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- Hachem, Hany, PhD Candidate, 1987-
(författare)
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Educating older adults : Theoretical and empirical examinations of the learning philosophies in older age
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this thesis, I theoretically and empirically examine the dominant learning philosophies in older age. Three statements of principles of educational gerontology coalesce into two notorious learning philosophies in older age: humanist and critical. They formulate answers to vital questions about the education of older people. Written in 1990 from a political economy perspective that heavily draws on Freirean pedagogy, the first statement provides a moral and philosophical backing for the practices and aims of a (then) flourishing field by examining the marginalisation of older people in societies. In the same year, the second statement responds to the first with a humanist individualist perspective on the education of older people. It provides a different view on why they choose to learn, the goals for their education, and the role of teachers in enacting said educational goals. Two decades later, the third statement is born. This time, it invigorated a critical but culturalist-leaning perspective. It engages with the focal points in the previous statements and remains loyal to Freirean ideals in the face of an increasingly individualistic and globalised world. Over time, the three statements of principles fuelled a polarising debate around central questions in the education of older people.In this methodologically rich thesis composed of four articles, I recommend and draft a fourth and late modern statement of the principles of educational gerontology, which overcomes agency/structure dualisms characterising the debate surrounding the current principles. First, this thesis confirms that leisure and liberal arts education empowers older people. Second, it attributes to the motives for learning in older age a reflexive ontological security nature that may go hand in hand with that of non-conscious class struggles. Third, it challenges the logic of emancipation embedded in critical educational gerontology and refutes the assumption that older learners are naïve. Finally, it envisages the teachers’ role as emancipators from a less coercive departure point.
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- Ajiko, Mary Margaret, et al.
(författare)
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Prevalence of Paediatric Surgical Conditions in Eastern Uganda : A Cross-Sectional Study
- 2022
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Ingår i: World Journal of Surgery. - New York, NY, United States : Springer Nature. - 0364-2313 .- 1432-2323. ; 46, s. 701-708
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Tidskriftsartikel (refereegranskat)abstract
- Background: The role of surgery in global health has gained greater attention in recent years. Approximately 1.8 billion children below 15 years live in low- and middle-income countries (LMIC). Many surgical conditions affect children. Therefore, paediatric surgery requires specific emphasis. Left unattended, the consequences can be dire. Despite this, there is a paucity of data regarding prevalence of surgical conditions in children in LMIC. The present objective was to investigate the prevalence of paediatric surgical conditions in children in a defined geographical area in Eastern Uganda.Method: A cross-sectional study was carried out in the Iganga-Mayuge Health and Demographic Surveillance Site located in Eastern Uganda. Through a two-stage, cluster-based sampling process, 490 households from 49 villages were randomly selected, generating a study population of 1581 children. The children’s caregivers were interviewed, and the children were physically examined by two medical doctors to identify any surgical conditions.Results: The interview was performed with 1581 children, and 1054 were physically examined. Among these, the overall prevalence of any surgical condition was 16.0 per cent (n = 169). Of these, 39 per cent had an unmet surgical need (66 of 169). This is equivalent to a 6.3 per cent prevalence of current unmet surgical need. The most common groups of surgical condition were congenital anomalies and trauma-related conditions.Conclusion: Surgical conditions in children are common in eastern Uganda. The unmet need for surgery is high. With a growing population, the need for paediatric surgical capacity will increase even further. The health care system must be reinforced to provide services for children with surgical conditions if United Nations Sustainability Development Goal 3 is to be achieved by 2030.
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- Ajiko, Mary Margaret, et al.
(författare)
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Surgical procedures for children in the public healthcare sector: A nationwide, facility-based study in Uganda
- 2021
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:7
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study investigated the surgical services for children at the highest levels of the public healthcare sector in Uganda. The aim was to determine volumes and types of procedure performed and the patients and the human resource involved.Design: The study was a facility-based, record review.Setting: The study was carried out at the National Referral Hospital, all 14 regional referral hospitals and 14 general hospitals in Uganda, representing the highest levels of hospital in the public healthcare sector.Participants: The subjects were children <18 years who underwent major surgery in the study hospitals during 2013 and 2014.Results: The study hospitals contribute with an average annual rate of paediatric surgery at 22.0 per 100 000 paediatric population. This is a fraction of the estimated need. Most of the procedures were performed for congenital anomalies (n=3111, 39.4%), inflammation and infection (n=2264, 28.7%) and trauma (n=1210, 15.3%). Specialist surgeons performed 60.3% (n=4758) of the procedures, and anaesthesia was administered by specialist physician anaesthetists in 11.6% (n=917) of the cases.Conclusions: A variety of paediatric surgical procedures are performed in a relatively decentralised system throughout Uganda. Task shifting and task sharing of surgery and anaesthesia are widespread: a large proportion of surgical procedures was carried out by non-specialist physicians, with anaesthesia mostly delivered by non-physician anaesthetists. Reinforcing the capacity and promoting the expansion of the health facilities studied, in particular the general hospitals and regional referral hospitals, could help reduce the immense unmet need for surgical services for children in Uganda.
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- Arvedson, Mats, et al.
