An estimated 70,000 preventable medication errors occur in Canada annually, causing up to 23,750 deaths. Medication errors increase when the number of medications being administered increases. Therefore, people with multi-morbidity who take several medications at once are more vulnerable to medication errors. Medication errors can be prevented by developing and managing an efficient healthcare system integrated with technology. Near Field Communication (NFC) technology, in particular, has been shown to improve the quality of health care and increase patient safety. NFC has a powerful ability to identify and track objects such as patients and medications; its identification and tracking abilities give it significant potential especially in detecting drug interaction and drug allergy. The main objective of this thesis is to present a novel solution using NFC-enabled smartphone integrated with NFC application to detect and update drug allergies and drug interactions for people with multi-morbidity during medication administration. / The system has been implemented using Samsung Nexus S smartphone with Android 2.3.6 platform, MIFARE Classic 1K tags, and a database populated with 10 patients’ record and 30 medications. The system was validated for the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and computational and communicational cost.

The purpose of this study was to compare between ethnicities if there is a difference in survival and treatment when it comes to cardiovascular diseases in the Middle East. To find out if there is a difference 28 articles was selected for inclusion, both qualitative and quantitative studies. Searches were made in the databases Medline, PubMed, Google and Google Scholar.The results showed that it is possible that there are differences in mortality and morbidity between ethnicities affected by cardiovascular disease. These may be due to differences in abdominal obesity, insulin resistance in diabetes and other risks such as C-reactive protein in the blood plasma which is normally excreted in inflammation in the body and also adiponectin, which is a hormone found in fat tissue whose secretion is diminished in people who have diabetes. But studies saying that a difference does exist are too few and the need for more and larger studies is needed. It may also be that not all ethnicities are as benefited from current treatments available against cardiovascular diseases for example beta-blockers. The conclusion of this study is that more research in this area is needed as well as more comprehensive studies regarding public health in the Middle East. / Syftet med denna studie var att jämföra mellan etniska grupper om det finns en skillnad i överlevnad och behandling när det gäller hjärt-och kärlsjukdomar i Mellanöstern. För att ta reda på det har 28 artiklar valts ut efter inklusionskriterierna, både kvalitativa och kvantitativa studier. Sökningar gjordes i databaserna Medline, Pubmed, Google and Google Scholar.Resultatet visade på att det sannolikt finns skillnader i dödlighet samt sjuklighet mellan etniciteter som drabbats av hjärt- och kärlsjukdomar. Dessa kan bero på skillnader i abdominal fetma, insulin resistens vid diabetes och andra risker så som C-reaktivt protein som finns i blodplasman och i vanliga fall utsöndras vid inflammationer i kroppen och adiponectin som är ett hormon som finns i fettvävnaden vars utsöndring är sämre hos personer som har diabetes. Dock är studierna som visar på skillnader alldeles för få, det behövs fler och större undersökningar inom detta område. Denna litteratur översikt visar också att det även kan vara så att inte alla etniciteter gynnas av dagens behandlingar som finns mot hjärt- och kärlsjukdomar som t ex Betablockerare. Slutsatsen i denna studie är att mer forskning inom ämnet behövs samt fler övergripande studier gällande folkhälsan i Mellanöstern.

Objective: Evaluation of surgical quality ensures consistency of care and facilitates improvements in the quality of care delivered. Methods: An overview of surgical quality measurement is presented. A system for monitoring thoracic morbidity and mortality (TM&M) at the Ottawa Hospital is introduced and evaluated. Results of a needs assessment survey on the involvement in thoracic surgical research and quality improvement initiatives are presented. Results: Structure, process, and outcomes reflect different viewpoints on how to evaluate surgical quality. The feasibility of the TM&M system is evaluated using descriptive and univariate statistics, while its inter-rater reliability is assessed amongst the Canadian Association of Thoracic Surgeons. Conclusions: Outcomes have been fundamental in the evaluation of surgical quality. TM&M classification system advocates for a practice of continuous quality improvement and provides standardized and reliable feedback on surgical outcomes. Results of the needs assessment have built a strong foundation of knowledge on prospective ways to enhance the monitoring of surgical quality.

