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Search Results: 1 - 10 of 3082 matches for " Tony Reid "
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Providing HIV care in the aftermath of Kenya's post-election violence Medecins Sans Frontieres' lessons learned January – March 2008
Tony Reid, Ian van Engelgem, Barbara Telfer, Marcel Manzi
Conflict and Health , 2008, DOI: 10.1186/1752-1505-2-15
Abstract: Following the disputed presidential election in Kenya in December 2007, widespread violence broke out resulting in an estimated 1500 people killed and 600,000 displaced from their homes.[1] Although problems had occurred during previous elections, this level of violence was unprecedented in Kenya, a country regarded as a model of democracy and stability. The rapid escalation of events caught many services off guard, and health care was significantly disrupted.The violence was particularly severe in Kibera, a large slum near Nairobi where Medecins Sans Frontieres (MSF) has been operating three primary health care centers. Medical services in these areas were rapidly affected and there was concern that patients with HIV, in particular, would be unable to obtain their medications, resulting in treatment interruption. The problem was compounded since many patients and health care staff had returned to their home villages to vote, and were prevented from returning to Nairobi due to the violence.MSF's three clinics in Kibera had been providing comprehensive primary care in addition to full HIV services, including Highly Active AntiRetroviral Therapy (HAART) for several years. By the end of 2007, 5200 patients were enrolled in the HIV program and 1800 were on HAART. [2]This report describes MSF's response to the challenges of providing HIV services in Kibera slum during the post-election violence. The experience produced some lessons learned that could apply to other contexts that are generally stable but where violence or disorder may be anticipated.Kibera is home to approximately 800,000 people, many of whom are transient and without regular employment. There are very limited municipal services such as sewage and electricity. MSF has been working there for ten years and at the time of the election was operating three health centers; two provided full primary care services with a comprehensive HIV program (Kibera South and Silanga Health Centres) while a third (Gatwekera)
The Role of Packaging Size on Contamination Rates during Simulated Presentation to a Sterile Field
Tony Trier, Nora Bello, Tamara Reid Bush, Laura Bix
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0100414
Abstract: Objective The objective of this study was to assess the impact of package size on the contact between medical devices and non-sterile surfaces (i.e. the hands of the practitioner and the outside of the package) during aseptic presentation to a simulated sterile field. Rationale for this objective stems from the decades-long problem of hospital-acquired infections. This work approaches the problem from a unique perspective, namely packaging size. Design Randomized complete block design with subsampling. Setting Research study conducted at professional conferences for surgical technologists and nursing professionals. Participants Ninety-seven healthcare providers, primarily surgical technologists and nurses. Methods Participants were gloved and asked to present the contents of six pouches of three different sizes to a simulated sterile field. The exterior of pouches and gloves of participants were coated with a simulated contaminant prior to each opening trial. After presentation to the simulated sterile field, the presence of the contaminant on package contents was recorded as indicative of contact with non-sterile surfaces and analyzed in a binary fashion using a generalized linear mixed model. Results Recruited subjects were 26–64 years of age (81 females, 16 males), with 2.5–44 years of professional experience. Results indicated a significant main effect of pouch size on contact rate of package contents (P = 0.0108), whereby larger pouches induced greater rates of contact than smaller pouches (estimates±SEM: 14.7±2.9% vs. 6.0±1.7%, respectively). Discussion and Conclusion This study utilized novel methodologies which simulate contamination in aseptic presentation. Results of this work indicate that increased contamination rates are associated with larger pouches when compared to smaller pouches. The results add to a growing body of research which investigate packaging's role in serving as a pathway for product contamination during aseptic presentation. Future work should investigate other packaging design factors (e.g. material, rigidity, and closure systems) and their role in contamination.
