U.S. state governments have implemented numerous policies to help mitigate the spread of COVID-19. While there is strong biological evidence supporting the wearing of face masks or coverings in public spaces, the impact of public masking policies remains unclear. We aimed to evaluate how early versus delayed implementation of state-level public masking orders impacted subsequent COVID-19 growth rates. We defined “early” implementation as having a state-level mandate in place before September 1, 2020, the approximate start of the school-year. We defined COVID-19 growth rates as the relative increase in confirmed cases 7, 14, 21, 30, 45, 60-days after September 1. Primary analyses used targeted maximum likelihood estimation (TMLE) with Super Learner and considered a wide range of potential confounders to account for differences between states. In secondary analyses, we took an unadjusted approach and calculated the average COVID-19 growth rate among early-implementing states divided by the average COVID-19 growth rate among late-implementing states. At a national level, the expected growth rate after 14-days was 4%lower with early vs. delayed implementation (aRR: 0.96; 95%CI: 0.95-0.98). Associations did not plateau over time, but instead grew linearly. After 60-days, the expected growth rate was 16% lower with early vs. delayed implementation (aRR:0.84; 95%CI: 0.78-0.91). Unadjusted estimates were exaggerated (e.g. 60-day RR:0.72; 95%CI: 0.60-0.84). Sensitivity analyses varying the timing of the masking order yielded similar results. In both the short and long term, state-level public masking mandates were associated with lower COVID-19 growth rates. Given their low-cost and minimal (if any) impact on the economy, masking policies are promising public health strategies to mitigate further spread of COVID-19.

This qualitative study describes relationships problems highlighted by individuals with an autism diagnosis and professionals at Vuxenhabiliteringen (adult disability services). It also captures the individuals’ and professionals’ opinion of how to work with these particular problems. Nine people were interviewed for this study. The interviews were semi-structured and systems Theory in Social Work were used to understand the organisational tension between where support for relationship problems for people with an autism diagnosis should lie. An autism diagnosis is linked to problems in social-emotional reciprocity, for example difficulties to initiate or respond to social interactions, inflexible adherence to routines and difficulties with sensory input. Several themes emerged regarding relationship problems; structure and planning, communication, understanding, sex and intimacy and partners’ own difficulties. Professionals reported that a number of services are currently being offered, such as diagnose information, talking therapy, help with planning and structure, among others. Professionals expressed that including the partner more, working more jointly with other professionals and starting a relationship group to share experiences could improve services. The support that neurodiverse participants asked for were couple’s therapy, information and education about sex, relationships and men. Relationship support can be given by VUH through the services already offered and by expanding them further. More research is needed to understand relationship issues in relation to an autism diagnosis.  Keywords: Relationship, autism, neurodiversity, Vuxenhabiliteringen, health care, organisation, couple’s therapy, relationship difficulties Sökord: Relationer, autism, neurodiverse, Vuxenhabiliteringen, Hälso och sjukvård, organisation, parterapi, relationssvårigheter Author: Jessica Vannoorenberghe Word count: 16846

No description available.

