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1
Ahmed, Ahmed Ali. "Study of visceral leishmaniasis in Ethiopia." Thesis, University of Liverpool, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316716.
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Weis, Julianne Rose. "Women and childbirth in Haile Selassie's Ethiopia." Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:55eec5f9-5fcc-41f6-90a5-2eb7588b771a.
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As the first analytic history of Ethiopian medicine, this thesis explores the interchange between the institutional development of a national medical network and the lived experiences of women as patients and practitioners of medicine from the years 1940-1975. Using birth and gender as mechanisms to explore the nation's public health history allows me to pursue alternative threads of enquiry: I ask questions not only about state activities and policy pursuits, but also about the relevance and acceptance of those actions in the lives of the citizenry. This thesis is also the first medical history of a non-colonial African country, opening up new questions about the role of non-Western actors in the expansion of Western medicine in the twentieth century. I explore the ways in which the exceptional history of Ethiopia can be couched in existing narratives of African modernity, medicine, and birth history. Issues of local agency and the creation of new social elites in the pursuit of modernity are all pertinent to the case of Ethiopia. Through both extensive archival research and oral interviews of nearly 200 participants in Haile Selassie's medical campaigns, I argue that the extent to which the imperial medical project in Ethiopia 'succeeded' was highly predicated on pre-existing conditions of gender, class, and geography.
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Molla, Yordanos. "The spatial epidemilogy of podoconiosis in northern Ethiopia." Thesis, University of Brighton, 2014. https://research.brighton.ac.uk/en/studentTheses/ae89b0b2-7451-4f8d-9b5e-12c6f3b66e8e.
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The presence of environmental variables associated with the occurrence of podoconiosis was indicated in studies by Price in the 1970s. Observation of red clay soil of volcanic origin and barefoot people in podoconiosis-endemic areas were starting points for investigating these factors. Recently, demonstration of genetic susceptibility to the disease has shown the added value of understanding individual level variations and the presence of gene-environment interactions in the development of podoconiosis. Deeper understanding of which environmental and individual variables determine the development of podoconiosis, and at what spatial scale these variables act, will assist intervention at national and local levels. The present study aims to investigate individual and environmental level variables related to podoconiosis at local scale.
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Smith, Anthony C. "The feasibility and cost-effectiveness of a novel telepaediatric service in Queensland /." [St. Lucia, Qld.], 2004. http://adt.library.uq.edu.au/public/adt-QU20050121.145040/index.html.
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Getachew, Mulugeta Adako. "Endoparasites of working donkeys in Ethiopia : epidemiological study and mathematical modelling." Thesis, University of Glasgow, 2006. http://theses.gla.ac.uk/1444/.
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A mathematical approach was used to model seasonal variation of cyathostomin faecal egg output, and in simulating anthelmintic control strategy. The model is based on parameters of biological development of cyathostomins and climatic data. A good fit of the model prediction to the field data was obtained after some parameter adjustments. The development rate of ingested larvae to egg laying adults, survival time of adults and the assumption made in modelling the peak pasture larval availability were the main driving forces for the model prediction to fit to the observed data. The apparent fit of the model prediction to the field data obtained after parameter adjustment generally indicated some major differences between donkeys and horse in their reaction to the parasite and/or between cyathostomins of donkeys and horses. The results of the stimulation of the effect of various protocols for the timing and frequency of anthelmintic treatment on the adult cyathostomin worm burden have shown that treating donkeys only once in a year or a combination of once in a year followed by every two or even four years can substantially reduces and maintains the parasite burden far below the pre-treatment level for many years. Generally the study made has revealed that the non-strongyle gastrointestinal parasites of donkeys are highly prevalent and have a high pathogenic potential, and the findings of cestodes and trematodes are not accidental or unusual, as previously suggested.
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Kennedy, Craig. "Impact of telemedicine in a rural community /." St. Lucia, Qld, 2001. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16114.pdf.
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Frean, Isobel. "Modelling communication requirements in aged care using HL7 V3 methods." Access electronically, 2006. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20070221.131236/index.html.
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Hora, Bona. "Analysis and management factors affecting the immunisation programme in Ethiopia : the implications of adopting alternative epidemiological methods." Thesis, University of Leeds, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.293877.
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Adam, Zenaw. "Iron supplementation and malaria : a randomised, placebo-controlled field trial on women and children in rural Ethiopia." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1997. http://researchonline.lshtm.ac.uk/682229/.
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The health situation in Sub-Saharan Africa is complex and multifactorial. Along with its poorly developed economy and lack of basic health services, vector-borne diseases and nutritional disorders are major contributors to the high morbidity and mortality seen today. Malaria and anaemia due to iron deficiency and/or to infectious diseases are rampant in the area affecting its population in general women and children in particular. Although the problem of iron deficiency and anaernia was dealt with varying strategies in different places iron supplementation is widely used in many developing countries and has become a routine procedure in maternal and child health programmes. In recent years, however, there has been a growing concern regarding this approach due to the emergence of conflicting evidence on the health outcome of iron supplementation. In addition to the beneficial effect of iron supplementation, a possible adverse effect on health, particularly on the risk to malaria, has been suggested. The continued controversy has raised doubts as to whether to implement iron supplementation programmes in malaria endemic areas. A randomised, placebo-controlled field trial was conducted in a malaria endemic area in the northwestern part of Ethiopia in May 1993-October 1995 to determine the haernatological response to oral iron supplementation and measure the risk of malarial illness associated with iron. The study involved 776 women and 841 children with low haemoglobin (HB) level who were randomly allocated to receive oral iron or a look alike placebo for a period of 12 weeks. The results of this study showed that anaernia is common in the study population with prevalences of 72.3% and 84.6% among women and children respectively. The content of the staple diet in the area was generally iron insufficient. The dietary iron insufficiency was further realised to be both due to inadequate intake and poor absorption of the iron ingested. The supplementation for 12 weeks was completed by 729 (93.9%) women and 740 (88%) children in the study. After supplementation more women (82.6%) and children (93.5%) in the iron group showed an improvement in their FIB compared with those women (54.6%) and children (43.7%) in the placebo respectively. The mean HB rise was also significantly higher in women and children in the iron than in the placebo group, 1.43 vs 0.28 g/dL, (t= 12.6; p<0.0001) for women and 1.38 vs 0.22 g/dL Q=21.3; p<0.0001) for children respectively. After supplementation women and children with severe anaemia were fewer in the iron (5.1% and 0.3%; x 17.2; p<0.001) than in the placebo group (13.5% and 8.0%; y, 2 =27.9; p<0.001) . After supplementation more women (9.6%) and children (18.2%) in the iron group reached the HB cut-off point showing no anaernia than women (1.4%) and children (9.6%) who received placebo (X2" =23.9; p<0.001 and X2 =34.3; p<0.001 for women and children respectively). Post-supplementation prevalences of clinical malaria among women in the iron and placebo groups were 24.2% and 18.3% respectively (RR=1.3, C1,1.0-1.8). The parasite rate was also higher in the iron supplemented women than those in the placebo, 29.4% and 20.2% respectively (RR=1.47, Cl, 1.4-1.9). During supplementation, women in the iron group experienced more frequent episodes of fever and spent more days with fever than women in the placebo group, (RR=1.16, CI, 1.03-1.30). Similarly, clinical malaria was diagnosed in 19.7% and 13.2% of children in the iron and placebo treatment groups respectively, (RR=1.49, CI, 1.07-2.08). Splenomegaly in children was detected in 27.3% of those in the iron 19.1% of those in the placebo, (RR=1.43, Cl, 1.1-1.9). The parasite rates for iron and placebo supplemented children were 34.5% and 27.1% respectively, (RR=1.28, Cly 1.0-1.6). Febrile episodes were experienced by 68.9% and 58.9% of children in the iron and placebo groups respectively, (RR=1.17; CI, 1.05-1.30. The results indicated not only that the dietary iron intake of the population was inadequate but also was poorly bioavailable due to lack of foods which enhance absorption and due to a high intake of food substances which interfere absorption all of which may have contributed to the anaernia. Study women and children who received iron supplementation have shown a substantial haernatological response (HB rise) and significantly improved their anaemia. The study has also demonstrated that there is a considerable risk of uncomplicated malaria associated with oral iron supplementation as malariometric indices used in this study were all significantly higher among women and children in the iron than in the placebo group. Intervention programmes involving iron supplementation in malaria endemic areas in the future need to weigh the health benefits and the malarial risk attributable to iron. In the present study area,w here nearly all women and children suffer from anaerniaa nd its consequenceso n health, the haematological response to iron supplementation outweighs the associated drawbacks. In such areas oral iron supplementation should therefore continue to be used to prevent and control iron deficiency and anaemia. Public health activities pertaining to the control and prevention of malaria and/or anaernia should, however, protect the population most at risk from malaria when implementing iron supplementation during the malaria transmission seasons.