(författare)
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Packet or Circuit Switched Voice Radio Bearers-A Capacity Evaluation for GERAN
- 2002
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Konferensbidrag (refereegranskat)abstract
- GERAN, including the EDGE radio interface, con-stitutes the 3G evolution of GSM. The use of packet switched voice radio bearers has been discussed in the GERAN standardization, but has as yet not been adopted. This paper presents a thorough capacity comparison of circuit and packet switched voice bearers, applied to GERAN. Thus the standardization decision is verified, but also a framework for future similar investigations is provided. Several parameters affect the relative performance of circuit and packet switching. This report evaluates the effect of four of these parameters, expected to have major impact on the relative performance: reuse factor, resource pool size, voice activity, and additional overhead in the packet switched case. Varying the above parameters, it is seen that in certain blocking-limited scenarios packet switching may increase capacity significantly. The highest overall capacity is however achieved in inter-ference-limited scenarios, for which packet switching provides no capacity gain.
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- Ashley, Thomas, et al.
(författare)
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Outcomes After Elective Inguinal Hernia Repair Performed by Associate Clinicians vs Medical Doctors in Sierra Leone A Randomized Clinical Trial
- 2021
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Ingår i: JAMA Network Open. - : American Medical Association. - 2574-3805. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Task sharing of surgical duties with medical doctors (MDs) without formal surgical training and associate clinicians (ACs; health care workers corresponding to an educational level between that of a nurse and an MD) is practiced to provide surgical services to people in low-resource settings. The safety and effectiveness of this has not been fully evaluated through a randomized clinical trial. OBJECTIVE To determine whether task sharing with MDs and ACs is safe and effective in mesh hernia repair in Sierra Leone. DESIGN, SETTING, AND PARTICIPANTS This single-blind, noninferiority randomized clinical trial included adult, healthy men with primary inguinal hernia randomized to receiving surgical treatment from an MD or an AC. In Sierra Leone, ACs practicing surgery have received 2 years of surgical training and completed a 1-year internship. The study was conducted between October 2017 and February 2019. Patients were followed up at 2 weeks and 1 year after operations. Observers were blinded to the study arm of the patients. The study was carried out in a first-level hospital in rural Sierra Leone. Data were analyzed from March to June 2019. INTERVENTIONS All patients received an open mesh inguinal hernia repair under local anesthesia. The control group underwent operations performed by MDs, and the intervention group underwent operations performed by ACs. MAIN OUTCOMES AND MEASURES The primary end point was hernia recurrence at 1 year. Outcomes were assessed by blinded observers at 2 weeks and 1 year after operations. RESULTS A total of 230 patients were recruited (mean [SD] age, 43.0 [13.5] years), and all but 1 patient underwent inguinal hernia repair between October 23, 2017, and February 2, 2018, performed by 5 MDs and 6 ACs. A total of 114 patients were operated on by MDs, and 115 patients were operated on by ACs. There were no crossovers between the study arms. The follow-up rate was 100% at 2 weeks and 94.1% at 1 year. At 1 year, hernia recurrence occurred in 7 patients (6.9%) operated on by MDs and 1 patient (0.9%) operated on by ACs (absolute difference, -6.0 [95% CI, -11.2 to 0.7] percentage points; P < .001). CONCLUSIONS AND RELEVANCE These findings demonstrate that task sharing of elective mesh inguinal hernia repair with ACs was safe and effective. The task sharing debate should progress to focus on optimizing surgical training programs for nonsurgeons and building capacity for elective surgical care in low- and middle-income countries.
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- Ashley, Thomas, et al.
(författare)
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Standardised Competency-Based Training of Medical Doctors and Associate Clinicians in Inguinal Repair with Mesh in Sierra Leone
- 2023
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Ingår i: World Journal of Surgery. - : SPRINGER. - 0364-2313 .- 1432-2323. ; 47:10, s. 2330-2337
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionIn low-income settings, there is a high unmet need for hernia surgery, and most procedures are performed with tissue repair techniques. In preparation for a randomized clinical trial, medical doctors and associate clinicians received a short-course competency-based training on inguinal hernia repair with mesh under local anaesthesia. The aim of this study was to evaluate feasibility, safety and effectiveness of the training.MethodsAll trainees received a one-day theoretical module on mesh hernia repair under local anaesthesia followed by hands-on training. Performance was assessed using the American College of Surgeons Groin Hernia Operative Performance Rating System. Patients were followed up two weeks and one year after surgery. Outcomes of the patients operated on during the training trial were compared to the 229 trial patients operated on after the training.ResultsDuring three surgical camps, seven medical doctors and six associate clinicians were trained. In total, 129 patients were operated on as part of the training. Of the 13 trainees, 11 reached proficiency. Patients in the training group had more wound infections after two weeks (8.5% versus 3.1%; p = 0.041). There was no difference in recurrence and mortality after one year, and none of the deaths were attributed to the surgery.Discussion and conclusionMesh repair is the international standard for inguinal hernia repair worldwide. Nevertheless, this is not widely accessible in low-income settings. This study has demonstrated that short-course intensive hands-on training of MDs and ACs in mesh hernia repair is effective and safe.Trial Registration: International Clinical Trial Registry ISRCTN63478884.
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