Short-Term Medical Missions (STMMs) seek to provide healthcare services to people where poverty remains prevalent and limited healthcare access remains prevalent. While STMMs increase access to quality healthcare, contributions may not yet be optimal. Traveling medical professionals make a diagnosis and treatment plan based on previously established knowledge. While these treatment plans may prove to be acceptable, plans may not fully consider local customs, or ongoing medication access. A comprehensive literature review was conducted to determine best practices in developing a formulary for STMMs to investigate if an evidence-based Diagnosis & Treatment Formulary (D&TF) improves cost and time efficiency. The World Health Organization (WHO) executive summary, global essential medicines list, and the International Pharmaceutical Federation and WHO joint guidelines on good pharmacy practice were reviewed for best practices and formulary guidance. The National Institutes of Health’s PubMed, Cumulative Index to Nursing and Allied Health Literature, and the Web of Science Core Collection were searched using keywords cost-effective, evidence-based, formulary, missions, and pharmacy. Fourteen articles were identified and reviewed with inclusion criteria including English language and both within the U.S. and outside the U.S. Exclusion criteria included reviews, editorials, letter publications, and publications prior to 2005. Current best practices for STMM formularies include utilizing the WHO’s sample formulary and guiding principles to develop a team formulary. Formularies for STMMs should be specific to the WHO region, address primary health needs while including medications based on disease prevalence, utilize locally available and affordable medications, and incorporate easy-to-read pictorial medication dispensing labels in the region’s native language. Through literature review, considerations for development and implementation of WHO regional D&TFs have been identified. Appropriate diagnoses and provision of optimal medication regimens relevant to a region’s primary health needs are critical in delivering healthcare services during STMMs. Improving provider confidence in prescribing, increasing team efficiency in medication provision, and advancing equitable health care that is patient-centered and safe, are possible benefits of improved formulary practices. D&TFs go beyond a list of medications by providing an evidence-based treatment regimen for each diagnosis. A need for D&TFs for STMMs that can be further individualized has been identified. The recommended prescription for developing a D&TF for STMMs is for it to include evidence-based treatment plans, utilize essential medicines, be cost-effective, and locally relevant. Pictorial labels should be developed, utilizing local language on any text. STMM teams will need education on the prescription utilized to develop the formulary and its expected benefits to assist with implementation.

Introduction: In 2003, Purdue University College of Pharmacy (PUCOP) in West Lafayette, Indiana, began the Purdue Kenya Partnership (PKP) in collaboration with the Academic Model Providing Access to Healthcare, Moi University, and Moi Teaching and Referral Hospital, in Eldoret, Kenya. PUCOP's involvement utilized a tripartite approach of engagement, education, and scholarship to provide and expand sustainable access to high quality care. Objective: This paper discusses outcomes and impacts of this academic partnership. Methods: Purdue Kenya Partnership's progress in achieving its stated mission was evaluated using an outcome-approach logic model. This model highlighted inputs, activities, and results which encompassed outputs, outcomes, and impact. A comprehensive set of ratios were calculated to quantify annual change in PKP investments against estimated metrics for engagement, education, and scholarship. These metrics were weighted by involvement level and pharmacist effort in various clinical domains. Descriptive statistics were completed that identified cumulative and totals per year for each collected data type of data collected. Results: Purdue Kenya Partnership implementation utilized initial inputs of human resources, financial capital, and strategic partnerships. These inputs supported pharmacy involvement in 16 distinct care programs in both inpatient and outpatient settings which supported the care of 457 833 individual patients and grown a clinical pharmacy staff from 0 to 22 practicing clinical pharmacists. Five unique educational programs have been established which have graduated 457 trainees. Purdue Kenya Partnership has generated over $6.2 million in grant funding and disseminated 302 peer reviewed manuscripts, posters, and oral presentations combined. Ratios describing trends in engagement, education, and scholarship as a result of using the locally focused PKP approach highlight higher initial costs compared with much lower costs per outcome several years into the partnership. Conclusion: The PKP's global health approach of prioritizing the population's care needs (“leading with care”) has enabled the development of sustainable engagement, education, and scholarship infrastructure with significant gains in all three domains.