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Vuza, Xolisa. "Social and technical issues of IP-based multi-modal semi-synchronous communication: rural telehealth communication in South Africa." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
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Most rural areas of developing countries are faced with problems like shortage of doctors in hospitals, illiteracy and poor power supply. Because of these issues, Information and Communication Technology (ICT) is often sees as a useful solution for these areas. Unfortunately, the social environment is often ignored. This leads to inappropriate systems being developed for these areas. The aims of this thesis were firstly, to learn how a communication system can be built for a rural telehealth environment in a developing country, secondly to learn how users can be supported to use such a system.
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Paul, David Lawrence. "Telemedicine : a study of virtual collaboration and trust in hypercompetitive environments /." Digital version accessible at:, 2000. http://wwwlib.umi.com/cr/utexas/main.
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Chan, Susanna. "Effect, safety and cost of insulin adjustment through telecommunication in lieu of frequent clinic visits for diabetic patients : a retrospective study /." Click to view the E-thesis via HKUTO, 2005. http://sunzi.lib.hku.hk/hkuto/record/b39723987.
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Cheung, Hiu-yan, and 張曉欣. "Home telehealth remote monitoring and blood pressure reduction: a meta-analysis of randomized controlledtrials." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46935009.
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Ramakrishnan, Chandrika. "Technology-based interventions in diabetes care, its future implications in young adults: a review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46941435.
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Cilliers, Liezel. "Critical success factors for user acceptance of telemedicine in South Africa." Thesis, University of Fort Hare, 2010. http://hdl.handle.net/10353/384.
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The World Health Organization has recommended Telemedicine to improve health care in developing countries. The objective of this study was to produce Critical Success Factors that will investigate and identify factors that influence the acceptance and continued use of Telemedicine in the Eastern Cape Department of Health, and to suggest ways to sustain this technology from initial adoption (the pilot programme) to full adoption. Sub questions investigated which other facilitating factors, such as management support or previous Information Technology exposure must be present in order for the technology to be adopted successfully. The study made use of a questionnaire to investigate the user acceptance and behaviour of health care workers. A return rate of 76% was achieved. The data was analysed making use of Statistical Package for the Social Sciences (SPSS), specifically the Chi Square test. From these results Critical Success Factors where then formulated to address the problems identified. The Critical Success Factors that were identified include: Implement and disseminate best practice within a legislative framework; Find a champion; Change management strategies; Training; Sustainable finance; Technical issues and Project management principles If these CSFs are addressed before and during the implementation of Telemedicine it will increase the acceptance and use of the technology among health care workers. Critical Success Factors for User Acceptance of Telemedicine in South Africa.
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Harris, Kimberly D. "Acceptance of computer-based telemedicine in three rural Missouri counties /." free to MU campus, to others for purchase, 1999. http://wwwlib.umi.com/cr/mo/fullcit?p9945181.
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Tulu, Assefa Nega. "Determinants of malaria transmission in the highlands of Ethiopia : the impact of global warming on morbidity and mortality ascribed to malaria." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1996. http://researchonline.lshtm.ac.uk/682286/.
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A study was undertaken in Debre Zeit sector, central Ethiopia to identify the most important determinants of malaria transmission with a specific purpose of assessing whether global warming was the main cause of increased morbidity and mortality ascribed to malaria in the highlands of Ethiopia. Both retrospective and prospective methods were employed to conduct the study in 430 localities with a total population of 406,891. Some nine data sets were collected including altitude, malaria incidence and prevalence, hospital morbidity and mortality, outbreaks of malaria, vector control, climate patterns and in-vivo drug resistance mostly on a monthly basis with varying time periods ranging from 1951 to 1993. Morbidity analysis revealed a 67-fold increase in monthly incidence of malaria in about two decades. Mortality patterns showed a 13-fold increase in deaths ascribed to malaria in the last decade alone. Furthermore, highland communities living in localities lying between 2,000 and 2,200 metres were affected by P. falciparum transmission for the first time since 1986. Time series analysis of climate patterns revealed a trend of increased climatic warming in both day-time and night-time temperature especially since 1988, at which time a coincident peak in the incidence rate of malaria was also observed despite a decrease in total rainfall. Each °C rise in monthly mean night-time temperature was associated with up to 64% and 58% estimated rise in monthly incidence of falciparum malaria two and three months later respectively. The historic epidemic of malaria in which 150,000 people were estimated to have died among 3 million cases of malaria in Ethiopia in 1958 was associated with abnormally high ambient temperature and rainfall. This year also saw a very strong El Niño event. A simultaneous peak was seen in incidence of malaria, hospital admissions and hospital deaths ascribed to malaria together with an abnormal rise in mean night-time temperature in 1988. Based on current data it is concluded that epidemics of malaria in the highlands of Ethiopia that were observed during the past decade were mainly due to an increase in night-time temperature. The coincident peak in both malaria and ambient temperature together with statistical evidence suggested that global warming was the main cause of the rise in incidence of highland malaria. This appeared to be the cause of new foci of transmission at high altitude localities while also increasing both the rate and duration of transmission in previously known epidemic-prone areas from highly seasonal to perennial transmission. Furthermore, non-climatic biological and human conditions such as chloroquine resistant falciparum malaria, decreased vector control efforts and large scale population migration were also identified as important factors amplifying the impact of global warming on morbidity and mortality ascribed to highland malaria by affecting more distal parts of the causal pathway.
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Nigatu, Wondatir. "Promotion of oral fluid methods for evaluation and surveillance of the measles immunization programme in Ethiopia." Thesis, University of Warwick, 2002. http://wrap.warwick.ac.uk/2369/.
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This work aims to demonstrate the use of oral-fluid methods in evaluating the effectiveness of a vaccination programme at the individual (vaccine conversion) and population levels (herd immunity and virus transmission and origin) within a developing country context. The setting for this work was Ethiopia- a country beset with huge economic, social and logistical difficulties in vaccine programme implementation. The study comprises the following: First, the development and evaluation of highly sensitive measles specific IgG/IgM ELISAs using oral-fluid, second, the application of these assays to evaluate routine and campaign measles vaccination programmes, and third genotyping of measles virus strains circulating in the country, again using oral-fluid samples. Paired blood and oral fluid samples were obtained from787 individuals of all ages from rural Ethiopia for evaluation of the measles enhanced IgG antibody capture (GAC) enzyme linked immunosorbent assay (ELISA). Relative to serum, oral fluid assay sensitivity and specificity were: 97.4% and 91.1% for measles IgG. This work is the development and evaluation of a new method that has contributed scientifically to vaccination programme evaluation and refinement. Pre- and post-vaccine antibody determined in 296 children attending for routine measles immunization in Addis Ababa suggested the average vaccination age at which 92.6% (200/216) seroconversion rate attained was about nine and half months. Oral-fluid based testing show 87.3% (185/212) seroconversion rate for IgM antibody compared to the 92.6% serconversion rate for serum. This work included the development and use of an oral-fluid enhanced MACELISA as a useful substitute to serum in evaluating vaccine seroconversion. RT-PCR was performed for oral-fluid and serum samples collected from outbreaks and sporadic measles cases across the country to study the molecular genotype characteristics of the strains. Sequence analysis of outbreaks and sporadic case samples revealed that the viruses of the D4, D8 and B3 genotypes were found in the country. This study also demonstrates the practicality of integrating oral-fluid based genotyping into measles surveillance efforts. Pre-campaign survey work carried out in Assella town by collecting oral-fluid samples from 1928 children aged 9-59 months visiting vaccination stations, and post-campaign survey work undertaken by cluster-based random sampling of 750 oral fluid samples from eligible individuals aged between 9 months to <20 years clearly show (i) a shortfall in measles 'immunity 'in the target age group (9-59 months), and (ii) a significant deficit in 'immunity' in those too old to have received the vaccine. This work demonstrates for the first time the merit of oral-fluid sampling in evaluating a measles vaccine campaign. The main achievements summarized above, give weight towards the practicality of using oral fluid in evaluating and refining immunization programmes in the developing country setting. It waits to be seen if the non-invasive technology will gain wider support in the measles control activities.
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Nuramo, Adamu Addissie. "Adoption of 'Rapid Ethical Assessment' as a practical method for assessing ethical issues relating to biomedical research projects in Ethiopia." Thesis, University of Brighton, 2015. http://eprints.brighton.ac.uk/16168/.
