Introdução O Transtorno de Déficit de Atenção/hiperatividade (TDAH) tem sido muito estudado, mas informações econômicas referentes ao seu tratamento com o metilfenidato de liberação imediata (MFD-LI) ainda necessitam ser exploradas. Grande parte da população mundial, principalmente aqueles que vivem em países em desenvolvimento, utiliza essa formulação como principal escolha para o tratamento do TDAH. Esses países, por sua condição financeira, necessitam informações de análises econômicas para administrar de forma eficiente os recursos públicos destinados aos setores da saúde. Objetivos Avaliar a eficácia do MFD-LI através de estudos com tempo superior a 12 semanas, e realizar uma análise econômica para o tratamento do TDAH com MFD-LI para crianças e adolescentes brasileiros. Método O estudo foi planejado em cinco etapas: 1) estimativa de custo do não tratamento do TDAH para o Brasil, e estimativa de economia com tratamento com MFD-LI; 2) revisão sistemática da literatura nas principais bases de dados internacionais onde se buscaram estudos abertos com tratamento do TDAH com MFD-LI por tempo igual ou superior a 12 semanas; também foram feitas metanálises e uma metaregressão 3) estudo naturalístico para obterem-se dados de uma amostra brasileira referentes a probabilidades de uso e sucesso com tratamento com MFD-LI por 12 semanas, e estimar os utilities desses indivíduos; 4) painel Delphi com especialistas em TDAH no Brasil; 5) estudo de custo-efetividade para o tratamento do TDAH com MFD-LI no Brasil, utilizando um Modelo de Markov. A perspectiva adotada será a do sistema público de saúde brasileiro como pagador. Resultados Os resultados principais encontrados para cada uma das etapas foram: 1) a estimativa de custos anuais com o TDAH não tratado no Brasil foi de R$ 1.594 bilhões/ano, e da quantia que poderia ser economizada se tratado, R$ 1 bilhão/ano. 2) na revisão sistemática da literatura, de 4.498 resumos, sete foram incluídos para compor a metanálise. O tempo de tratamento variou entre 13 e 104 semanas. O efeito agregado para desatenção e hiperatividade medida pelos pais, respectivamente, foi 0.96 (95%CI 0.60 - 1.32) e 1.12 (95%CI 0.85 - 1.39), e pelos professores 0.98 (95%CI 0.09 - 1.86) e 1.25 (95% CI 0.7 - 1.81). A metaregressão não mostrou associação entre as variáveis idade, qualidade do artigo e tempo de tratamento com heterogeneidade. 3) no estudo naturalístico, de 171 pacientes avaliados, 73 forneceram informações para o baseline, e 56 para a 12a semana de tratamento com MFD-LI. Os utilities para um paciente com TDAH não tratado (baseline) foram 0.69 (crianças) e 0.66 (adolescentes), e estimaram-se ganhos entre 0.09 a 0.10 utilities/mês, se tratados adequadamente. 4) no painel Delphi, de 26 especialistas, 14 responderam o questionário online, e foi estimado que a probabilidade dos pacientes não tratados se manterem sintomáticos na 12a semana seria de 91%, e 9% a probabilidade de melhora espontânea; 5) no estudo de custo-efetividade, para o caso base, estimou-se que o Incremental Cost Effectiveness Ratio (ICER) seja I$9,103/QALY (Quality Adjusted Life Years) para crianças e I$11,883/QALY para adolescentes em um horizonte temporal de 06 anos. Para os cenários mais desfavoráveis, os ICERS mais elevados foram I$95,164/QALY para 50% de sucesso com o tratamento, e I$15,000/QALY para 70% de adesão em um horizonte temporal de 06 anos. Conclusões O MFD-LI é um tratamento eficaz para crianças e adolescentes, por um período superior a 12 semanas. Entretanto, o Brasil pode estar aumentando os custos referentes à saúde por não estar fornecendo um tratamento eficaz e economicamente acessível para o TDAH. O tratamento mostrou ser uma opção custo-efetiva para crianças e adolescentes brasileiros, mesmo em cenários desfavoráveis para o tratamento. / Introduction Attention-Deficit/Hyperactivity Disorder (ADHD) is a well-known psychiatric disorder, but some economical aspects of the treatment with Methylphenidate Immediate-release (MPH -IR) still need to be explored. A large number of people around the world, most living in Low-Middle Income Countries (LMIC), use this formulation as the first choice for ADHD treatment. These countries, due to their financial condition, need information from health economic analyzes to efficiently manage the public resources allocated to the health sector. Objective To study the efficacy of MPH-IR reviewing studies conducted for more than 12 weeks long, and to perform an economic analysis for the treatment of ADHD with MPH-IR for Brazilian children. Method The study was planned in a five stages process: 1) to estimate the cost of untreated ADHD for Brazil, and to estimate the savings if MPH-IR were adequately provided; 2) systematic review of the literature to identify papers published where young patients with ADHD were treated with MPH-IR for more than 12 weeks, and to perform a meta-analysis and a meta-regression; 3) to conduct a naturalistic study with a Brazilian sample to collect the probabilities of use and success with the MPH-IR treatment for 12 weeks, and to estimate the utilities; 4) to perform a Delphi panel with ADHD Brazilian experts; 5) to conduct a cost-effectiveness analysis for the treatment of ADHD with MPH-IR in Brazil, using a Markov model. The perspective is the one of the Brazilian public health system as the payer. Results The main findings for each step were: 1) the estimated annual expenditures with untreated ADHD in Brazil were R$1.594billon/year, and the estimated amount that could be saved was R$1billion/year; 2) in the systematic review, from 4,498 abstracts, 7 studies were selected. The length of treatment ranged from 13 to 104 weeks. The aggregate effects for inattention and hyperactivity, according to parents evaluations were respectively 0.96 (95%CI 0.60 - 1.32) and 1.12 (95%CI 0.85 - 1.39), and for teachers 0.98 (95%CI 0.09 - 1.86) e 1.25 (95% CI 0.7 - 1.81). There was no evidence of association between heterogeneity and the variables, age, paper quality and length of treatment; 3) in the naturalistic study, from 171 patients assessed, 73 provided information in the baseline, and 56 in the 12th week of MPH-IR treatment. Utilities for an untreated ADHD patient (baseline) were 0.69 (children) and 0.66 (adolescents), and it was estimated a gain ranging from 0.09 to 0.10 utilities/month if subjects were properly treated; 4) in the Delphi Panel, 26 experts were addressed and 14 filled in the online questionnaire. It was estimated the probability of untreated patients to remain symptomatic on the 12th week to be 91%, and the probability of spontaneous improvement, 9%; 5) in the cost-effectiveness analysis, for the base case, it was estimated an Incremental Cost Effectiveness Ratio (ICER) of I$9,103/QALY (Quality Adjusted Life Years) for children and I$11,883/QALY for adolescents, in a time horizon of 6 years. The worst case scenarios were also tested, and the highest ICER were I$95,164/QALY when patient reached 50 % of success with the treatment, and I$15,000/QALY if only 70% of use was observed in a time horizon of 6 years. Conclusions MPH-IR is an efficacious treatment for ADHD children and adolescents for periods longer than 12 weeks. However, Brazil may be probably wasting money due to not provide an efficient and affordable treatment for ADHD such as the MPH-IR. The treatment proved to be cost-effective for children and adolescents living in Brazil, even when the worst case scenarios were tested.

