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Capacity building for child health: Canadian paediatricians in Uganda

Jennifer L Brenner, John C Godel
2005 Paediatrics & child health  
For six years, Canadian paediatricians have worked in partnership with their Ugandan colleagues to promote improved child health in southwestern Uganda. To describe a collaboration between the Mbarara University of Science and Technology and Canadian partners that aims to build local capacity in child health through support of training at university, community and health centre levels. Three low-cost initiatives are now implemented. At the university level, volunteer Canadian paediatricians
more » ... ort Ugandan faculty colleagues through teaching health care trainees at a busy tertiary referral and teaching hospital. In the community, the Healthy Child Project helps Ugandans train local health volunteers who educate mothers and caregivers about child health. At health centres in the Mbarara and Bushenyi Districts, Canadians support a locally initiated outreach program that provides paediatric consultation and continuing medical education for staff at rural health posts. Ugandans and Canadians have benefited from this collaboration. Hundreds of Ugandan undergraduate and graduate health care trainees, more than 100 community volunteers and numerous local health practitioners have received child health training through one of these three Canadian-supported paediatric initiatives. More than 25 Canadian paediatricians have benefited greatly from their overseas teaching and clinical experience. The strength of this collaboration is a shared interest in improving child health in southwestern Uganda. A strong Ugandan-Canadian partnership has built significant child health capacity with great benefit to both partners. These initiatives may serve as a model for other child health providers wishing to support capacity-building initiatives in less developed countries to improve global health.
pmid:19668631 pmcid:PMC2722544 fatcat:fdrfzlwambbzpflvfwg4c5sxou

A 12-year-old girl with pharyngitis, meningitis and sinovenous thrombosis

Jacob L Jaremko, Adam Kirton, Jennifer L Brenner
2003 CMAJ - Canadian Medical Association Journal  
Boras, Department of Microbiology, Lethbridge Regional Hospital P R AC T I C E C L I N I C A L V I S TA S tigue, anorexia and neck pain.  ...  However, she continued to experience low-grade fa-A 12-year-old girl with pharyngitis, meningitis and sinovenous thrombosis C L I N I C A L V I S TA S Department of Radiology, Alberta Children's Hospital  ... 
pmid:14557322 pmcid:PMC203287 fatcat:4casiewjtreqvp6v4n57mdauju

Evaluating Shared Decision Making for Lung Cancer Screening

Alison T. Brenner, Teri L. Malo, Marjorie Margolis, Jennifer Elston Lafata, Shynah James, Maihan B. Vu, Daniel S. Reuland
2018 JAMA Internal Medicine  
10.1001/jamainternmed.2018.3054 Author Affiliations: Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill (Brenner  ... 
doi:10.1001/jamainternmed.2018.3054 pmid:30105393 pmcid:PMC6233759 fatcat:pptbhnrybvfhffmqi7cxzxg3b4

Rater training for standardised assessment of Objective Structured Clinical Examinations in rural Tanzania

Elaine L Sigalet, Dismas Matovelo, Jennifer L Brenner, Maendeleo Boniphace, Edgar Ndaboine, Lusako Mwaikasu, Girles Shabani, Julieth Kabirigi, Jaelene Mannerfeldt, Nalini Singhal
2020 BMJ Paediatrics Open  
ORCID iD Elaine L Sigalet http:// orcid. org/ 0000-0002-9103-9968 Figure 1 1 This figure provides a visual of the research design we used in the study each day.  ... 
doi:10.1136/bmjpo-2020-000856 pmid:33324763 pmcid:PMC7722831 fatcat:6o7zooalpnfgnfcrji4ot57ote

Repeated-bout exercise in the heat in young athletes: physiological strain and perceptual responses