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Background: The universal principles of biomedical ethics provide overall guidance which are applicable to all settings. However, the range of ethical issues present in different communities differs subject to variations in ethno-cultural contexts. Rapid Ethical Assessment (REA) is an approach developed to improve context-tailored application of the informed consent process in low-income settings. The tool employs ethnographic and action research techniques to explore and address context specific ethical issues. However, information is lacking on its feasibility and applicability for wide-scale use. This study aimed to explore the need for REA and establish its usefulness for research in Ethiopia and similar settings. The study also aimed to assess feasibility of REA so as to provide further guidance on strategies for its future application. Methods: Pilot REA studies were conducted in three different research projects, 'parent studies', in Ethiopia between 2012 and 2013. The studies employed a range of study designs with multi-disciplinary approach and were conducted in multi-ethnic and multi-cultural settings in Ethiopia. The study disciplines employed ranged from ethics, social science and anthropology to public health. The study designs employed ranged from qualitative, ethnographic and mixed methods to quantitative interventional studies. Results: Qualitative and quantitative studies of research stakeholders indicated presence of gaps in the research consent process in Ethiopia. The need for the REA approach in understanding and addressing these gaps was highlighted. Based on the pilot studies, REA was found to be useful to identify important context-specific ethical issues and contextualizing consent processes for community-based medical research. The ethical issues ranged from general issues such as the cultural setting of the study, perception about research, health and health care practices to perceptions about the research subject matters, and communication dynamics and norms and their hierarchies. REA was associated with improved levels of information comprehension and quality of the informed consent process. REA also appeared to be a feasible intervention in terms of cost, time and skill. REA skills were easily transferrable to local experts and the approach was flexible and adaptable to circumstances, settings and needs. Conclusion: Given clear strategic guidelines, REA is a highly useful approach to identify important ethical issues in research conducted in the Ethiopian context. It is feasible that the approach could be applied at wider scale in such settings. The approach is recommended for further dissemination coupled with continued documentation and validation.
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Kativu, Kevin. "Guidelines for the effective use of telemedicine in public healthcare in resource constrained settings." Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1020061.
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On September 8 2000, world leaders gathered at the United Nations summit and resolved to help citizens in the world's poorest countries to achieve a better life by the year 2015. This resolve was outlined in the Millennium Development Goals that were subsequently published with goals 4, 5 and 6 specific to healthcare. The integration of ICT‘s in the remote delivery of services has opened new avenues from which centralised, scarce resources can be accessed remotely for the benefit of the general population. Telemedicine has made great strides in the developed world with remote populations benefiting from the improved access to healthcare. In the Eastern Cape Province of South Africa, the sub-field of teleradiology has shown promise for enabling the wider delivery of specialist services. However, in resource constrained settings such as developing countries, telemedicine has had limited success and as a result, the equitable access to healthcare for remote populations remains inconceivable. This is exacerbated by the migration of healthcare professionals both domestically and internationally. The public sector has suffered the most with acute staff shortages in the public healthcare institutions, more so in rural and remote areas. This study identifies the prevailing challenges posing as barriers to the effective use of telemedicine services in the Public health sector in resource constrained settings and provides recommendations and guidelines aimed at facilitating the adoption and effective use of telemedicine. Challenges are identified from literature and from the first person accounts of specific role-players who are directly involved with telemedicine in their respective institutions. Participants are drawn from institutions offering telemedicine services within the Eastern Cape Province of South Africa. Challenges identified from literature are collated with those identified from the participant interviews to provide a concise list of factors that is used as input to the recommendation and guideline development process. The results thus far point to an enthusiastic environment coupled with a semi-capable infrastructure but however hampered by staff shortages and a general lack of support structures and propulsion mechanisms to adequately encourage the wider use of telemedicine. The proposed guidelines aim to address the challenges at the different role-player levels.
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Berhane, Fana Hagos. "Prenatal HIV screening of pregnant women in Ethiopia using 'opt-out' approach : the human rights and ethical concerns." Thesis, University of Warwick, 2015. http://wrap.warwick.ac.uk/77134/.
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Following the recommendation of the WHO and UNAIDS the Ethiopian Government revised its guidelines on Prevention of Mother-to-Child Transmission to adopt a routine provider-initiated ‘opt-out’ HIV testing approach to all maternal health care services. The testing approach requires all pregnant women to be provided with HIV test unless they expressly decline it. This thesis examines the human rights and ethical implications of the implementation of this HIV testing approach within the maternal health care settings in Ethiopia to screen pregnant women. It argues that this HIV testing approach may be able to meet the pressing public health imperatives presented by the incidence of HIV in Ethiopia. However, a full understanding of the context in which this testing takes place reveals that, the implementation of this testing approach can result in the denial of pregnant women’s rights to informed consent, to have access to adequate counselling and to ensure confidentiality of their HIV test results. This thesis argues that the implementation of routine provider-initiated ‘opt-out’ HIV testing approach in the maternal health care settings is affected by the weak health system, the feminization of poverty, and the persistence of HIV related stigma and violence as well as gender inequality. The fieldwork undertaken in the Tigray region provided insights into the subjective experiences of women in relation to their ability to make autonomous decisions regarding the HIV test offered during their pregnancies. It involved in-depth semi-structured interviews with pregnant women and key stakeholders as well as non-participatory observation. In addition, the normative and conceptual aspects of human rights and ethical principles inform the thrust of discussions and arguments in this thesis. This thesis concludes that although the HIV testing approach adopted by the Ethiopian Government to screen pregnant women for HIV infections does not violate human rights requirements, its implementation in the context Ethiopian socio- economic, cultural and legal context raises serious concerns. The study therefore recommends that attention must be paid to balancing the scaling up HIV testing of pregnant women in Ethiopia to prevent vertical transmission of HIV and respecting the individual’s rights to make their own medical decisions including refusing the HIV test.
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Li, Yifang, and 李怡芳. "Effectiveness of telemedicine applications for weight management : a meta-analysis of randomized controlled trials." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206938.
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Background
The telemedicine application has great potential to address the prevalence of overweight and obesity, a severe the public healthcare burden in the 21st century. However, no exiting systematic review has been investigated the effectiveness of telemedicine application of weight reduction. The absence of quantitative evaluations and relatively rigorous qualitative assessments explains the carry-out of the present systematic review with a meta-analysis.
Objectives
The objectives are to determine the aggregated effect of thetelemedicine application to the management of overweight and obesity, in particular to investigate the effect of thetelemedicine application on reducing body weight, and to evaluate major contributable factors to commit a successful telemedicine intervention in body weight lowering.
Methods
This meta-analysis is guided by the PRISMA statement, with the automatic and manual searching by input keywords in the main databases. Only RCTs with absolute reduction of body weight as outcome measure, comparing the effect of the telemedicine application interventions with other stated interventions in reducing human body weightare potentially to be included. The selected RCTs are subject to the Jaded scale and the CONSORT for quality assessment. The studies identification and the data extraction were performed by two independent reviewers separately.The heterogeneity across the selected RCTs was assessed by Cochran Q test and I-square statistic. The meta-analysis was conducted with random-effect models and sensitivity analyses were performed by eliminating studies with extreme outcome values. Publication bias was examined through visual inspection of funnel plots and statistical assessments of the Begg‟s rank correlation test and the fail-safe N.
Results
723 studies were identified from the preliminary database searches, 32 full-text articles were retrieved to review, after which, 12 RCTs were subject to the quality assessment process. Only 10 RCTs of high quality were selected into the meta-analysis. The generalizability of the meta-analysis is great since the patients subgroups were broadly from different geographical and cultural settings with the age ranging from 18 to 70, and no comorbidity conditions were excluded. The single element, the telemedicine application intervention, contributed to a significant extra 4.17 kg absolute reduction of human body weight in the average time period of 42 weeks. The outcome of the sensitivity analysis excluding the studies with extreme outcome measures was also consistent with the finding, which means the telemedicine application intervention contributed to a significant extra 2.58 kg absolute reduction of human body weight in the average time period of 46.5 weeks.
Conclusions
The telemedicine application is an effective public health intervention with broad generalizability for weight reduction in the future. Further studies to assess the effect of the telemedicine intervention among the populations of the developing countries, especially the large Chinese population, and to evaluate the confounding effect of the Hawthorne effect are critically important to support the international guideline on the promotion of the telemedicine intervention.published_or_final_version
Public Health
Master
Master of Public Health
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Gideon, Valerie. "Telehealth and citizen involvement." Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=36593.
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Telehealth is defined by Jocelyne Picot as "the use of communications and information technology to deliver health and health care services and information over large and small distances" (Telehealth Industry 1). Current research in telehealth focuses on the evaluation of applications and projects, on the competitiveness of the telehealth industry, and on its role in international development. In contrast, this dissertation contextualizes telehealth in social history and theory. In so doing, it adopts an analytical, cultural studies approach rather than an empirical one. It also studies the extent of citizen involvement in current telehealth initiatives in Canada. More specifically, the dissertation examines whether the forms of involvement promoted by telehealth initiatives empower Canadian citizens. The examination is conducted through a five-step process. The first four steps involve an overview of the following: (1) histories of medical technology; (2) critiques of medical technology; (3) history and critique of the Canadian health care system; (4) critiques of information and communications technology and policy. The fifth step consists in mapping out the current state of telehealth development in Canada, including policy, applications and projects, as well as distinguishing the main roles of citizens in such initiatives. In closing, ways of achieving citizen empowerment through telehealth are suggested, whether it is found to be achieved in recent initiatives or not. Theoretical frameworks with the aim of positioning new technology in order that it may accomplish social change and citizen empowerment are put forward as an innovative means of evaluating current telehealth applications and projects in Canada.