As the most prevalent chronic health condition in children under the age of 18, asthma is a disease for which significant health disparities exist. Current literature has established that ethnic minorities, families living in poverty, and families living in urban environments are at higher risk for worse morbidity. In recent years, studies focusing distinctly on Latino families, with emphasis on Puerto Rican families, have emerged. As a singular group, Puerto Rican children have demonstrated the worst outcomes and a significantly greater use of emergency room (ER) services, often related to poor adherence to adequate asthma care regimens. Guided by the biopsychosocial approach, this study sought to examine cultural and family variables and their relationship to pediatric asthma morbidity. Data from a sample of 639 children and their families from the Rhode Island region and Puerto Rico participated in this study. The data derived from the Rhode Island/Puerto Rico Asthma Center (RIPRAC) study and collected between 2002 and 2007. Bivariate analyses investigated correlations among familism and morbidity variables. Group comparisons were conducted between mainland Puerto Ricans living in the Rhode Island region and island Puerto Ricans and between Latino and non-Latino White families living in mainland United States. Confirmatory factor analysis using Mplus software evaluated a measurement model of familism and morbidity, followed by invariance testing in multiple group analyses by asthma severity and ethnicity. Lastly, structural equation modeling investigated a predictive relationship between the latent variables of familism and morbidity and meditational relationships through balanced integration. A secondary analysis for families who endorsed alternate child caregivers investigated a meditational relationship between familism and morbidity through involvement in asthma management by alternate caregivers. Significant correlations and group differences on mediator variables and observed familism variables and morbidity variables were found. Although a significant relationship between familism and morbidity was not found, significant relationships between familism and balanced integration and between balanced integration and morbidity were identified. This study contributes to emerging research on family variables as potential protective factors in pediatric asthma by focusing on familism as a primary concept amongst biological and psychosocial variables.

Meeting the health care needs of people with chronic conditions presents one of the greatest challenges for 21st century health care system renewal. Appropriate redesign of health care delivery with this complex patient population in mind requires information from many sources. Although much is known about the patient experience of chronic illness much less is understood about how patients navigate their health care delivery context. The purpose of this qualitative study was to examine the point of view of patients dealing with multi-morbidity. These people have a unique understanding of how health care delivery links across time, place, and settings because of the care they require for their multiple chronic conditions. An interpretive descriptive design was used to examine patient navigation from the perspective of 20 adult patients with chronic kidney disease, and co-existing diagnoses of diabetes mellitus and/or cardiovascular disease. The findings generated from iterative, constant comparative analysis add important patient perspectives about health care system navigation. From the consumer perspective health care navigation is challenging, requiring (a) ongoing discovery about the complex social structures that make up the health care system, and (b) learning how to strategically use this knowledge to manage the health care system. The findings highlight the disjunctures and misalignments in the health care delivery system, the cumulative health care-related burden of multiple chronic conditions for consumers, and consumer concerns about subtle inequities in the health care system. As health care renewal efforts gain momentum new knowledge from the perspective of consumers, such as that captured in this research, is important. The consumer perspective provides a valuable opportunity for stakeholders in health care policy- and decision-making to contextualize and make greater sense of the information used in making decisions about health care service delivery for vulnerable populations, like patients with multiple chronic conditions.

Thesis (M.S.)--University of South Florida, 2007. / Title from PDF of title page. Document formatted into pages; contains 89 pages. Includes bibliographical references.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 4 uppsatser.

Philosophiae Doctor - PhD / This study is based on the assumption that the under-five mortality rate, in recent decades, has declined, particularly in developing countries. However, all the social strata across many countries do not seem to benefit from this reduction of mortality - and mortality remains abnormally high among children especially those from underprivileged social strata. This research is, therefore, a holistic approach to analyse and quantify the inequalities of health among children under five in sub-Saharan Africa over the last two decades (1990-2010). The research sought to investigate the trend and determinants of health inequalities of under-five years (mortality and morbidity) in sub-Saharan Africa (SSA) from 1990 to 2010. An essential point has been devoted to the decomposition of effects and analysis of the contribution of the factors explaining these inequalities. The data used in the study come from Demographic and Heath Surveys (DHS) done between 1990 and 2015 in sub-Saharan Africa countries. In order to analyse the inequalities in trends of mortality and morbidity of children, different selected countries that have conducted at least three DHS during the 1990-2010 period. Several statistical methods were used for data analysis. There were four chapters which is prepared with an article style. For the first paper titled "Decomposing Inequalities in Under- Five Mortality in Selected African Countries", concentration index (CI) and Generalised Linear Model (GLM) with a logit link were used to analyse and measure under 5 mortality inequalities and the associated factors. This paper has been published in the Iranian Journal of Public Health. For the second paper titled "Determinants of Under-Five Mortality in Burkina Faso: A Concentration Dimension". The study used logistics regression and Oaxaca-Blinder decomposition method for the binary outcome to analyse data was involved. For data analysis of the third paper titled "Women Education, Health Inequalities in Under-Five Mortality in sub-Saharan Africa, 1990 – 2013", logistic regression and Bius's decomposition method were used to examine the effect of mother's education level on childhood mortality. In the fourth paper titled "Trends and Risk Factors for Childhood Diarrheal in sub-Saharan Countries (1990-2010): Assessing the Neighbourhood Inequalities", a multilevel logistic regression modelling was used to determine the fixed and random effects of the risk factors associated with the diarrheal morbidity. The work carried out during this on-going thesis helps to understand the magnitude of inequalities in under-five mortality in sub-Saharan countries. The findings showed that the contributing factors of inequalities of child mortality were birth order, maternal age, parity and household size. With regards to the relationship between mother's education level and inequalities in mortality of children under-five in sub-Saharan Africa, findings showed that children of mothers who did not attend school have a higher rate of death compared to those who had been to school. However, we have observed that the inequalities have narrowed over time. The results showed the risk factors of diarrheal morbidity varied from one country to another, but the main factors included: child's age, the size of the child at birth, the quality of the main floor material, mother's education and her occupation, type of toilet, and place of residence. In conclusion, the results of this study show that inequalities in under-five mortality are still important among different social strata in sub-Saharan Africa countries. It is then urgent to take actions to save the lives of children in disadvantaged social strata. / National Research Foundation

