No description available.

<p>Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens &amp / Zupan, 2005). Early&nbsp / detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing&nbsp / countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking&nbsp / behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home&nbsp / visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit,&nbsp / community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing&nbsp / community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured&nbsp / questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers&rsquo / home or at the study&nbsp / offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis.&nbsp / Descriptive analysis was&nbsp / conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant&nbsp / associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were&nbsp / enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the&nbsp / highest number of which occurred within&nbsp / the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking&nbsp / their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW.&nbsp / Conclusion: This study found&nbsp / high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South&nbsp / African National Department of Health (SANDOH) which will involve the establishment of family health worker teams&nbsp / including community health workers. A key function of these workers will&nbsp / be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with&nbsp / non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by&nbsp / community health workers. Most of the referrals in this study were&nbsp / neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal&nbsp / and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater&nbsp / realization of a team approach to PHC.</p>

A previous population-based study of survival in Chronic Lymphocytic Leukemia (CLL) patients in the province of Manitoba demonstrated a lower five-year relative survival among CLL patients compared with the age- and gender-adjusted general population. This decreased relative survival was most pronounced among elderly male CLL patients. In this study, we have demonstrated that the reduced five-year relative survival observed in CLL patients compared to the general population of Manitoba may partially be attributed to increased risk of second cancers and non-referral to specialized CLL clinics. The increased risk of second cancers in CLL patients compared to Follicular Lymphoma (FL), a similar indolent B cell malignancy, was only observed after CLL diagnosis indicating that a CLL-specific factor may be responsible for the increased risk of second cancers in these patients. The risk of second cancers is independent of treatment and surveillance bias but is further increased with chemotherapy. A superior outcome in CLL patients who have been referred to the CancerCare Manitoba (CCMB) specialized CLL clinic was observed that was independent of age, gender, treatment and history of previous cancers. This superior outcome was most pronounced in the elderly CLL patients. We propose that CLL patients should be referred to CLL-specific hematologists and, where not possible, that guidelines created by such experts be followed. Appropriate screening for second cancers should be performed during routine follow up of CLL patients.

From earliest times, child protection has formed an important part of the social worker's responsibilities. When child protection is referred to, statutory intervention, with the accompanying supportive or therapeutic intervention, is often necessary. In cases of sexual abuse of children, the nature of the service rendered is complex, requiring a wide range of inputs. Forensic social work is a fairly new specialist field in terms of service provision in social work in South Africa. The forensic social worker is primarily involved in investigating reports of alleged sexual abuse and must draw up a court report and, as an expert, give evidence in court. The forensic social worker is not involved with the child at therapeutic level. Social workers involved with generic child and family care can be involved in both the statutory and the therapeutic interventions, but are not always sure when a child should be referred for forensic assessment. This may lead to role confusion and conflict. This study attempts to establish a guideline for social workers in the offices of the Christian Council Social Services in the Highveld Synod, in order to facilitate referral for forensic assessment and to eliminate the role confusion and conflict mentioned above. The guidelines have been drawn up on the basis of information gathered from the relevant literature and from focus group conversations with social workers and individual interviews with social workers specialising in forensic social work. Although the guidelines have been developed specifically for the above–mentioned organisation, social workers in other child and family care organisations could also derive benefit from them. / Thesis (M.A. (MW))--North-West University, Potchefstroom Campus, 2011.

From earliest times, child protection has formed an important part of the social worker's responsibilities. When child protection is referred to, statutory intervention, with the accompanying supportive or therapeutic intervention, is often necessary. In cases of sexual abuse of children, the nature of the service rendered is complex, requiring a wide range of inputs. Forensic social work is a fairly new specialist field in terms of service provision in social work in South Africa. The forensic social worker is primarily involved in investigating reports of alleged sexual abuse and must draw up a court report and, as an expert, give evidence in court. The forensic social worker is not involved with the child at therapeutic level. Social workers involved with generic child and family care can be involved in both the statutory and the therapeutic interventions, but are not always sure when a child should be referred for forensic assessment. This may lead to role confusion and conflict. This study attempts to establish a guideline for social workers in the offices of the Christian Council Social Services in the Highveld Synod, in order to facilitate referral for forensic assessment and to eliminate the role confusion and conflict mentioned above. The guidelines have been drawn up on the basis of information gathered from the relevant literature and from focus group conversations with social workers and individual interviews with social workers specialising in forensic social work. Although the guidelines have been developed specifically for the above–mentioned organisation, social workers in other child and family care organisations could also derive benefit from them. / Thesis (M.A. (MW))--North-West University, Potchefstroom Campus, 2011.

