A web-based telemedicine system for low-resource settings 13 years on: insights from referrers and specialists

Background: One way to tackle health inequalities in resource-poor settings is to establish links between doctors and health professionals there and specialists elsewhere using web-based telemedicine. One such system run by the Swinfen Charitable Trust has been in existence for 13 years which is an unusually long time for such systems.

Objective: We wanted to gain some insights into whether and how this system might be improved.

Methods: We carried out a survey by questionnaire of referrers and specialists over a six months period.

Results: During the study period, a total of 111 cases were referred from 35 different practitioners, of whom 24% were not doctors. Survey replies were received concerning 67 cases, a response rate of 61 per cent. Eighty-seven per cent of the responding referrers found the telemedicine advice useful, and 78% were able to follow the advice provided. As a result of the advice received, the diagnosis was changed in 22% of all cases and confirmed in a further 18 per cent. Patient management was changed in 33 per cent. There was no substantial difference between doctors and non-doctors. During the study period, the 111 cases were responded to by 148 specialists, from whom 108 replies to the questionnaire were received, a response rate of 73 per cent. About half of the specialists (47%) felt that their advice had improved the management of the patients. There were 62 cases where it was possible to match up the opinions of the referrer and the consultants about the value of a specific teleconsultation. In 34 cases (55%) the referrers and specialists agreed about the value. However, in 28 cases (45%) they did not: specialists markedly underestimated the value of a consultation compared to referrers. Both referrers and specialist were extremely positive about the system which appears to be working well. Minor changes such as a clearer referral template and an improved web interface for specialists may improve it.

Non-apologies and prolonged silences in post-conflict settings: The case of post-colonial Cyprus

Despite the growing use of apologies in post-conflict settings, cases of non-apology remain unaddressed and continue to puzzle scholars. This article focuses on the absence of apology by non-state and anti-state actors by examining the case of the Cypriot armed group EOKA, which has refused to offer an apology to the civilian victims of its ‘anti-colonial’ struggle (1955–1959). Using field data and parliamentary debates, and drawing on comparisons, this article analyses the factors that contributed to a lack of apology. It is argued that the inherited timelessness of Greek nationalism, and the impression of a perpetual need for defence, set up textbook conditions for the development of a hegemonic discourse and prevented an apology for human rights violations.

Towards groundwater security in coastal East Africa: initiating a regional research network and integrated hydrogeologic, climatic & socio-economic observatories in coastal aquifers of the Comoros Islands, Kenya and Tanzania

African coastal regions are expected to experience the highest rates of population growth in coming decades. Fresh groundwater resources in the coastal zone of East Africa (EA) are highly vulnerable to seawater intrusion. Increasing water demand is leading to unsustainable and ill-planned well drilling and abstraction. Wells supplying domestic, industrial and agricultural needs are or have become, in many areas, too saline for use. Climate change, including weather changes and sea level rise, is expected to exacerbate this problem. The multiplicity of physical, demographic and socio-economic driving factors makes this a very challenging issue for management. At present the state and probable evolution of coastal aquifers in EA are not well documented. The UPGro project 'Towards groundwater security in coastal East Africa' brings together teams from Kenya, Tanzania, Comoros Islands and Europe to address this knowledge gap. An integrative multidisciplinary approach, combining the expertise of hydrogeologists, hydrologists and social scientists, is investigating selected sites along the coastal zone in each country. Hydrogeologic observatories have been established in different geologic and climatic settings representative of the coastal EA region, where focussed research will identify the current status of groundwater and identify future threats based on projected demographic and climate change scenarios. Researchers are also engaging with end users as well as local community and stakeholder groups in each area in order to understanding the issues most affecting the communities and searching sustainable strategies for addressing these.

Older women living and coping with domestic violence

Although domestic violence is seen as a serious public health issue for women worldwide, international evidence suggests that women aged over 50 who are victims are suffering in silence because the problem is often ignored by health professionals. More UK research is needed to identify the extent of the problem, and services to meet the needs of older women. This study aims to bridge this gap by gaining a deeper understanding of how ‘older women’ cope with domestic violence and how it affects their wellbeing. Eighteen older women who were currently, or had been in an abusive relationship were recruited. Semi-structured interview schedules were used to discuss the personal nature of DV and its effects on wellbeing, ways of coping and sources of support. Findings suggest that living in a domestically violent context has extremely negative effects on older women’s wellbeing leading to severe anxiety and depression. Three-quarters of the women defined themselves as in ‘very poor’ mental and physical health and were using pathogenic coping mechanisms, such as excessive and long-term use of alcohol, prescription and non-prescription drugs and cigarettes. This negative coping increased the likelihood of these women experiencing addiction to drugs and alcohol dependence and endangered their health in the longer term. Our findings suggest that health professionals must receive appropriate education to gain knowledge and skills in order to deal effectively and support older women experiencing domestic violence.

Older Women Living with Domestic Violence: Coping Resources and Mental Health and Wellbeing

Background: Domestic violence represents a serious public health issue for women and their children worldwide. International evidence suggests that women aged over 50 who are victims of domestic violence are suffering in silence because the problem is ignored by professionals and policy makers. More UK research is needed to identify the extent of the problem, and services to meet the needs of older women.

Study aims: To bridge this gap by seeking to gain a deeper, systematic understanding of how ‘older women’ cope with domestic violence and how it effects their wellbeing, using a theoretical framework of ‘salutogenesis’ to consider coping resources used in lifelong abuse.

Methods: The study recruited a convenience sample of eighteen older women who are currently, or had been in an abusive relationship. A semi-structured interview schedule was used to discuss the personal nature, of domestic violence in their lives, and the pattern of abuse over time and its effects on their wellbeing, ways of coping and sources of support, barriers to reporting and accessing support, and experiences in seeking help.

Results: Living in a domestically violent context has extremely negative effects on older women’s wellbeing. Living with a perpetrator of long-term violence is predisposing these women to extremely negative health outcomes such as Post Traumatic Stress Disorder, anxiety and depression. Three-quarters of the women defined themselves as in poor mental health and were using pathogenic coping mechanisms, such as excessive and long-term use of alcohol, prescription and non-prescription drugs and cigarettes. This negative coping increased the likelihood of these women experiencing addiction to drugs and alcohol dependence and endangering their health and wellbeing in the longer term. Conclusions Public health interventions can work well from a ‘salutogenic’ perspective by finding ways to promote healthy behaviours that increase older women’s sense of wellbeing and coping. The application of this theoretical framework offers the potential for new knowledge to contribute to the discourse about wellbeing in older women dealing with domestic violence.