This research explores how community-centered solutions facilitate the success and ownership of the response actions to deal with a public health emergency, such as the Covid-19 pandemic. When an outbreak or a hazard impacts a group of people, there is a strong need for communication in order to be able to access to the right information that takes people to make the correct decision and thus to take a protective action to be safe. This approach, known as Risk Communication and Community Engagement (RCCE)[1], allows the co-production of knowledge needed for a group of people to remain safe. For this approach, social listening tools, such as media monitoring and community feedback collection are critical understand communities’ needs. Its analysis allows to tailor a RCCE strategy that is able to substantially reduce the threat that a public health emergency poses to human lives[2].  Communities need solutions that are adapted to their needs in order to be able to deal with any emergency, including the Covid-19 pandemic. The RCCE approach empowers communities and provides them with the tools to amplify their voices. This participatory approach allows them to co-produce knowledge and get full ownership of the solutions.  Nevertheless, in an environment with excess of information, it may not be easy to discern the truth from the false. Unverified information and rumors are frequent and social media channels facilitate their rapid dissemination without borders. ‘Infodemic’ refers to an excessive amount of information concerning a problem such that the solution is made more difficult. (WHO, 2020)[3]  Some rumors may encourage people to take wrong decisions and perform actions that exacerbate risks during an emergency. The RCCE approach helps to promote real-time exchange of information to avoid that rumors and disinformation flourish. (WHO, 2018)[4]. It also allows to identify and implement community-centered solutions to communities’ problems.  RCCE needs data to monitor and evaluate its activities and reach effectively populations in risk to encourage them to observe the health preventive measures. Lives at risk depends on the right information conveyed through the right channel at the right time. To be able to supply tailored and accurate information to those communities and engage them, evidence-based RCCE strategies are needed, respecting the socio-anthropological and cultural context of the community. This research is based on the findings from five African countries -Cabo Verde, Cameroon, the Gambia, Mozambique and Niger-, all of them seriously affected by current Covid-19 pandemic. Its conclusions help to understand the critical role that RCCE plays in health emergencies resilient recovery.   [1] World Health Organization (WHO) (‎2020)‎. Risk communication and community engagement (‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎RCCE)‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎ readiness and response to the 2019 novel coronaviruses (‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎2019-‎‎nCoV)‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎: interim guidance, 26 January 2020. Geneva: WHO. [2] Risk Communication is one of the eight core functions of the International Health Regulations (2005) [3] World Health Organization (WHO) (‎2020)‎. Infodemic management: a key component of the COVID-19 global response. Weekly Epidemiological Record 95 (‎16)‎, 145 - 148. World Health Organization.  [4] World Health Organization (WHO) (2018). Communicating Risk in Public Health Emergencies - A WHO Guideline for Emergency Risk Communication (ERC) policy and practice. Geneva: World Health Organization.

