Papers by Shafik Dharamsi
British Dental Journal, Nov 1, 2008
How action research (AR) transforms the action researcher is seldom a focus of inquiry itself. To... more How action research (AR) transforms the action researcher is seldom a focus of inquiry itself. To address this previously unexplored phenomenon, I recruited participants currently
Brain Behavior and Immunity, 2022
Annals of Internal Medicine, Jan 5, 2016
TO THE EDITOR: As a third-year medical student rotating in labor and delivery, I agree with a rec... more TO THE EDITOR: As a third-year medical student rotating in labor and delivery, I agree with a recent commentary (1) and urge everybody to consider his point about Laine and colleagues' editorial (2). As a field, we do need to talk about the good, the bad, and the ugly. However, featuring 2 of these ugly stories about obstetrics and gynecology in an internal medicine journal without input from our colleagues in this field could be counterproductive. If we are ready to talk about the dark side, making a conscious effort to avoid targeting and to start sharing the secrets of the whole family would probably be more beneficial.
Medicina Social, Jul 4, 2017
New Zealand journal of occupational therapy, 2015
Background. Capability as a human rights construct has similarities to the occupational therapy c... more Background. Capability as a human rights construct has similarities to the occupational therapy construct of occupation that has been conceptualised within three primary frameworks: person-centred, context-centred, and person/context-centred. Purpose. In this narrative review, we explore similarities and differences in the constructs of occupation and capability vis-a-vis the ten central human functional capabilities comprised within Nussbaum's capabilities approach. Findings and conclusion. The central capabilities of this approach are not only congruent with both person and context aspects of occupation, but also extend these conceptualisations. Exploration of occupational therapists' views about these central capabilities would elucidate the practical implications of these findings.
The Lancet Global Health, 2021
Background Blood pressure measurement is a marker of antenatal care quality. In well resourced se... more Background Blood pressure measurement is a marker of antenatal care quality. In well resourced settings, lower blood pressure cutoffs for hypertension are associated with adverse pregnancy outcomes. We aimed to study the associations between blood pressure thresholds and adverse outcomes and the diagnostic test properties of these blood pressure cutoffs in low-resource settings. Methods We did a secondary analysis of data from 22 intervention clusters in the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials (NCT01911494) in India (n=6), Mozambique (n=6), and Pakistan (n=10). We included pregnant women aged 15-49 years (12-49 years in Mozambique), identified in their community by trained community health workers, who had data on blood pressure measurements and outcomes. The trial was unmasked. Maximum blood pressure was categorised as: normal blood pressure (systolic blood pressure [sBP] <120 mm Hg and diastolic blood pressure [dBP] <80 mm Hg), elevated blood pressure (sBP 120-129 mm Hg and dBP <80 mm Hg), stage 1 hypertension (sBP 130-139 mm Hg or dBP 80-89 mm Hg, or both), non-severe stage 2 hypertension (sBP 140-159 mm Hg or dBP 90-109 mm Hg, or both), or severe stage 2 hypertension (sBP ≥160 mm Hg or dBP ≥110 mm Hg, or both). We classified women according to the maximum blood pressure category reached across all visits for the primary analyses. The primary outcome was a maternal, fetal, or neonatal mortality or morbidity composite. We estimated dose-response relationships between blood pressure category and adverse outcomes, as well as diagnostic test properties.
The Lancet Global Health, 2021
Background Incomplete vital registration systems mean that causes of death during pregnancy and c... more Background Incomplete vital registration systems mean that causes of death during pregnancy and childbirth are poorly understood in low-income and middle-income countries. To inform global efforts to reduce maternal mortality, we compared physician review and computerised analysis of verbal autopsies (interpreting verbal autopsies [InterVA] software), to understand their agreement on maternal cause of death and circumstances of mortality categories (COMCATs) in the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials. Methods The CLIP trials took place in India, Pakistan, and Mozambique, enrolling pregnant women aged 12-49 years between Nov 1, 2014, and Feb 28, 2017. 