Michael F. Bergeron, Melissa D. Laird, Elaina L. Marinik, Joel S. Brenner, Jennifer L. Waller
2009 Journal of applied physiology  
A short recovery period between same-day competitions is common practice in organized youth sports. We hypothesized that young athletes will experience an increase in physiological strain and perceptual discomfort during a second identical exercise bout in the heat, with 1 h (21°C) between bouts, even with ample hydration. Twenty-four athletes (6 boys and 6 girls: 12-13 yr old, 47.7 Ϯ 8.3 kg; 6 boys and 6 girls: 16 -17 yr old, 61.0 Ϯ 8.6 kg) completed two 80-min intermittent exercise bouts
more » ... dmill 60%, cycle 40% peak oxygen uptake) in the heat (33°C, 48.9 Ϯ 6.1% relative humidity). Sweat loss during each bout was similar within each age group (12-13 yr old: bout 1, 943.6 Ϯ 237.1 ml; bout 2, 955.5 Ϯ 250.3 ml; 16 -17 yr old: bout 1, 1,382.2 Ϯ 480.7 ml; bout 2, 1,373.1 Ϯ 472.2 ml). Area under the curve (AUC) was not statistically different (P Ͼ 0.05) between bouts for core body temperature (12-13 yr old: bout 1 peak, 38.6 Ϯ 0.4°C; bout 2, 38.4 Ϯ 0.2°C; 16 -17 yr old: bout 1 peak, 38.8 Ϯ 0.7°C; bout 2, 38.7 Ϯ 0.6°C), physiological strain index (12-13 yr old: bout 1 peak, 7.9 Ϯ 0.9; bout 2, 7.5 Ϯ 0.7; 16 -17 yr old: bout 1 peak, 8.1 Ϯ 1.5; bout 2, 7.9 Ϯ 1.4), or thermal sensation for any age/sex subgroup or for all subjects combined. However, rating of perceived exertion AUC and peak were higher (P ϭ 0.0090 and 0.0004, respectively) during bout 2 in the older age group. Notably, four subjects experienced consistently higher responses throughout bout 2. With these healthy, fit, young athletes, 1 h of complete rest, cool down, and rehydration following 80 min of strenuous exercise in the heat was generally effective in eliminating any apparent carryover effects that would have resulted in greater thermal and cardiovascular strain during a subsequent identical exercise bout.
doi:10.1152/japplphysiol.00122.2008 pmid:19023026 fatcat:twwxzj5up5asfa2nxf6zwi4cjq

The fear of social stigma experienced by men: a barrier to male involvement in antenatal care in Misungwi District, rural Tanzania

Maendeleo Boniphace, Dismas Matovelo, Rose Laisser, Victoria Yohani, Hadija Swai, Leonard Subi, Zabroni Masatu, Sylvia Tinka, Hannah Faye G. Mercader, Jennifer L. Brenner, Jennifer L. Mitchell
2022 BMC Pregnancy and Childbirth  
Background Evidence has shown that male involvement is associated with improved maternal health outcomes. In rural Tanzania, men are the main decision makers and may determine women's access to health services and ultimately their health outcomes. Despite efforts geared towards enhancing male participation in maternal health care, their involvement in antenatal care (ANC) remains low. One barrier that impacts men's participation is the fear and experience of social stigma. This study, builds on
more » ... previous findings about men's perspectives in attending antenatal care appointments in Misungwi district in Tanzania, examining more closely the fear of social stigma amongst men attending ANC together with their partners. Methods Twelve individual interviews and five focus group discussions were conducted using semi-structured questionnaires with fathers and expectant fathers. In-depth interviews were conducted with health providers, volunteer community health workers and village leaders. Interviews were audiotaped, and transcripts were transcribed and translated to English. Transcripts were organized in NVivo V.12 then analyzed using thematic approach. Results Three main themes were found to create fear of social stigma for men: 1. Fear of HIV testing; 2. Traditional Gender Norms and 3. Insecurity about family social and economic status. Conclusion Respondent's experiences reveal that fear of social stigma is a major barrier to attend ANC services with their partners. Attention must be given to the complex sociocultural norms and social context that underly this issue at the community level. Strategies to address fear of social stigma require an understanding of the real reasons some men do not attend ANC and require community engagement of community health workers (CHWs), government officials and other stakeholders who understand the local context.
doi:10.1186/s12884-022-04383-x pmid:35039002 pmcid:PMC8764782 fatcat:gh765fsqm5fflhlrcyjqgdtrl4

Stakeholders' Perceptions of Integrated Community Case Management by Community Health Workers: A Post-Intervention Qualitative Study