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Li, Man-ying, and 李敏瑩. "The effectiveness of telemedicine in the management of chronic obstructive pulmonary disease: a systematicreview." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46939222.
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Imaniraguha, Alphonsine. "Implementation of medical imaging with telemedicine for the early detection and diagnosis of breast cancer to women in remote areas /." Online version of thesis, 2008. http://hdl.handle.net/1850/8059.
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Aksoy, Onder. "Telemedicine patient identification with RFID : an embedded approach /." Online version of thesis, 2009. http://hdl.handle.net/1850/10747.
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Bekele, Adane Mihret. "Gene expression and cytokine pattern of pulmonary tuberculosis patients and their contacts in Ethiopia." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71942.
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Thesis (PhD)--Stellenbosch University, 2013.ENGLISH ABSTRACT: The immune response against M. tuberculosis is multifactorial, involving a network of innate and adaptive immune responses. Characterization of the immune response, a clear understanding of the dynamics and interplay of different arms of the immune response and the identification of infection-stage specific biomarkers are critical to allow the development of better tools for combating tuberculosis. In an attempt to identify such biomarkers, we studied pulmonary tuberculosis patients and their contacts in Addis Ababa, Ethiopia as part of EDCTP and BMGF funded tuberculosis projects by using multiplex techniques. We analysed 45 genes using the Multiplex Ligation Dependent Probe Amplification (MLPA) technique and the expression of IL-4δ2, BLR1, MARCO, CCL-19, IL7R, Bcl2, FcyR1A, MMP9, and LTF genes discriminate TB cases from their healthy contacts. FoxP3, TGFß1 and CCL-19 discriminate latently infected from uninfected contacts. Single genes predict with an area under the Receiver Operating Characteristic (ROC) curve of 0.68 to 0.85 while a combination of genes identified up to 95% of the different groups. Similarly, the multiplex analysis of cytokines and chemokines also showed that single or combinations of plasma cytokines and chemokines discriminate between different clinical groups accurately. The median plasma level of EGF, fractalkine, IFN-y, IL-4, MCP-3 and IP-10 is significantly different (p<0.05) in active tuberculosis and non active tuberculosis infection and the median plasma levels of IFN-y, IL-4, MCP-3, MIP-1ß and IP-10 were significantly different (p<0.05) before and after treatment. We also found a significant difference (p<0.05) in plasma levels of cytokines of patients infected with the different lineages and different families of the modern lineage. The plasma level of IL-4 was significantly higher in patients infected with lineage 3 (p<0.05) as compared to lineage 4 and the CAS familyinfected patients had a higher plasma level of IL-4 (P<0.05) as compared to patients infected with H and T families but there was no difference between H and T families. We identified genes and cytokines which had been reported from other studies in different settings and we believe that these molecules are very promising biomarkers for classifying active tuberculosis, latent infection, absence of infection and treated infection. These markers may be suitable for the development of clinically useful tools but require further validation and qualification in different populations and in larger studies.
AFRIKAANSE OPSOMMING: Die immuunrespons teen M. tuberculosis is multifaktoriaal en betrek ‘n netwerk van niespesifieke and spesifieke immuunresponse. Karakterisering van die immuunrespons, ‘n duidelike insig in die dinamika en tussenspel deur die verskillende arms van die immuunrespons en die identifikasie van spesifieke biomerkers is krities belangrik om die ontwikkeling van nuwe hulpmiddels teen tuberkulose te bevorder. In ‘n poging om sulke biomerkers te identifiseer het ons pulmonale tuberkulose pasiënte en hulle kontakte in Addis Ababa, Etiopië, as deel van die EDCTP en BMGF befondste tuberkulose projekte bestudeer met multipleks tegnieke. Ons het 45 gene analiseer met ‘Multiplex Ligation Dependent Probe Amplification (MLPA)’ en gevind dat die geenuitdrukking van IL-4•2, BLR1, MARCO, CCL-19, IL7R, Bcl2, Fc•R1A, MMP9, en LTF TB pasiënte van hulle kontakte onderskei. FoxP3, TGF•1 en CCL-19 onderskei tussen latent infekteerde en ongeïnfekteerde kontakte. Enkele gene voorspel met ‘n area onder die ‘Receiver Operating Characteristic (ROC)’ kurwe van 0.68 tot 0.85 terwyl die kombinasie van gene 95% van die verskillende groepe identifiseer. Soortgelyk het multipleks analise van sitokiene en chemokiene verskillende kliniese groepe akkuraat van mekaar onderskei. Die mediane plasmavlakke van EGF, fractalkine, IFN-•, IL-4, MCP-3 en IP-10 is beduidend verskillend (p<0.05) in aktiewe tuberkulose en nie-aktiewe tuberkulose infeksie en die mediane plasmavlak van IFN-•, IL-4, MCP-3, MIP-1• en IP-10 was beduidend verskillend voor en na behandeling. Ons het ook beduidende verskille (p<0.05) in plasmavlakke van sitokiene in pasiënte gevind wat infekteer is met verskillende stamme and verskillende families van die moderne stamme. Die plasmavlak van IL-4 was beduidend hoër in pasiënte wat infekteer is met stam 3 (p<0.05) teenoor stam 4 en die CAS familie-infekteerde pasiënte het ‘n hoër plasmavlak van IL-4 (p<0.05) teenoor pasiënte met H en T familie infeksie hoewel daar geen versikke was tussen die H en T families nie. Ons het gene en sitokiene identifiseer wat deur ander werkers onder verskillende omstandighede ook beskryf is en ons glo dat hierdie molekules baie belowende biomerkers is om aktiewe tuberkulose, latent tuberkulose, die afwesigheid van infeksie en behandelde infeksie van mekaar te onderskei. Hierdie merkers mag toepaslik wees vir die ontwikkeling van bruikbare kliniese hulpmiddele maar benodig verdere validasie en kwalifikasie in verskillende populasiegroepe en in groter studies.
Bill and Melinda Gates Foundation (BMGF)
European and Developing Countries Clinical Trials Partnership (EDCTP)
African European Tuberculosis Consortium (AE TBC).
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Docef, Alen. "Telemedicine applications of subband image coding at very low bit rates." Diss., Georgia Institute of Technology, 1998. http://hdl.handle.net/1853/14776.
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Russell, Trevor G. "Establishing the efficacy of telemedicine as a clinical tool for physiotherapists : from systems design to randomised controlled trial /." [St. Lucia, Qld.], 2004. http://adt.library.uq.edu.au/public/adt-QU20040608.114117/index.html.
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Momanyi, Kevin. "Enhancing quality in social care through economic analysis." Thesis, University of Aberdeen, 2019. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=240815.
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Population ageing has motivated policy makers around the world to focus on how best to organise health and social care services to meet an aniticipated growing demand on services. Two popular initiatives are reablement and telecare. Reablement is an approach within homecare that enables older individuals with social care needs to improve their functional performance and live independently. Telecare, on the other hand, involves use of devices to monitor individuals' health and safety, and provide response when needed. This thesis investigates the effectiveness of reablement and telecare by conducting a comprehensive review of the literature and undertaking three empirical studies. It is composed of six chapters. The first chapter presents a theoretical model that links the demand for reablement and telecare to various outcomes. The model is estimated using a strategy that controls for the effects of confounding variables and unobservable factors, and is general in the sense that it nests several other estimation strategies and study designs as special cases. The next chapter contains the literature review. Chapters 3, 4 and 5 present the three empirical studies. The first study investigates the effect of telecare on independent living at home; the second study determines the relationship between the use of telecare and admission to hospital, while the third study determines the relationship between telecare use and the length of stay in hospital. Chapter 6 concludes the thesis and provides some suggestions for further research. Unlike the results of the previous studies, the findings from this thesis suggest that the treatment effects are not homogenous across the poulation and also vary depending on the type of telecare device under consideration.
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Malindi, Phumzile. "Methods for providing rural telemedicine with quality video transmission." Thesis, Cape Peninsula University of Technology, 2007. http://hdl.handle.net/20.500.11838/1197.
