Revolutionary progress in healthcare over the last 100 years has aided humanity in addressing critical vulnerabilities due to infectious and chronic diseases. Developments in pharmaceutics, medical technology, and practice have disproportionately but universally increased the life expectancy of people in all countries. Coupled with improved life expectancy, the exponential trend of population growth has driven encroachment on the habitats of other earth-dwelling species increasing the chances of zoonotic transmission of novel diseases. As population growth has begun to slow and taper, new generations of healthcare professionals entering the field today face the unique challenge of addressing the increasing occurrences of novel disease outbreaks in the context of a disproportionately increasing elderly population as large cohorts of existing generations age past their physiological prime and become increasingly immuno-vulnerable. The current care context focuses on secondary and tertiary levels of care in fragmented supply-chain-driven health systems usually centralized to hospitals or ambulatory health centers known as healthcare “silos”. Such downstream models are unsustainable as it faces well-known capacity issues, most recently demonstrated by the COVID-19 pandemic, and are expensive to scale and maintain, making it especially difficult for developing countries to model and develop. To mitigate capacity issues, improve society’s overall health, and be able to detect and address health emergencies quickly, more emphasis must be placed on primary-level health systems. Integrating these systems at the community level can decentralize the burden of care from “silos” and develop early monitoring, detection, and response systems, significantly improving access to quality care. Primary-level health system models which revolve around the professionalization of community health workers (CHW), an umbrella term used to describe the age-long practice of community-based care by designated healers, have been regaining attention in recent years as innovative health leaders and global health partners have established several successful programs worldwide. CHWs are trusted community members with a deep understanding of their community’s dynamics, language, experiences, and, importantly, their needs. In this capacity, CHWs are very effective in establishing a dynamic relationship between the patient community and healthcare providers essential to better assessing and understanding community needs, constructively strategizing approaches to address these needs, and effectively delivering care to all. As a community-based approach, CHWs decentralize the locus of care from silo facilities and empower communities to take ownership of their stake in the local health ecosystem to improve the access, trust, and quality of care bilaterally, which leads to a more empowered, effective, and sustainable health system level necessary to address the increasing burden of disease. In recognition of the stark disparity in access to quality healthcare globally, the World Health Organization (WHO) focused 16 of 17 Sustainable Development Goals (SDG) on topics, directly and indirectly, related to improving a population’s access to quality healthcare. The third SDG focuses exclusively on improving health and wellbeing for all at all ages, which includes the “Framework on integrated, people-centered health services” (IPCHS), a strategy passed by the Health Assembly in 2016. This strategy is designed to reorient fragmented supply-chain-driven health systems towards a more cross-sectoral health system centered around the people and communities it serves; to provide responsive services both within and beyond hospital settings irrespective of development status (WHO, 2016). The IPCHS presents a detailed framework with a variety of goals in working towards achieving an integrated people-centered health system, which serves as the primary evaluation framework of this thesis. This thesis reviews studies on CHW programs globally, presenting evaluations on how and which IPCHS goals CHWs can attain and how CHW programs can be utilized to achieve a more sustainable integrated people-centered health system.

Air pollution is a significant issue around the world, with dense concentrations of pollutants leading to decreased visibility and increased temperatures. This situation can lead to many negative health outcomes, such as respiratory illnesses, cardiac diseases, and mental health disorders. Two notable negative mental health outcomes are major depressive disorder (MDD) and anxiety. These conditions are prevalent around the world, and they have the capacity to be exacerbated by pollution. This paper examined various studies in the literature on the associations between air pollution and MDD and anxiety, the length of exposure to pollution and how it can affect health outcomes, and two biological-level mechanisms for the onset of MDD and anxiety. These studies incorporated questionnaires designed to assess MDD and anxiety symptom severity. Air pollution was measured using air monitors to determine the density of each pollutant. Various spatial analyses were performed to evaluate personal exposure to air pollution. These studies all produced findings that were consistent with the idea that air pollution either leads to or exacerbates MDD and anxiety; however, further work is necessary to establish significant associations. The main pollutant in these studies was particulate matter with a diameter less than 2.5 microns (PM2.5). Because of its microscopic size, PM2.5 can travel deep into the human body. These studies concluded that long-term exposure, past exposure, and childhood exposure lead to conditions of MDD and anxiety. In addition, MDD and anxiety mediated the relationship between air pollution and cognitive function, resulting in a decrease in cognitive function. Air purifiers were shown to reduce PM2.5 levels in the air that resulted in a decrease in glucocorticoids and catecholamines which are typically associated with anxiety. These findings suggest that mitigation efforts aimed at reducing air pollution can lessen the prevalence and intensity of MDD and anxiety.

