ScienceDirect Search: "human resources for health"

Subscribe to canal de noticias ScienceDirect Search: "human resources for health" ScienceDirect Search: "human resources for health"
ScienceDirect RSS
Actualizado: hace 55 mins 4 segs

Child survival in England: strengthening governance for health

Mar, 19/09/2017 - 05:59
Publication date: Available online 17 September 2017
Source:Health Policy

Author(s): Ingrid Wolfe, Kate Mandeville, Katherine Harrison, Raghu Lingam

The United Kingdom, like all European countries, is struggling to strengthen health systems and improve conditions for child health and survival. Child mortality in the UK has failed to improve in line with other countries. Securing optimal conditions for child health requires a healthy society, strong health system, and effective health care. We examine inter-sectoral and intra-sectoral policy and governance for child health and survival in England. Literature reviews and universally applicable clinical scenarios were used to examine child health problems and English policy and governance responses for improving child health through integrating care and strengthening health systems, over the past 15 years. We applied the TAPIC framework for analyzing policy governance: transparency, accountability, participation, integrity, and capacity. We identified strengths and weaknesses in child health governance in all the five domains. However there remain policy failures that are not fully explained by the TAPIC framework. Other problems with successfully translating policy to improved health that we identified include policy flux; policies insufficiently supported by delivery mechanisms measurable targets, and sufficient budgets; and policies with unintended or contradictory aspects. We make recommendations for inter-sectoral and intra-sectoral child health governance, policy, and action to improve child health in England with relevant lessons for other countries.





Categorías: Investigaciones

Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Vie, 15/09/2017 - 04:53
Publication date: 16–22 September 2017
Source:The Lancet, Volume 390, Issue 10100

