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  • Item
    Open Access
    The Management of Asymptomatic Congenital Pulmonary Airway Malformation: Results of a European Delphi Survey
    (Multidisciplinary Digital Publishing Institute, 2022-07-30) Kersten, Casper M.; Hermelijn, Sergei M.; Mullassery, Dhanya; Muthialu, Nagarajan; Cobanoglu, Nazan; Gartner, Silvia; Bagolan, Pietro; Mesas Burgos, Carmen; Sgrò, Alberto; Heyman, Stijn; Till, Holger; Suominen, Janne; Schurink, Maarten; Desender, Liesbeth; Losty, Paul; Steyaert, Henri; Terheggen-Lagro, Suzanne; Metzelder, Martin; Bonnard, Arnaud; Sfeir, Rony; Singh, Michael; Yardley, Iain; Rikkers-Mutsaerts, Noor R. V. M.; van der Ent, Cornelis K.; Qvist, Niels; Cox, Des W.; Peters, Robert; Bannier, Michiel A. G. E.; Wessel, Lucas; Proesmans, Marijke; Stanton, Michael; Hannon, Edward; Zampoli, Marco; Morini, Francesco; Tiddens, Harm A. W. M.; Wijnen, René M. H.; Schnater, Johannes M.
    Consensus on the optimal management of asymptomatic congenital pulmonary airway malformation (CPAM) is lacking, and comparison between studies remains difficult due to a large variety in outcome measures. We aimed to define a core outcome set (COS) for pediatric patients with an asymptomatic CPAM. An online, three-round Delphi survey was conducted in two stakeholder groups of specialized caregivers (surgeons and non-surgeons) in various European centers. Proposed outcome parameters were scored according to level of importance, and the final COS was established through consensus. A total of 55 participants (33 surgeons, 22 non-surgeons) from 28 centers in 13 European countries completed the three rounds and rated 43 outcome parameters. The final COS comprises seven outcome parameters: respiratory insufficiency, surgical complications, mass effect/mediastinal shift (at three time-points) and multifocal disease (at two time-points). The seven outcome parameters included in the final COS reflect the diversity in priorities among this large group of European participants. However, we recommend the incorporation of these outcome parameters in the design of future studies, as they describe measurable and validated outcomes as well as the accepted age at measurement.
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    Open Access
    On the Road to Net Zero Health Care Systems: Governance for Sustainable Health Care in the United Kingdom and Germany
    (Multidisciplinary Digital Publishing Institute, 2022-09-26) Weimann, Léa; Weimann, Edda
    Health care lies at the forefront of the impacts of climate change. Since the health sector is a major polluting and emission intensive sector, it remains a crucial challenge to address sustainability. The English National Health System (NHS) aims to be the first in the world to achieve net zero in all emission classes (Scope 1–3). In Germany, sustainability in health care is being driven bottom-up, while the Federal Ministry of Health at the time of the research in early 2021 takes no active stance on a net zero health care system. This article analyses the approaches to sustainability in the two different health care systems, explores common challenges, and draws recommendations to support the transition of the sector to a net zero future. An exploratory mixed method approach was taken applying qualitative and quantitative methods. This includes high-level expert interviews and an online survey from the United Kingdom (UK) and Germany. Results reveal the complex nature of health care systems and the need for engraining a systems-thinking approach. The findings call for the legal embedding of sustainability into the key principles of health care in Germany, endorses the ambition of the national health care systems in the UK, recommends collaborative cross-sector approaches for sustainability, and highlights the need for increased public awareness on the interrelation between human and planetary health to enable governance for sustainable health care.