69 330 pregnant women were enrolled in 44 clusters (36 008 in the 22 intervention clusters and 33 322 in the 22 control clusters). In this secondary analysis of maternal deaths in CLIP, we included women who died in any of the 22 intervention clusters or 22 control clusters. Trained staff administered the WHO 2012 verbal autopsy after maternal deaths. Two physicians (and a third for consensus, if needed) reviewed trial surveillance data and verbal autopsies, and, in intervention clusters, community health worker-led visit data. They determined cause of death according to the WHO International Classification of Diseases-Maternal Mortality (ICD-MM). Verbal autopsies were also analysed by InterVA computer models (versions 4 and 5) to generate cause of death. COMCAT analysis was provided by InterVA-5 and, in India, by physician review of Maternal Newborn Health Registry data. Causes of death and COMCATs assigned by physician review, Inter-VA-4, and InterVA-5 were compared, with agreement assessed with Cohen's κ coefficient. Findings Of 61 988 pregnancies with successful follow-up in the CLIP trials, 143 maternal deaths were reported (16 deaths in India, 105 in Pakistan, and 22 in Mozambique). The maternal death rate was 231 (95% CI 193-268) per 100 000 identified pregnancies. Most deaths were attributed to direct maternal causes (rather than indirect or undetermined causes as per ICD-MM classification), with fair to good agreement between physician review and InterVA-4 (κ=0•56 [95% CI 0•43-0•66]) or InterVA-5 (κ=0•44 [0•30-0•57]), and InterVA-4 and InterVA-5 (κ=0•72 [0•60-0•84]). The top three causes of death were the same by physician review, InterVA-4, and InterVA-5 (ICD-MM categories obstetric haemorrhage, non-obstetric complications, and hypertensive disorders); however, attribution of individual patient deaths to obstetric haemorrhage varied more between methods (physician review, 38 [27%] deaths; InterVA-4, 69 [48%] deaths; and InterVA-5, 82 [57%] deaths), than did attribution to non-obstetric causes (physician review, 39 [27%] deaths; InterVA-4, 37 [26%] deaths; and InterVA-5, 28 [20%] deaths) or hypertensive disorders (physician review, 23 [16%] deaths; InterVA-4, 25 [17%] deaths; and InterVA-5, 24 [17%] deaths). Agreement for all nine ICD-MM categories was fair for physician review versus InterVA-4 (κ=0•48 [0•38-0•58]), poor for physician review versus InterVA-5 (κ=0•36 [0•27-0•46]), and good for InterVA-4 versus InterVA-5 (κ=0•69 [0•59-0•79]). The most commonly assigned COMCATs by InterVA-5 were emergencies (68 [48%] of 143 deaths) and health systems (62 [43%] deaths), and by physician review (India only) were health systems (seven [44%] of 16 deaths) and inevitability (five [31%] deaths); agreement between InterVA-5 and physician review (India data only) was poor (κ=0•04 [0•00-0•15]). Interpretation Our findings indicate that InterVA-5 is less accurate than InterVA-4 at ascertaining causes and circumstances of maternal death, when compared with physician review. Our results suggest a need to improve the next iteration of InterVA, and for researchers and clinicians to preferentially use InterVA-4 when recording maternal deaths. Funding University of British Columbia (grantee of the Bill & Melinda Gates Foundation).
Pregnancy Hypertension, 2020
Pregnancy hypertension is associated with 7•1% of maternal deaths in India. The objective of this... more Pregnancy hypertension is associated with 7•1% of maternal deaths in India. The objective of this trial was to assess whether task-sharing care might reduce adverse pregnancy outcomes related to delays in triage, transport, and treatment. Study design The Indian Community-Level Interventions for Pre-eclampsia (CLIP) open-label cluster randomised controlled trial (NCT01911494) recruited pregnant women in 12 clusters (initial four-cluster internal pilot) in Belagavi and Bagalkote, Karnataka. The CLIP intervention (6 clusters) consisted of community engagement, community health workers (CHW) provided mobile health (mHeath)-guided clinical assessment, initial treatment, and referral to facility either urgently (<4hrs) or non-urgently (<24hrs), dependent on algorithm-defined risk. Treatment effect was estimated by multi-level logistic regression modelling, adjusted for prognostically-significant baseline variables. Predefined secondary analyses included safety and evaluation of the intensity of mHealth-guided CHW-provided contacts. Main outcome measures 20% reduction in composite of maternal, fetal, and newborn mortality and major morbidity. Results All 14,783 recruited pregnancies (7,839 intervention, 6,944 control) were followed-up. The primary outcome did not differ between intervention and control arms (adjusted odds ratio (aOR) 0•92 [95% confidence interval 0•74, 1•15]; p=0•47; intraclass correlation coefficient 0•013). There were no intervention-related safety concerns following administration of either methyldopa or MgSO 4 , and 401 facility referrals. Compared with intervention arm women without CLIP contacts, those with ≥8 contacts suffered fewer stillbirths (aOR 0•19 [0•10, 0•35]; p<0•001), at the probable expense of survivable neonatal morbidity (aOR 1•39 [0•97, 1•99]; p=0•072). Conclusions As implemented, solely community-level interventions focussed on pre-eclampsia did not improve outcomes in northwest Karnataka. Funding The University of British Columbia (PRE-EMPT), a grantee of the Bill & Melinda Gates Foundation (OPP1017337).