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Thesis (DTech (Electrical engineering))--Cape Peninsula University of Technology, Cape Town, 2007Telemedicine has been identified as a tool to distnllUte medical expertise to medically underserved rural community. However, due to the underdeveloped or non-existent telecommunication infrastructure, which is needed as the platform for telemedicine, the full benefits of telemedicine are yet to be realized in most parts of South Africa and Africa as a whole. This study aims to explore ways on how to provide lP-based lCI system that can be used as a communication platform for telemedicine in rural areas. In order to emulate the onsite face-to-face consultation experience, the rural telemedicine system must be able to provide quality video transmission. Quality video is also important in order for the physician at the distant end to be able to make correct diagnosis. Hence the main focus of this study is on ways ofproviding quality video over lP-based multiservice network. A conceptual model of a rural area network that can be used for rural telemedicine has been deVeloped, and different access technologies that can be used for rural areas are presented. Techniques for compesating IP best effort datagram delivery are provided. Factors that can affect the quality of video transmission on an lP-based packet network are identified, and a holistic approach to mitigate them is proposed. That includes adopting coding techniques that will provide coding efficiency, high quality video that is consistent at high and low bit rates, resilience to transmission errors, scalability, and network friendliness, which will result in perceived quality improvement, highcompression efficiency, and possibility of transportation over different networks. Secondly, it also includes mechanisms to compensate for packet networks idiosyncrasy, especially JP best-effort debilities, in order to meet the latency and jitter requirements of real-time video traffic. For video coding, H.264 is proposed as it meets most of the encoding requirements listed above, and for prioritising and protecting.video traffic from JP network's best-effort debilities a combination of differential services (DiflServ) and multi-protocol label switching (MPLS) have been adopted, where DiflServ is used for traffic classification and MPLS is used for traffic engineering and fast-rerouting in the event of route failure. To verify and validate the proposed solutions, modelling and simulation has been used, where the Network Simulator (NS-2.93) has been used to simulate network functions, and PSNR, VQM score and double stimulus impairment scale (DSIS) have been used for evaluating video quality.
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Chan, Susanna, and 陳智彬. "Effect, safety and cost of insulin adjustment through telecommunication in lieu of frequent clinic visits for diabeticpatients: a retrospective study." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B39723987.
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Borälv, Erik. "Design in telemedicine : development and implementation of usable computer systems /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4760.
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Vasudevan, Sridhar. "Secure telemedicine system for home health care." Morgantown, W. Va. : [West Virginia University Libraries], 2000. http://etd.wvu.edu/templates/showETD.cfm?recnum=1254.
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Thesis (M.S.)--West Virginia University, 2000.Title from document title page. Document formatted into pages; contains vi, 94 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 92-93).
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Dunphy, Gerard Michael. "Requirements analysis of a multimedia patient information system in telemedicine applications." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0029/MQ47447.pdf.
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Brandon, Amy Ford Schuessler Jenny H. "The effects of an advanced practice nurse-led telephone-based intervention upon hospital readmissions, quality of life, and self-care behaviors of heart failure patients." Auburn, Ala, 2008. http://repo.lib.auburn.edu/EtdRoot/2008/SUMMER/Nursing/Thesis/Brandon_Amy_11.pdf.
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Behaimanot, Kibreab Ghebrehiwet. "Video camera design and implementation for telemedicine application." Thesis, Stellenbosch : Stellenbosch University, 2005. http://hdl.handle.net/10019.1/20959.
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Thesis (MScIng)--University of Stellenbosch, 2005.ENGLISH ABSTRACT: Primary health care telemedicine services require the acquisition and transmission of patient data including high quality still and video images via telecommunication networks. The objective of this thesis is to investigate the implementation of a generalpurpose medical camera as an alternative to the complex and costly CCD based cameras generally in use at present. The design is based on FillFactory’s SXGA (1280 ×1024) CMOS image sensor. A low-cost Altera Cyclone FPGA is used for signal interfacing, filtering and colour processing to enhance image quality. A Cypress USB 2.0 interface chip is employed to isochronously transfer video data up to a maximum rate of 23.04 MBytes per second to the PC. A detailed design and video image results are presented and discussed; however the camera will need repackaging and an approval for medical application by medical specialists and concerned bodies before releasing it as full-fledged product.
AFRIKAANSE OPSOMMING: Primêre gesondheidssorg telemedisyne dienste moet hoëkwaliteit televisiebeelde van hul pasiënte verkry deur van telekommunikasienetwerke gebruik te maak. Die doel van hierdie tesis is om die toepassing van n meerdoelige mediese kamera te ondersoek as n alternatief tot duur, komplekse CCD-gebaseerde kameras wat huidiglik gebruik word. Die ontwerp is gebaseer op n hoëkwaliteit CMOS beeldsensor. n Goedkoop Altera Cyclone FPGA word gebruik vir seinkoppelvlak, filtering en kleurprosessering om die kwaliteit van die beeld te verhoog. n Hoëspoed USB 2.0 poort word gebruik om die data teen die nodige spoed te versend. n Gedetailleerde ontwerp, en die beeldresultate word voorgelê en bespreek. Die kamera moet egter eers deur mediese spesialiste en relevante beheerliggame goedgekeur word voordat dit as n volledige produk vrygestel kan word.
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Sankara, Krishnan Shivaranjani. "Delay sensitive delivery of rich images over WLAN in telemedicine applications." Thesis, Atlanta, Ga. : Georgia Institute of Technology, 2009. http://hdl.handle.net/1853/29673.
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Thesis (M. S.)--Electrical and Computer Engineering, Georgia Institute of Technology, 2009.Committee Chair: Jayant, Nikil; Committee Member: Altunbasak, Yucel; Committee Member: Sivakumar, Raghupathy. Part of the SMARTech Electronic Thesis and Dissertation Collection.
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Reid, Noreen. "An action research study to investigate the strategies that can be used by health care professionals, during video consultations with palliative care patients, to enhance the therapeutic alliance." Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/27690.
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Background: The use of telemedicine was gaining momentum. Although the strength of the therapeutic alliance (TA) correlated with treatment outcomes, there was no research exploring the skills, attitudes and behaviours that enhanced the TA during Skype consultations in palliative care. Aims: This study identified the skills, attitudes and behaviours that affected the TA between palliative care patients and health care professionals during Skype consultations and identified strategies that enhanced the TA. Study Design: Two cycles of action research engaged the participants in self-reflective inquiry and encouraged the identification of strategies that enhanced the TA and the Skype experience. Participants: Six health professionals and nine patients were recruited from a Hospice out patient service in one Health Authority in England. Data Collection: Data from the audio-recorded consultation were managed quantitatively and the TA was measured using the Working Alliance Inventory (S). Qualitative data were collected from participant interviews and focus groups attended by the professionals. Data Analysis: The analysis ran in parallel with the data collection, started after the first consultation and all sources of data were cross-referenced. Thematic analysis was used to sequentially code the qualitative data to help identify, examine and record patterns within the data set. Findings: The findings suggested that it was possible to establish and a positive therapeutic alliance between health professionals and palliative care patients when using Skype. There was a shift in perception for those health professionals who had reservations about their ability to establish a therapeutic alliance (TA) via a computer link. It was demonstrated that advanced communication skills were transferrable between face to face and video consultations. No additional communication skills training was needed to enable a strong TA when using Skype. Including some social talk, working with the patient’s as opposed to the professional’s agenda and actively offering solutions improved the Skype experience for the patients. The strategies that health professionals promoted to enhance the TA included using Skype with appropriately selected patients to complement the existing Service. Mandatory training in the effective use of Skype was recommended even for those health professionals who used Skype socially. Clarification to address the challenge of clinical governance was recommended. In keeping with an action research design the change impacted on both the health professionals own practice and the Organisation’s approach to telemedicine. The potential for using action research to engage nurses and doctors in critical self-reflective inquiry and to empower them to be change facilitators was demonstrated. Conclusion: Although a small sample size, this study identified strategies that enhanced the TA during Skype consultations. The findings were significant because they added to the current body of knowledge about using Skype to facilitate consultations within the palliative care population. Additionally, the findings may be transferable to different populations and healthcare contexts.
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Dikweni, Lulama. "An assessment of the health channel broadcasting multimedia for communication and dissemination of information in the health sector." Thesis, Stellenbosch : University of Stellenbosch, 2006. http://hdl.handle.net/10019.1/17349.