There is an increase in the number of adolescents and young people who are growing up with HIV across the globe. These adolescents and young people are transitioning into adulthood with the pandemic, which necessitates research on the experiences of growing up with HIV and how caregivers manage raising these children. This study explored experiences of adolescents and young people living with HIV by examining the context of growing up with HIV, how caregivers manage raising HIV positive adolescents and young people and the overall management of paediatric HIV. The research investigated a) how adolescents and young people experience the process of HIV disclosure; b) the experiences of adolescents and young people and caregivers with the different healing systems i.e., biomedical, religious, and traditional healing systems; c) how adolescents and young people and caregivers navigate, experience, and manage living with HIV as a chronic illness; and d) some of the key social and cultural practices and contexts that HIVpositive adolescents and young people and their caregivers must negotiate in managing HIV infection. This research was conducted in Khayelitsha Township in Cape Town. Different stakeholders who work on paediatric HIV Khayelitsha were purposively and conveniently sampled to participate in the research. Furthermore, adolescents and young people between the ages of 14 – 24, who were vertically infected and whose HIV status has been fully disclosed and their caregivers participated in the research. Qualitative methods including participant observation, semi-structured interviews were conducted, and participatory research methods including the River of Life maps and Vision Boards and WhatsApp were used. The study design used a mini-ethnographic, longitudinal study which included action research, used a grounded theory approach to interview and conduct the analysis. The data was transcribed analysed thematically to understand the patterns of the emerging data. A further analysis was conducted using NVivo QSR software. The research findings highlight the importance of understanding the complex biomedical, social, and cultural components of HIV and how those intersect with social contexts of raising HIV positive adolescents and young people. The thesis documents the significance of disclosure of HIV status to adolescents and young people as a starting point to retaining them in care. The process of disclosure is noted as complex for the adolescents and young people, their caregivers and for the different people they have relationships with including their extended families, friends, partners, communities, and their schools. This research also maps out the day-to-day experiences of adolescents and young people who know they are growing up with HIV to understand their social context. This social context explores the different facets of life that these adolescents and young people navigate as they seek to make sense of their lives while growing up with HIV. Furthermore, this thesis documents the different ways in which communities understand the concept of healing and health, and how these concepts intersect. The research the points at which the different belief systems interact with how people understand being healthy and the interplay between the biomedical, traditional, and spiritual understandings of being healthy. People's engagement with the different systems of healing are important for HIV management. Participants also created vignettes illustrating their river of lives journey and vision boards depicting their dreams and aspirations. Key recommendations were made about how to further understand the different facets of HIV and how a holistic public health approach that is tailored for adolescents and young people growing up with HIV can facilitate improved HIV management.

This paper explores the existing prevalence data from migraine studies of the efficacy of over-the-counter medications compared to the demographic information from pharmacological studies of migraine medications. A literature review using PubMed with keywords related to migraine, over the counter, medication, and prevalence. Studies were then reviewed for demographic data including biological sex, age, socioeconomic status, insurance status, ethnicity, and race. Review of the available literature revealed notable differences in demographic data including biological sex, age, socioeconomic status, insurance status, ethnicity, and race between prevalence in the general American population when compared to demographics from over-the-counter migraine medication studies. The current medical literature on the efficacy of migraine treatment with medication may not be representative of a large portion of migraine sufferers in the United States. Studies of over-the-counter medications should be repeated with a focus on recruiting from yet underrepresented demographic populations which prevalence data strongly suggests are also suffering from migraine.

The study examined the association of antisocial personality disorder (ASPD), compared to syndromal adult antisocial behavior without childhood conduct disorder, with time to and severity of first posttreatment lapse to drugs among clients in residential relapse prevention/health education treatment. It also investigated gender differences in ASPD symptom patterns, subtypes of ASPD defined by presence vs. absence of remorse, and validity of self-reported posttreatment abstinence measured against results of hair analysis. Data were drawn from the baseline and first follow-up assessments of Project IMPACT, a federally funded study of the efficacy of residential drug abuse treatment in reducing HIV risk. Participants' baseline demographics, drug behaviors, psychiatric comorbidity, and circumstances of index admission were examined in bivariate analyses to determine their association with ASPD. ASPD and variables associated with it at baseline were subjected to bivariate and multivariable survival analyses to determine their associations with lapse risk. Differences in symptom patterns by gender and remorse, severity of first lapse, and validity of self-reported drug behavior were investigated using contingency table approaches. ASPD was associated with a small increase in lapse risk among subjects followed within 180 days after treatment exit, but was not the most important determinant of first lapse. The nature of the data precluded meaningful evaluation of the contribution of lack of remorse to risk. Individuals entering treatment at the prompting of the legal system and because of "wanting to get clean" were at increased risk; females, nonwhites, older clients, those staying longer in treatment, and those with longer previous voluntary abstinences from drugs were at decreased risk. Neither ASPD nor lack of remorse was associated with severity of lapse. Gender differences in ASPD symptom patterns mainly resembled those found in the general population, although some may have reflected factors selecting clients into treatment. Associations of the likelihood of lapse with age, race, and time in treatment, and variations in ASPD symptom patterns with gender, suggest implications for the design of treatment programs. Participants with ASPD were less likely than others to have self-reported abstinence corroborated by hair analysis.

