The Architecture of a Software System for Supporting Community-based Primary Health Care with Mobile Technology: The Mobile Technology for Community Health (MoTeCH) Initiative in Ghana

This paper describes the software architecture of a system designed in response to the health development potential of two concomitant trends in poor countries: i) The rapid expansion of community health worker deployment, now estimated to involve over a million workers in Africa and Asia, and ii) the global proliferation of mobile technology coverage and use. Known as the Mobile Technology for Community Health (MoTeCH) Initiative, our system adapts and integrates existing software applications for mobile data collection, electronic medical records, and interactive voice response to bridge health information gaps in rural Africa. MoTeCH calculates the upcoming schedule of care for each client and, when care is due, notifies the client and community health workers responsible for that client. MoTeCH also automates the aggregation of health status and health service delivery information for routine reports. The paper concludes with a summary of lessons learned and future system development needs.     

A nursing association's leadership in primary health care: policy, projects, and partnerships in the 1990s.

This paper documents the work of one provincial nursing association, the Registered Nurses Association of British Columbia (RNABC), to promote primary health care (PHC) as the foundation of the health-care system. In 1990 the RNABC embarked on a comprehensive policy program to influence change from a nursing perspective. A wide array of strategies was used over a 10-year period to help make PHC a reality in British Columbia's health-care system. Successful strategies used during this period included: writing and distributing policy papers, conducting and evaluating demonstration projects, and developing partnerships with other groups. Some of the projects and their outcomes are highlighted, followed by a critical reflection on lessons learned through the various initiatives. Although remarkable achievements were made from the RNABC's policy work during the 1990s, the advancement of PHC requires further collaborative efforts using multiple strategies.     

Independent predictors of breastfeeding intention in a disadvantaged population of pregnant women

Background  

Breastfeeding rates in Scotland are very low, particularly in the more disadvantaged areas. Despite a number of interventions to promote breastfeeding very few women actually intend to breastfeed their baby. The aim of this study was to identify personal and social factors independently associated with intention to breastfeed.     

CardioDiabetes: Core Competencies for Cardiovascular Clinicians in a Rapidly Evolving Era of Type 2 Diabetes Management

A sea change in the management of diabetes is occurring with the publication of clinical trials showing unequivocal cardiovascular (CV) protection through the use of certain antihyperglycemic agents. This change is similar to the change that occurred when lipid lowering with statins was first shown to have CV benefits, an event necessitating changes in training and the proactive treatment of lipids by CV specialists. As was the case then, many CV specialists currently feel poorly equipped to address diabetes with this new information even though diabetes is common in CV practice. The purpose of this overview is to provide an updated, comprehensive, and evidence-based CV protection plan for patients with type 2 diabetes, intended specifically for cardiologists and vascular medicine specialists. We attempt to elucidate a set of “CardioDiabetes” core competencies by merging the CV-relevant elements of the Diabetes Canada 2018 guidelines within a framework of comprehensive vascular protection as supported by other CV guidelines. We review the rationale for measuring hemoglobin A1C, understanding its use for establishing a diagnosis and for monitoring treatment. We also provide a brief review of the medications most important for a CV specialist to know. We provide useful memory aids and a succinct set of reminders and tips (“ABCDEFR’S”) that can serve as a comprehensive checklist in the clinic and help to motivate trainees and clinicians to consult the original guideline source documents to enrich their knowledge and improve treatment in this rapidly changing arena.     

Interactions between hippocampal activity and striatal dopamine in people at clinical high risk for psychosis: relationship to adverse outcomes

Preclinical models propose that increased hippocampal activity drives subcortical dopaminergic dysfunction and leads to psychosis-like symptoms and behaviors. Here, we used multimodal neuroimaging to examine the relationship between hippocampal regional cerebral blood flow (rCBF) and striatal dopamine synthesis capacity in people at clinical high risk (CHR) for psychosis and investigated its association with subsequent clinical and functional outcomes. Ninety-five participants (67 CHR and 28 healthy controls) underwent arterial spin labeling MRI and ¹⁸F-DOPA PET imaging at baseline. CHR participants were followed up for a median of 15 months to determine functional outcomes with the global assessment of function (GAF) scale and clinical outcomes using the comprehensive assessment of at-risk mental states (CAARMS). CHR participants with poor functional outcomes (follow-up GAF < 65, n = 25) showed higher rCBF in the right hippocampus compared to CHRs with good functional outcomes (GAF ≥ 65, n = 25) (p_fwe = 0.026). The relationship between rCBF in this right hippocampal region and striatal dopamine synthesis capacity was also significantly different between groups (p_fwe = 0.035); the association was negative in CHR with poor outcomes (p_fwe = 0.012), but non-significant in CHR with good outcomes. Furthermore, the correlation between right hippocampal rCBF and striatal dopamine function predicted a longitudinal increase in the severity of positive psychotic symptoms within the total CHR group (p = 0.041). There were no differences in rCBF, dopamine, or their associations in the total CHR group relative to controls. These findings indicate that altered interactions between the hippocampus and the subcortical dopamine system are implicated in the pathophysiology of adverse outcomes in the CHR state.Subject terms: Predictive markers, Psychosis