Academia Mental Health and Well-Being, Oct 8, 2024
High rates of sexual and gender related violence (SGRV) against girls occur in sub-Saharan Africa... more High rates of sexual and gender related violence (SGRV) against girls occur in sub-Saharan Africa. SGRV generates fear, anxiety and depression and leads to multiple adverse outcomes; its pervasive nature constitutes a significant public health crisis; the need for effective interventions is evident as currently-applied programs have known limitations and 1 in 3 women still suffer gender-based violence in their lifetime. This report reviews the challenge and mental health impact of the high prevalence of SGRV reported in sub-Saharan Africa, summarizes the strength and weaknesses of currently-applied interventions, and describes preliminary data from a novel social empowerment intervention piloted in Uganda which achieved nationwide reach. Girls were engaged in high schools to identify the SGRV issues they saw as priorities. A music video was recorded by celebrity artists with scenarios to illustrate these issues and promote positive interventions; this used the framework for Education-Entertainment media, a validated form of health promotion. The video and theme song were made accessible across Uganda through free viewing and streaming via social media, and promoted nationally through concert performances and broadcasts. Over 12 months the video was viewed 36,651 times on YouTube and generated >200,000 comments posted on social media; streaming platforms saw 113,757 individuals download the song; >310,000 people at major concerts heard the song performed; and eight national TV and radio stations each broadcast the video or song at least 30 times reaching a combined audience of >9,500,000. We can only hypothesize on the extent of the mental health benefit achieved. However, there are urgent calls and a clear need for effective interventions. Hence, we suggest our data indicating significant reach, and the inherent merit of a preventive intervention warrant further consideration of this music video model. In future, other countries can produce region-specific and population-focused versions to meet the global need for targeted interventions to address SGRV and enhance mental health support for those living in fear of sexual violence.
Journal of Developmental Origins of Health and Disease, 2017
A challenge for implementing DOHaD-defined health promotion is how to engage the at-risk populati... more A challenge for implementing DOHaD-defined health promotion is how to engage the at-risk population. The WHO Health Promoting School (HPS) model has proven success engaging youth and improving health behaviors. Hence, we introduced DOHaD concepts to 151 pupils aged 12–15 years in three HPS programs in rural Uganda, inquired what factors would make DOHaD-related health promotion resonate with them, and discussed how they recommended making learning about DOHaD acceptable to youth. Economic factors were judged the most compelling; with nutrition and responsive care elements next in importance. Suggested approaches included: teach how good health is beneficial, what works and why, and give tools to use to achieve it, and make information positive rather than linked to later harm. Involve youth in making DOHaD learning happen, make being a parent sound interesting, and include issues meaningful to boys. These are the first data from youth charged with addressing their engagement in the ...
Background There is widespread dissatisfaction with the status quo of health care. However, the p... more Background There is widespread dissatisfaction with the status quo of health care. However, the priorities seen by youth and their ideas for improvement are rarely sought even though they are the policy makers and consumers of the future. Method A workshop on health was included in “UBC Connect 2005 - Learning and the World,” a UBC summer camp intended to attract able high school seniors towards higher education. Groups of high school participants were tasked with identifying problems and priorities for domestic and third world health care and proposing strategies for improvement. These data were content coded. Participants completed a questionnaire ranking issues as 1 = strongly agree (SA); 2 = agree (A); 3 = neutral (N); 4 = disagree (D); 5 = strongly disagree (SD). Results Subjects; 17 participants; 10 grade 10, 5 grade 11, 2 grade 12; 9 female, 8 male. Questions: Shortage of doctors and nurses requires action (16 SA, 1 A); aid worldwide health care strategies (11 SA, 4 A, 1 N, 1 D); involve youth in deciding future care options (7 SA, 10 A); status quo of health care is unacceptable (4 SA, 11 A, 2 N; innovations are required not just repairs (1 SA, 9 A, 5 N, 2 S D), rewarding those who follow healthy lifestyles (15 SA, 1 A, 1 N); legislation to follow proven preventive care (14 SA, 2 A, 1 N); legislation to allow the choice of euthanasia (10 SA, 1 A, 2 N, 2 D, 2 SD); a levy for third world health care in my premium (7 SA, 6 A, 2 N, 2 D); legislation to limit how many children I have (6 SA, 7 A, 2 N, 2 D); legislation for genetic screening in pregnancy (5 SA, 5 A, 3 N, 3 D, 1 SD); a lifetime health credit to be used as I choose (5 SA, 6 A, 6 N); legislation to make organ donation obligatory (4 SA, 7 A, 4 N, 2 D). Issues that need to be urgently addressed are identified in rank order: Domestic: funding and more efficient spending; staff shortages; waiting lists: more medical education places; more rural facilities; support for aging population Developing world: education; access to basic health care; clean water; medical education; funding and compassion from first world; immunization; staff and facility shortages: HIV Strategies: promote healthy lifestyle (remove vending machines, ban tobacco, less fast food, motivate to exercise); increase training places MDs and RNs; promote immunization and organ donation; drop-in fees; integrate physicians trained abroad. Conclusions Youth are aware of, interested in, and informed about the status quo of health care and have valid and novel suggestions. We would do well to engage them.