Author(s): GBD 2016 DALYs and HALE CollaboratorsAmanuel AlemuAbajobirKalkidan HassenAbateCristianaAbbafatiKaja MAbbasFoadAbd-AllahRizwan SuliankatchiAbdulkaderAbdishakur MAbdulleTeshome AbukaAbeboSemaw FeredeAberaVictorAboyansLaith JAbu-RaddadIlana NAckermanIsaac AAdedejiOlatunjiAdetokunbohAshkanAfshinRakeshAggarwalSutapaAgrawalAnuragAgrawalMuktar BeshirAhmedMiloud Taki EddineAichourAmani NidhalAichourIbtihelAichourSnehaAiyarTomi FAkinyemijuNadiaAkseerFaris HasanAl LamiFaresAlahdabZiyadAl-AlyKhurshidAlamNooreAlamTahiyaAlamDeenaAlasfoorKefyalew AddisAleneRaghibAliRezaAlizadeh-NavaeiJuma MAlkaabiAla'aAlkerwiFrançoisAllaPeterAllebeckChristineAllenFatmaAl-MaskariMohammad AbdulAzizAlMazroaRajaaAl-RaddadiUbaiAlsharifShirinaAlsowaidiBenjamin MAlthouseKhalid AAltirkawiNelsonAlvis-GuzmanAzmeraw TAmareErfanAminiWalidAmmarYaw AmpemAmoakoMustafa GeletoAnshaCarl Abelardo TAntonioPalwashaAnwariJohanÄrnlövMeghaAroraAlArtamanKrishna KumarAryalSolomon WAsgedomTesfay MehariAteyNiguse TadeleAtnafuLeticiaAvila-BurgosEuripide Frinel G ArthurAvokpahoAshishAwasthiShallyAwasthiMahmoud RezaAzarpazhoohPeterAzzopardiTesleem KayodeBabalolaUmarBachaAlaaBadawiKalpanaBalakrishnanMarlena SBannickAleksandraBaracSuzanne LBarker-ColloTillBärnighausenSimonBarqueraLope HBarreroSanjayBasuRobertBattistaKatherine EBattleBernhard TBauneShahrzadBazargan-HejaziJustinBeardsleyNeerajBediYannickBéjotBayu BegashawBekeleMichelle LBellDerrick ABennettJames RBennettIsabela MBensenorJenniferBensonAdugnawBerhaneDerbew FikaduBerheEduardoBernabéBalem DemtsuBetsuMirceaBeuranAddisu ShunuBeyeneAnilBhansaliSamirBhattZulfiqar ABhuttaSibhatuBiadgilignBurcu KucukBicerKellyBienhoffBorisBikbovCharlesBirungiStanBiryukovDonalBisanzioHabtamu MellieBizuayehuFiona MBlythDube JaraBoneyaDipanBoseIbrahim RBou-OrmRupert R ABourneMichaelBraininCarolBrayneAlexandraBrazinovaNicholas J KBreitbordePaul SBriantGabrielleBrittonTraolach SBrughaRachelleBuchbinderLemma Negesa BultoBultoBlair RBumgarnerZahid AButtLuceroCahuana-HurtadoEwanCameronIsmael RicardoCampos-NonatoHélèneCarabinRosarioCárdenasDavid OCarpenterJuan JesusCarreroAustinCarterFelixCarvalhoDanielCaseyCarlos ACastañeda-OrjuelaChris DCastleFerránCatalá-LópezJung-ChenChangFiona JCharlsonPankajChaturvediHongleiChenMirriamChibalabalaChioma EzinneChibuezeVesper HichilombweChisumpaAbdulaal AChitheerRajivChowdhuryDevasahayam JesudasChristopherLiliana GCiobanuMassimoCirilloDannyColombaraLeslie TrumbullCooperCyrusCooperPaolo AngeloCortesiMonicaCortinovisMichael HCriquiElizabeth ACromwellMaritaCrossJohn ACrumpAbel FekaduDadiKoustuvDalalAlbertinoDamascenoLalitDandonaRakhiDandonaJosédas NevesDragos VDavitoiuKairatDavletovBarborade CourtenDiegoDe LeoHansDe SteurBarthelemy KuateDefoLouisaDegenhardtSelinaDeiparineRobert PDellavalleKebedeDeribeAmareDeribewDon CDes JarlaisSubhojitDeySamath DDharmaratnePreet KDhillonDanielDickerShirinDjalainiaHuyen PhucDoKlaraDokovaDavid TeyeDokuE RayDorseyKadine Priscila Benderdos SantosTim RDriscollManishaDubeyBruce BartholowDuncanBeth EEbelMichelleEchkoZiad ZiadEl-KhatibAhmadaliEnayatiAman YesufEndriesSergey PetrovichErmakovHolly EErskineSetegnEshetieBabakEshratiAlirezaEsteghamatiKaraEstepFanuel Belayneh BekeleFanuelTamerFaragCarla Sofia e SaFarinhaAndréFaroFarshadFarzadfarMir SohailFazeliValery LFeiginAndrea BFeiglSeyed-MohammadFereshtehnejadJoão CFernandesAlize JFerrariTesfaye RegassaFeyissaIrinaFilipFlorianFischerChristinaFitzmauriceAbraham DFlaxmanNataliyaFoigtKyle JForemanRichard CFranklinJoseph JFrostadNancyFullmanThomasFürstJoao MFurtadoNeal DFutranEmmanuelaGakidouAlberto LGarcia-BasteiroTeshomeGebreGebremedhin BerheGebregergsTsegaye TeweldeGebrehiwotJohanna MGeleijnseAyeleGeletoBikila LenchaGemechuHailay AbrhaGesesewPeter WGethingAlirezaGhajarKatherine BGibneyRichard FGillumIbrahim Abdelmageem MohamedGinawiMelkamu DedefoGishuGiorgiaGiussaniWilliam WGodwinKashishGoelShifalikaGoenkaEllen MGoldbergPhilimon NGonaAmadorGoodridgeSameer ValiGopalaniRichard AGosselinCarolyn CGotayAtsushiGotoAlessandra CarvalhoGoulartNicholasGraetzHarish ChanderGugnaniPrakash CGuptaRajeevGuptaTanushGuptaVipinGuptaRahulGuptaReyna AGutiérrezVladimirHachinskiNimaHafezi-NejadAlemayehu DesalegneHailuGessessew BugssaHailuRandah RibhiHamadehSamerHamidiMouhanadHammamiAlexis JHandalGraeme JHankeyYuantaoHaoHilda LHarbHabtamu AberaHareriJosep MariaHaroKimani MHarunJamesHarveyMohammad SadeghHassanvandRasmusHavmoellerSimon IHayRoderick JHayMohammad THedayatiDeliaHendrieNathaniel JHenryIleana BeatrizHeredia-PiPouriaHeydarpourHans WHoekHoward JHoffmanMasakoHorinoNobuyukiHoritaH DeanHosgoodSorinHostiucPeter JHotezDamian GHoyAung SoeHtetGuoqingHuJohn JHuangChantalHuynhKim MoesgaardIburgEhimario UcheIgumborChadIkedaCaleb Mackay SalpeterIrvineSheikh Mohammed SharifulIslamKathryn HJacobsenNaderJahanmehrMihajlo BJakovljevicPeterJamesSimerjot KJassalMehdiJavanbakhtSudha PJayaramanPanniyammakalJeemonPaul NJensenVivekanandJhaGuohongJiangDennyJohnCatherine OJohnsonSarah CharlotteJohnsonJost BJonasMikkJürissonZubairKabirRajendraKadelAmahaKahsayRitulKamalChittaranjanKarNadim EKaramAndréKarchCorine KakiziKaremaSeyed MKarimiChanteKarimkhaniAmirKasaeianGetachew MulluKassaNigussie AssefaKassawNicholas JKassebaumAnshulKastorSrinivasa VittalKatikireddiAnilKaulNoritoKawakamiPeter NjengaKeiyoroLauraKemmerAndre PascalKengneAndreKerenChandrasekharan NairKesavachandranYousef SalehKhaderIbrahim AKhalilEjaz AhmadKhanYoung-HoKhangAbdullah TKhojaArdeshirKhosraviJagdishKhubchandaniAliasghar AhmadKiadaliriChristianKielingYun JinKimDanielKimRuth WKimokotiYohannesKinfuAdnanKisaKatarzyna AKissimova-SkarbekNiranjanKissoonMikaKivimakiAnn KristinKnudsenYoshihiroKokuboDhavalKolteJacek AKopecSoewartaKosenGeorgios AKotsakisParvaiz AKoulAiKoyanagiMichaelKravchenkoKristopher JKrohnG AnilKumarPushpendraKumarHmwe HKyuAnton Carl JonasLagerDharmesh KumarLalRatilalLallooTeaLallukkaNkurunzizaLambertQingLanVan CLansinghAndersLarssonJanet LLeasherPaul HLeeJamesLeighCheru TesemaLeshargieJanniLeungRickyLeungMiriamLeviYichongLiYongmeiLiXiaofengLiangMisgan LegesseLibenStephen SLimShaiLinnPatrick YLiuAngelaLiuShiweiLiuYangLiuRakeshLodhaGiancarloLogroscinoKatharine JLookerAlan DLopezStefanLorkowskiPaulo ALotufoRafaelLozanoTimothy