The contribution of Emergency Obstetric Care (EmOC) in reducing maternal mortality in Ethiopia is very minimal as evidenced by poor provision and low utilization of EmOC. Client centred EmOC provision improves the provision and utilization of EmOC; leading to the treatment of the majority of obstetric complications which are the main causes of maternal mortality. This study describes clients’ views and perspectives concerning the quality of EmOC provision in Ethiopian public health facilities. An explorative and descriptive phenomenological qualitative study design was used in the study in order to explore and describe the lived experiences of clients with EmOC services. Key informant interviews with women who had direct obstetric complications and received EmOC at three public health facilities in Addis Ababa generated rich data on their lived experiences. Content analysis was used to analyze the data as it complies with the phenomenological data analysis and Atlas ti version 6.2 qualitative data analysis software was employed. The findings revealed that quality EmOC is a welcoming, life-saving timely care given in a clean environment with humility, respect, equal treatment and encouragement. It is care that is safe for the client, technically sound, responsive and meets clients’ needs and expectations. Accessibility of life saving care at all time and collaborative and coordinated care created good experiences for the clients. The causes of clients’ disappointment with the provision of EmOC were higher expectations from female providers, underestimation by providers, non responsive providers, and ethical misconduct by providers such as mocking, insulting, yelling, advantage taking providers, undelivered promises by providers, expectation with place of delivery, expectation with newborn care and a limited number of health workers attending delivery. Discrimination, high cost of care and asking client to buy drugs and supplies and referrals from centres, are some of the barriers on r the use of EmOC at public health facilities. The provision of EmOC is constrained by overloaded staffs, shortage of space to accommodate clients and inadequate number of beds. In conclusion, clients have expectations and experiences of provision of EmOC that influence their future decision to seek care. Finally, a client centred guideline for the provision of client centred EmOC provision was developed. / Health Studies / D. Litt. et Phil. (Health Studies)

Aid relief workers active in complex humanitarian emergencies often develop mental health issues, due to the complex context of these settings and several workplace stressors. In order to cope with these problems, aid relief workers rely on organizational preparation and support, and social support. However, there is a gap between the needs for and availability of preparation and support, which has negative effects on their mental health. This qualitative study provides a phenomenological review of the experiences of aid relief workers active in these complex humanitarian emergencies, with regard to mental health issues, levels of preparation, organizational support and social support. For this study, interviews with five aid relief workers in different fields were conducted to research the effects of working in complex humanitarian emergencies on their mental health, and how preparation and support, or the lack thereof, influences their psychological resilience. The results show that organizational preparation and support, and social support have a positive impact on the psychological resilience of aid relief workers. However, the availability of and access to adequate preparation and support often lacks, which has negative consequences for their mental health. Therefore, this study provides recommendations to humanitarian NGO’s to improve their mental health support, and explores how the psychological resilience of aid relief workers in complex humanitarian emergencies can be improved.