Pulse oximeters optimize care in the pre-hospital setting. As British Columbia ambulance teams of... more Pulse oximeters optimize care in the pre-hospital setting. As British Columbia ambulance teams often provide care in subzero temperatures, we conducted a study to determine the reliability of 3 commercially-available portable oximeters in a subzero environment. We hypothesized that there is no significant difference between SaO2 readings obtained using a pulse oximeter at room temperature and a pulse oximeter operating at sub-zero temperatures. Subjects were stable normothermic children in intensive care on Hewlett Packard monitors (control unit) at room temperature. The test units were packed in dry ice in an insulated bin (temperature - 15 degrees C to -30 degrees C) and their sensors placed on the subjects, contralateral to the control sensors. Data were collected simultaneously from test and control units immediately following validation of control unit values by co-oximetry (blood gas). No data were unacceptable. Two units (Propaq 106EC and Nonin 8500N) functioned well to < ...
perceptions include beliefs that Medicaid patients generally have poorer health, higher rates of ... more perceptions include beliefs that Medicaid patients generally have poorer health, higher rates of complications, and worse outcomes and are more likely to become involved in legal issues. The maximum physician reimbursement for TKA from Medicare was $1,225.44; the maximum reimbursement rate from Medicaid was $908.72. In contrast, the maximum physician reimbursement from a PPO was $2,073.76. Conclusion: Medicareand PPO-insured patients have roughly equal access to orthopedic surgeons when seeking TKA, whereas Medicaid beneficiaries have significantly less access. Although the uninsured appear to have equal access, the financial costs of physician visits likely serve as a barrier to prevent equal access to orthopedic surgery services. The access gap appears to be a function of low physician reimbursement rates and physician perceptions of Medicaid patients.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 1987
Over 22 million visitors attended the 1986 world exposition in Vancouver, and this had a signific... more Over 22 million visitors attended the 1986 world exposition in Vancouver, and this had a significant impact on the local pediatric facility. A total of 559 children visited the emergency department of British Columbia's Children's Hospital with injuries or illnesses resulting from the fair. Of these, 193 (34%) had come directly from the site. The children's ages ranged from 1 1/2 months to 18 years, 4 months (mean 6.99 years). Of the 559 children 31% were not covered by medical insurance. Twenty-four of the children were admitted to the hospital, and one died at the Expo site. Most of the illnesses were upper respiratory tract infections and gastroenteritis. The proportion of visits for trauma was 50%, compared with the yearly average of 25%. There was a 6% increase in the workload in the emergency department during the fair; the percentage was even higher during July and August, particularly after 1800 hours. Recommendations are made to aid with the planning of medical ...
Canadian family physician Medecin de famille canadien, 1988
Sudden unexpected death is a traumatic event for all concerned, but it is of benefit to a family ... more Sudden unexpected death is a traumatic event for all concerned, but it is of benefit to a family to have a family physician who knows the family, is available, and can put to use previously established rapport. Commonly, however, the family of the child and the physician at the hospital meet as strangers. Professionals in the Emergency Room or Intensive Care setting can be particularly effective in promoting positive bereavement outcomes, as effective early interventions make healthy and appropriate grief responses more likely for all family members.(1-3) Consequently, guidelines for appropriate intervention should be available, whether to the family's long-standing physician or to an unfamiliar physician meeting the family for the first time in an emergency situation.
Background: Near infrared spectroscopy (NIRS) is used to quantify multiple physiologic measures; ... more Background: Near infrared spectroscopy (NIRS) is used to quantify multiple physiologic measures; several of these are applied to optimize muscle training regimens in elite athletes. However, pelvic floor muscle training (PMFT), the definitive therapy for urge urinary incontinence (UUI) due to PFM damage/dysfunction in women, lacks quantifiable measures beyond simple pressure manometry. A NIRS interface able to transvaginally monitor the PFM bilaterally has been developed; we now describe a method to quantify oxygen kinetics in the PFM. Methods: The NIRS interface (interoptode distance 20 mm) enables dual-channel monitoring at 10 Hz during PFM sustained maximal voluntary contraction (SMVC) with a 4-wavelength (766nm, 861nm, 906nm 971nm) continuous wave instrument. Changes in oxy and deoxy-hemoglobin concentration (O2Hb/HHb) in the right and left PFM were used to derive HbDiff (O2Hb - HHb). Established HbDiff half-recovery time (½RT) methodology was then applied to quantify PFM reoxyg...