A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the Degree of Master of Science in Medicine (Pharmaceutical Affairs) Johannesburg, 2016 / Background The World Health Organization (WHO) defines medicines regulation as the “promotion and protection of public health by ensuring the safety, efficacy and quality of drugs, and the appropriateness and accuracy of product information” (1). Medicines regulation is a key function in the realisation of the right to essential medicines. However, a satisfactory level of harmonization of regulatory activities has not been achieved in the Southern African Development Community (SADC) region as yet. Objectives The study evaluated the current status of medicines regulatory harmonization within the SADC region, as well as explored perceived barriers to regulatory harmonization and potential strategies to address these. Methods A cross-sectional exploratory study design with qualitative techniques, as well as an inductive approach was used. In-depth, semi-structured, face-to-face interviews with interviewees from the SADC Secretariat, the African Medicines Harmonization (AMRH) Initiative and the Southern Africa Regional Programme on Access to Medicines and Diagnostics (SARPAM) was used, involving secondary formal qualitative approaches to identify the emergent themes, was utilised initially. A questionnaire was formulated and adapted using secondary data collected from the face-to-face interviews, then piloted. Questionnaires were sent to senior members of all 15 regulatory authorities belonging to SADC, including registrars and deputy registrars. Theoretical and analytical codes were identified from repeated ideas, concepts or elements. Codes were grouped into concepts, and then into categories. Trend analysis was conducted, involving an in-depth analysis of patterns. Results Barriers to regulatory harmonization in the SADC region perceived by participants included i) deficiencies in governance and leadership within the SADC Secretariat, ii) human resource and technical capacity constraints, iii) limited financial resources, iv) lack of political will within SADC governments, v) lack of intra-SADC relationships, vi) risk-benefit analysis differences in assessment of applications and bias according to local population needs, as well as vii) different guidance documents and legal frameworks among member countries. Strategies identified to address these included i) using other harmonization initiatives as models, ii) application format harmonization and African Union (AU) Model Law adoption, iii) redirecting focus of harmonization to information sharing and technical matter rather than complex legislative frameworks, iv) regulator initiatives of harmonization instead of SADC secretariat reliance, v) World Bank Agreement adoption, vi) human resource capacity development and vii) convergence of guidelines instead of complete harmonization of all regulatory requirements. Conclusions The findings in this study suggest that it may be necessary to redirect the focus of harmonization to more readily achievable activities and aim for convergence of guidelines. Regulatory harmonization is possible if barriers to it are addressed. / MT2016

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No description available.

Background: Mental health is recognised as a critical public health challenge globally, yet child and adolescent mental health receive low priority, particularly in low- and middle-income countries. Children and adolescents spend a significant proportion of their lives in school, suggesting that educational settings are potentially important environments where child and adolescent mental health (CAMH) can be strengthened to improve early identification and treatment. This study explored the perspectives of key service providers on needs, barriers and facilitators of child and adolescent mental health services (CAMHS) in schools in the Western Cape province of South Africa. Methods: This study employed an exploratory qualitative approach. In-depth individual interviews were conducted by one of the authors (SM), and the first author (KM) conducted a thematic analysis on the interview data. Results: There were nine interviewees selected who were diverse health service providers involved in child and adolescent health which included school doctors, school nurses, psychiatrists, occupational therapist, clinical nurse and mental health nurse. Thematic findings were grouped under: a) perceived needs, b) barriers and c) facilitators. The need to improve intersectoral collaboration, following a referral pathway, a strong multidisciplinary team (MDT) and integration of services were all identified important in the delivery of CAMHS. The neglect of CAMHS in both education and health sectors and limited resources were identified as barriers. Facilitators included intersectoral collaboration, task shifting from nurses and doctors to community health workers, and committed health workers. Conclusion: CAMHS receives very low priority in comparison to other health issues such as HIV/TB in South Africa. There is an urgent need to address CAMHS in South Africa, and the school setting is an important site of intervention. Intersectoral collaboration, task-shifting, continuous training of teachers and health professionals are potential strategies that could be used to strengthen access to CAMHS in education sector and have integrated services in the Western Cape Province.

Background: Non-communicable diseases (NCDs) account for over two-thirds of deaths worldwide, and global efforts to address NCDs have accelerated. Current prevention and control efforts rely primarily on individual behavior/lifestyle approaches that place the onus of responsibility for health on the individual. These approaches, however, have not stopped the increasing trend of NCDs worldwide. Thus, there is urgent need for exploring alternative approaches in order to attain the aim of reducing global premature NCDs mortality by 25% by 2025, and meeting the NCD reduction objective in the Sustainable Development Goals. Discussion: We suggest the need for a structural approach to addressing the NCDs epidemic that integrates social science and public health theories. We evaluate two overarching principles (empowerment and human rights) and three social determinants of health (labor and employment, trade and industry, and macroeconomics) addressed in the 2013 Global Action Plan for the Prevention and Control of NCDs to demonstrate how a structural approach to NCDs can be incorporated into existing NCD interventions. For each area considered, theoretical considerations for structural thinking are provided and conclude with recommended actions. Conclusion: Achieving the global health agenda goals of reducing NCDs mortality will require a shift to a paradigm that embraces concerted efforts to address both behavioral/lifestyle factors and structural dimensions of NCDs.