Background: In the face of overwhelming need and increasingly scarce resources, the humanitarian charge of “saving lives and alleviating suffering” is often reduced to simply saving lives. In 2014, World Health Assembly Resolution 67.19 called for the strengthening of palliative care as a key component of comprehensive care. However, even when palliative care is the only available option (ie. 2014-2015 Ebola Crisis), there is little evidence showing it is available in the field. More research is needed to understand this dissonance between policy and practice, and to ensure that humanitarians are providing ethical and contextually appropriate care. Methodology: Twelve individual, in-depth, semi-structured interviews were conducted in English and French with humanitarian healthcare policy makers from North America, Europe, and the Middle East, average 10+ years of experience representing various international organizations. Interviews were transcribed and coded using NVivo11 and an interpretive description framework. Findings: Participant comments suggested the existence of an institutionalized rescue culture, characterized by the fear of failure, equating of death with failure of the humanitarian healthcare professional, and a resultant systemic devaluation of palliative- type care in disaster contexts. The indoctrination of this culture may begin as early as medical school, and manifests clearly in the lack of consistent nomenclature and awareness of palliative care, treatment of palliative-triaged individuals, and resources allocated to palliative care in humanitarian contexts. Palliative care provision is a moral obligation as a final bastion of the human right to dignity and to health. Discussion & Conclusion: In order for palliative care to be integrated into the humanitarian mandate, a significant cultural shift must first take place. The findings of this thesis and the larger Humanitarian Health Ethics study will provide key guidance for the adoption and adaptation of policies that help humanitarians maintain the dignity of individuals in their most vulnerable moments. / Thesis / Master of Science (MSc)

Background: Since the 1980s, there has been a growing interest in research to focus on positive mental health instead of narrowing attention toward risk factors and to foster resilience instead of treating trauma. There is substantial empirical evidence that despite being exposed to the same risk; individuals react differently to the same stimuli. The ability of some people to successfully cope and adapt despite adversity is what constitutes resilience. In the context of forced migration, resilience research examines the elements that ameliorate wellbeing and positive adjustment rather than focusing on the pathological consequences of trauma. However, little is known about how the construct of resilience is conceptualized within the field of forced migration research. This research aims to critically appraise and map the existing literature on resilience in the forced migration population, and to analyze how the concept of resilience is defined, operationalized, and applied in refugee research. Methods: Arksey and O’Malley scoping review framework was followed to search 5 online databases. Numerical and thematic analysis were both conducted to examine the breadth of the literature and to chart the relevant data. Results: A total of 20 studies were selected for the scoping review. The findings included a description of the literature regarding geographic distribution, recruited methods, and targeted populations. In addition, the results investigated definitions of resilience, measures used to operationalize resilience, the relationship between resilience and mental health illnesses, internal and external protective factors contributing to fostering resilience processes, and resilience across cultures and languages. Conclusion: There is an increase in interest to understand the concept of resilience through synthesizing both qualitative and quantitative data. However, longitude and evaluation studies remain the exception. Further research is needed to validate resilience instruments across cultures and languages. The interactions between mental health illnesses and resilience should be better understood in the context of forced migration as well. / Thesis / Master of Health Sciences (MSc)

ABSTRACT Background Water is an essential requirement for the survival and development of people. It is estimated that 435 million people get their drinking water from unprotected wells worldwide. Water scarcity and chemical or biological aspects in water have been revealed, which can negatively affect health. This study aims to explore individuals’ experiences in drinking water with non-public water, hence individual wells. A further aim of the study is to explore authorities’ perspectives for implementing safe drinking water (SDGs 6) in Swedish coastal and rural areas.     Method In this qualitative study, semi-structured interviews were implemented to explore the experiences of 17 individual well owners and 4 authorities in non-public water use in Sweden. A thematic analysis was conducted to analyse the collected data.     Findings There were three main findings in the study: Firstly, concerns about water scarcity and water quality, mostly from families with children. Secondly, there was a feeling of exclusion among individuals due to lack of support from authorities and thirdly, a gap between existing assessment guidelines and the practices of individuals in terms of follow-up and benchmarking of the National health guidelines.   Conclusion The experiences of the individual well owners in Stockholm had some concerns due to water quality, the understanding, and implementation of the guidelines to safe drinking water. The authorities also highlighted the need for sustainable strategies. It concluded that multi-disciplinary approaches, communication, and community participation are necessary for a sustainable water strategy. These must be addressed globally as climate change impacts water supply and has a massive effect on rural and coastal areas. / <p>_{<em>We never know the worth of water till the well is dry (Thomas Fuller)</em>}</p> / The project “Evaluation of individual wells and systems”