La saisine de la Cour pénale internationale désigne l'ensemble des mécanismes d'ouverture de l'instance pénale internationale. Elle naît formellement de l'acte introductif d'instance qui peut être le fait des États parties au Statut, du Conseil de sécurité de l'ONU et du Procureur. Les procédures diligentées à la suite des saisines ont pour finalité de situer la responsabilité pénale individuelle et de réprimer les violations massives des droits de l'homme et du droit international humanitaire. L'évaluation de la pratique sélective des saisines permet de déceler la lenteur des procédures en cours. Si cette lenteur a des justifications endogènes, elle est explicable, au plan exogène, par les rapports complexes que la juridiction entretient avec les États au regard du principe de complémentarité. Il en est de même de l'emprise du Conseil de sécurité de l'ONU sur la compétence de la Cour et le traitement des saisines. Par ailleurs, en raison de l'exécution discutable de l'obligation de coopération par les États, la CPI assure avec difficulté l'objectif de la lutte contre l'impunité des crimes graves. En tout état de cause, l'essor de la saisine est tributaire d'une application optimale des dispositions statutaires et d'un rééquilibrage des rapports entre les États, le Conseil de sécurité et la Cour / The referral to the International Criminal Court refers to all the opening mechanisms of the international criminal trial. It officially comes from the writ of summons which can be the fact of States parties in the Status, of the UN Security Council and the Prosecutor. The procedures undertaken following the Court referrals have for purpose to locate the individual criminal responsibility and to repress the massive violations of the human rights and the international humanitarian law. The assessment of the selective referrals allows to reveal the slowness of the current procedures. If this slowness has endogenous reasons, it is explained, in the exogenous plan, by the complex relationships that the jurisdiction maintains with States towards the principle of Complementarity. It is the same about the influence of the UN Security Council on the jurisdiction of the Court and the referrals processing. Moreover, because of the questionable performance of the obligation of cooperation by States, the ICC insures with difficulty the objective of the fight against the impunity for serious crimes. In any case, the development of the Court referral is dependent on an optimal application of the statutory disposals and a rebalance of relationships between States, Security Council and Court

The purpose of this study was to establish empirical evidence on risk factors influencing drug-resistant tuberculosis (DR-TB) in Swaziland. Globally factors have been identified and specific programmatic interventions were implemented to counter the emergence of DR-TB, but the case still remains with Swaziland. The research question was “What are the risk factors influencing the epidemiology of DR-TB patients enrolled for treatment at the National Tuberculosis Referral Hospital? The research objectives were to investigate factors that influence the emergence of DR-TB in Swaziland, to establish the relationship between DR-TB and HIV and to develop a poster that will exhibit the findings on the study on risk factors influencing the epidemiology of DR-TB. A mixed method was used. A qualitative study of participants using the in-depth one on one interview with a grand tour question “ What are the risk factors that resulted in you having DR-TB” and probing questions. The quantitative retrospective part was utilised to review medical records. Convenience sampling was utilised to recruit participants using an interview guide to collect data and random sampling for the quantitative aspect using a checklist to collect data. Risk factors influencing the development of DR-TB were identified to be previous treatment with anti-tuberculosis drugs, human immunodeficiency virus (HIV). The findings showed that the prevalence of HIV in DR-TB was 61% for HIV positive and 39% for negative and the quantitative data showed 77% HIV positive and 23% negative to HIV. Lack of education for patients and their families on precautionary measures to take when caring for a family member, and what to do in cases of developing side effects. This study concludes that both the need to ensure that bacteriologically confirmed patients are initiated to treatment, adhere to their treatment and complete treatment and due to the number of direct cases being infected with DR-TB ensuring that infection control strategies are put in place at work and at home settings / Health Studies / M.A. (Public Health)