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    Open Access
    Association of Perceived Neighbourhood Walkability with Self-Reported Physical Activity and Body Mass Index in South African Adolescents
    (Multidisciplinary Digital Publishing Institute, 2023-01-30) Wayas, Feyisayo A.; Smith, Joanne A.; Lambert, Estelle V.; Guthrie-Dixon, Natalie; Wasnyo, Yves; West, Sacha; Oni, Tolu; Foley, Louise
    Adolescence is a life stage critical to the establishment of healthy behaviours, including physical activity (PA). Factors associated with the built environment have been shown to impact PA across the life course. We examined the sociodemographic differences in, and associations between, perceived neighbourhood walkability, PA, and body mass index (BMI) in South African adolescents. We recruited a convenience sample (n = 143; 13–18 years; 65% female) of students from three high schools (middle/high and low-income areas). Participants completed a PA questionnaire and the Neighbourhood Environment Walkability Scale (NEWS)-Africa and anthropometry measurements. Multivariable linear regression was used to examine various relationships. We found that, compared with adolescents living in middle/high income neighbourhoods, those living in low-income neighbourhoods had lower perceived walkability and PA with higher BMI percentiles. The associations between neighbourhood walkability and PA were inconsistent. In the adjusted models, land use diversity and personal safety were associated with club sports participation, street connectivity was positively associated with school sports PA, and more favourable perceived walkability was negatively associated with active transport. Overall, our findings suggest that the perceived walkability of lower income neighbourhoods is worse in comparison with higher income neighbourhoods, though the association with PA and BMI is unclear.
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    Open Access
    Poultry Slaughterhouse Wastewater Treatment Using an Integrated Biological and Electrocoagulation Treatment System: Process Optimisation Using Response Surface Methodology
    (Multidisciplinary Digital Publishing Institute, 2022-08-03) Ngobeni, Philadelphia Vutivi; Gutu, Larryngeai; Basitere, Moses; Harding, Theo; Ikumi, David
    The feasibility of a biological (EcoflushTM) and/or electrocoagulation (EC) treatment system in removing chemical oxygen demand (COD) and fats, oils, and grease (FOG) from poultry slaughterhouse wastewater (PSW) were studied. The response surface methodology (RSM) was used to identify the optimum operating condition for EC and its integration with EcoflushTM as a pre-treatment for the removal of lipids. The optimum operating conditions were obtained at a pH of 3.05, a current density of 66.9 A/m2, 74-min of treatment time, and without Ecoflush™. These conditions produced a high-quality clarified effluent after 92.4% COD reduction and 99% FOG reduction. The treatment with EcoflushTM only resulted in 85–99% FOG reduction, 20–50% COD reduction, and odourless effluent. However, the combination of both processes (EcoflushTM and EC) did not yield a significant difference (F test, p > 0.05) when compared to the performance of EC alone. Despite the low removal percentages of nitrogen and phosphorus, the present study proved that EC is an effective method for the removal of COD and FOG, rendering an effluent that meets the permissible discharge standards for the City of Cape Town. The novel Ecoflush™ also proved to be very efficient in the removal of FOG from PSW.
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    Open Access
    Reflections on Digital Maternal and Child Health Support for Mothers and Community Health Workers in Rural Areas of Limpopo Province, South Africa
    (Multidisciplinary Digital Publishing Institute, 2023-01-19) Muthelo, Livhuwani; Mbombi, Masenyani Oupa; Bopape, Mamare Adelaide; Mothiba, Tebogo M.; Densmore, Melissa; van Heerden, Alastair; Norris, Shane A.; Dias, Nervo Verdezoto; Griffiths, Paula; Mackintosh, Nicola
    Introduction: Digital health support using mobile and digital technologies, such as MomConnect and WhatsApp, is providing opportunities to improve maternal and child healthcare in low- and middle-income countries. Yet, the perspective of health service providers, pregnant women, and mothers as recipients of digital health support is under-researched in rural areas. Material and Methods: An exploratory-descriptive qualitative research approach was adopted to reflect on the experiences of mothers, community leaders, and community health workers on mobile health opportunities in the context of maternal and child health in rural areas. Purposive sampling was used to select 18 participants who participated in the two focus groups and individual semi-structured interviews for data collection about digital maternal and child health support. The thematic open coding method of data analysis assisted authors in making sense of the given reflections of mothers, community leaders, and healthcare workers about digital health support. Results: Participants commented on different existing digital support apps and their importance for maternal and child health. For example, MoMConnect, Pregnancy+, WhatsApp, and non-digital resources were perceived as useful ways of communication that assist in improving maternal and child health. However, participants reported several challenges related to the use of digital platforms, which affect following the health instructions given to pregnant women and mothers. Conclusions: Participants expressed the significant role of digital support apps in maternal and child health, which is impacted by various challenges. Addressing the lack of digital resources could improve access to health instructions for pregnant women and mothers.