C DLucasRaimundasLuneviciusRonan ALyonsErlyn Rachelle KingMacarayanEmilie RMaddisonHassan Magdy AbdMagdy Abd El RazekMohammedMagdy Abd El RazekCarlosMagis-RodriguezMahdiMahdaviMarekMajdanRezaMajdzadehAzeemMajeedRezaMalekzadehRajeshMalhotraDeborah CarvalhoMaltaAbdullah AMamunHelenaManguerraTrehManhertzLorenzo GMantovaniChabila CMapomaLyn MMarchLaurie BMarczakJoseMartinez-RagaPaulo Henrique ViegasMartinsFrancisco RogerlândioMartins-MeloIraMartopulloWinfriedMärzManu RajMathurMohsenMazidiColmMcAlindenMadelineMcGaugheyJohn JMcGrathMartinMcKeeSureshMehataToniMeierKidanu GebremariamMelesPeterMemiahZiad AMemishWalterMendozaMelkamu MeridMengeshaMubarek AberaMengistieDesalegn TadeseMengistuGeorge AMensahTuomo JMeretojaAtteMeretojaHaftay BerhaneMezgebeRenataMichaAnoushkaMillearTed RMillerShawnMinnigMojdeMirarefinErkin MMirrakhimovAwokeMisganawShiva RajMishraPhilip BMitchellKarzan AbdulmuhsinMohammadAlirezaMohammadiMuktar Sano KedirMohammedKedir EndrisMohammedShafiuMohammedMurali B VMohanAli HMokdadSarah KMollenkopfLorenzoMonastaJulio CesarMontañez HernandezMarcellaMonticoMaziarMoradi-LakehPaulaMoragaLidiaMorawskaRintaroMoriShane DMorrisonMarkMosesCliffMountjoy-VenningKalayu BirhaneMrutsUlrich OMuellerKateMullerMichele EMurdochChristopher J LMurrayGudlavalleti Venkata SatyanarayanaMurthySrinivasMurthyKamarul ImranMusaJean BNachegaGabrieleNagelMohsenNaghaviAliyaNaheedKovin SNaidooVinayNangiaJamal TNasherGopalakrishnanNatarajanDumessa EdessaNegasaRuxandra IrinaNegoiIonutNegoiCharles RNewtonJosephine WanjikuNgunjiriCuong TatNguyenQuyen LeNguyenTrang HuyenNguyenGrantNguyenMinhNguyenEmmaNicholsDina Nur AnggrainiNingrumVuong MinhNongOle FNorheimBoNorrvingJean Jacques NNoubiapAlypioNyandwiCarla MakhloufObermeyerMartin JO'DonnellFelix AkpojeneOgboIn-HwanOhAnselmOkoroOlanrewajuOladimejiAndrew ToyinOlagunjuTinuke OluwasefunmiOlagunjuHelen EOlsenBolajoko OlubukunolaOlusanyaJacob OlusegunOlusanyaKanyinOngJohn NelsonOpioEyalOrenAlbertoOrtizRichard HOsborneAaronOsgood-ZimmermanMajdiOsmanErikaOtaMayowa OOwolabiMaheshPARosana EPacellaBasant KumarPandaJeyaraj DuraiPandianChristinaPapachristouEun-KeeParkCharles DParryMahboubehParsaeianSnehal TPatilScott BPattenGeorge CPattonDeepakPaudelKatherinePaulsonNeilPearceDavid MPereiraKrystle MariePerezNorbertoPericoKonradPesudovsCarrie BethPetersonWilliam ArthurPetriMaxPetzoldMichael RobertPhillipsGeoffreyPhippsDavid MPigottJulian DavidPillayChristinePinhoMichael APiradovDietrichPlassMartin APletcherSvetlanaPopovaRichie GPoultonFarshadPourmalekDorairajPrabhakaranNarayanPrasadCarriePurcellManoramaPurwarMostafaQorbaniBeatriz Paulina AyalaQuintanillaRynaz H SRabieeAmirRadfarAnwarRafayKazemRahimiAfarinRahimi-MovagharVafaRahimi-MovagharMohammad Hifz UrRahmanMuhammad AzizRahmanMahfuzarRahmanRajesh KumarRaiSasaRajsicUshaRamChhabi LalRanabhatTharaRangaswamyZaneRankinPaturi VishnupriyaRaoPuja CRaoSalmanRawafSarah ERayRobert CReinerNikolasReinigMarissaReitsmaGiuseppeRemuzziAndre M NRenzahoSergeResnikoffSatarRezaeiAntonio LRibeiroJacqueline CastilloRivasHirbo ShoreRobaStephen RRobinsonDavidRojas-RuedaMohammad BagherRokniLucaRonfaniGholamrezaRoshandelGregory ARothDietrichRothenbacherAmbujRoyEnricoRubagottiGeorge MugambageRuhagoSoheilSaadatMahdiSafdarianSaeidSafiriRajeshSagarRameshSahathevanMohammad AliSahraianJosephSalamaMuhammad MuhammadSalehJoshua ASalomonSundeep SantoshSalviAbdallah MSamyJuan RamonSanabriaMaria DoloresSanchez-NiñoDamianSantomauroJoão VascoSantosItamar SSantosMilena MSantric MilicevicBennSartoriusMaheswarSatpathyMonikaSawhneySoniaSaxenaKathrynSchelonkaMaria InêsSchmidtIone J CSchneiderBenSchöttkerAletta ESchutteDavid CSchwebelFalkSchwendickeSorayaSeedatSadaf GSepanlouEdson EServan-MoriAmiraShaheenMasood AliShaikhMansourShamsipourRajeshSharmaJayendraSharmaJunShePeilinShiKenjiShibuyaChloeShieldsGirma TemamShifaMekonnen SisayShiferawMikaShigematsuRahmanShiriRezaShirkoohiShreyaShirudeKawkabShishaniHaithamShomanSorayaSiabaniAbla MehioSibaiInga DoraSigfusdottirDonald HSilberbergDiego Augusto SantosSilvaJoão PedroSilvaDayane Gabriele AlvesSilveiraJasvinder ASinghOm PrakashSinghNarinder PalSinghVirendraSinghDhirendra NarainSinhaEiriniSkiadaresiErica LeighSlepakDavid LSmithMariSmithBadr H ASobaihEugeneSobngwiMichaelSoljakReed J DSorensenTatiane Cristina MoraesSousaLuciano ASposatoChandrashekhar TSreeramareddyVinaySrinivasanJeffrey DStanawayVasilikiStathopoulouNicholasSteelDan JSteinCaitlynSteinerSabineSteinkeMark AndrewStokesLars JacobStovnerBryanStrubMichelleSubartMuawiyyah BabaleSufiyanBruno FSunguyaPatrick JSurSoumyaSwaminathanBryan LSykesDillonSylteCassandra E ISzoekeRafaelTabarés-SeisdedosSantosh KumarTadakamadlaGetachew RedaeTaffereJukka STakalaNikhilTandonDavidTanneYihunie LTarekegnMohammadTavakkoliNunoTaveiraHugh RTaylorTeketo KassawTegegneArashTehrani-BanihashemiTesfalidetTekelabAbdullah SuliemanTerkawiDawit JemberTesfayeBelayTesssemaJSThakurOrnwipaThamsuwanAlice MTheadomAndrew MTheisKatie EThomasNihalThomasRobertThompsonAmanda GThriftRuoyanTobe-GaiMyriamTobollikMarcelloTonelliRomanTopor-MadryMiguelTortajadaMathildeTouvierJeffersonTraebertBach XuanTranChristopherTroegerThomasTruelsenDerrickTsoiEmin MuratTuzcuHayleyTymesonStefanosTyrovolasKingsley NnannaUkwajaEduardo AUndurragaChigozie JesseUnekeRachelUpdikeOlalekan AUthmanBenjamin S ChudiUzochukwuJob F Mvan BovenSantoshVarugheseTommiVasankariLennert JVeermanSVenkateshNarayanaswamyVenketasubramanianRameshVidavalurLakshmiVijayakumarFrancesco SViolanteAbhishekVishnuSergey KVladimirovVasiliy VictorovichVlassovStein EmilVollsetTheoVosFisehaWadiloTolassaWakayoMitchell TWallinYuan-PangWangScottWeichenthalElisabeteWeiderpassRobert GWeintraubDaniel JWeissAndreaWerdeckerRonnyWestermanHarvey AWhitefordTissaWijeratneHywel CWilliamsCharles SheyWiysongeBelete GetahunWoldeyesCharles D AWolfeRachelWoodbrookAnthony DWoolfAbdulhalikWorkichoDenisXavierGelinXuSimonYadgirMohsenYaghoubiBereketYakobLijing LYanYuichiroYanoPengpengYeMahari GideyYihdegoHassen HamidYimamPaulYipNaohiroYonemotoSeok-JunYoonMarcelYotebiengMustafa ZYounisChuanhuaYuZoubidaZaidiMaysaa El SayedZakiElias AsfawZegeyeZerihun MenlkalewZenebeXueyingZhangYingfengZhengMaigengZhouBenZipkinSanjayZodpeyLeoZoecklerLiesl JoannaZuhlke