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Thesis (MPhil)--University of Stellenbosch, 2006.ENGLISH ABSTRACT: The study reported on here was conducted between December 2003 and April 2004. The aim of the study was to assess the use of Health Channel Broadcast Multimedia (HCBM) in order to maximise its success. The HCBM is an Information Technology method that was used to disseminate health information in public health facilities. HCBM was installed in health facilities and was used as an education tool. This was done by further developing the clinical skills of the health care workers (HCWs) and to inform the patients, including the community members on HIV/AIDS and related communicable diseases. The study was conducted in eight health facilities in seven provinces where HCBM was piloted. Facilities and forty-nine health professionals (HCWs) were selected conveniently and one hundred and twenty-eight patients were sampled using a systematic random method. The convenient sampling method was relevant since these were key facilities with HCBM. There were very few HCWs who did view HCBM and they were drawn into the study. HCBM used programmes disseminating messages in Afrikaans, English, sePedi, seSotho, siSwati, isiXhosa and isiZulu. The Rapid Assessment Response (RAR) approach was used to give a quick appraisal of the study. The report focuses on the cross-sectional reporting of the quantitative technique of the RAR. Of the HCWs, 86% had viewed the broadcast content, 70% were satisfied with the broadcast mode of service delivery; 56% indicated that the messages were good and added educational value to their professional work, while 52% chose to use the IP box content with HIV/AIDS topics. Ninety-two percent of HCWs stated that HCBM targeted patients and young people, 48% said HCBM had the ability to convey information and 48% said it was capable of addressing health problem. When HCBM was being set up, 62% HCWs engaged in decision making. Patients mentioned that HCBM as a method of information dissemination was educative (62%) and informative (52%). They reported that they did hear messages on HIV/AIDS telling them that medication was available for free to treat within 72 hours after being raped (72%); they had the right to say no to unsafe sex (92%); and 76% said the broadcast had the ability to change people’s behaviour. Respondents reported that the messages were easily understood (44%). The conclusion is that the findings will be useful to inform the government and managers of HCBM programmes on how to maximise the success of HCBM, especially at the implementation phase.
AFRIKAANSE OPSOMMING: Hierdie verslag doen verslag oor die resultate van ’n ondersoek wat tussen Desember 2003 en April 2004 onderneem is. Die doel van die verslag is om die doeltreffendheid van die gebruik van ’n multimedia gesondheidsuitsendingkanaal, Health Channel Broadcast Multimedia (HCBM) te bepaal. Hierdie is nuwe tegnologie wat gebruik word om gesondheidsinligting slegs in die openbare gesondheidsektor te versprei. Die studie is by agt openbare gesondheidsfasiliteite in sewe provinsies waar die HCBM volledig gevestig was, onderneem. Nege-en-veertig gesondheidskundiges (HPW’s) is volgens ’n gerieflikheidsteekproef geselekteer, en 128 pasiënte is met behulp van ’n sistematiese ewekansige steekproef geselekteer. Die HCBM het programme gebruik wat boodskappe in Afrikaans, Engels, sePedi, seSotho, siSwati, isiXhosa en isiZulu uitgesaai het. ’n Benadering bekend as die Rapid Assessment Response (RAR) is gebruik om ’n vinnige evaluering van die studie te maak. Die verslag konsentreer op die deursneerapportering van die kwantitatiewe tegniek van die RAR. Van die HPW’s het 85% na die inhoud van die uitsending gekyk, 70% was tevrede met die uitsendingmodus van dienslewering, 56% het aangedui dat die boodskappe goed was en van opvoedkundige waarde in hulle professionele werk, terwyl 52% verkies het om die Internet Platform-inhoud met MIV/Vigs-temas te gebruik. Twee-en-negentig persent van die HPW’s het te kenne gegee die HCBM is gerig op pasiënte en die jeug, 48% het gesê HCBM het die vermoë om inligting oor te dra, en 48% het gesê dit is geskik om na die gesondheidsprobleem om te sien. Tydens die instelling van die HCBM het 62% HPW’s aan besluitneming deelgeneem. Van die pasiënte met grade 0–6 as opvoedingspeil het 75% verkies om brosjures te gebruik bo enige ander massamedia, en 72% mans en 67% vrouens het na boodskappe oor die behandeling van MIV/Vigs-simptome geluister. Inligting oor vrywillige berading en toetsing voor swangerskap is deur 66% van die vrouens gehoor. Meer as 90% van hulle was bewus van die reg om nee te sê vir seks of onveilige seks. Pasiënte oor die hele residensiële gebied was dit eens dat die taalgebruik in die uitsendings maklik verstaanbaar was. Oor al die opvoedkundige grade heen is saamgestem dat die HCBM die voorgenome boodskap oorgedra het. Die gevolgtrekking is dat die bevindings waardevol is om die regering en bestuurders van die uitsendingsprogram in te lig oor hoe om die ander fases te verbeter. Dit sluit Fase 2 in, wat die uitvoering van die HCBM behels.
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Deetjen, Ulrike. "Internet use and health : a mixed methods analysis using spatial microsimulation and interviews." Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:92b1d35c-1aed-435d-8daa-18b1cd9ccaa1.
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Internet use is considered a lever for empowering patients, levelling inequalities and reducing healthcare expenditure. However, with digital inclusion, health provision quality and health system efficiency high on the UK and EU policy agendas, we need to better understand the relationship between Internet use and health outcomes to assess potential benefits and adverse effects. This research addresses the question of how Internet use influences individuals' health service use and their perceived health in the context of England. Focusing on health information-seeking, it analyses variations across different kinds of users, mechanisms between Internet use and both health outcomes, and the role of individual and contextual factors in this relationship. To answer this question, this research uses a mixed methods approach. Quantitative data from the Oxford Internet Surveys (OxIS), the English census and Hospital Episode Statistics (HES) was connected through spatial microsimulation based on output areas. Qualitative data was collected through semi-structured, face-to-face interviews, primarily with former OxIS participants from output areas in the quantitative strand. The quantitative data was revisited based on emerging interview themes. The results indicate that Internet use influences perceived health and health service use via various mechanisms based on the Internet's content, mediation and connection affordances. However, the boundaries between users and non-users are blurry and outcomes vary for different types of individuals, classified here as learners, pragmatists, sceptics, worriers, delegators and adigitals. Age, education, socioeconomic status, long-term health conditions, and geographic context influence Internet use and health outcomes separately, while the social context shapes their relationship too. These findings advance the theoretical understanding of Internet-based health outcomes, and provide practical implications for health professionals and policymakers with insights down to the local level. Moreover, this research demonstrates how novel insights for public wellbeing can be derived from qualitatively enriched secondary data in privacy-preserving and cost-effective ways.
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Lockwood, Lauren. "Introduction of pneumococcal conjugate vaccination in Ethiopia: a cross-sectional analysis of predictors of vaccine use in children aged 12-23 months using Demographic and Health Survey data from 2016." Thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-352902.
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Vu, Manh Tuan. "Feasibility, acceptability and utilization of a moblie cardiovascular risk factor profile e-platform amongst physicians and patients in HongKong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B47869823.
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Study methods: Mixed-method study design was used to investigate feasibility of implementing a mobile-phone based behavioural intervention to reduce CVD risk factors among the Chinese population. Patients, who were 45-79 years old, fair English literacy, had access to a JAVA enabled mobile phone and had no mental health problems, cognitive impairment or severe illness, were eligible to the study.
Intervention: Patients recruited from three settings (1 GP, 1 specialist and 1 public clinics) had the study software installed to their phone. The software enabled patients to access their CVD risk profiles (including weight, BP, HbA1c, and lipoprotein profile), 10-year CVD risk prediction (based on Framingham Cardiac Risk Score), and pre-set behavioural recommendations. Patients’ CVD risk profiles were updated at 1-month and 3-month follow-up when their test results were available. Patients were alerted with healthy behaviours recommendations.
Outcomes: Outcomes were measured at baseline and 3-month follow-up. Clinical outcomes included Cardiac Risk Factor Score and its components (BMI, Systolic & Diastolic BP, total cholesterol, HDL and HbA1c). Two sets of questionnaires were used to measure knowledge, risk reduction behaviour and attitude toward usefulness of medical records (pre-intervention) and perceived ease of use, usefulness, satisfaction and utilisation of the software (post-intervention).
Results and Discussion: 19 patients were recruited at baseline. 75% (14) aged 45-55 years, 58% (11) were male, 79% (15) had secondary or lower education, 63% (12) were married, and 95% (18) never smoked. Patients’ understanding about CVD risk factors and risk reduction behaviour was moderate. Patients’ attitude toward electronic medical record was positive. Overall patients’ perception of usefulness, ease of use and satisfaction with the software was satisfactory. Post-intervention, a decreasing trend was observed in patients’ CVD risk profiles i.e. weight, BMI, SBP&DBP, HbA1c and Lipoprotein profile.
Focus group discussions revealed that there was a mismatch between physicians and patients perspectives about the use of mobile phone in a behavioural intervention. Physicians tended to express their concern about the quality of records, security of technology, and patients’ actual benefit, while patients showed little concern about security and great excitement about further use of mobile phone technology in assisting their disease self-management. The public sector physicians admitted that their patients were passive in term of seeking information about their health. Patients were willing to use this software for future care if it could provide more real-time data, tailored recommendations for behavioural change, and an interactive communication tool with their physicians. Physicians would like to try the software if it could ease patient-management process, especially enhance patient-physician communication, and be a decision support system to help them keep track with changes that their patients made.