The way we understand the term health is being changed significantly under continuous globalisation. Even though in the past, health issues were a concern of a particular country, today, as a result of intensive trade and travelling, these issues reach beyond the boarders of national states and influence millions of people around the world consequently. Thus, the issue of health is moving from the national to the international level and a new concept of Global health emerges. Global health is a notion, which has evoked a lot of interest among politicians, academics, theoreticians, and within the whole international community, too. The international community is aware of its responsibility for global improvements to health through collective action. Thus, this thesis is aimed at the analysis of the development and practice of diplomacy in the sphere of health, as well as identifying the reasons of international co-operation of states in this field. The thesis concludes that the co-operation in global health is based on moral values, which are included in human right to health. Lastly, thesis scrutinizes human right to the enjoyment of the highest attainable standard of health.

The coronavirus disease 2019 (COVID-19) has led to more than 3,000,000 deaths globally. During the first year of the pandemic, countries have focused their response strategies on non-pharmaceutical interventions (NPIs) such as lockdowns and use of facial coverings. Because of collateral effects (psycho-social, and economical) by NPIs, investigating their effectiveness is increasingly important for optimal policies. The aim of this study is to investigate whether varying degrees of response strategies affect the rate of change in mortality at specific time points in the epidemic. The containment and health index (CHI) is used to identify the degree of response measures adopted by each country. Six time points around the peak of daily mortality are identified for the first two epidemiological waves for 40 European countries. The response was then correlated to the rate of change of mortality observed over one week 26 days later (time lag for the intervention to take effect). Spearman’s rank correlation coefficient was used for the unadjusted analysis, and multiple linear regression is used in the adjusted analysis. The intensity of CHI reduced the rate of increase of mortality before the first epidemic peak but had no detectable effect at any other time point. Different covariates and interactions between CHI and covariates such as population density and GDP, affected the rate of change of mortality at different time points during the two waves. NPIs may be effective, as suggested by a significant effect of CHI on mortality early in the first wave. However, the effect is not consistent across time points, and the extent of collateral damage suggests a closer look at other factors influencing the epidemic is necessary.

No description available.

Background There has been an increase in antibiotic consumption in the last decades in lower income countries, still, it is insufficient to meet everyone’s needs. Ensuring access to them is essential to lower the burden of disease and mortality, as well as to accomplish the Sustainable Developmental Goals. However, this consumption needs to be responsible to avoid faster spreading of antibiotic resistances. The recent COVID-19 pandemic has threatened the healthcare systems everywhere, both directly and indirectly. Nevertheless, there is a lack of research on how it has impacted antibiotics’ stock.  Methods This study used secondary data of a cross-sectional cohort design to follow the impact of the pandemic on the stock of three commonly used antibiotics in healthcare facilities of Uganda. The data was compared between three time periods: before the pandemic started (January 2019-February 2020), during the first months of the pandemic and coinciding with the harshest restrictions (March 2020-May 2020), and the second period of the pandemic (June 2020-December 2020). Results An increase in stock of the antibiotics was observed as the restrictions hardened, followed by a decrease when they were lifted. Likewise, this rise happened both in the consumption and arrival of antibiotics. Stratified analysis was preformed grouping by healthcare level and by region, seeing that the strongest change happened in facilities at level II and III in the Eastern region of Uganda. Conclusions  This suggests that the pandemic influenced the antibiotics stocks and consumption. Further research needs to be done to better understand this effect.

Although the global population is older than ever before, older persons' health is not necessarily included in policy planning. This study aimed to study how older people were included, excluded, and framed in Agenda 2030. Through qualitative content analysis, the sub-targets and indicators of Agenda 2030 were categorised and analysed. Seven categories were located; Poverty relates to age, Violence relates to age, Political inclusion relates to age, Elderly as a vulnerable group, Health of children and fertile women prioritised, Sexual health, and Youth seen as an investment. By analysing the manifest and latent material, this study showed that older persons are not prioritised in the SDGs and that when they are included, they are framed as vulnerable. While older persons are explicitly included in some ways (such as in political inclusion), they are also excluded from many sub-targets and indicators of Agenda 2030. This study argues that in order to not “leave the elderly behind”, more needs to be done to include older persons and to age disaggregate the data. / <p>Betyg i Ladok 220617.</p>