Implementation of a comprehensive program including psycho-social and treatment literacy activities to improve adherence to HIV care and treatment for a pediatric population in Kenya
Joelle Van Winghem, Barbara Telfer, Tony Reid, Judith Ouko, Angela Mutunga, Zaina Jama, Shobha Vakil
BMC Pediatrics , 2008, DOI: 10.1186/1471-2431-8-52
Abstract: We based our program on factors reported to influence adherence to HIV care and treatment. We describe, in detail, our program with respect to how we adapted our clinical settings, implemented psycho-social support activities for children and their caregivers and developed treatment literacy for children and teenagers living with HIV/AIDS.This paper focused on the details of the program, with the treatment outcomes as secondary. However, our program appeared to have been effective; for 648 children under 15 years of age who were started on HAART, the Kaplan-Meier mortality survival estimate was 95.27% (95%CI 93.16–96.74) at 12 months after the time of initiation of HAART.Our model of pediatric HIV/AIDS care, focused on a child-centered approach with inclusion of caregivers and extended family, addressed the main factors influencing treatment adherence. It appeared to produce good results and is replicable in resource-limited settings.While the overall prevalence of Human Immunodeficiency Virus (HIV) infection in Kenya was reported to have declined to 5.1% in 2006, an estimated 102,000 children under 15 years of age were living with HIV, of whom about 6000 received highly active antiretroviral therapy (HAART).[1,2] In resource limited settings, HAART has produced good results in the treatment of HIV in children.[3-7] In Kenya, increased access to free HIV-rapid testing, PCR testing and, since June 2006, free HAART, has reduced mortality among children living with HIV.[2]To achieve good clinical outcomes from HAART, patient adherence to treatment and care is a key feature. [8] Adherence is also important to reduce the risk of development of drug resistant strains of HIV.[8] For children living with HIV, a number of studies have emphasized the importance of patient and caregiver psychosocial support to optimise adherence to treatment and care. [9-13] Children are vulnerable and feel stress differently from adults. For instance, they are often dependent on caregivers, o
Success with antiretroviral treatment for children in Kigali, Rwanda: Experience with health center/nurse-based care
Johan van Griensven, Ludwig De Naeyer, Jeanine Uwera, Anita Asiimwe, Claire Gazille, Tony Reid
BMC Pediatrics , 2008, DOI: 10.1186/1471-2431-8-39
Abstract: Program treatment and outcome data were reported from two government-run health centers that were supported by Médecins Sans Frontières (MSF) in Kigali, Rwanda between October 2003 and June 2007. Interviews were held with health center staff and MSF program records were reviewed to describe the organization of the program. Important aspects included adequate training and supervision of nurses to manage ARV treatment. The program also emphasized family-centered care addressing the psychosocial needs of both caregivers and children to encourage early diagnosis, good adherence and follow-up.A total of 315 children (< 15 years) were started on ARVs, at a median age of 7.2 years (range: 0.7–14.9). Sixty percent were in WHO clinical stage I/II, with a median CD4% of 14%. Eighty-nine percent (n = 281) started a stavudine-containing regimen, mainly using the adult fixed-dose combination. The median follow-up time after ARV initiation was 2 years (interquartile range 1.2–2.6). Eighty-four percent (n = 265) of children were still on treatment in the program. Thirty (9.5%) were transferred out, eight (2.6%) died and 12 (3.8%) were lost to follow-up. An important feature of the study was that viral loads were done at a median time period of 18 months after starting ARVs and were available for 87% of the children. Of the 174 samples, VL was < 400 copies/ml in 82.8% (n = 144). Two children were started on second-line ARVs. Treatment was changed due to toxicity for 26 children (8.3%), mainly related to nevirapine.This report suggests that providing ARVs to children in a health center/nurse-based program is both feasible and very effective. Adequate numbers and training of nursing staff and an emphasis on the psychosocial needs of caregivers and children have been key elements for the successful scaling-up of ARVs at this level of the health system.Treatment of children with the acquired immunodeficiency syndrome (AIDS) using antiretroviral drugs (ARVs) has been a major challenge i
Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation
Sophie Lambert-Evans, Frederique Ponsar, Tony Reid, Catherine Bachy, Michel Van Herp, Mit Philips
International Journal for Equity in Health , 2009, DOI: 10.1186/1475-9276-8-36