Denise L. Buchner, Jennifer L. Brenner, Jerome Kabakyenga, Kyomuhangi Teddy, Samuel Maling, Celestine Barigye, Alberto Nettel-Aguirre, Nalini Singhal, Suryaprakash Sambhara
2014 PLoS ONE  
Integrated community case management (iCCM) involves delivery of simple medicines to children with pneumonia, diarrhea and/or malaria by community health workers (CHWs). Between 2010 and 2012, an iCCM intervention trial was implemented by Healthy Child Uganda. This study used qualitative tools to assess whether project stakeholders perceived that iCCM improved access to care for children under five years of age. Methods: The intervention involved training and equipping 196 CHWs in 98 study
more » ... ges in one sub-county in Uganda in iCCM. During the eight-month intervention, CHWs assessed sick children, provided antimalarials (coartem) for fever, antibiotics (amoxicillin) for cough and fast breathing, oral rehydration salts/zinc for diarrhea, and referred very sick children to health facilities. In order to examine community perceptions and acceptability of iCCM, post-intervention focus groups and key respondent interviews involving caregivers, health workers, CHWs and local leaders were carried out by experienced facilitators using semi-structured interview guides. Data were analyzed using thematic analysis techniques.
doi:10.1371/journal.pone.0098610 pmid:24927074 pmcid:PMC4057118 fatcat:rw57hrjbujam5m4tcojyyo4pwu

The uptake and effect of a mailed multi-modal colon cancer screening intervention: A pilot controlled trial

Carmen L Lewis, Alison T Brenner, Jennifer M Griffith, Michael P Pignone
2008 Implementation Science  
A through L served as the pool for the intervention group and M through Z for the control/waitlist groups.  ... 
doi:10.1186/1748-5908-3-32 pmid:18518990 pmcid:PMC2427049 fatcat:7bceeodvnrghrftl6k4gjyybiq

Men perspectives on attending antenatal care visits with their pregnant partners in Misungwi district, rural Tanzania: a qualitative study

Maendeleo Boniphace, Dismas Matovelo, Rose Laisser, Hadija Swai, Victoria Yohani, Sylvia Tinka, Lusako Mwaikasu, Hannah Mercader, Jennifer L. Brenner, Jennifer Mitchell
2021 BMC Pregnancy and Childbirth  
Background Mens'attendance with their pregnant partners at facility-based antenatal care (ANC) visits is important for maternal and child health and gender equality yet remains uncommon in parts of rural Tanzania. This study examined men's perspectives on attending ANC with their pregnant partners in Misungwi District, Tanzania. Methods Twelve individual interviews and five focus group discussions were conducted using semi-structured questionnaires with fathers, expectant fathers, and in-depth
more » ... nterviews were done to health providers, volunteer community health workers, and village leaders. Interviews were recorded and transcribed in Swahili and later translated to English. The research team conducted thematic analysis to identify common themes among interviews. Results We identified two broad themes on the barriers to male attendance at facility-based ANC visits: (1) Perceived exclusion during ANC visits among men (2) Traditional gender norms resulting to low attendance among men. Conclusion Attendance at health facility for ANC visits by men with their pregnant partners in the study areas were challenged by structural and local cultural norms. At the facility men were uncomfortable to sit with women due to lack of specific waiting area for men and that they perceived to be neglected. Local cultural norms demanded women to have secrecy in pregnancy while men perceived not to have a role of being with their partners during ANC visits.
doi:10.1186/s12884-021-03585-z pmid:33509124 fatcat:27ahbcurrraslompk74ipkr3ve

Soil N and 15 N variation with time in a California annual grassland ecosystem

Dana L. Brenner, Ronald Amundson, W.Troy Baisden, Carol Kendall, Jennifer Harden
2001 Geochimica et Cosmochimica Acta  
Brenner, a NASA Earth System Science fellowship to W.T.  ...  L. Brenner et al. tion relative to wet N deposition.  ...  L. Brenner et al. Fig. 7 .Fig. 8 . 78 The variation in mean ␦ 15 N values with soil age.  ... 
doi:10.1016/s0016-7037(01)00699-8 fatcat:vme3bymynbc73a3ywrxfb4yeyy

Drugs for some but not all: inequity within community health worker teams during introduction of integrated community case management