Introduction: The US Health Care and Social Services sector (North American Industrial Classification System 'sector 62') has become an extremely important component of the nation's economy, employing approximately 18 million workers and generating almost $753 billion in annual payrolls. At the county level, the health care and social services sector is typically the largest or second largest employer. Hospital employment is often the largest component of the sector's total employment. Hospital employment is particularly important to non-metropolitan or rural communities. A high quality healthcare sector serves to promote economic development and attract new businesses and to provide stability in economic downturns. The purpose of this study was to examine the intensity of hospital employment in rural counties relative to the nation as a whole using location quotients and to draw conclusions regarding how potential changes in Medicare and Medicaid might affect rural populations. Methods: Estimates for county-level hospital employment are not commonly available. Estimates of county-level hospital employment were therefore generated for all counties in the USA the Census Bureau's County Business Pattern Data for 2010. These estimates were used to generate location quotients for each county which were combined with demographic data to generate a profile of factors that are related to the magnitude of location quotients. The results were then used to draw inferences regarding the possible impact of the Patient Protection and Affordable Care Act 2010 (ACA) and the possible imposition of aspects of the Budget Control Act 2011 (BCA). Results: Although a very high percentage of rural counties contain medically underserved areas, an examination of location quotients indicates that the percentage of the county workforce employed by hospitals in the most rural counties tends to be higher than for the nation as a whole, a counterintuitive finding. Further, when location quotients are regressed upon data related to poverty, county demographics, and the percentage of the population insured, a relationship between the proportion of the population over 65 years, the percentage of the population living in poverty, the percentage of the population without insurance and county density was found. Conclusion: The results of the analysis suggest that hospital employment in rural communities is higher than would be expected in the absence of programs that provide external funding to support hospital hiring. The most important public programs providing this support are Medicare and Medicaid. Social Security is another source of federal funding important for rural populations. Sequestration and other cuts in funding could impact rural communities significantly. This can be even worse in states that fail to expand Medicaid and in states that fail to increase Medicaid reimbursements for services important in rural communities.

Introduction: The US Health Care and Social Services sector (North American Industrial Classification System 'sector 62') has become an extremely important component of the nation's economy, employing approximately 18 million workers and generating almost $753 billion in annual payrolls. At the county level, the health care and social services sector is typically the largest or second largest employer. Hospital employment is often the largest component of the sector's total employment. Hospital employment is particularly important to non-metropolitan or rural communities. A high quality healthcare sector serves to promote economic development and attract new businesses and to provide stability in economic downturns. The purpose of this study was to examine the intensity of hospital employment in rural counties relative to the nation as a whole using location quotients and to draw conclusions regarding how potential changes in Medicare and Medicaid might affect rural populations. Methods: Estimates for county-level hospital employment are not commonly available. Estimates of county-level hospital employment were therefore generated for all counties in the USA the Census Bureau's County Business Pattern Data for 2010. These estimates were used to generate location quotients for each county which were combined with demographic data to generate a profile of factors that are related to the magnitude of location quotients. The results were then used to draw inferences regarding the possible impact of the Patient Protection and Affordable Care Act 2010 (ACA) and the possible imposition of aspects of the Budget Control Act 2011 (BCA). Results: Although a very high percentage of rural counties contain medically underserved areas, an examination of location quotients indicates that the percentage of the county workforce employed by hospitals in the most rural counties tends to be higher than for the nation as a whole, a counterintuitive finding. Further, when location quotients are regressed upon data related to poverty, county demographics, and the percentage of the population insured, a relationship between the proportion of the population over 65 years, the percentage of the population living in poverty, the percentage of the population without insurance and county density was found. Conclusion: The results of the analysis suggest that hospital employment in rural communities is higher than would be expected in the absence of programs that provide external funding to support hospital hiring. The most important public programs providing this support are Medicare and Medicaid. Social Security is another source of federal funding important for rural populations. Sequestration and other cuts in funding could impact rural communities significantly. This can be even worse in states that fail to expand Medicaid and in states that fail to increase Medicaid reimbursements for services important in rural communities.