Academia Mental Health and Well-Being, Oct 8, 2024
High rates of sexual and gender related violence (SGRV) against girls occur in sub-Saharan Africa... more High rates of sexual and gender related violence (SGRV) against girls occur in sub-Saharan Africa. SGRV generates fear, anxiety and depression and leads to multiple adverse outcomes; its pervasive nature constitutes a significant public health crisis; the need for effective interventions is evident as currently-applied programs have known limitations and 1 in 3 women still suffer gender-based violence in their lifetime. This report reviews the challenge and mental health impact of the high prevalence of SGRV reported in sub-Saharan Africa, summarizes the strength and weaknesses of currently-applied interventions, and describes preliminary data from a novel social empowerment intervention piloted in Uganda which achieved nationwide reach. Girls were engaged in high schools to identify the SGRV issues they saw as priorities. A music video was recorded by celebrity artists with scenarios to illustrate these issues and promote positive interventions; this used the framework for Education-Entertainment media, a validated form of health promotion. The video and theme song were made accessible across Uganda through free viewing and streaming via social media, and promoted nationally through concert performances and broadcasts. Over 12 months the video was viewed 36,651 times on YouTube and generated >200,000 comments posted on social media; streaming platforms saw 113,757 individuals download the song; >310,000 people at major concerts heard the song performed; and eight national TV and radio stations each broadcast the video or song at least 30 times reaching a combined audience of >9,500,000. We can only hypothesize on the extent of the mental health benefit achieved. However, there are urgent calls and a clear need for effective interventions. Hence, we suggest our data indicating significant reach, and the inherent merit of a preventive intervention warrant further consideration of this music video model. In future, other countries can produce region-specific and population-focused versions to meet the global need for targeted interventions to address SGRV and enhance mental health support for those living in fear of sexual violence.
Journal of Developmental Origins of Health and Disease, 2017
A challenge for implementing DOHaD-defined health promotion is how to engage the at-risk populati... more A challenge for implementing DOHaD-defined health promotion is how to engage the at-risk population. The WHO Health Promoting School (HPS) model has proven success engaging youth and improving health behaviors. Hence, we introduced DOHaD concepts to 151 pupils aged 12–15 years in three HPS programs in rural Uganda, inquired what factors would make DOHaD-related health promotion resonate with them, and discussed how they recommended making learning about DOHaD acceptable to youth. Economic factors were judged the most compelling; with nutrition and responsive care elements next in importance. Suggested approaches included: teach how good health is beneficial, what works and why, and give tools to use to achieve it, and make information positive rather than linked to later harm. Involve youth in making DOHaD learning happen, make being a parent sound interesting, and include issues meaningful to boys. These are the first data from youth charged with addressing their engagement in the ...
Background There is widespread dissatisfaction with the status quo of health care. However, the p... more Background There is widespread dissatisfaction with the status quo of health care. However, the priorities seen by youth and their ideas for improvement are rarely sought even though they are the policy makers and consumers of the future. Method A workshop on health was included in “UBC Connect 2005 - Learning and the World,” a UBC summer camp intended to attract able high school seniors towards higher education. Groups of high school participants were tasked with identifying problems and priorities for domestic and third world health care and proposing strategies for improvement. These data were content coded. Participants completed a questionnaire ranking issues as 1 = strongly agree (SA); 2 = agree (A); 3 = neutral (N); 4 = disagree (D); 5 = strongly disagree (SD). Results Subjects; 17 participants; 10 grade 10, 5 grade 11, 2 grade 12; 9 female, 8 male. Questions: Shortage of doctors and nurses requires action (16 SA, 1 A); aid worldwide health care strategies (11 SA, 4 A, 1 N, 1 D); involve youth in deciding future care options (7 SA, 10 A); status quo of health care is unacceptable (4 SA, 11 A, 2 N; innovations are required not just repairs (1 SA, 9 A, 5 N, 2 S D), rewarding those who follow healthy lifestyles (15 SA, 1 A, 1 N); legislation to follow proven preventive care (14 SA, 2 A, 1 N); legislation to allow the choice of euthanasia (10 SA, 1 A, 2 N, 2 D, 2 SD); a levy for third world health care in my premium (7 SA, 6 A, 2 N, 2 D); legislation to limit how many children I have (6 SA, 7 A, 2 N, 2 D); legislation for genetic screening in pregnancy (5 SA, 5 A, 3 N, 3 D, 1 SD); a lifetime health credit to be used as I choose (5 SA, 6 A, 6 N); legislation to make organ donation obligatory (4 SA, 7 A, 4 N, 2 D). Issues that need to be urgently addressed are identified in rank order: Domestic: funding and more efficient spending; staff shortages; waiting lists: more medical education places; more rural facilities; support for aging population Developing world: education; access to basic health care; clean water; medical education; funding and compassion from first world; immunization; staff and facility shortages: HIV Strategies: promote healthy lifestyle (remove vending machines, ban tobacco, less fast food, motivate to exercise); increase training places MDs and RNs; promote immunization and organ donation; drop-in fees; integrate physicians trained abroad. Conclusions Youth are aware of, interested in, and informed about the status quo of health care and have valid and novel suggestions. We would do well to engage them.