Background Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. Findings The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9–78·6) for females and 72·0 years (68·8–75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0–49·5]) and for males was in Lesotho (41·5 years [39·0–44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97–6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74–6·27) for males and 6·49 years (6·08–6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61–1·93) for males and 1·96 years (1·69–2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (–2·3% [–5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. Interpretation At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. Funding Bill & Melinda Gates Foundation.





Categorías: Investigaciones

The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa

Jue, 14/09/2017 - 04:38
Publication date: Available online 13 September 2017
Source:The Lancet

Author(s): Irene Akua Agyepong, Nelson Sewankambo, Agnes Binagwaho, Awa Marie Coll-Seck, Tumani Corrah, Alex Ezeh, Abebaw Fekadu, Nduku Kilonzo, Peter Lamptey, Felix Masiye, Bongani Mayosi, Souleymane Mboup, Jean-Jacques Muyembe, Muhammad Pate, Myriam Sidibe, Bright Simons, Sheila Tlou, Adrian Gheorghe, Helena Legido-Quigley, Joanne McManus, Edmond Ng, Maureen O'Leary, Jamie Enoch, Nicholas Kassebaum, Peter Piot







Categorías: Investigaciones

Longer and healthier lives for all Africans by 2030: perspectives and action of WHO AFRO

Jue, 14/09/2017 - 04:38
Publication date: Available online 13 September 2017
Source:The Lancet

Author(s): Matshidiso Moeti







Categorías: Investigaciones

A study on assessment of ASHA’s work profile in the context of Udupi Taluk, Karnataka, India

Sáb, 02/09/2017 - 01:21
Publication date: Available online 1 September 2017
Source:Clinical Epidemiology and Global Health

Author(s): Swathi Shet, Kumar Sumit, Sameer Padnis

Accredited social health activist (ASHA) workers and their activity are considered as the one of the key component of National Health Mission (NHM). ASHA workers serves as an important link between community and the health facilities. Objective To assess the knowledge and practice of ASHA workers regarding their roles and responsibilities and to study the challenges faced by them. Method A cross sectional study was conducted in health care centers of Udupi Taluka, Karnataka with 100 ASHA workers for Quantitative and 10 for Qualitative. Result The study revealed that the knowledge of the ASHA workers on ANC and PNC (82%) is considerably higher than the knowledge on Family planning (71%), Child health (65%) and General health (67%). 80% had expressed their dissatisfaction towards incentives and other working conditions Conclusion The overall knowledge of ASHA workers was sufficient in the field of MCH but there is a need for mitigation of few key challenges, which would significantly contribute to improvement of ASHA’s work profile.





