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Future of education in closing the equity gap in global cancer control

Jue, 01/03/2018 - 06:17
Publication date: March 2018
Source:The Lancet Global Health, Volume 6, Supplement 1

Author(s): Meredith Giuliani, Julio Frenk

Categorías: Investigaciones

Surgical Care and Otolaryngology in Global Health

Mié, 28/02/2018 - 06:09
Publication date: Available online 27 February 2018
Source:Otolaryngologic Clinics of North America

Author(s): Regan W. Bergmark, David A. Shaye, Mark G. Shrime

Teaser Surgical access is inadequate for most people. The Lancet Commission on Global Surgery established 6 indicators to measure surgical access: geographic accessibility, density of surgical providers, number of procedures performed, perioperative mortality, impoverishing expenditure, and catastrophic expenditure. Otolaryngology surgical, training, and research efforts use these 6 indicators to maximize impact and coordination of worldwide efforts in surgery. Research must be rigorous and consider the counterfactual. For otolaryngologists who want to contribute, focusing on 1 of the 6 indicators may be most impactful.

Categorías: Investigaciones

Towards the introduction of pneumococcal conjugate vaccines in Bhutan: A cost-utility analysis to determine the optimal policy option

Vie, 23/02/2018 - 02:52
Publication date: Available online 22 February 2018

Author(s): Kinley Dorji, Sonam Phuntsho, Pempa, Suthasinee Kumluang, Sarayuth Khuntha, Wantanee Kulpeng, Sneha Rajbhandari, Yot Teerawattananon

Background Due to competing health priorities and limited resources, many low-income countries, even those with a high disease burden, are not able to introduce pneumococcal conjugate vaccines. Objective To determine the cost-utility of 10- and 13-valent pneumococcal conjugate vaccines (PCV10 and PCV13) compared to no vaccination in Bhutan. Methods A model-based cost-utility analysis was performed in the Bhutanese context using a government perspective. A Markov simulation model with one-year cycle length was used to estimate the costs and outcomes of three options: PCV10, PCV13 and no PCV programmes for a lifetime horizon. A discount rate of 3% per annum was applied. Results are presented using an incremental cost-effectiveness ratio (ICER) in United State Dollar per quality-adjusted life year (QALY) gained (USD 1 = Ngultrum 65). A one-way sensitivity analysis and a probabilistic sensitivity analysis were conducted to assess uncertainty. Results Compared to no vaccination, PCV10 and PCV13 gained 0.0006 and 0.0007 QALYs with additional lifetime costs of USD 0.02 and USD 0.03 per person, respectively. PCV10 and PCV13 generated ICERs of USD 36 and USD 40 per QALY gained compared to no vaccination. In addition, PCV13 produced an ICER of USD 92 compared with PCV10. When including PCV into the Expanded Programme on Immunization, the total 5-year budgetary requirement is anticipated to increase to USD. 3.77 million for PCV10 and USD 3.75 million for PCV13. Moreover, the full-time equivalent (FTE) of one health assistant would increase by 2.0 per year while the FTE of other health workers can be reduced each year, particularly of specialist (0.6–1.1 FTE) and nurse (1–1.6 FTE). Conclusion At the suggested threshold of 1xGDP per capita equivalent to USD 2708, both PCVs are cost-effective in Bhutan and we recommend that they be included in the routine immunization programme.

Categorías: Investigaciones

Creation, Implementation, and Assessment of a General Thoracic Surgery Simulation Course in Rwanda

Jue, 22/02/2018 - 02:43
Publication date: Available online 21 February 2018
Source:The Annals of Thoracic Surgery

Author(s): Adriana G. Ramirez, Nebil Nuradin, Fidele Byiringiro, Robinson Ssebuufu, George J. Stukenborg, Georges Ntakiyiruta, Thomas M. Daniel