Pulse oximeters optimize care in the pre-hospital setting. As British Columbia ambulance teams of... more Pulse oximeters optimize care in the pre-hospital setting. As British Columbia ambulance teams often provide care in subzero temperatures, we conducted a study to determine the reliability of 3 commercially-available portable oximeters in a subzero environment. We hypothesized that there is no significant difference between SaO2 readings obtained using a pulse oximeter at room temperature and a pulse oximeter operating at sub-zero temperatures. Subjects were stable normothermic children in intensive care on Hewlett Packard monitors (control unit) at room temperature. The test units were packed in dry ice in an insulated bin (temperature - 15 degrees C to -30 degrees C) and their sensors placed on the subjects, contralateral to the control sensors. Data were collected simultaneously from test and control units immediately following validation of control unit values by co-oximetry (blood gas). No data were unacceptable. Two units (Propaq 106EC and Nonin 8500N) functioned well to < ...
perceptions include beliefs that Medicaid patients generally have poorer health, higher rates of ... more perceptions include beliefs that Medicaid patients generally have poorer health, higher rates of complications, and worse outcomes and are more likely to become involved in legal issues. The maximum physician reimbursement for TKA from Medicare was $1,225.44; the maximum reimbursement rate from Medicaid was $908.72. In contrast, the maximum physician reimbursement from a PPO was $2,073.76. Conclusion: Medicareand PPO-insured patients have roughly equal access to orthopedic surgeons when seeking TKA, whereas Medicaid beneficiaries have significantly less access. Although the uninsured appear to have equal access, the financial costs of physician visits likely serve as a barrier to prevent equal access to orthopedic surgery services. The access gap appears to be a function of low physician reimbursement rates and physician perceptions of Medicaid patients.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 1987
Over 22 million visitors attended the 1986 world exposition in Vancouver, and this had a signific... more Over 22 million visitors attended the 1986 world exposition in Vancouver, and this had a significant impact on the local pediatric facility. A total of 559 children visited the emergency department of British Columbia's Children's Hospital with injuries or illnesses resulting from the fair. Of these, 193 (34%) had come directly from the site. The children's ages ranged from 1 1/2 months to 18 years, 4 months (mean 6.99 years). Of the 559 children 31% were not covered by medical insurance. Twenty-four of the children were admitted to the hospital, and one died at the Expo site. Most of the illnesses were upper respiratory tract infections and gastroenteritis. The proportion of visits for trauma was 50%, compared with the yearly average of 25%. There was a 6% increase in the workload in the emergency department during the fair; the percentage was even higher during July and August, particularly after 1800 hours. Recommendations are made to aid with the planning of medical ...
Canadian family physician Medecin de famille canadien, 1988
Sudden unexpected death is a traumatic event for all concerned, but it is of benefit to a family ... more Sudden unexpected death is a traumatic event for all concerned, but it is of benefit to a family to have a family physician who knows the family, is available, and can put to use previously established rapport. Commonly, however, the family of the child and the physician at the hospital meet as strangers. Professionals in the Emergency Room or Intensive Care setting can be particularly effective in promoting positive bereavement outcomes, as effective early interventions make healthy and appropriate grief responses more likely for all family members.(1-3) Consequently, guidelines for appropriate intervention should be available, whether to the family's long-standing physician or to an unfamiliar physician meeting the family for the first time in an emergency situation.
Background: Near infrared spectroscopy (NIRS) is used to quantify multiple physiologic measures; ... more Background: Near infrared spectroscopy (NIRS) is used to quantify multiple physiologic measures; several of these are applied to optimize muscle training regimens in elite athletes. However, pelvic floor muscle training (PMFT), the definitive therapy for urge urinary incontinence (UUI) due to PFM damage/dysfunction in women, lacks quantifiable measures beyond simple pressure manometry. A NIRS interface able to transvaginally monitor the PFM bilaterally has been developed; we now describe a method to quantify oxygen kinetics in the PFM. Methods: The NIRS interface (interoptode distance 20 mm) enables dual-channel monitoring at 10 Hz during PFM sustained maximal voluntary contraction (SMVC) with a 4-wavelength (766nm, 861nm, 906nm 971nm) continuous wave instrument. Changes in oxy and deoxy-hemoglobin concentration (O2Hb/HHb) in the right and left PFM were used to derive HbDiff (O2Hb - HHb). Established HbDiff half-recovery time (½RT) methodology was then applied to quantify PFM reoxyg...
Uploads
Papers by Andrew Macnab