooper and Orrell, 2016, p. 111). The Flipped WIL case studies comprised scaffolded, practice-based units culminating in a capstone unit. Student learning occurred through working as, and alongside, industry in a specially configured, university-based multimedia newsroom. In contrast, the Event WIL case studies involved students working collaboratively with industry at specific newsworthy events – the G20 Leaders’ Summit in Brisbane, the Blues on Broadbeach annual music festival on the Gold Coast and the 2018 Commonwealth Games, also on the Gold Coast. The Purpose WIL case studies engaged with the community around the social issues of domestic violence, refugee mental health and disability, with a social justice focus. Each model involved students producing relevant multimedia news stories for an authentic news outlet, and building skills in analysis, critique, creativity and innovation. The models allowed students enrolled in on-campus journalism programs to be prepared for employment in an evolving and challenging media landscape because they provided equivalent access to what Billett (2002, p. 29) refers to as ‘affordances’, that is, the workplace’s ‘readiness to afford opportunities for individuals to engage in work activities’, and ‘engagement’, that is, the ‘degree by which individuals wish to engage purposefully in the workplace’. The affordances offered by industry workplaces were incorporated into the hybrid space created by the university-led model described, and were enabled and enhanced to produce inclusive, quality WIL when five key dimensions were invoked. These are that the WIL experience is university-led, undertaken in a hybrid space, embedded in community and sustainable, and recognises and encourages student agency. There are, however, challenges to implementing inclusive, quality WIL, including with online students, access issues, high academic workloads and a student and industry perception about a lack of legitimacy for WIL experiences within the university context. This project sets out to provide a timely, engaging, robust and reflexive analysis of the development and objectives of the Wise Practice Work-integrated learning model in journalism education. Illustrated by the nine case studies, this model has potential to serve as a template for other institutions while contributing to journalism pedagogy in Australia. The implications of the WIL model discussed here, through the testing and analysis of the Flipped WIL model, the Event model and the Purpose WIL model, will form the basis for future projects and/or the adoption of similar models elsewhere.

The research theme of this investigation is driven by a strong clinical need for new and improved technology to help the modern surgeon. Since the beginning of the 21st century, the emergence of innovative technologies made further advances in minimal access surgery possible. Surgical techniques have evolved rapidly, for example the introduction of minimally invasive surgery (MIS) and robotically-assisted MIS which have improved outcomes for patients with faster recovery, reduced post-operative pain and fewer scars. For such a reason, there is an increasing need to develop innovative en- gineering solutions to some of the challenges being faced as surgery evolves to help surgeons to achieve the best possible clinical outcome and also to develop solutions helping to reduce costs and improve quality. As a matter of fact, robotic surgery and medical simulator addressed the limitations of medical procedures, thus revolutionizing minimal access surgery. First of all, with the introduction of robotics in the operating room, an evolutionary stage in the development of surgical technique was achieved to enhance the control and the visual field of the surgeon. It can be stated that this new approach was patient oriented as it brings several critical advantages for him: damage to healthy tissue is minimal; patients hospitalization is reduced to an average of 1.2 days; psychological impact of the procedure upon the patient is significantly lower; the risk of an unwanted infection is almost zero; using robotic systems the precision of the intervention is below one hundred of a millimetre; the risk of unwanted cuts (vessel sectioning, nerve damage, etc.) is minimal; the number of assistants in the operation room is reduced; 3D visual feedback. Second, training with a surgical simulator offers several advantages. It is similar to a wet laboratory, human cost in the form of adverse outcomes for patients is minimized, and residents can practice in a relaxed learning environment at their own pace. Additionally, training on surgical simulators can be incorporated into a curriculum that is available to residents at any time. Furthermore, the development of physical and cognitive surgical simulators offers an approach for learning which is different from the traditional apprenticeship model. Simulators cannot replace experienced surgical preceptors, but they are fast becoming an attractive and acceptable adjunct in surgical curricula. As the technology improves, the simulations will become more realistic, and the experience will become more valuable. Simulation programs will play a greater role in future surgical education. For what concerns improving patient care and providing technology for healthcare professionals, there are many limitations and obstacles to overcome, before robotic surgery systems and medical simulators being able to be integrated into the medical field. Motivated by the above observations, the goal of this research is to develop a new manipulator in order to improve such electromecanical limitation of the current surgery robotic systems and also to build a new surgery simulator to address some obstacles when doing some open surgery performances.