Conclusion: This pilot study has provided preliminary evidence of the feasibility, acceptability, and utility of an e-platform in primary interventions for CVD in Hong Kong.published_or_final_version
Community Medicine
Master
Master of Philosophy
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Asfaw, Abay. "Costs of illness, demand for medical care, and the prospect of community health insurance schemes in the rural areas of Ethiopia /." Frankfurt am Main : Lang, 2003. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=010171224&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Pira, Rahim S. "Supporting asynchronous telemedicine : electronic mail vs. the world wide web vs. replicated databases /." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0007/MQ42422.pdf.
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Duffield, Tyler Cole. "A comparison of paper-pencil versus video-conferencing administration of a neurobehavioral screening test." Master's thesis, University of Central Florida, 2011. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/4882.
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Regardless of the reason, many patients/clients do not have access to face-to-face medical, neuropsychological, or mental health consultation, assessment, or treatment (Cowain, 2001). The term Remote Neuropsychological Assessment (RNA) has been proposed by Browndyke to denote the general use of telecommunication and Internet-based technologies in neuropsychological assessment and practice (as cited in Schatz & Browndyke, 2002). RNA (Telemedicine) offers a plausible, potentially cost-effective solution to individuals in need of medical, neuropsychological, or mental health consultation, assessment, or treatment that are located in geographical areas away from the specialist (Armstrong, 2006; Berman, 2005; Cowain, 2001; Jacobsen, Sprenger, Andersson, & Krogstad, 2003). The purpose of this study was to examine if test performance for RNA administration of the Cognistat is comparable to test performance for the pencil-paper administration. A one-way repeated measures multivariate analysis of variance (MANOVA) was used to analyze the data. The main effect for administration modality was not significant, F(9, 126) = .375, p = .945. The present study demonstrated the utility of a widely used neurobehavioral screening test that provides a differentiated profile of cognitive status can now reliably be used through a video-conferencing administration. The importance of this finding is that a more comprehensive detection of deficits in multiple domains of cognitive functioning for screening purposes is now possible remotely.ID: 030422907; System requirements: World Wide Web browser and PDF reader.; Mode of access: World Wide Web.; Thesis (M.A.)--University of Central Florida, 2011.; Includes bibliographical references (p. 38-40).
M.A.
Masters
Psychology
Sciences
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Dini, Samira. "Women's Empowerment a Determinant for Contraceptive use among women in Ethiopia : A secondary analysis of Ethiopian Demographic and Health Survey from 2016." Thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-421621.
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Ethiopia has one of the largest populations in the world, an estimate of 114 million inhabitants. With more than 40% of the population below the age of 15 the country has to make further progress in meeting its family planning needs. The fertility rate has slowly declined, but the population continues to grow. Efforts to reduce gender disparities and empower women have fallen short in many parts of the world. Evidence suggesting a link between women’s empowerment, health outcomes and health care service utilization. A secondary analysis of the 2016 Ethiopian Demographic and Health Survey was conducted. The aim of this study was to determine the association between women’s empowerment, sociodemographic and reproductive factors and contraceptive use among married women and women living with partner aged 15-49 in Ethiopia. Logistic regression, bivariate, and descriptive analysis was conducted. Decision-making role in regard to husband’s money was a strong predictor for contraceptive use. Women who alone or jointly made decision were more likely to use contraceptives. The state of wealth of women was a significant determinant for contraceptive use. Those with lower education were more likely to use contraceptives compared to those with higher education. Women who did not intend to have more children were more likely to use contraceptives. This study showed that contraceptive use is associated with women’s economic decision-making age, and several sociodemographic and reproductive factors. Improving women’s empowerment, through decision making power can improve contraceptive use and therefore achieve better maternal health.
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Petratos, Anastasia. "An ICT strategy to support a patient-centred approach to diabetes care." Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/14466.
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Factors such as poverty, ethnicity, socio-economic status, poor infrastructure and governance, etc., are some of the reasons that effective and proven prevention and treatment interventions for most of the major causes of mortality and morbidity in the developing world continue to fail. Chronic diseases require complex interventions that these countries simply cannot maintain. Diabetes mellitus (DM) is a chronic disease that is on the rise worldwide. This disease is a lifestyle disease, which means, that it is brought on by poor health habits. Statistics show that 285 million (6.4%) people aged between 20 and 79 years will be affected by Diabetes in 2010 and a staggering 439 million (7.7%) by 2030. This is a projected growth of 69% in developing countries and 20% in developed countries. The findings from studies conducted from 1993 to 2003 in Sub-Saharan Africa, particularly in South Africa, around the health care services for diabetes highlights many challenges. Sadly, the challenges 10 years after that study, are very similar. The conditions of people with Diabetes can be improved through regular monitoring of patients, improvement and monitoring of health care provided, education on healthy lifestyle, as well as education on the importance of adherence to treatment plans for the successful management of the condition. The diabetes endemic in South Africa is exacerbated by the manual functions that are performed in all aspects of monitoring and management of the disease. With the advancements that have been made in ICT and the many apps that already exist for healthcare, it is sensible to state that ICT can assist in the monitoring and management of diabetes. Another factor that is considered is that of patient-centred care. The huge number of people who need acute care and treatment in hospitals and clinics have forced a previously caring environment, to turn into a cold, almost production line affair. The sick wait in long queues and are ushered in and out of the consulting rooms as fast as possible without even as much as a “hallo”. This has left a void in the healthcare delivery to South Africans which should never have been removed in the first place, namely patient-centred care. This means that the patient is at the centre of the treatment and fully involved in the decisions about his/her health. Every patient deserves to be recognised as a human-being and treated with dignity and respect. Treatment plans for long term chronic care patients such as diabetics, should be thoroughly discussed with the patient and they should believe and comit themselves to the treatment plan. These plans are life-long and require dedication and as it is vital that patients are part of decision making and understand fully what they are expected to do. Bearing this in mind, this study has investigated the needs and care plans for people with diabetes. Specialist in the field of diabetes were interviewed and recognised care plans for diabetes such as those from WHO, IDF and SEMSDA were studied. This study also established, that by practising a patient-centred approach the adherence to a treatment plan is likely to be higher. The strategy developed involves the person with diabetes, the healthcare worker and the support structure in the care plan of the diabetic. The use of ICT as part of the solution must consider the patient-centred requirements for using IT so that the people using the strategy are comfortable and not intimidated by the technology. The need to incorporate e-health into governments’ healthcare plans has been growing over the last decade. The GSMA conducted research into mobile health opportunities in South Africa and found that SA now has a penetration of 98% and that this is the ideal medium to address the inaccessibility and inequality of healthcare in SA. The causes identified as playing a major role in the rise in diabetes were identified and it was determined that through the implementation of an ICT strategy for diabetes care, many of these can be addressed. These include the use of technology for, improved monitoring and management, increased diabetes awareness and education, and promotion of healthy lifestyle. The study focuses on the self-management aspect of diabetes and produces a strategy that incorporates various ICT solutions that would assist in the daily aspects of diabetes care, as well as follow a patient-centred approach to diabetes care. This strategy developed in this study does not need any intervention from government as it is driven by the people who have diabetes and their healthcare workers, with the aid of the technology that they currently have on hand.
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Berge, Mari S. "Challenges and possibilities in telecare : realist evaluation of a Norwegian telecare project." Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/26094.
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This thesis reports from a telecare evaluation in a Norwegian municipality (2012-2016). The project was established to provide domestic results from a hitherto new field in the country to underpin future policy. This evaluation includes pre- and post-implementation data collection, which has been scarce in telecare. The methodological approach was realist evaluation that seeks to explore how telecare works, for whom, why and in which circumstances – or why it does not work. The research aimed to explore the hypothesis elicited from national policy documents: ‘If telecare is used, then people are enabled to remain safe in their own home for longer’. Various methods were used to gather data from multiple stakeholders as they have different knowledge about how the implementation developed. The methods in this evaluation included literature reviews, observations, and sequential interviews with users and relatives in addition to sequential focus groups with frontline staff. Realist evaluation was particularly suitable in demonstrating how and why telecare is useful to some users but not to others. Telecare had to match users’ abilities and needs for them to benefit from it. Telecare operates in a dynamic context, and therefore requires adjustment according to the user’s current situation, taking into account changes as they occur. This appears to have been often underestimated. Telecare holds a different position from other devices and technologies in people’s everyday life, which also needs to be acknowledged. Correct assessment is significant for users to obtain the intended effect from telecare. When telecare is correctly adjusted to users, it increases safety, which is essential for enabling older people to remain living at home. Several challenges in establishing telecare projects are identified and alternative ways to understand multi-disciplinary partnerships are suggested. By using realist evaluation the findings are nuanced and point to elements that are significant for achieving the intended outcomes.