Abstract: An evaluation was carried out in 2005 to assess the impact of this project. Primary data collection was through a cross-sectional household survey of the catchment areas of 10 public health centres. A questionnaire was used to determine the accuracy of the community-identification method, households' access to health care, and costs of care. Household socioeconomic status was determined by reported expenditures and access to land.Financial access to care at the nearest health centre was ensured for 70% of the population. Of the remaining 30%, half experienced financial barriers to access and the other half chose alternative sites of care. The community-based assessment increased the number of people of the population who qualified for fee exemptions to 8.6% but many people who met the indigent criteria did not receive a card. Eighty-eight percent of the population lived under the poverty threshold. Referring to the last sickness episode, 87% of households reported having no money available and 25% risked further impoverishment because of healthcare costs even with the financial support system in place.The flat fee policy was found to reduce cost barriers for some households but, given the generalized poverty in the area, the fee still posed a significant financial burden. This report showed the limits of a programme of fee exemption for indigent households and a flat fee for others in a context of widespread poverty.Although the political situation in Burundi has now stabilised, the civil conflict of 1993-2003 deeply affected the country's inhabitants and infrastructure, particularly the health care system. In order to help rebuild the system, a countrywide cost recovery was implemented in 2002 along with a national policy where the communal authorities were supposed to issue exemption certificates for the poorest who could not afford health care costs [1]. Despite this plan, significant financial barriers to access health care continued to exist. A Save the Childre
Low referral completion of rapid diagnostic test-negative patients in community-based treatment of malaria in Sierra Leone
Anna Thomson, Mohammed Khogali, Martin de Smet, Tony Reid, Ahmed Mukhtar, Stefan Peterson, Johan von Schreeb
Malaria Journal , 2011, DOI: 10.1186/1475-2875-10-94
Abstract: In MSF's operational area in Bo and Pujehun districts, Sierra Leone, a retrospective analysis of referral records was carried out for a period of three months. All referral records from CMVs and referral health structures were reviewed, compared and matched for personal data. The eligible study population included febrile children between three and 59 months and pregnant women in their second or third trimester with fever who were noted as having received a referral advice in the CMV recording form.The study results showed a total referral rate of almost 15%. During the study period 36 out of 2,459 (1.5%) referred patients completed their referral. There was a significant difference in referral compliance between patients with fever but a negative RDT and patients with signs of severe malaria. Less than 1% (21/2,442) of the RDT-negative patients with fever completed their referral compared to 88.2% (15/17) of the patients with severe malaria (RR = 0.010 95% CI 0.006 - 0.015).In this community-based malaria programme, RDT-negative patients with fever were referred to a health structure for further diagnosis and care with a disappointingly low rate of referral completion. This raises concerns whether use of CMVs, with referral as backup in RDT-negative cases, provides adequate care for febrile children and pregnant women. To improve the referral completion in MSF's community-based malaria programme in Sierra Leone, and in similar community-based programmes, a suitable strategy needs to be defined.Malaria is one of the leading causes of mortality and morbidity among children in Sub-Saharan Africa. The disease causes nearly 800,000 deaths per year, most of which are in children under five years of age [1]. Sierra Leone has one of the highest under-five mortality rates in the world, corresponding to 269 deaths per 1,000 live births [2]. Malaria is hyper-endemic and one of the main killers in children under five years of age in the country [3]. Due to the high chloroquine
Family Background and Environment, Psychological Distress, and Juvenile Delinquency  [PDF]
Tony Cassidy
Psychology (PSYCH) , 2011, DOI: 10.4236/psych.2011.29142
Abstract: The relationship between youth offending and family background is still unclear in the literature. This study explored the role of family factors and psychological distress in relation to delinquency and youth offending to try and explicate the relative importance of family structure, family relations, and psychological distress. The study used the Brief Symptom Inventory, the Family Environment Scale, and the Delinquency Scale in a structured interview format to measure psychological distress, family structure and relations, and levels of youth offending, in 219 older children and adolescents aged between 12-17 years living in areas associated with high levels of youth offending in the UK. Analysis involved correlations, hierarchical multiple regression and analysis of variance. Family relations were the best predictors of delinquency and were also correlated with psychological distress. The relationship between delinquency and psychological distress indicated that participants with more psychological distress were less likely to be involved in criminal behaviour. The study supports the conclusion that youth offending and psychological distress are both influenced by a range of factors in the family, but may be unrelated to each other.
