Designing systems for the care we need: A transformation journey in Southwestern Ontario.

Primary care is considered the foundation of any health system. In Ontario, Canada Bills 41 and 74 introduced in 2016 and 2019, respectively, aimed to move towards a primary care-focused and sustainable integrated care approach designed around the needs of local populations. These bills collectively set the stage for integrated care and population health management in Ontario, with Ontario Health Teams (OHTs) introduced as a model of integrated care delivery systems. OHTs aim to streamline patient connectivity through the healthcare system and improve outcomes aligned with the Quadruple Aim. When Ontario released a call for health system partners to apply to become an OHT, providers, administrators, and patient/caregiver partners from the Middlesex-London area were quick to respond. We highlight the critical elements and journey of the Middlesex-London Ontario Health Team since its start.

The Impact of Catchment Land Use Land Cover Changes on Lake Dandi, Ethiopia.

Highland freshwater lakes are currently threatened with catchment land use land cover changes particularly in developing countries like Ethiopia despite their wide range of valuable ecosystem services. This study was conducted to assess trends of catchment land use land cover change and associated impacts on a highland Lake, Dandi over three decades from 1990 to 2020 years period based on GIS (ArcMap 10.4.1) and remote sensing (ERDAS Imagine 14) software as well as questioner survey, key informant interviews, and field observation. The study covered 3,794 ha with five major land use land covers, namely mixed agriculture/settlement, bush-/shrubland, grassland, bare land, and water body (Lake Dandi). The assessment revealed that farmland/residential area increased by 593 ha (35.34%), while bare land, grassland, shrubland, and Lake Dandi decreased by 290 ha (26.12%), 218 ha (12.15%), 57 ha (6.85%), and 28 ha (19.53%), respectively. Responses also indicated increased farmland/settlement area (66.66%) and declined areas of bare land (84.63%), bush-/shrubland (84.86%), grassland (96.96%), and Lake Dandi (61.05%). Furthermore, responses indicated expanding agricultural land use (48%), population growth (38%), climate change (32%), overgrazing (30%), and poverty (28%) as major factors currently threatening the lake and its ecosystem services. Field observation also revealed expansion of agricultural land use in the catchment of Lake Dandi including in steeper slopes and hillsides that might exacerbate on-site soil erosion as well as lake sedimentation and toxic contamination. Thus, results indicated deterioration in the storage capacity and water quality of Lake Dandi due to catchment land use land cover change that might in turn adversely affect its ecosystem services and the resident biota suggesting urgent intervention.

Determinants of stunting among under-five children in Ethiopia: a multilevel mixed-effects analysis of 2016 Ethiopian demographic and health survey data.

BACKGROUND: Childhood stunting is the most widely prevalent among under-five children in Ethiopia. Despite the individual-level factors of childhood stunting are well documented, community-level factors have not been given much attention in the country. This study aimed to identify individual- and community-level factors associated with stunting among under-five children in Ethiopia. METHODS: Cross-sectional data from the 2016 Ethiopian Demographic and Health Survey was used. A total of 8855 under-five children and 640 community clusters were included in the current analysis. A multilevel logistic regression model was used at 5% level of significance to determine the individual- and community-level factors associated with childhood stunting. RESULTS: The prevalence of stunting was found to be 38.39% in Ethiopian under-five children. The study showed that the percentage change in variance of the full model accounted for about 53.6% in odds of childhood stunting across the communities. At individual-level, ages of the child above 12 months, male gender, small size of the child at birth, children from poor households, low maternal education, and being multiple birth had significantly increased the odds of childhood stunting. At community-level, children from communities of Amhara, Tigray, and Benishangul more suffer from childhood stunting as compared to Addis Ababa's community children. Similarly, children from Muslim, Orthodox and other traditional religion followers had higher log odds of stunting relative to children of the protestant community. CONCLUSIONS: This study showed individual- and community-level factors determined childhood stunting in Ethiopian children. Promotion of girl education, improving the economic status of households, improving maternal nutrition, improving age-specific child feeding practices, nutritional care of low birth weight babies, promotion of context-specific child feeding practices and narrowing rural-urban disparities are recommended.

Functionalized carbon nanotube adsorption interfaces for electron transfer studies of galactose oxidase.

Modified electrodes featuring specific adsorption platforms able to access the electrochemistry of the copper containing enzyme galactose oxidase (GaOx) were explored, including interfaces featuring nanomaterials such as nanoparticles and carbon nanotubes (CNTs). Electrodes modified with various self-assembled monolayers (SAMs) including those with attached nanoparticles or amide-coupled functionalized CNTs were examined for their ability to effectively immobilize GaOx and study the redox activity related to its copper core. While stable GaOx electrochemistry has been notoriously difficult to achieve at modified electrodes, strategically designed functionalized CNT-based interfaces, cysteamine SAM-modified electrode subsequently amide-coupled to carboxylic acid functionalized single wall CNTs, were significantly more effective with high GaOx surface adsorption along with well-defined, more reversible, stable (≥ 8 days) voltammetry and an average ET rate constant of 0.74 s-1 in spite of increased ET distance - a result attributed to effective electronic coupling at the GaOx active site. Both amperometric and fluorescence assay results suggest embedded GaOx remains active. Fundamental ET properties of GaOx may be relevant to biosensor development targeting galactosemia while the use functionalized CNT platforms for adsorption/electrochemistry of electroactive enzymes/proteins may present an approach for fundamental protein electrochemistry and their future use in both direct and indirect biosensor schemes.

First Generation Amperometric Biosensing of Galactose with Xerogel-Carbon Nanotube Layer-By-Layer Assemblies.