Indiana University-Purdue University Indianapolis (IUPUI) / Collaborative helping via social networking conversation threads can pose serious challenges in emergency situations. Interfaces that support complex group interaction and sense-making can help. This research applies human-computer interaction (HCI), computer-supported cooperative work (CSCW), and collaboration engineering in developing an interactive design, the Mega-Collaboration Tool (MCT). The goal is to reduce the cognitive load of a group’s growing mental model, thus increasing the general public’s ability to organize spontaneous collaborative helping. The specific aims of this research include understanding the dynamics of mental model negotiation and determining whether MCT can assist the group’s sense-making ability without increasing net cognitive load. The proposed HCI theory is that interfaces supporting collaborative cognition motivate contribution and reduce information bias, thus increasing the information shared. These research questions are addressed: 1. Does MCT support better collaborative cognition? 2. Does increasing the size of the shared data repository increase the amount of information shared? 3. Does this happen because group members experience 1) a greater sense of strategic commitment to the knowledge structure, 2) increased intrinsic motivation to contribute, and 3) reduced resistance to sharing information? These questions were affirmed to varying degrees, giving insight into the collaborative process. Greater content did not motive group members directly; instead, half of their motivation came from awareness of their contribution’s relevance. Greater content and organization improved this awareness, and also encouraged sharing through increased enthusiasm and reduced bias. Increased commitment was a result of this process, rather than a cause. Also, MCT increased collaborative cognition but was significantly hampered by Internet performance. This challenge indicates MCT’s system components should be redesigned to allow asynchronous interaction. These results should contribute to the development of MCT, other collaboration engineering applications, and HCI and information science theory.

The number of children living in a conflict zone in 2021 reached a staggering 449 million, which represents more than one out of every six children (Save the Children, 2022). When children are exposed to armed conflict the experiences can impair cognitive and social and emotional function. These functions can in return challenge and impair the child's learning processes. Through a comparative multiple-case study, using the lens of the Ecological Systems Theory, two humanitarian interventions; BLP in Gaza by NRC and HCT in Lebanon by IRC, the research aims at shining light on the opportunities and challenges with PSS educational interventions targeting children's trauma recovery and academic achievement. The research questions seek to create an understanding about how the interventions are designed and implemented and which strategies are the most impactful and less impactful, and lastly, what recommendations can be derived from the findings to guide similar NGOs in their design and implementation process. The main results showed that both BTP and HCT interventions effectively reduced traumatic stress and improved academic achievement among the beneficiaries. BLP demonstrated strengths in its multi-leveled design, parent involvement, and comprehensive materials for teachers. HCT demonstrated strengths in creating a supportive environment and structured teacher training but had low parent involvement. The findings emphasize the importance of a multi-leveled approach to enrich the child's social ecosystem.

To assess the validity of case mix adjustment methods used to derive standardised mortality ratios for hospitals, by examining the consistency of relations between risk factors and mortality across hospitals. DESIGN: Retrospective analysis of routinely collected hospital data comparing observed deaths with deaths predicted by the Dr Foster Unit case mix method. SETTING: Four acute National Health Service hospitals in the West Midlands (England) with case mix adjusted standardised mortality ratios ranging from 88 to 140. PARTICIPANTS: 96 948 (April 2005 to March 2006), 126 695 (April 2006 to March 2007), and 62 639 (April to October 2007) admissions to the four hospitals. MAIN OUTCOME MEASURES: Presence of large interaction effects between case mix variable and hospital in a logistic regression model indicating non-constant risk relations, and plausible mechanisms that could give rise to these effects. RESULTS: Large significant (P<or=0.0001) interaction effects were seen with several case mix adjustment variables. For two of these variables-the Charlson (comorbidity) index and emergency admission-interaction effects could be explained credibly by differences in clinical coding and admission practices across hospitals. CONCLUSIONS: The Dr Foster Unit hospital standardised mortality ratio is derived from an internationally adopted/adapted method, which uses at least two variables (the Charlson comorbidity index and emergency admission) that are unsafe for case mix adjustment because their inclusion may actually increase the very bias that case mix adjustment is intended to reduce. Claims that variations in hospital standardised mortality ratios from Dr Foster Unit reflect differences in quality of care are less than credible.