Digital Renaissance: The Creative Potential of Narrative Technology in Education  [PDF]
Tony Hall
Creative Education (CE) , 2012, DOI: 10.4236/ce.2012.31016
Abstract: This paper outlines research which explores the potential of narrative technology: the synergy of storytelling and computing to enhance creativity and creative education. The paper outlines the theoretical basis of the research: n?ogenic narrative, which is informed by contemporary debates and themes in the educational sciences. These include narrativity and storytelling in education; and positive and humanistic psychology. Furthermore, from an empirical/practical perspective, a number of examples of narrative technology are presented and discussed. These exemplify the principal ways in which narrative technology has been deployed in the research-enhanced teaching outlined in this paper: as both a pedagogical, and as a reflective methodology. The paper concludes with insights regarding the deployment of narrative technology to enhance creativity and creative education; and how the synergy of storytelling and computing is potentially affording new possibilities for a digital renaissance in education and educational technology.
The Spirit of Motivational Interviewing as an Apparatus of Governmentality. An Analysis of Reading Materials Used in the Training of Substance Abuse Clinicians  [PDF]
Tony Carton
Sociology Mind (SM) , 2014, DOI: 10.4236/sm.2014.42019
Abstract:

Substance abuse clinicians working at the coal face with clients daily are confronted with client problems that are robust and tangible. The understanding of these problems is granted epistemological and ontological legitimacy by the psy-sciences. As a result, practice in the substance abuse treatment and addiction fields are rarely subject to the scrutiny provided by post-structural analysis. Moreover, the disciplines of addiction treatment and sociology rarely collaborate in any meaningful way for numerous reasons. For the AoD clinician caught betwixt and between biological psychological and sociological discourses, there has been a tendency to opt for the perceived problem solving capabilities of psychological discourses. However, in a post-aetiological hemisphere, attention is increasingly fixated on the fiscal imperative. Clinician/Client relationships have been reconfigured in neo-liberal society. In this study, materials used to train undergraduate students Motivational Interviewing skills in an Alcohol and Drug degree programme were subject to a textual analysis deploying the Foucaultian concept of governmentality. The familiar aetiological descriptor model used in the field was transposed into the Foucaultian term discourse. One article subject to analysis is presented here. The intention was to interrogate the effects of Motivational Interviewing on client and clinician and the resultant repositioning. It was found that Motivational Interviewing technologies reposition the client as an active self-governing autonomous subject while the clinician is professionally and spiritually imprecated in the manufacture of a neo liberal subjectivity within the client. It is

Counselling: The Current Opium of the People?  [PDF]
Tony Carton
Sociology Mind (SM) , 2015, DOI: 10.4236/sm.2015.52011
Abstract: Western religion’s propensity to stultify holiness and the sacred is eclipsed in the profession of counselling. With its fundamentalist enthralment with the individual self, this poster-girl of liberalism, through its central modusoperandi, language has achieved a privileged rhetoric thereby relegating itself to the dustbin of history certainly in Western society. It is less a “sigh of the oppressed soul” (Marx, 1978) as the empowerment of an opportunistic harlotry that energises the profession in a neoliberal marketplace with discourses of social justice routinely cheapened and ideologically hijacked. The author designates a genealogy of this ascendant plummet learnt through retrospective insight. Counsellors have not only unconditionally accepted tablets of stone around truths but also binaries of truths. Interrogating several sacred cows in the profession including the concept of burnout, the should/need dichotomy and the parallel process he apprehends a trajectory chronicling nodal points and concluding that many undertakings within counselling serve increasingly to perpetuate a political-non-political conflation with marketplace morality idealised as liberalism morphs seamlessly into neoliberalism. What descends from a neoliberal paradise are reconfigurations of dichotomies not” of our choosing” (Marx, 1978) but of our own choice. Willingly with the anesthetising of any coherent Judeo-Christian impulses we opt for the sanctity of a vacuous Starbuck spirituality as liberalism or religion in its “degutted” version (Eagleton, 2009: p. 41) enacts the comfort of the afflicted but never the affliction of the comfortable.
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