Background: Teenage pregnancy is an evolving global public health problem. Level of life assets could predict behaviors and take effect to less sexual risk behaviors in teenagers. Objective: To compare life assets between pregnant and non-pregnant teenagers and to evaluate the relationship between basic factors and teenage pregnancy. Methods: A total of 172 female teenagers aged 12-19 years were included. The control group was matched with the case group by age with mean age of 17.07 years old. The case group consisted of 86 pregnant teenagers who attended the Teenage Antenatal Care Unit at Siriraj Hospital. The control group consisted of 86 teenagers who were not pregnant and who had never been pregnant. The research instruments were general information and life assets inventory questionnaires developed by Suriyadeo Tripathi with Cronbach’s Alpha coefficient at 0.890. Results: Mean life assets scores were significantly higher in the control group than in the case group (T-test analysis: Mean = 94.70/87.65, SD = 17.45/22.68, p-value =.024, respectively). The control group scored more favorably than the case group on 16 items. In addition, the case group could not meet the minimum assessment criteria on 21 items, which indicated their status as an at risk group. A total of 12 factors were found to be statistically significantly associated with teenage pregnancy. Conclusion: Overall life assets were significantly higher among teenagers who had not experienced pregnancy. The risk factors included level of education, GPA, family income, mothers or family members of teenagers having experience of teenage pregnancy, main guardians, father education, mother occupation, parental relationship, family warmth and smoking were found to be significantly associated with risk of teenage pregnancy in this study. These results will help to facilitate preventive interventions and the development of policies and guidelines to control and perhaps reverse current trends in teenage pregnancy.

Children with life limiting conditions require intensive, complex management of the physical, psychosocial and spiritual issues that evolve for the child and their family as the focus of care moves from curative treatment to palliation. Optimal palliative care for children can be limited by the lack of health professionals with the necessary skills and experience to confidently and competently manage the care of both the child and the family. The University of Queensland's Centre for Online Health has been working closely with the Paediatric Palliative Care Service (PPCS) at the Royal Children's Hospital (RCH) in Brisbane, Australia, to investigate the potential of telemedicine for the delivery of specialist support in the home or local community. Research conducted in Queensland has shown how telemedicine can be effectively used to link the specialist paediatric palliative care team into the home of families caring for a child receiving palliative care, regardless of their physical distance from the RCH. This qualitative report describes two case studies, each illustrating the value of home telemedicine for families at this vulnerable and distressing time. This work should provide a useful insight for other specialty disciplines contemplating home telemedicine applications.

This research identified drivers and barriers to routine National Health Service (NHS) adoption of Computer Aided Design (CAD) and Additive Manufacturing (AM) for the production of patient-specific devices. It proposed and verified a design process intervention, which aimed to overcome the most important barriers and better exploit the drivers. The data generated and recorded in this work spanned qualitative and quantitative findings from fourteen real-world clinical case studies, a fully-realised structure for a Quality Management System (QMS), prototyping of a design intervention in a paper-based format, and verification of its intended impacts with three users across commercial and clinical contexts. Key barriers to routine adoption were identified as being the nature of existing publications, evolving regulatory requirements, poor awareness of design or design control, and inconsistent approaches to procuring custom devices.The literature featured necessarily short clinical follow-up, and often reported on design and fabrication methods in very poor detail – to the detriment of reproducibility. Health economics evidence was scarce. In the short to medium term future, new regulatory requirements will compel all institutions, including hospitals, to implement a Quality Management System for the design of medical devices. As such, generalisable procedures, forms, and records for compliance with the BS EN ISO 13485 quality standard were devised, and used as the foundation of the design intervention. The QMS-led design intervention form aimed to: create fully-populated product requirements lists before commencing modelling; introduce project management, identification, traceability, review, verification, and feedback activities; improve the confidence and experience of the designer or acting designer; and prompt record keeping in-line with the requirements of ISO 13485. It achieved all of these aims, at least as far as could be ascertained within the research constraints. Further expansion and verification of the framework is required in future – across different specific surgeries and across more users.Thesis completed in 2018.

Family and Health: Evolving Needs, Responsibilities, and Experiences

In conducting social science research on religion, the religious identity of investigators (or lack of such identity) may pose various challenges to objectivity. This paper is based on our experiences, as haredi (‘ultra-Orthodox’ Jewish) sociologists, in conducting a women’s health survey amongst our own community. It discusses two particular incidents, occurring before and after data-collection, in which our status as insiders became an issue. We discuss how these incidents shaped our evolving views regarding the interplay between identity, objectivity, and research ethics.

A multi-level analysis of psychological well-being related to work and family in 33 countries / Makiko Hori, Yoshinori Kamo -- The influence of family socioeconomic status on health care professional recommendations of the HPV vaccine / Hanna Jokinen-Gordon -- Multiple motherhoods : the effect of the internalization of motherhood ideals on life satisfaction / Kayla M. Pritchard, Lisa A. Kort-Butler -- The lived experiences of daughters of women with breast cancer / Amanda C. Ginter, M. Elise Radina -- Demographic trends and the healthcare system in Moldova : reforms and challenges / Valentina Bodrug-Lungu, Erin Kostina-Ritchey -- Long-term care needs and long-term care policy : comparing Germany and Israel / Monika Reichert ... [et al.] -- An examination of the effects of current obstetrical opinions, diagnostic and practice trends in the management of twin to twin transfusion syndrome patients / Lauren Nicholas -- Stress and support among people caring for homeless adult relatives / Michael F. Polgar, Carol S. North, David E. Pollio -- Depressive symptomology among rural low-income Latina and non-Latina white mothers / Jacy Downey, Kimberly Greder -- From boys to men : shifting family gender ideologies among black and white adult men / Myron T. Strong, Erma Lawson