Estima-se que a carÃncia de vitamina A atinja atualmente 250 milhÃes de prÃ-escolares. Destas, de 250.000 a 500.000 se tornam irreversivelmente cegas, e metade desse nÃmero evolui para o Ãbito nos primeiros 12 meses seguintes, apÃs a perda da visÃo. A defici-Ãncia de vitamina A ainda à a principal causa de cegueira infantil no mundo. Os efeitos mais divulgados da suplementaÃÃo de vitamina A sÃo a reduÃÃo da gravidade de episÃdios de diar-reia e de infecÃÃes de vias aÃreas superiores. A reduÃÃo da mortalidade total em crianÃas atra-vÃs da suplementaÃÃo à identificada em grupos populacionais de extrema pobreza e com alta prevalÃncia de diarreia. A suplementaÃÃo periÃdica de vitamina A em crianÃas à o mÃtodo recomendado pela OrganizaÃÃo Mundial de SaÃde para a correÃÃo desta deficiÃncia nutricio-nal, e a suplementaÃÃo com altas doses à efetiva, suprindo a carÃncia por vÃrios meses. Neste trabalho, objetiva-se observar a prevalÃncia da suplementaÃÃo de vitamina A em cinco perÃo-dos distintos, entre 1987 e 2007, medindo o impacto que esta suplementaÃÃo causa na morbi-dade, e, atravÃs da sÃrie histÃrica, observar a importÃncia dos programas de suplementaÃÃo nos nÃveis de vitamina A populacionais, bem como os fatores socioeconÃmicos e biolÃgicos que levaram a esta suplementaÃÃo em cada perÃodo e nÃvel nutricional. Os estudos utilizados como base foram do tipo transversal de base populacional, com abrangÃncia estadual, estu-dando uma amostra representativa da populaÃÃo de crianÃas prÃ-escolares do CearÃ, de cerca de duas mil crianÃas em cada ano. O estado do Cearà se caracteriza como um dos mais pobres do paÃs. Fez-se anÃlise inicialmente descritiva, seguida por anÃlise bivariada e multivariada. Ao se analisar a prevalÃncia de suplementaÃÃo no estado do Cearà nos perÃodos estudados, pode-se observar uma tendÃncia de aumento na distribuiÃÃo das megadoses, variando de 9,6% a 65,8% de cobertura, porÃm com flutuaÃÃes devido a mudanÃas na polÃtica de distribuiÃÃo de vitamina A. Pode-se observar tambÃm que o impacto da suplementaÃÃo na reduÃÃo das mor-bidades tem se tornado cada vez menor. AlÃm disso, observa-se que a suplementaÃÃo pode estar associada com maior frequÃncia de morbidades, mesmo quando esta à corrigida para a alimentaÃÃo rica em vitamina A (RC 1,8, IC95% [1,204-2,956]). Viu-se que os fatores mais impactantes na adesÃo a suplementaÃÃo sÃo os associados a cuidados em saÃde e os socioeco-nÃmicos (RC 1,7, IC95% [1,416-2,274]). Verificou-se diminuiÃÃo da inequidade na cobertura de vitamina A. Conclui-se que os programas polÃticos sÃo essenciais para a cobertura, que os cuidados em saÃde sÃo os fatores de maior importÃncia para a frequÃncia da suplementaÃÃo, e que esta tem benefÃcio controverso na reduÃÃo de morbidade.