O consumo de drogas e álcool constitui cada vez mais um problema social e de saúde pública, pelas consequências negativas que provocam no desenvolvimento emocional e físico dos indivíduos. Existem poucas referências na literatura avaliando o uso destas substâncias por portadores de doença falciforme (DF). Estes pacientes apresentam crises álgicas severas, recorrentes, frequentemente controladas por opióides. O comprometimento da qualidade de vida predispõe a ocorrência de transtornos psiquiátricos não-psicóticos, como depressão por exemplo, tornando o grupo vulnerável ao uso abusivo de substâncias. Objetivos: avaliar o consumo de álcool e drogas em pacientes portadores de DF acompanhados pelo Centro de Referência de Doença Falciforme (CRAF) do Hospital de Clínicas de Porto Alegre (HCPA), estimar o percentual de pacientes em tratamento da doença falciforme que fazem uso abusivo de álcool e drogas, e colaborar com o estudo que avaliará a efetividade de um centro de referência multidisciplinar para esta população. Métodos: estudo transversal, de uma amostra de conveniência, com 139 pacientes portadores de DF acompanhados no CRAF do HCPA. Resultados: a prevalência do uso abusivo foi de 1,5% para o álcool e 3,0% para o tabaco, e não se identificou o uso abusivo de outras substâncias, inclusive opióides. O padrão para o uso de substâncias não foi influenciado pela exposição ou por transtornos psiquiátricos não-psicóticos. Conclusão: São necessários mais estudos para reforçar estes achados, mas demonstra-se a segurança do uso de analgésicos opióides para o manejo das crises dolorosas apresentadas pelos portadores de DF. / Drug abuse is increasingly becoming a social and public health problem, because of the negative consequences that such abuse causes on the emotional and physical development of individuals. There are few references in the literature evaluating the use of these substances by individuals with sickle cell disease (SCD). These patients have severe and recurrent pain crises, frequently needing opioids drugs to control it. The compromised quality of life can predispose this population to the occurrence of non-psychotic psychiatric disorders such as depression, making them vulnerable to substance abuse. Objectives: To evaluate the level of consumption of alcohol and drugs in patients with SCD followed by Sickle Cell Disease Reference Center (CRAF) at Hospital de Clínicas de Porto Alegre; to estimate the percentage of patients in treatment of SCD who abuse alcohol and drugs, and to collaborate with the study evaluating the effectiveness of the CRAF. Methods: cross-sectional study of a convenience sample of 139 patients with SCD treated at CRAF. Results: the prevalence of abusive use of the studied population was 1.5% for alcohol and 3.0% for tobacco, and no abusive use of any other substance, including opioids, was identified. It was verified that the pattern for substance use was not influenced by exposure to substances or the presence of non-psychotic psychiatric disorders. Conclusion: More studies are needed to reinforce these findings, but they suggested that the use of opioid analgesics for the management of SCD painful crises is safe and do not induces substance abuse.

O consumo de drogas e álcool constitui cada vez mais um problema social e de saúde pública, pelas consequências negativas que provocam no desenvolvimento emocional e físico dos indivíduos. Existem poucas referências na literatura avaliando o uso destas substâncias por portadores de doença falciforme (DF). Estes pacientes apresentam crises álgicas severas, recorrentes, frequentemente controladas por opióides. O comprometimento da qualidade de vida predispõe a ocorrência de transtornos psiquiátricos não-psicóticos, como depressão por exemplo, tornando o grupo vulnerável ao uso abusivo de substâncias. Objetivos: avaliar o consumo de álcool e drogas em pacientes portadores de DF acompanhados pelo Centro de Referência de Doença Falciforme (CRAF) do Hospital de Clínicas de Porto Alegre (HCPA), estimar o percentual de pacientes em tratamento da doença falciforme que fazem uso abusivo de álcool e drogas, e colaborar com o estudo que avaliará a efetividade de um centro de referência multidisciplinar para esta população. Métodos: estudo transversal, de uma amostra de conveniência, com 139 pacientes portadores de DF acompanhados no CRAF do HCPA. Resultados: a prevalência do uso abusivo foi de 1,5% para o álcool e 3,0% para o tabaco, e não se identificou o uso abusivo de outras substâncias, inclusive opióides. O padrão para o uso de substâncias não foi influenciado pela exposição ou por transtornos psiquiátricos não-psicóticos. Conclusão: São necessários mais estudos para reforçar estes achados, mas demonstra-se a segurança do uso de analgésicos opióides para o manejo das crises dolorosas apresentadas pelos portadores de DF. / Drug abuse is increasingly becoming a social and public health problem, because of the negative consequences that such abuse causes on the emotional and physical development of individuals. There are few references in the literature evaluating the use of these substances by individuals with sickle cell disease (SCD). These patients have severe and recurrent pain crises, frequently needing opioids drugs to control it. The compromised quality of life can predispose this population to the occurrence of non-psychotic psychiatric disorders such as depression, making them vulnerable to substance abuse. Objectives: To evaluate the level of consumption of alcohol and drugs in patients with SCD followed by Sickle Cell Disease Reference Center (CRAF) at Hospital de Clínicas de Porto Alegre; to estimate the percentage of patients in treatment of SCD who abuse alcohol and drugs, and to collaborate with the study evaluating the effectiveness of the CRAF. Methods: cross-sectional study of a convenience sample of 139 patients with SCD treated at CRAF. Results: the prevalence of abusive use of the studied population was 1.5% for alcohol and 3.0% for tobacco, and no abusive use of any other substance, including opioids, was identified. It was verified that the pattern for substance use was not influenced by exposure to substances or the presence of non-psychotic psychiatric disorders. Conclusion: More studies are needed to reinforce these findings, but they suggested that the use of opioid analgesics for the management of SCD painful crises is safe and do not induces substance abuse.

Magister Public Health - MPH / Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens Zupan, 2005). Early detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit, community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers home or at the study offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis. Descriptive analysis was conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the highest number of which occurred within the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW. Conclusion: This study found high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South African National Department of Health (SANDOH) which will involve the establishment of family health worker teams including community health workers. A key function of these workers will be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by community health workers. Most of the referrals in this study were neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater realization of a team approach to PHC. / South Africa