A first-generation amperometric galactose biosensor has been systematically developed utilizing layer-by-layer (LbL) construction of xerogels, polymers, and carbon nanotubes toward a greater fundamental understanding of sensor design with these materials and the potential development of a more efficient galactosemia diagnostic tool for clinical application. The effect of several parameters (xerogel silane precursor, buffer pH, enzyme concentration, drying time and the inclusion of a polyurethane (PU) outer layer) on galactose sensitivity were investigated with the critical nature of xerogel selection being demonstrated. Xerogels formed from silanes with medium, aliphatic side chains were shown to exhibit significant enhancements in sensitivity with the addition of PU due to decreased enzyme leaching. Semi-permeable membranes of diaminobenzene and resorcinol copolymer and Nafion were used for selective discrimination against interferent species and the accompanying loss of sensitivity with adding layers was countered using functionalized, single-walled carbon nanotubes (CNTs). Optimized sensor performance included effective galactose sensitivity (0.037 µA/mM) across a useful diagnostic concentration range (0.5 mM to 7 mM), fast response time (~30 s), and low limits of detection (~80 µM) comparable to literature reports on galactose sensors. Additional modification with anionic polymer layers and/or nanoparticles allowed for galactose detection in blood serum samples and additional selectivity effectiveness.

Morphology of hydrothermally synthesized ZnO nanoparticles tethered to carbon nanotubes affects electrocatalytic activity for H2O2 detection.

We describe the synthesis of zinc oxide (ZnO) nanoparticles and demonstrate their attachment to multiwalled carbon tubes, resulting in a composite with a unique synergistic effect. Morphology and size of ZnO nanostructures were controlled using hydrothermal synthesis, varying the hydrothermal treatment temperature, prior to attachment to carboxylic acid functionalized multi-walled carbon nanotubes for sensing applications. A strong dependence of electrocatalytic activity on nanosized ZnO shape was shown. High activity for H2O2 reduction was achieved when nanocomposite precursors with a roughly semi-spherical morphology (no needle-like particles present) formed at 90 °C. A 2.4-fold increase in cyclic voltammetry current accompanied by decrease in overpotential from the composites made from the nanosized, needle-like-free ZnO shapes was observed as compared to those composites produced from needle-like shaped ZnO. Electrocatalytic activity varied with pH, maximizing at pH 7.4. A stable, linear response for H2O2 concentrations was observed in the 1-20 mM concentration range.

Patients from across Europe have similar views on patient-centred care: an international multilingual qualitative study in infertility care.

BACKGROUND: International patient centredness concepts were suggested but never conceptualized from the patients' perspective. Previously, a literature review and a monolingual qualitative study defined 'patient-centred infertility care' (PCIC). The present study aimed to test whether patients from across Europe value the same aspects of infertility care. METHODS: An international multilingual focus group (FG) study with 48 European patients from fertility clinics in Austria, Spain, the UK and Belgium, with deductive content analysis. RESULTS: All specific care aspects important to participants from all countries could be allocated to the 10 dimensions of PCIC, each discussed in every FG, including: 'information provision', 'attitude of and relationship with staff', 'competence of clinic and staff', 'communication', 'patient involvement and privacy', 'emotional support', 'coordination and integration', 'continuity and transition', 'physical comfort' and 'accessibility'. Most specific care aspects (65%) were discussed in two or more countries and only a few new codes (11%) needed to be added to the previously published coding tree. Rankings from across Europe clearly showed that 'information provision' is a top priority. CONCLUSIONS: The PCIC-model is the first patient-centred care (PCC) model based on the patients' perspective to be validated in an international setting. Although health-care organization and performance differ, the similarities between countries in the infertile patients' perspective were striking, as were the similarities with PCC models from other clinical conditions. A non-condition specific international PCC model and a European instrument for the patient centredness of infertility care could be developed. European professionals can learn from each other on how to provide PCC.

Health providers' perception towards safe abortion service at selected health facilities in Addis Ababa.

In Ethiopia, unsafe abortion accounts up to 32% of maternal deaths. The perception of health providers towards safe abortion provision at selected health facilities in Addis Ababa, Ethiopia was assessed. A stratified random sampling was used to select 431 health providers. A cross-sectional study was conducted from March 25-April 15, 2008 using a structured self-administered questionnaire. The results were interpreted using descriptive statistics and odds ratios. A majority of the health providers (96.4%) recognized that unsafe abortion was a serious health problem. Providers who had safe abortion practice were 2.57 (95% CI 1.49-4.44) times more likely to have favorable attitude towards safe abortion than those without practice. Similarly, providers who knew the law governing abortion were 1.77 (95% CI 1.12-2.78) times more likely to have this favorable attitude than those who lack this knowledge. In conclusion, training of health providers on safe abortion and reproductive rights are essential to reduce maternal mortality.

Health providers' perception towards safe abortion service at selected health facilities in Addis Ababa

In Ethiopia, unsafe abortion accounts up to 32% of maternal deaths. The perception of health providers towards safe abortion provision at selected health facilities in Addis Ababa, Ethiopia was assessed. A stratified random sampling was used to select 431 health providers. A cross-sectional study was conducted from March 25-April15, 2008 using a structured self-administered questionnaire. The results were interpreted using descriptive statistics and odds ratios. A majority of the health providers (96.4%) recognized that unsafe abortion was a serious health problem. Providers who had safe abortion practice were 2.57(95% CI 1.49-4.44) times more likely to have favorable attitude towards safe abortion than those without practice. Similarly, providers who knew the law governing abortion were 1.77 (95% CI 1.12-2.78) times more likely to have this favorable attitude than those who lack this knowledge. In conclusion, training of health providers on safe abortion and reproductive rights are essential to reduce maternal mortality (Afr J Reprod Health 2011; 15[1]: 31-36)