Categorías: Investigaciones

Coalition for Global Clinical Surgical Education: The Alliance for Global Clinical Training

Sáb, 02/09/2017 - 01:21
Publication date: Available online 1 September 2017
Source:Journal of Surgical Education

Author(s): Jahanara Graf, Mackenzie Cook, Samuel Schecter, Karen Deveney, Paul Hofmann, Douglas Grey, Larry Akoko, Ali Mwanga, Kitembo Salum, William Schecter

Objective Assessment of the effect of the collaborative relationship between the high-income country (HIC) surgical educators of the Alliance for Global Clinical Training (Alliance) and the low-income country surgical educators at the Muhimbili University of Health and Allied Sciences/Muhimbili National Hospital (MUHAS/MNH), Dar Es Salaam, Tanzania, on the clinical global surgery training of the HIC surgical residents participating in the program. Design A retrospective qualitative analysis of Alliance volunteer HIC faculty and residents' reports, volunteer case lists and the reports of Alliance academic contributions to MUHAS/MNH from 2012 to 2017. In addition, a survey was circulated in late 2016 to all the residents who participated in the program since its inception. Results Twelve HIC surgical educators provided rotating 1-month teaching coverage at MUHAS/MNH between academic years 2012 and 2017 for a total of 21 months. During the same time period 11 HIC residents accompanied the HIC faculty for 1-month rotations. HIC surgery residents joined the MUHAS/MNH Department of Surgery, made significant teaching contributions, performed a wide spectrum of “open procedures” including hand-sewn intestinal anastomoses. Most had had either no or limited previous exposure to hand-sewn anastomoses. All of the residents commented that this was a maturing and challenging clinical rotation due to the complexity of the cases, the limited resources available and the ethical and emotional challenges of dealing with preventable complications and death in a resource constrained environment. Conclusions The Alliance provides an effective clinical global surgery rotation at MUHAS/MNH for HIC Surgery Departments wishing to provide such an opportunity for their residents and faculty.





Categorías: Investigaciones

Perceptions of women on workloads in health facilities and its effect on maternal health care: a multi-site qualitative study in Nigeria

Jue, 31/08/2017 - 01:07
Publication date: Available online 30 August 2017
Source:Midwifery

Author(s): Ogu Rosemary, L.F.C. Ntoimo, F.E. Okonofua

Objective of the study was to explore women's perception of maternal health care providers’ workload and its effects on the delivery of maternal healthcare in secondary and tertiary hospitals in Nigeria. Research Design, setting, participants: five focus groups discussions (FGDs) were conducted with women in each of eight secondary and tertiary hospitals in 8 States in four geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. We elicited information on women's perceptions of workloads of maternal health providers and the effects of the workloads on maternity care. The discussions were audio-taped and transcribed while thematic analysis was carried out using Atlas.ti computer software. Findings the majority of the participants submitted that the health providers are burdened with heavy workloads in the provision of maternal health care. Examples of heavy workload cited included complaints from health providers, evidence of stress and strain in care provision by providers and the sheer numbers of patients that are left unattended to in health facilities. Poor quality care, insufficient time to carry out necessary investigations on patients, and prolonged waiting time experienced by women in accessing care featured as consequences of heavy workload, with the secondary result that women are reluctant to seek care in the health facilities because of the belief that they would spend a long time in receiving care. Key conclusions and implications for practice: we conclude that women are concerned about heavy workloads experienced by healthcare providers and may partly account for the low utilization of referral health facilities for maternal health care in Nigeria.. Efforts to address this problem should include purposeful human resource policy development, the development of incentives for health providers, and the proper re-organization of the health system.





Categorías: Investigaciones

e-Health readiness assessment factors and measuring tools: A systematic review

Vie, 25/08/2017 - 23:53
Publication date: Available online 25 August 2017
Source:International Journal of Medical Informatics

Author(s): Yusif Salifu, Abdul Hafeez-Baig, Jeffrey Soar

Background The evolving, adoption and high failure nature of health information technology (HIT)/IS/T systems requires effective readiness assessment to avert increasing failures and system benefits. However, literature on HIT readiness assessment is myriad and fragmented. This review bares the contours of the available literature concluding in a set of manageable and usable recommendations for policymakers, researchers, individuals and organizations intending to assess readiness for any HIT implementation. Objectives Identify studies, analyze readiness factors and offer recommendations. Method Published articles 1995-2015 were searched using Medline/PubMed, Cinahl, Web of Science, PsychInfo, ProQuest. Studies were included if they were assessing IS/T/mHealth readiness in the context of HIT. Articles not written in English were excluded. Themes that emerged in the process of the data synthesis were thematically analysed and interpreted. Results Analyzed themes were found across 63 articles. In accordance with their prevalence of use, they included but not limited to “Technological readiness”, 30 (46%); “Core/Need/Motivational readiness”, 23 (37%); “Acceptance and use readiness”, 19 (29%); “Organizational readiness”, 20 (21%); “IT skills/Training/Learning readiness” (18%), “Engagement readiness”, 16 (24%) and “Societal readiness” (14%). Despite their prevalence in use, “Technological readiness”, “Motivational readiness” and “Engagement readiness” all had myriad and unreliable measuring tools. Core readiness had relatively reliable measuring tools, which repeatedly been used in various readiness assessment studies Conclusion Thus, there is the need for reliable measuring tools for even the most commonly used readiness assessment factors/constructs: Core readiness, Engagement and buy-ins readiness, Technological readiness and IT Skills readiness as this could serve as an immediate step in conducting effective/reliable e-Health readiness assessment, which could lead to reduced HIT implementation failures.