Hannah Faye G Mercader, Teddy Kyomuhangi, Denise L Buchner, Jerome Kabakyenga, Jennifer L Brenner
2014 BMC Health Services Research  
Bainomugisha Christopher Appuli, Nasulu Samula Nasser, Mubiru Magidu for help with field work and mobilization; data assistants Rwabijaju Bob and Areeba Kevin for translation assistance; academic advisor Jennifer  ... 
doi:10.1186/1472-6963-14-s1-s1 pmid:25078968 pmcid:PMC4108853 fatcat:tqxaku6fvnawnonez5rpgfz2my

Context matters in understanding the vulnerability of women: perspectives from southwestern Uganda

Neema Murembe, Teddy Kyomuhangi, Kimberly Manalili, Florence Beinempaka, Primrose Nakazibwe, Clare Kyokushaba, Basil Tibanyendera, Jennifer L. Brenner, Eleanor Turyakira
2021 Archives of Public Health  
Background Vulnerability at the individual, family, community or organization level affects access and utilization of health services, and is a key consideration for health equity. Several frameworks have been used to explore the concept of vulnerability and identified demographics including ethnicity, economic class, level of education, and geographical location. While the magnitude of vulnerable populations is not clearly documented and understood, specific indicators, such as extreme
more » ... show that vulnerability among women is pervasive. Women in low and middle-income countries often do not control economic resources and are culturally disadvantaged, which exacerbates other vulnerabilities they experience. In this commentary, we explore the different understandings of vulnerability and the importance of engaging communities in defining vulnerability for research, as well as for programming and provision of maternal newborn and child health (MNCH) services. Methodology In a recent community-based qualitative study, we examined the healthcare utilization experiences of vulnerable women with MNCH services in rural southwestern Uganda. Focus group discussions were conducted with community leaders and community health workers in two districts of Southwestern Uganda. In addition, we did individual interviews with women living in extreme poverty and having other conventional vulnerability characteristics. Findings and discussion We found that the traditional criteria of vulnerability were insufficient to identify categories of vulnerable women to target in the context of MNCH programming and service provision in resource-limited settings. Through our engagement with communities and through the narratives of the people we interviewed, we obtained insight into how nuanced vulnerability can be, and how important it is to ground definitions of vulnerability within the specific context. We identified additional aspects of vulnerability through this study, including: women who suffer from alcoholism or have husbands with alcoholism, women with a history of home births, women that have given birth only to girls, and those living on fishing sites. Conclusion Engaging communities in defining vulnerability is critical for the effective design, implementation and monitoring of MNCH programs, as it ensures these services are reaching those who are most in need.
doi:10.1186/s13690-020-00523-x pmid:33413655 fatcat:zbksvo57trc5dggbgt5j4c4ivi

Why don't illiterate women in rural, Northern Tanzania, access maternal healthcare?

Dismas Matovelo, Pendo Ndaki, Victoria Yohani, Rose Laisser, Respicious Bakalemwa, Edgar Ndaboine, Zabron Masatu, Magdalena Mwaikambo, Jennifer L. Brenner, Warren M. Wilson
2021 BMC Pregnancy and Childbirth  
Background In 2017, roughly 540 women in Sub-Saharan Africa died every day from preventable causes related to pregnancy and childbirth. To stem this public-health crisis, the WHO recommends a standard continuity of maternal healthcare, yet most women do not receive this care. Surveys suggest that illiteracy limits the uptake of the recommended care, yet little is understood about why this is so. This gap in understanding why healthcare is not sought by illiterate women compromises the ability
more » ... public health experts and healthcare providers to provide culturally relevant policy and practice. This study consequently explores the lived experiences related to care-seeking by illiterate women of reproductive age in rural Tanzania to determine why they may not access maternal healthcare services. Methods An exploratory, qualitative study was conducted in four communities encompassing eight focus group discussions with 81 illiterate women, 13 in-depth interviews with illiterate women and seven key-informant interviews with members of these communities who have first-hand experience with the decisions made by women concerning maternal care. Interviews were conducted in the informant's native language. The interviews were coded, then triangulated. Results Two themes emerged from the analysis: 1) a communication gap arising from a) the women's inability to read public-health documents provided by health facilities, and b) healthcare providers speaking a language, Swahili, that these women do not understand, and 2) a dependency by these women on family and neighbors to negotiate these barriers. Notably, these women understood of the potential benefits of maternal healthcare. Conclusions These women knew they should receive maternal healthcare but could neither read the public-health messaging provided by the clinics nor understand the language of the healthcare providers. More health needs of this group could be met by developing a protocol for healthcare providers to determine who is illiterate, providing translation services for those unable to speak Swahili, and graphic public health messaging that does not require literacy. A failure to address the needs of this at-risk group will likely mean that they will continue to experience barriers to obtaining maternal care with detrimental health outcomes for both mothers and newborns.
doi:10.1186/s12884-021-03906-2 pmid:34182949 fatcat:6oyqtjssjrfv7jdqxzzlpulzr4