BACKGROUND: Gender power differences between males and adolescent girls and young women (AGYW) limit AGYW’s ability to make decisions about sex and relationships and to access sexual and reproductive health services and rights (SRHR). In Mozambique, 46% of AGYW aged 15–19 have a child or were pregnant and 26% report an unmet need for contraception. Pathfinder International’s Impacto Project aims to empower AGYW in Manica and Tete Provinces to exercise their rights to bodily integrity and access contraception and abortion. METHODS: This mixed methods study explored the multilevel factors that influence gender equality and modern contraceptive use (MCU) among AGYW aged 15–24 in Impacto Project communities. Using previously-collected project baseline data, logistic regression was used to determine factors associated with: 1) MCU among AGYW and 2) measures of gender equality using the Gender Equitable Men (GEM) Scale among AGYW and males aged 18–49. To expand on these findings, we conducted 19 focus group discussions with AGYW and males and 25 key informant interviews with project stakeholders. RESULTS: MCU was associated with higher education levels and being in a relationship. For rural AGYW, MCU was also associated with having more children, higher contraceptive knowledge, greater wealth, shared or partner-led contraceptive decision-making, and having a moderate or high GEM score. Greater wealth was also associated a high GEM score for men and urban AGYW. A high GEM score was associated with mass media access for all men and urban residence for men who completed secondary school or higher. AGYW, males, and stakeholders elucidated individual-, relationship-, community-, and societal-level factors influencing AGYW MCU, such as relationship status, discussions with family, harmful myths, and SRHR and gender policies. Some positive changes were reported, including growing acceptance of AGYW MCU and improved contraceptive decision-making for AGYW. RECOMMENDATIONS: SRHR interventions should be adapted to meet AGYW’s needs. Study findings informed programmatic and policy recommendations that can enhance efforts to improve MCU, gender equality, and women’s empowerment for AGYW. Key recommendations include: engaging parents and community members more closely in project activities, training AGYW in negotiation and media literacy, and expanding the reach of the Impacto Project. / 2026-01-31T00:00:00Z

Acute Lymphoblastic Leukemia (ALL) is the most common childhood cancer with approximately 3000 new cases diagnosed in the United States every year, a number that has stayed fairly constant over decades (Mody, 2008). Fortunately, ALL is very responsive to treatment. The prognosis has progressively improved achieving approximately an 80% 10-year-disease-free survival and a 90% 10-year overall survival (OS) probability in the last five years (Devilli, 2021). Most research in the past has looked into the survival rates, chronic illness, and relapse rates of certain treatments for ALL, especially when it comes to pediatric populations. But ALL treatments have been associated with increased risks for adverse outcomes such as late mortality, secondary malignancies, and neurological, cardiac, endocrine, and social/psychological disorders (Kızılocak, 2018). Being that children will have to live with the consequences of cancer for the rest of their lives the long-term effects of the disease and its treatments on the neurological, socioeconomic, and social development of the survivors needs to fully be evaluated. With such a large number of leukemia survivors joining the population every year, it is becoming essential for medical professionals, educators, employers, legislators, and society in general to be aware of the issues faced by the survivors.

A high burden of sickness-related absenteeism (SRA) amongst healthcare workers (HCWs) may impact health service delivery. The burden is known in high-income settings but not well evaluated in low and middle income (LMIC) settings and absent within a South African context. To determine the prevalence, associated medical conditions and cost of SRA amongst HCWs in a LMIC setting, we evaluated Human Resource (HR) absence records from a teaching hospital in South Africa over a 3 year period. Of the 3,543 HCW employed during the study period, 78% (n = 2,748) had at least 1 SRA episode. The overall SRA prevalence was 2.63%. The mean duration of absence was 2.25 days per episode and the mean frequency was 2.65 episodes per annum. Conditions of the musculoskeletal system (40.1%) were the most commonly reported, followed by acute infections of the upper respiratory tract (13.2%) and other respiratory conditions (6.2%). The total direct cost SRA was US$5,105,061.78 over the study period and the mean direct SRA cost per person was US$1,857.74 per episode. The results demonstrate a higher SRA burden compared with studies in similar settings and prompts further research into the causative factors and targeted risk mitigation strategies.

No description available.

No description available.