Background The primary objective was to provide proof of concept of conducting thoracic surgical simulation in a low-middle income country (LMIC). Secondary objectives were to accelerate general thoracic surgery skills acquisition by general surgery residents and sustain simulation surgery teaching through a website, simulation models, and teaching of local faculty. Methods Five training models were created for use in a LMIC setting and implemented during on-site courses with Rwandan general surgery residents. A website <> was created as a supplement to the on-site teaching. All participants completed pre- and post-simulation course knowledge assessment and feedback/confidence surveys. Descriptive and univariate analyses were performed on participants’ responses. Results Twenty-three participants completed the simulation course. Eight (35%) had previous training with the course models. All training levels were represented. Participants reported higher rates of meaningful confidence – defined as moderate to complete on a Likert scale – for all simulated thoracic procedures (p<0.05). The overall mean knowledge assessment score improved from 42.5% pre-simulation to 78.6% post-simulation, (p<0.0001). When stratified by procedure, the mean scores for each simulated procedure showed statistically significant improvement except for ruptured diaphragm repair (p=0.45). Conclusions General thoracic surgery simulation provides a practical, inexpensive, and expedited learning experience in settings lacking experienced faculty and fellowship training opportunities. Resident feedback showed enhanced confidence and knowledge of thoracic procedures suggesting simulation surgery could be an effective tool in expanding the resident knowledge base and preparedness for performing clinically needed thoracic procedures. Repeated skills exposure remains a challenge for achieving sustainable progress.

Categorías: Investigaciones

A model for developing postgraduate trauma and emergency nursing capacity in a resource-constrained setting

Dom, 18/02/2018 - 01:51
Publication date: Available online 17 February 2018
Source:International Emergency Nursing

Categorías: Investigaciones

Task sharing interventions for cardiovascular risk reduction and lipid outcomes in low-middle income countries. A systematic review and meta-analysis

Sáb, 17/02/2018 - 01:42
Publication date: Available online 16 February 2018
Source:Journal of Clinical Lipidology

Author(s): T.N. Anand, Linju M. Joseph, A.V. Geetha, Joyita Chowdhury, Dorairaj Prabhakaran, Panniyammakal Jeemon

Background One of the potential strategies to improve health care delivery in understaffed low-middle income countries (LMIC) is task sharing, where specific tasks are transferred from more qualified healthcare cadre to a lesser trained cadre. Dyslipidaemia is a major risk factors for cardiovascular disease but often it is not managed appropriately. Objective We conducted a systematic review with the objective to identify, and evaluate the effect of task sharing interventions on dyslipidaemia in LMIC. Methods Published studies (RCTs and observational studies) were identified via electronic databases such as PubMed, EMBASE, Cochrane Library, PsycINFO, and CINAHL. We searched the databases from inception to September 2016 and updated till 30 June 2017, using search terms related to task shifting, and cardiovascular disease prevention in LMIC. All eligible studies were summarised narratively, and potential studies were grouped for meta-analysis. Results Although our search yielded 2938 records initially and another 1628 in the updated search, only 15 studies met the eligible criteria. Most of the studies targeted lifestyle modification, and care-coordination by involving nurses or allied health workers. Eight RCTs were included in the meta-analysis. Task sharing intervention were effective in lowering LDL- c (-6.90 mg/dl; 95% CI -11·81- -1·99) and total cholesterol (-9.44 mg/dl; 95% CI -17·94- -0.93) levels with modest effect size. However, there were no major differences in HDL-c (-0·29 mg/dl; 95% CI -0·88- 1·47) and triglycerides (-14·31 mg/dl; 95% CI -33.32- 4·69). The overall quality of evidence based on GRADE was either ‘low’ or ‘very low’. Conclusion Available data are not adequate to make recommendations on the role of task sharing strategies for the management of dyslipidaemia in LMIC. However, the studies conducted in LMIC demonstrate the potential use of this strategy especially in terms of reduction in LDL-cholesterol and total cholesterol levels. Our review calls for the need of well-designed, and large-scale studies to demonstrate the effect of task sharing strategy on lipid management in LMIC.