Categorías: Investigaciones

Palliative Care in Rwanda: Aiming for Universal Access

Jue, 10/08/2017 - 20:42
Publication date: Available online 10 August 2017
Source:Journal of Pain and Symptom Management

Author(s): Eric L. Krakauer, Marie-Aimee Muhimpundu, Diane Mukasahaha, Jean-Claude Tayari, Christian Ntizimira, Blaise Uhagaze, Théodosie Mugwaneza, Aimable Ruzima, Egide Mpanumusingo, Magnus Gasana, Vincent Karamuka, Jean-Luc Nkurikiyimfura, Paul Park, Peter Barebwanuwe, Neo Tapela, Shekinah N. Elmore, Gene Bukhman, Mhoira Leng, Liz Grant, Agnes Binagwaho, Richard Sezibera

In 2011, Rwanda’s Ministry of Health (MoH) set a goal of universal access to palliative care by 2020. Toward this audacious egalitarian and humanitarian goal, the MoH worked with partners to develop palliative care policies and a strategic plan, secure adequate supplies of opioid for the country, initiate palliative care training programs, and begin studying a model for integrating coordinated palliative care into the public healthcare system at all levels. It also initiated training of a new cadre of home-based care practitioners (HBCPs) to provide palliative care in the home. Based on these developments, the goal appears within reach.





Categorías: Investigaciones

Second-line antiretroviral therapy: so much to be done

Sáb, 05/08/2017 - 19:08
Publication date: Available online 4 August 2017
Source:The Lancet HIV

Author(s): Yibeltal Assefa, Charles F Gilks







Categorías: Investigaciones

Bibliometric Review: Identifying Evolving and Emergent Regulatory Trends

Sáb, 29/07/2017 - 17:33
Publication date: July 2017
Source:Journal of Nursing Regulation, Volume 8, Issue 2, Supplement

Author(s): David Benton







Categorías: Investigaciones

Cervical cancer control in HIV-infected women: Past, present and future

Vie, 21/07/2017 - 15:41
Publication date: Available online 21 July 2017
Source:Gynecologic Oncology Reports

Author(s): Rahel Ghebre, Surbhi Grover, Melody J. Xu, Linus T. Chuang, Hannah Simonds

Since the initial recognition of acquired immunodeficiency syndrome (AIDS) in 1981, an increased burden of cervical cancer was identified among human immunodeficiency virus (HIV)-positive women. Introduction of antiretroviral therapy (ART) decreased risks of opportunistic infections and improved overall survival. HIV-infected women are living longer. Introduction of the human papillomavirus (HPV) vaccine, cervical cancer screening and early diagnosis provide opportunities to reduce cervical cancer associated mortality. In line with 2030 Sustainable Development Goals to reduce mortality from non-communicable diseases, increased efforts need to focus on high burden countries within sub-Saharan Africa (SSA). Despite limitations of resources in SSA, opportunities exist to improve cancer control. This article reviews advancements in cervical cancer control in HIV-positive women.





Categorías: Investigaciones

Health Policy in Times of Austerity—A Conceptual Framework for Evaluating Effects of Policy on Efficiency and Equity Illustrated with Examples from Europe since 2008

Jue, 20/07/2017 - 15:26
Publication date: Available online 19 July 2017
Source:Health Policy

Author(s): Martin Wenzl, Huseyin Naci, Elias Mossialos

The objective of this paper is to provide a framework for evaluation of changes in health policy against overarching health system goals. We propose a categorisation of policies into seven distinct health system domains. We then develop existing analytical concepts of insurance coverage and cost-effectiveness further to evaluate the effects of policies in each domain on equity and efficiency. The framework is illustrated with likely effects of policy changes implemented in a sample of European countries since 2008. Our illustrative analysis suggests that cost containment has been the main focus and that countries have implemented a mix of measures that are efficient or efficiency neutral. Similarly, policies are likely to have mixed effects on equity. Additional user charges were a common theme but these were frequently accompanied by additional exemptions, making their likely effects on equity difficult to evaluate. We provide a framework for future, and more detailed, evaluations of changes in health policy.





Categorías: Investigaciones

Can adverse effects of excessive vitamin D supplementation occur without developing hypervitaminosis D?

Jue, 20/07/2017 - 15:26
Publication date: Available online 19 July 2017
Source:The Journal of Steroid Biochemistry and Molecular Biology

Author(s): Mohammed S. Razzaque

Vitamin D is a fat-soluble hormone that has endocrine, paracrine and autocrine functions. Consumption of vitamin D-supplemented food & drugs have increased significantly in the last couple of decades due to campaign and awareness programs. Despite such wide use of artificial vitamin D supplements, serum levels of 25 hydroxyvitamin D [25(OH)D] does not always reflect the amount of uptake. In contrast to the safe sunlight exposure, prolonged and disproportionate consumption of vitamin D supplements may lead to vitamin D intoxication, even without developing hypervitaminosis D. One of the reasons why vitamin D supplementation is believed to be safe is, it rarely raises serum vitamin D levels to the toxic range even after repeated intravenous ingestion of extremely high doses of synthetic vitamin D analogs. However, prolonged consumption of vitamin D supplementation may induce hypercalcemia, hypercalciuria and hyperphosphatemia, which are considered to be the initial signs of vitamin D intoxication. It is likely that calcium and phosphorus dysregulation, induced by exogenous vitamin D supplementation, may lead to tissue and organ damages, even without developing hypervitaminosis D. It is needed to be emphasized that, because of tight homeostatic control of calcium and phosphorus, when hypercalcemia and/or hyperphosphatemia is apparent following vitamin D supplementation, the process of tissue and/or organ damage might already have been started.