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Triegaardt, Myra. "Picture archiving and communication systems in the South African public healthcare environment : a suitable structure and guidelines to assist implementation and optimisation." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/85615.
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Thesis (MScEng)-- Stellenbosch University, 2013.ENGLISH ABSTRACT: South Africa has a great number of patients and not enough medical expertise to attend to their patient needs. The South African Department of Health (DoH) has recognised the potential benefit of the Picture Archiving and Communication System (PACS) to address the health needs of rural patients who do not have access to specialised medical care. PACS allows specialist remote access to patient information to assist the diagnosis and treatment process remotely. South African healthcare institutions have been implementing PACS for over a decade, in an attempt to address the health needs of rural patients that do not have access to specialised medical care. Despite numerous deployment attempts, and the DoH’s support for PACS, the system is not operating successfully in South Africa. PACS was chosen due to its proven success as an appropriate technical system in most international hospitals of first and third- world countries (van Wetering, 2008) (Horri, 2010). However, specifications, guidelines and best practice operational methods for the appropriate PACS technical structure are lacking in South African literature and in governmental strategies. Additionally, there are no guidelines for implementation or support for hospital decision makers to manage the system and enterprise change. The purpose of this thesis is to (a) define a PACS technical and operational structure suited for the South African public healthcare environment and, (b) to develop guidelines for implementation and optimisation of PACS for managing the system and the enterprise change and progressively reach the defined structure. A combination of literature research, field observations and focus group discussions led to the understanding of the current (“As-Is”) PACS healthcare delivery system in South Africa and its barriers. Three types of PACS structures were found to be currently available: a DICOM-only image management system; a vendor supplied PACS; and a super-PACS. It was found that currently very few PACS systems in South Africa are operational and integrated with other healthcare institutions. This was due to a combination of factors: a) the complex, long chain of interdependent process steps and domains; b) vendor imposed limitations and propriety data formats; in combination with c) a lack of governing standards to ensure integration of digital PACS systems within the healthcare delivery environment; and lastly d) key decision makers lack the expert knowledge necessary to make informed decisions to deploy and manage PACS optimally. Further research led to establishing the (“To-Be”) PACS technical and operational structure suited for the South African public healthcare environment. Research has shown that the suited PACS technical and operational structure is a hospital-owned PACS system, free from vendor-imposed limits. The system consists of two databases, one with patient information and the other with patient images. The two databases are integrated by a hospital-owned server, which accesses the separate data files by means of patient identity keys. The requirements for the PACS implementation and optimisation guidelines for managing the system and the enterprise change to progressively reach the defined structure were developed. Different Enterprise Architectural Frameworks, as improvement and optimisation guidelines, were considered and compared in accordance with the requirements established. A maturity model (MM) was deemed as the appropriate framework to offer guidelines for managing PACS implementation and optimisation in the public medical sector of South Africa. After establishing that the available MMs were not sufficient in process or technical system detail, a new MM was developed for the deployment and maturation of PACS. The study was validated by means of usability study, user acceptance and goal checking, through focus group discussion and expert review. Users found the model to be a suitable deployment and optimisation guide, as well as a strategic planning tool. Verification was achieved by means of requirement analysis and consistency checking through the focus group discussions. It was found that it is needed to define a PACS technical and operational structure is suited for the South African public healthcare environment and that the guidelines for implementation and optimisation of PACS for managing the system and the enterprise needs to change to reach the defined structure functional. Implementing the use of PACS MM to reach the defined structure in South Africa will assist in improving healthcare delivery in South Africa and improving PACS system operation.
AFRIKAANSE OPSOMMING: Suid-Afrika het 'n groot aantal pasiënte en nie genoeg mediese kundiges om aan hul pasiënt behoeftes te voorsien nie. Die Suid-Afrikaanse Departement van Gesondheid (DvG) erken die potensiële voordeel van ‘n Foto Argief en Kommunikasie Stelsel (PACS) om die gesondheidsbehoeftes van alle Suid-Afrikaners aan te spreek – tot die landelike pasiënte wat nie toegang tot gespesialiseerde mediese sorg het nie. PACS laat spesialiste toe om toegang te kry tot afgeleë pasiënt inligting, en daardeur fasiliteer dit die diagnose- en behandelingsproses. Suid-Afrikaanse gesondheidsorginstellings poog al vir meer as ‘n dekade om PACS te implementeer, om daardeur die gesondheidsbehoeftes van landelike pasiënte wat nie toegang tot gespesialiseerde mediese sorg het nie, aan te spreek. Ten spyte van talle ontplooiings pogings, en die DvG se steun vir PACS, is die stelsel steeds nie suksesvol in Suid-Afrika nie. PACS is gekies as ‘n oplossing, as gevolg van die sisteem se bewese sukses as 'n geskikte tegniese stelsel in meeste internasionale hospitale in eerste en derde wêreld lande (van Wetering, 2008) (Horri, 2010). Suid-Afrikaanse regering strategie en literatuur het egter ‘n gebrek aan spesifikasies, riglyne en beste- praktyk operasionele metodes vir die toepaslike PACS tegniese struktuur. Benewens is daar geen riglyne vir die implementering en ondersteuning van die stelsel en die onderneming se verandering vir hospitaal besluitnemers nie. Die doel van hierdie tesis is om (a) 'n PACS tegniese en operasionele struktuur, geskik vir die Suid-Afrikaanse openbare gesondheidsorg omgewing te definieer, en (b) riglyne vir die implementering en afronding van PACS vir die bestuur van die stelsel en die onderneming se verandering teen doel om progressief die gedefinieerde struktuur te bereik. 'n Kombinasie van literatuur navorsing, veldwaarnemings en fokusgroepbesprekings het gelei tot die begrip van die huidige ("as- is") PACS gesondheidsorg proses in Suid-Afrika en die hindernisse daarvan. Drie tipes PACS strukture is tans beskikbaar in SA: 'n DICOM (net-mediese- beelde) beheer stelsel, 'n verkoper verskafde PACS, en 'n super-PACS. Deur uitgebreide navorsing is daar gevind dat baie min PACS stelsels in Suid-Afrika tans operasioneel en geïntegreer is met ander gesondheidsorg instellings. Dit was te danke aan 'n kombinasie van faktore: a) die kompleks, lang ketting van interafhanklike proses stappe en gebiede; b) ondernemer opgelê beperkings en ordentlikheid data formate; in kombinasie met c) 'n gebrek aan beheer standaarde integrasie van digitale PACS stelsels om te verseker binne die lewering van gesondheidsorg-omgewing, en laastens d) sleutel besluitnemers nie die deskundige kennis wat nodig is om ingeligte besluite te sit en te bestuur PACS optimaal te benut. Verdere navorsing het gelei tot die vestigting van die geskikde("to-be") PACS tegniese en operasionele struktuur, vir die Suid-Afrikaanse openbare gesondheidsorg omgewing. Die geskik PACS tegniese en operasionele struktuur bestaan uit ‘n hospitaal-besitde PACS stelsel, vry van ondernemer-opgelegde grense. Die stelsel bestaan uit twee databasisse, een met 'n pasiënt inligting en die ander met dei pasiënte se mediese beelde. Die twee databasisse geïntegreer deur 'n hospitaal-besitde-rekenaarbediener, wat toegang tot die afsonderlike data lêers het deur middel van die unieke pasiënt nommers. Die vereistes vir die PACS implementering en afrondings riglyne, vir die bestuur van die stelsel en die ondernemings veranderinge, is ontwikkel. Verskillende ondernimings argitektuur raamwerke is oorweeg en vergelyking in terme van hulle vermoe om aan die gesigde vereistes et voldoen. As ‘n resultaat is die volwassenheid model (MM) beskou as die toepaslike raamwerk om riglyne vir die bestuur van PACS implementering en afronding in die openbare mediese sektor van Suid-Afrika te bied. Na die beskikbare MMs geasseseer was en nie voldoende bewys is, was 'n nuwe MM ontwikkel vir die implementeering en afronding van PACS. Die studie was gevalideer deur middel van die bruikbaarheid studie, gebruikers aanvaarding en doelwit asseseering, deur middel van fokusgroep besprekings en kundige oorsig. Gebruikers het gevind dat die model geskikte as implementeerings en afrondings gids, sowel as 'n geskikte strategiese beplanning hulpmiddel is. Verifikasie is bereik deur middel van vereiste-ontleding en konsekwentheid analiseering deur die fokusgroep besprekings en spesifikasie analise. Die PACS tegniese en operasionele struktuur wat definieer was, is geskik vir die Suid-Afrikaanse openbare gesondheidsorg omgewing en dat die riglyne vir die implementering en afronding van PACS funksioneel is . Die implementering en gebruik van die gedefinieerde struktuur deur mideel van die PACS MM in Suid-Afrika, sal help in die verbetering van gesondheidsorg dienslewering en die verbetering van PACS stelsel operasie.