Categorías: Investigaciones

Opportunities, challenges and strategies when building a midwifery profession. Findings from a qualitative study in Bangladesh and Nepal

Mar, 13/02/2018 - 00:00
Publication date: Available online 12 February 2018
Source:Sexual & Reproductive Healthcare

Author(s): Malin Bogren, Kerstin Erlandsson

Objective The aim of this paper was to identify opportunities and challenges when building a midwifery profession in Bangladesh and Nepal. Methods Data were collected through 33 semi-structured interviews with government officials, policy-makers, donors, and individuals from academia and non-government organizations with an influence in building a midwifery profession in their respective countries. Data were analyzed using content analysis. Findings The opportunities and challenges found in Bangladesh and Nepal when building a midwifery profession emerged the theme “A comprehensive collaborative approach, with a political desire, can build a midwifery profession while competing views, interest, priorities and unawareness hamper the process”. Several factors were found to facilitate the establishment of a midwifery profession in both countries. For example, global and national standards brought together midwifery professionals and stakeholders, and helped in the establishment of midwifery associations. The challenges for both countries were national commitments without a full set of supporting policy documents, lack of professional recognition, and competing views, interests and priorities. Conclusion and clinical application This study demonstrated that building a midwifery profession requires a political comprehensive collaborative approach supported by a political commitment. Through bringing professionals together in a professional association will bring a professional status. Global standards and guidelines need to be contextualized into national policies and plans where midwives are included as part of the national health workforce. This is a key for creating recognized midwives with a protected title to autonomously practice midwifery, to upholding the sexual and reproductive health and rights for women and girls.

Categorías: Investigaciones

Task-shifting of CD4 T cell count monitoring by the touchscreen-based Muse™ Auto CD4/CD4% single-platform system for CD4 T cell numeration in the Central African Republic: Implication for decentralization

Vie, 02/02/2018 - 20:36
Publication date: Available online 2 February 2018
Source:Journal of Immunological Methods

Author(s): André Kouabosso, Christian Diamant Mossoro-Kpinde, Ralph-Sydney Mboumba Bouassa, Jean De Dieu Longo, Marcel Mbeko Simaleko, Gérard Grésenguet, Laurent Bélec

Background The accuracy of CD4 T cell monitoring by the recently developed flow cytometry-based CD4 T cell counting Muse™ Auto CD4/CD4% Assay analyzer (EMD Millipore Corporation, Merck Life Sciences, KGaA, Darmstadt, Germany) was evaluated in trained lay providers against laboratory technicians. Methods After 2 days of training on the Muse™ Auto CD4/CD4% analyzer, EDTA-blood samples from 6 HIV-positive and 4 HIV-negative individuals were used for CD4 T cell counting in triplicate in parallel by 12 trained lay providers as compared to 10 lab technicians. Results Mean number of CD4 T cells in absolute number was 829 ± 380 cells/μl by lay providers and 794 ± 409 cells/μl by technicians (P > 0.05); and in percentage 36.2 ± 14.8%CD4 by lay providers and 36.1 ± 15.0%CD4 by laboratory technician (P > 0.05). The unweighted linear regression and Passing-Bablok regression analyses on CD4 T cell results expressed in absolute count revealed moderate correlation between CD4 T cell counts obtained by lay providers and lab technicians. The mean absolute bias measured by Bland–Altman analysis between CD4 T cell/μl obtained by lay providers and lab technicians was −3.41 cells/μl. Intra-assay coefficient of variance (CV) of Muse™ Auto CD4/CD4% in absolute number was 10.1% by lay providers and 8.5% by lab technicians (P > 0.05), and in percentage 5.5% by lay providers and 4.4% by lab technicians (P > 0.05). The inter-assay CV of Muse™ Auto CD4/CD4% in absolute number was 13.4% by lay providers and 10.3% by lab technicians (P > 0.05), and in percentage 7.8% by lay providers and 6.9% by lab technicians (P > 0.05). Conclusions The study demonstrates the feasibility of CD4 T cell counting using the alternative flow cytometer Muse™ Auto CD4/CD4% analyzer by trained lay providers and therefore the practical possibility of decentralization CD4 T cell counting to health community centers.