Categorías: Investigaciones

Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries

Lun, 17/07/2017 - 14:41
Publication date: Available online 17 July 2017
Source:The Lancet Global Health

Author(s): Karin Stenberg, Odd Hanssen, Tessa Tan-Torres Edejer, Melanie Bertram, Callum Brindley, Andreia Meshreky, James E Rosen, John Stover, Paul Verboom, Rachel Sanders, Agnès Soucat

Background The ambitious development agenda of the Sustainable Development Goals (SDGs) requires substantial investments across several sectors, including for SDG 3 (healthy lives and wellbeing). No estimates of the additional resources needed to strengthen comprehensive health service delivery towards the attainment of SDG 3 and universal health coverage in low-income and middle-income countries have been published. Methods We developed a framework for health systems strengthening, within which population-level and individual-level health service coverage is gradually scaled up over time. We developed projections for 67 low-income and middle-income countries from 2016 to 2030, representing 95% of the total population in low-income and middle-income countries. We considered four service delivery platforms, and modelled two scenarios with differing levels of ambition: a progress scenario, in which countries' advancement towards global targets is constrained by their health system's assumed absorptive capacity, and an ambitious scenario, in which most countries attain the global targets. We estimated the associated costs and health effects, including reduced prevalence of illness, lives saved, and increases in life expectancy. We projected available funding by country and year, taking into account economic growth and anticipated allocation towards the health sector, to allow for an analysis of affordability and financial sustainability. Findings We estimate that an additional $274 billion spending on health is needed per year by 2030 to make progress towards the SDG 3 targets (progress scenario), whereas US$371 billion would be needed to reach health system targets in the ambitious scenario—the equivalent of an additional $41 (range 15–102) or $58 (22–167) per person, respectively, by the final years of scale-up. In the ambitious scenario, total health-care spending would increase to a population-weighted mean of $271 per person (range 74–984) across country contexts, and the share of gross domestic product spent on health would increase to a mean of 7·5% (2·1–20·5). Around 75% of costs are for health systems, with health workforce and infrastructure (including medical equipment) as the main cost drivers. Despite projected increases in health spending, a financing gap of $20–54 billion per year is projected. Should funds be made available and used as planned, the ambitious scenario would save 97 million lives and significantly increase life expectancy by 3·1–8·4 years, depending on the country profile. Interpretation All countries will need to strengthen investments in health systems to expand service provision in order to reach SDG 3 health targets, but even the poorest can reach some level of universality. In view of anticipated resource constraints, each country will need to prioritise equitably, plan strategically, and cost realistically its own path towards SDG 3 and universal health coverage. Funding WHO.





Categorías: Investigaciones

A comprehensive assessment of breast and cervical cancer control infrastructure in Zambia

Mar, 11/07/2017 - 13:19
Publication date: Available online 11 July 2017
Source:Journal of Cancer Policy

Author(s): Carla Chibwesha, Leeya F. Pinder, Agnes Musonda, Kombatende Sikombe, Jane Matambo, Allen C. Bateman, Claire-Helene Mershon, Mulindi Mwanahamuntu, Sharon Kapambwe, Kennedy Lishimpi, Groesbeck P. Parham

Introduction: By 2030 cancer will kill one million Africans each year. Women will bear the heaviest burden, as cancers of the breast and cervix are the most common malignancies and causes of cancer-related death in the African region. National-level data that map the status of women’s cancer control services are needed to inform strategies for implementing platforms for the early detection and treatment of these “priority” cancers. Methods: Using mixed-methods, we assessed available services for breast and cervical cancer detection and treatment at all provincial hospitals, the national referral hospital, and the national cancer treatment center in Zambia. Results: A system for cervical cancer prevention using visual inspection with acetic acid (VIA) and ablation/excision of precancerous lesions has been established at the provincial level. The potential for mammography, clinical breast examination, diagnostic ultrasound and biopsy exist at the provincial level, albeit on a much smaller scale. Breast wedge resections and mastectomy can be performed in provinces where general surgeons are located; however, breast conserving and reconstructive surgery are not available. Invasive cancers are generally referred to University Teaching Hospital in Lusaka, where services for radiation, chemotherapy and hormonal therapy are available but overburdened. Pathology services nationwide are woefully inadequate. Discussion: The assessment revealed a critical need for centrally coordinated, but decentralized, public service platforms for women’s cancer control. Efforts are underway, through multiple stakeholders, to implement recommendations related to training healthcare workers who can provide advanced diagnostic and therapeutic services, improving pathology services, and innovative financing for these initiatives.





Categorías: Investigaciones

How do nurse practitioners work in primary health care settings? A scoping review

Jue, 29/06/2017 - 09:17
Publication date: Available online 28 June 2017
Source:International Journal of Nursing Studies

Author(s): Julian Grant, Lauren Lines, Philip Darbyshire, Yvonne Parry

Objectives This scoping review explores the work of nurse practitioners in primary health care settings in developed countries and critiques their contribution to improved health outcomes. Design A scoping review design was employed and included development of a research question, identification of potentially relevant studies, selection of relevant studies, charting data, collating, summarising and reporting findings. An additional step was added to evaluate the methodological rigor of each study. Data Data sources included literature identified by a search of electronic databases conducted in September 2015 (CINAHL, Informit, Web of Science, Scopus and Medline) and repeated in July 2016. Additional studies were located through hand searching and authors’ knowledge of other relevant studies. Results 74 articles from eight countries were identified, with the majority emanating from the United States of America. Nurse practitioners working in communities provided care mostly in primary care centres (n=42), but also in community centres (n=6), outpatient departments (n=6), homes (n=5), schools (n=3), child abuse clinics (n=1), via communication technologies (n=6), and through combined face-to-face and communication technologies (n=5). The scope of nurse practitioner work varied on a continuum from being targeted towards a specific disease process or managing individual health and wellbeing needs in a holistic manner. Enhanced skills included co-ordination, collaboration, education, counselling, connecting clients with services and advocacy. Measures used to evaluate outcomes varied widely from physiological data (n=25), hospital admissions (n=10), use of health services (n=15), self-reported health (n=13), behavioural change (n=14), patient satisfaction (n=17), cost savings (n=3) and mortality/morbidity (n=5). Conclusions The majority of nurse practitioners working in community settings did so within a selective model of primary health care with some examples of nurse practitioners contributing to comprehensive models of primary health care. Nurse practitioners predominantly worked with populations defined by an illness with structured protocols for curative and rehabilitative care. Nurse practitioner work that also incorporated promotive activities targeted improving social determinants of health for people rendered vulnerable due to ethnicity, Aboriginal identity, socioeconomic disadvantage, remote location, gender and aging. Interventions were at individual and community levels with outcomes including increased access to care, cost savings and salutogenic characteristics of empowerment for social change.