The Journal of the American Osteopathic Association, 2016
The public’s trust in physicians continues to decline. As a way to begin regaining this trust, st... more The public’s trust in physicians continues to decline. As a way to begin regaining this trust, stakeholders, including physicians, medical educators, patient advocacy groups, and community-based organizations, have called for medical education to meet societal health needs, particularly the needs of those members who are most vulnerable, by incorporating social accountability into the medical school curriculum. The unique attributes of the osteopath-ic medical profession provide an enabling and conducive environment for broader social accountability in the health care system. Osteopathic medical schools must actively safeguard the profession’s unequivocal commitment to producing healers that are fiduciaries for their patients, communities, and populations at large.
World Federation of Occupational Therapists Bulletin, 2015
Abstract There has been a shift in the perspective of care of people with disabilities, specifica... more Abstract There has been a shift in the perspective of care of people with disabilities, specifically, from an emphasis on biomedical needs for human rights. Although occupational therapists have had a tradition of empowering people's capabilities, only recently has a human rights perspective been advanced within the profession. In this review, we describe the historical shift over recent decades in approaches to rehabilitation services including occupational therapy, from traditional biomedical and social approaches to progressive socio-political and human rights approaches. Of the human rights approaches, Nussbaum's Capabilities Approach appears particularly consistent with contemporary occupational therapy professional values and perspectives. Further, its systematic adoption has implications for teaching and research as well as practice in occupational therapy. The integration of a human rights approach, such as the Capabilities Approach, within occupational therapy would clearly align occupational therapy with human rights initiatives of the United Nations and World Health Organization.
The Open Journal of Occupational Therapy, 2015
Rural and Remote Health
The COVID-19 pandemic has highlighted embedded inequities and fragmentation in our health systems... more The COVID-19 pandemic has highlighted embedded inequities and fragmentation in our health systems. Traditionally, structural issues with health professional education perpetuate these. COVID-19 has highlighted inequities, but may also be a disruptor, allowing positive responses and system redesign. Examples from health professional schools in high and low-and middle-income countries illustrate pro-equity interventions of current relevance. We recommend that health professional schools and planners consider educational redesign to produce a health workforce well equipped to respond to pandemics and meet future need.
Archive for the Psychology of Religion, 2017
A review of recent research suggests that academic and popular distinctions between “religion” an... more A review of recent research suggests that academic and popular distinctions between “religion” and “spirituality” are unfounded. Working from a meaning systems perspective, it is argued that recognizing that “religious” and “spiritual” are part of the same broad category does not go far enough. It is argued that a wider perspective that considers the interplay of many different cultural and social factors on both beliefs and practices is more useful. This broadening of the multi-level, interdisciplinary paradigm to examine all existential cultures, including the secular and non-religious, offers the potential to better understand the complexity and diversity of lived religion. Increased use of idiographic methodologies and a more reflective approach to the constructs used in nomothetic methodologies are advocated as a way to advance the field and better explore beliefs and practices in a more ecologically valid way.
La educación médica con consciencia social prepara a los futuros médicos para afrontar los proble... more La educación médica con consciencia social prepara a los futuros médicos para afrontar los problemas de salud prioritarios del pueblo, con atención especial a la gente marginada, usando modelos educativos, de investigación, y de servicio que involucran profesionales interdisciplinarios, las organizaciones sociales, públicas y privadas, y la sociedad civil
Hypertension, 2021
In pregnancy in well-resourced settings, limited data suggest that higher blood pressure (BP) vis... more In pregnancy in well-resourced settings, limited data suggest that higher blood pressure (BP) visit-to-visit variability may be associated with adverse pregnancy outcomes. Included were pregnant women in 22 intervention clusters of the CLIP (Community-Level Interventions for Preeclampsia) cluster randomized trials, who had received at least 2 prenatal contacts from a community health worker, including standardized BP measurement. Mixed-effects adjusted logistic regression assessed relationships between pregnancy outcomes and both BP level (median [interquartile range]) and visit-to-visit variability (SD and average real variability [ARV], adjusted for BP level), among all women and those who became hypertensive. The primary outcome was the CLIP composite of maternal and perinatal mortality and morbidity. Among 17 770 pregnancies, higher systolic and diastolic BP levels were associated with increased odds of the composite outcome per 5 mm Hg increase in BP (odds ratio [OR], 1.05 [95%...
Peer review reports. (PDF 274 kb)
BACKGROUND: There have been no prior studies of the political self-characterization of U.S. physi... more BACKGROUND: There have been no prior studies of the political self-characterization of U.S. physicians-in-training, and little is known about physicians ’ political leanings or the critical relationship between medical issues and political orientations of physicians and physicians-in-training. METHODS: All medical students in the class of 2003 at 16 nationally representative U.S. schools were eligible to complete three questionnaire administrations (at freshman orientation, entrance to wards, and senior year). RESULTS: Among these medical students, 5 % self-characterized as politically very conservative, 21%
As far as the laws of mathematics refer to reality, they are not certain; and as far as they are ... more As far as the laws of mathematics refer to reality, they are not certain; and as far as they are certain, they do not refer to reality.
Uploads
Papers by Shafik Dharamsi