Categorías: Investigaciones

Global access of patients with kidney disease to health technologies and medications: findings from the Global Kidney Health Atlas project

Dom, 28/01/2018 - 19:20
Publication date: February 2018
Source:Kidney International Supplements, Volume 8, Issue 2

Author(s): Htay Htay, Mona Alrukhaimi, Gloria E. Ashuntantang, Aminu K. Bello, Ezequiel Bellorin-Font, Mohammed Benghanem Gharbi, Branko Braam, John Feehally, David C. Harris, Vivekanand Jha, Kailash Jindal, Kamyar Kalantar-Zadeh, Rumeyza Kazancioglu, Peter G. Kerr, Adeera Levin, Meaghan Lunney, Ikechi G. Okpechi, Michelle E. Olah, Timothy Olusegun Olanrewaju, Mohamed A. Osman, Yasin Parpia, Jeffrey Perl, Bilal Qarni, Harun Ur Rashid, Ahmed Rateb, Eric Rondeau, Babatunde Lawal Salako, Laura Sola, Irma Tchokhonelidze, Marcello Tonelli, Natasha Wiebe, Isaac Wirzba, Chih-Wei Yang, Feng Ye, Alexander Zemchenkov, Ming-hui Zhao, David W. Johnson

Access to essential medications and health products is critical to effective management of kidney disease. Using data from the ISN Global Kidney Health Atlas multinational cross-sectional survey, global access of patients with kidney disease to essential medications and health products was examined. Overall, 125 countries participated, with 118 countries, composing 91.5% of the world’s population, providing data on this domain. Most countries were unable to access eGFR and albuminuria in their primary care settings. Only one-third of low-income countries (LICs) were able to measure serum creatinine and none were able to access eGFR or quantify proteinuria. The ability to monitor diabetes mellitus through serum glucose and glycated hemoglobin measurements was suboptimal. Pathology services were rarely available in tertiary care in LICs (12%) and lower middle-income countries (45%). While acute and chronic hemodialysis services were available in almost all countries, acute and chronic peritoneal dialysis services were rarely available in LICs (18% and 29%, respectively). Kidney transplantation was available in 79% of countries overall and in 12% of LICs. While over one-half of all countries publicly funded RRT and kidney medications with or without copayment, this was less common in LICs and lower middle-income countries. In conclusion, this study demonstrated significant gaps in services for kidney care and funding that were most apparent in LICs and lower middle-income countries.

Categorías: Investigaciones

Equitable access to global health internships: a documentary short

Dom, 28/01/2018 - 19:20
Publication date: February 2018
Source:The Lancet Global Health, Volume 6, Issue 2

Author(s): Tara Kedia, Ashton Barnett-Vanes, Jordan Jarvis, Kyle Ragins, Cai Long, Oluwaseyi Owaseye, Maziar Jamnejad, Robin Young, Tim Reed

Categorías: Investigaciones

Periodontal diseases and adverse pregnancy outcomes: Is there a role for vitamin D?

Dom, 28/01/2018 - 19:20
Publication date: Available online 16 January 2018
Source:The Journal of Steroid Biochemistry and Molecular Biology

Author(s): Anne Marie Uwitonze, Peace Uwambaye, Moses Isyagi, Chrispinus H. Mumena, Alice Hudder, Afrozul Haq, Kamrun Nessa, Mohammed S. Razzaque

Studies have shown a relationship between maternal periodontal diseases (PDs) and premature delivery. PDs are commonly encountered oral diseases which cause progressive damage to the periodontal ligament and alveolar bones, leading to loss of teeth and oral disabilities. PDs also adversely affect general health by worsening cardiovascular and metabolic diseases. Moreover, maternal PDs are thought to be related to increasing the frequency of preterm-birth with low birth weight (PBLBW) new-borns. Prematurity and immaturity are the leading causes of prenatal and infant mortality and is a major public health problem around the world. Inflamed periodontal tissues generate significantly high levels of proinflammatory cytokines that may have systemic effects on the host mother and the fetus. In addition, the bacteria that cause PDs produce endotoxins which can harm the fetus. Furthermore, studies have shown that microorganisms causing PDs can get access to the bloodstream, invading uterine tissues, to induce PBLBW. Another likely mechanism that connects PDs with adverse pregnancy outcome is maternal vitamin D status. A role of inadequate vitamin D status in the genesis of PDs has been reported. Vitamin D supplementation provided during pregnancy could reduce the risk of maternal infections and adverse pregnancy outcomes. As maternal PDs are significant risk factors for adverse pregnancy outcome, preventive antenatal care for pregnant women in collaboration with the obstetric and dental professions are needed.

Categorías: Investigaciones

The impact of emotional intelligence in health care professionals on caring behaviour towards patients in clinical and long-term care settings: Findings from an integrative review.