Multiple breast cancer risk variants are associated with differential transcript isoform expression in tumors

Jennifer L. Caswell, Roman Camarda, Alicia Y. Zhou, Scott Huntsman, Donglei Hu, Steven E. Brenner, Noah Zaitlen, Andrei Goga, Elad Ziv
2015 Human Molecular Genetics  
i P n j¼1 l j ; where n is the number of elements in ': We repeated this analysis for the splicing QTL analysis.  ...  We then plated HEK293T cells at 1 × 10 6 cells/60-mm culture dish in 4 ml growth medium (DMEM with 10% fetal bovine serum, 1% penicillin-streptomycin and 1% l-glutamine; GIBCO Life Technologies).  ... 
doi:10.1093/hmg/ddv432 pmid:26472073 pmcid:PMC4664170 fatcat:k3w2najgavg6nbtniuauwm7rky

Adherence to Competing Strategies for Colorectal Cancer Screening Over 3 Years

Peter S Liang, Chelle L Wheat, Anshu Abhat, Alison T Brenner, Angela Fagerlin, Rodney A Hayward, Jennifer P Thomas, Sandeep Vijan, John M Inadomi
2015 American Journal of Gastroenterology  
Objectives-We have shown that, in a randomized trial comparing adherence to different colorectal cancer (CRC) screening strategies, participants assigned to either fecal occult blood testing (FOBT) or given a choice between FOBT and colonoscopy had significantly higher adherence than those assigned to colonoscopy during the first year. However, how adherence to screening changes over time is unknown. Methods-In this trial, 997 participants were cluster randomized to one of the three screening
more » ... rategies: (i) FOBT, (ii) colonoscopy, or (iii) a choice between FOBT and colonoscopy. Research assistants helped participants to complete testing only in the first year. Adherence to screening was defined as completion of three FOBT cards in each of 3 years after enrollment or completion of colonoscopy within the first year of enrollment. The primary outcome was adherence to assigned strategy over 3 years. Additional outcomes included identification of sociodemographic factors associated with adherence. Results-Participants assigned to annual FOBT completed screening at a significantly lower rate over 3 years (14%) than those assigned to colonoscopy (38%, P<0.001) or choice (42%, P<0.001); however, completion of any screening test fell precipitously, indicating the strong effect of patient navigation. In multivariable logistic regression analysis, being randomized to the choice or colonoscopy group, Chinese language, homosexuality, being married/partnered, and having a nonnurse practitioner primary care provider were independently associated with greater adherence to screening (P<0.01). Conclusions-In a 3-year follow-up of a randomized trial comparing competing CRC screening strategies, participants offered a choice between FOBT and colonoscopy continued to have relatively high adherence, whereas adherence in the FOBT group fell significantly below that of the choice and colonoscopy groups. Patient navigation is crucial to achieving adherence to CRC screening, and FOBT is especially vulnerable because of the need for annual testing. Liang et al. Variable Number/total number (%) Univariable OR (95% CI) P value Multivariable OR (95% CI) b P value No 176/489 (36.0) Reference NA Yes 95/274 (34.7) 0.92 (0.66-1.29) 0.64 NA PCP type Attending 128/346 (37.0) Reference Liang et al. Page 19 Variable Number/total number (%) Univariable OR (95% CI) P value Multivariable OR (95% CI) b P value Yes 135/364 (37.1) 1.63 (1.20-2.23) 0.002 1.70 (1.14-2.52) 0.009
doi:10.1038/ajg.2015.367 pmid:26526080 pmcid:PMC4887132 fatcat:gi4o4mmxjrab7ok356dpmflj7y
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