No / To build an early warning score (EWS) based exclusively on routinely undertaken laboratory tests that might provide early discrimination of in-hospital death and could be easily implemented on paper. Using a database of combined haematology and biochemistry results for 86,472 discharged adult patients for whom the admission specialty was Medicine, we used decision tree (DT) analysis to generate a laboratory decision tree early warning score (LDT-EWS) for each gender. LDT-EWS was developed for a single set (n=3496) (Q1) and validated in 22 other discrete sets each of three months long (Q2, Q3...Q23) (total n=82,976; range of n=3428 to 4093) by testing its ability to discriminate in-hospital death using the area under the receiver-operating characteristic (AUROC) curve. The data generated slightly different models for male and female patients. The ranges of AUROC values (95% CI) for LDT-EWS with in-hospital death as the outcome for the validation sets Q2-Q23 were: 0.755 (0.727-0.783) (Q16) to 0.801 (0.776-0.826) [all patients combined, n=82,976]; 0.744 (0.704-0.784, Q16) to 0.824 (0.792-0.856, Q2) [39,591 males]; and 0.742 (0.707-0.777, Q10) to 0.826 (0.796-0.856, Q12) [43,385 females]. CONCLUSIONS: This study provides evidence that the results of commonly measured laboratory tests collected soon after hospital admission can be represented in a simple, paper-based EWS (LDT-EWS) to discriminate in-hospital mortality. We hypothesise that, with appropriate modification, it might be possible to extend the use of LDT-EWS throughout the patient's hospital stay.

In Suid-Afrika word kinders dikwels opgeneem in die Intensiewesorgeenheid na 'n traumatiese gebeurtenis. Die Kerk het die opdrag om vir hierdie kinders te sorg en wel in die vorm van pastoraat. In die praktyk ontvang kinders egter nie altyd die sorg waarop hulle geregtig is nie. Een van die faktore waarom dit nie altyd gebeur nie, is omdat daar gebruik gemaak word van 'n intervensie metode wat steun op verbale kommuniekasievaardighede. Die ses stappe van intervensienavorsing is gebruik om 'n pastorale praktykmodel in die vorm van 'n kursus te ontwikkel. Die aanvanklike praktykmodel is in gevallestudies getoets en later verfyn. Die klem van hierdie praktykmodel is die gebruik van spel as modus van intervensie vanuit 'n Gestalt benadering. Die kursus sal pastors en geestelike werkers in staat stel om effektief vir kinders te sorg. Die hoofkonsepte van die navorsing vorm die vertrekpunte van die kursus saam met praktiese oefeninge in spelterapietegnieke. / Many children in South-Africa are admitted in the Intensive Care Unit after a traumatic event. The Church is called to care for these children in the form of pastoral care. In practise children are often neglected and do not receive the care that they are entiteld to. One of the main reasons is because pastors and religious workers use an intervention method that depends mainly on the verbal skills of the child. The six steps of intervention research was used to develop a pastoral model in the form of course. The innitial intervention model was tested in case studies and refined. The focus of this model is to use play as a mode of intervention from a Gestalt approach. The course will enable pastors and religious workers to care for children more effectively. The main concepts of the research forms the basis of this model with practical excercises. / Social Work / D. Diac. (Spelterapie)

Various studies have found that South Africa’s high unemployment rate contributes to poverty, inequality, crime and ill-health. Furthermore, South African low to middle-income households are characterised by a high debt to income ratio which contributes to low or negative savings rates. This has left many households vulnerable to financials risk and shocks. This research examined how households with low-income or no income manage to cope on a daily basis. The research adopted an auto ethnography method. During the initial phase of the fieldwork the researcher observed participants over a period of more than a year in the provinces of Limpopo and Gauteng, this was followed by in-depth interviews with households selected using purposive and snowballing sampling. The results revealed that the most common coping strategies used by participants’ to deal with financial risks and shocks are borrowing from peers (family, friends and neighbours) and high-risk lenders i.e. mashonisas and accessing social support networks. Other strategies employed included pawning and selling of assets as well as employers’ loans. It was interesting to note that unlike studies in other countries, skipping meals were not a common coping strategy, and this could mainly be ascribed to the social support networks (Ubuntu) that were found in the communities studied. Future research is recommended on the impact of family financial obligations on households’ financial well-being. / Taxation / M. Phil. (Accounting Sciences)