Categorías: Investigaciones

What are Chinese nurses’ experiences whilst working overseas? A narrative scoping review

Vie, 23/06/2017 - 08:20
Publication date: Available online 22 June 2017
Source:International Journal of Nursing Studies

Author(s): Yaping Zhong, Lisa McKenna, Beverley Copnell

Background Transnational nurse migration has become an apparent attribute of the global nurse shortage and it is foreseeable that China will play an increasingly significant role in nurse exports. These nurses have unique cultural and professional needs throughout their journey of migration and in-depth analysis of Chinese migrant nurses’ experiences is urgently required to manage and empower an ethnically diverse workforce. Objective To synthesise Chinese migrant nurses’ experiences by examining the findings of existing studies. Design Scoping review methods incorporating narrative synthesis were conducted. Method Arksey and O’Malley’s five-stage scoping review framework was utilised to identify Chinese migrant nurses’ experiences. 13 databases were searched, and 5009 articles were retrieved. After screening the titles and abstracts, 169 articles were assessed in full text for eligibility, and finally 22 articles plus 2 manually included ones, representing 19 discrete studies, were further analysed and synthesised with a three-step narrative synthesis. Results 13 qualitative studies, 5 quantitative studies and 1 mixed- methods study met inclusion criteria. Two main themes were identified. “Contexts and migration” comprised three subthemes: perceptions of nursing, original culture and nursing differences. “The self and migration” included four subthemes: initiating, transition, reality and future. Conclusion This scoping review revealed the literature on Chinese migrant nurses and provided insight into their stories and circumstances. There were external factors which affected Chinese nurses’ interpretations and choices. Throughout their migration journeys, they encountered various challenges and also successes. They responded with positive or negative behavioural and psychosocial changes.





Categorías: Investigaciones

The SELFIE Framework for Integrated Care for Multi-Morbidity: development and description

Mié, 21/06/2017 - 08:08
Publication date: Available online 20 June 2017
Source:Health Policy

Author(s): Fenna R.M. Leijten, Verena Struckmann, Ewout van Ginneken, Thomas Czypionka, Markus Kraus, Miriam Reiss, Apostolos Tsiachristas, Melinde Boland, Antoinette de Bont, Roland Bal, Reinhard Busse, Maureen Rutten-van Mölken

Background The rise of multi-morbidity constitutes a serious challenge in health and social care organisation that requires a shift from disease- towards person-centred integrated care. The aim of the current study was to develop a conceptual framework that can aid the development, implementation, description, and evaluation of integrated care programmes for multi-morbidity. Methods A scoping review and expert discussions were used to identify and structure concepts for integrated care for multi-morbidity. A search of scientific and grey literature was conducted. Discussion meetings were organised within the SELFIE research project with representatives of five stakeholder groups (5Ps): patients, partners, professionals, payers, and policy makers. Results In the scientific literature 11,641 publications were identified, 92 were included for data extraction. A draft framework was constructed that was adapted after discussion with SELFIE partners from 8 EU countries and 5P representatives. The core of the framework is the holistic understanding of the person with multi-morbidity in his or her environment. Around the core, concepts were grouped into adapted WHO components of health systems: service delivery, leadership & governance, workforce, financing, technologies & medical products, and information & research. Within each component micro, meso, and macro levels are distinguished. Conclusion The framework structures relevant concepts in integrated care for multi-morbidity and can be applied by different stakeholders to guide development, implementation, description, and evaluation.





Categorías: Investigaciones

An International Collaboration for the Training of Medical Chief Residents in Rwanda

Mar, 13/06/2017 - 06:50
Publication date: March–April 2017
Source:Annals of Global Health, Volume 83, Issue 2

Author(s): Tim Walker, Vincent Dusabejambo, Janet J. Ho, Claudine Karigire, Bradley Richards, Andre N. Sofair

Background The year-long position of chief medical resident is a time-honored tradition in the United States that serves to provide the trainee with an opportunity to gain further skills as a clinician, leader, teacher, liaison, and administrator. However, in most training programs in the developing world, this role does not exist. Objectives We sought to develop a collaborative program to train the first medical chief residents for the University of Rwanda and to assess the impact of the new chief residency on residency training, using questionnaires and qualitative interviews with Rwandan faculty, chief residents, and residents. Methods The educational context and the process leading up to the appointment of Rwandan chief residents, including selection, job description, and necessary training (in the United States and Rwanda), are described. One year after implementation, we used a parallel, mixed methods approach to evaluate the new chief medical resident program through resident surveys as well as semistructured interviews with key informants, including site chief residents, chief residents, and faculty. We also observed chief residents and site chief residents at work and convened focus groups with postgraduate residents to yield additional qualitative information. Results Rwandan faculty and residents generally felt that the new position had improved the educational and administrative structure of the teaching program while providing a training ground for future academicians. Conclusions A collaborative training program between developing and developed world academic institutions provides an efficient model for the development of a new chief residency program in the developing world.





Categorías: Investigaciones

Páginas