Dom, 28/01/2018 - 19:20
Publication date: Available online 11 January 2018
Source:International Journal of Nursing Studies

Author(s): Suzanne Nightingale, Helen Spiby, Kayleigh Sheen, Pauline Slade

Background Over recent years there has been criticism within the United Kingdom’s health service regarding a lack of care and compassion, resulting in adverse outcomes for patients. The impact of emotional intelligence in staff on patient health care outcomes has been recently highlighted. Many recruiters now assess emotional intelligence as part of their selection process for health care staff. However, it has been argued that the importance of emotional intelligence in health care has been overestimated. Objectives To explore relationships between emotional intelligence in health care professionals, and caring behaviour. To further explore any additional factors related to emotional intelligence that may impact upon caring behaviour. Design An integrative review design was used. Data sources Psychinfo, Medline, CINAHL Plus, Social Sciences Citation Index, Science Citation Index, and Scopus were searched for studies from 1995 to April 2017. Review methods Studies providing quantitative or qualitative exploration of how any healthcare professionals' emotional intelligence is linked to caring in healthcare settings were selected. Results Twenty two studies fulfilled the inclusion criteria. Three main types of health care professional were identified: nurses, nurse leaders, and physicians. Results indicated that the emotional intelligence of nurses was related to both physical and emotional caring, but emotional intelligence may be less relevant for nurse leaders and physicians. Age, experience, burnout, and job satisfaction may also be relevant factors for both caring and emotional intelligence. Conclusions This review provides evidence that developing emotional intelligence in nurses may positively impact upon certain caring behaviours, and that there may be differences within groups that warrant further investigation. Understanding more about which aspects of emotional intelligence are most relevant for intervention is important, and directions for further large scale research have been identified.

Categorías: Investigaciones

Development, Testing, and Implementation of a Training Curriculum for Nonphysician Health Workers to Reduce Cardiovascular Disease

Dom, 28/01/2018 - 19:20
Publication date: Available online 10 January 2018
Source:Global Heart

Author(s): Maheer Khan, Pablo Lamelas, Hadi Musa, Jared Paty, Tara McCready, Robby Nieuwlaat, Eleonor Ng, Patricio Lopez-Jaramillo, Jose Lopez-Lopez, Khalid Yusoff, Fadhlina A. Majid, Kien Keat Ng, Len Garis, Oyere Onuma, Salim Yusuf, Jon-David Schwalm

Background Cardiovascular disease (CVD) is the leading cause of death worldwide. The need to address CVD is greatest in low- and middle-income countries where there is a shortage of trained health workers in CVD detection, prevention, and control. Objectives Based on the growing evidence that many elements of chronic disease management can be shifted to nonphysician health care workers (NPHW), the HOPE-4 (Heart Outcomes Prevention and Evaluation Program) aimed to develop, test, and implement a training curriculum on CVD prevention and control in Colombia, Malaysia, and low-resource settings in Canada. Methods Curriculum development followed an iterative and phased approach where evidence-based guidelines, revised blood pressure treatment algorithms, and culturally relevant risk factor counseling were incorporated. Through a pilot-training process with high school students in Canada, the curriculum was further refined. Implementation of the curriculum in Colombia, Malaysia, and Canada occurred through partner organizations as the HOPE-4 team coordinated the program from Hamilton, Ontario, Canada. In addition to content on the burden of disease, cardiovascular system pathophysiology, and CVD risk factors, the curriculum also included evaluations such as module tests, in-class exercises, and observed structured clinical examinations, which were administered by the local partner organizations. These evaluations served as indicators of adequate uptake of curriculum content as well as readiness to work as an NPHW in the field. Results Overall, 51 NPHW successfully completed the training curriculum with an average score of 93.19% on module tests and 84.76% on the observed structured clinical examinations. Since implementation, the curriculum has also been adapted to the World Health Organization's HEARTS Technical Package, which was launched in 2016 to improve management of CVD in primary health care. Conclusions The robust curriculum development, testing, and implementation process described affirm that NPHW in diverse settings can be trained in implementing measures for CVD prevention and control.

Categorías: Investigaciones

International Trends in Designing Electronic Health Information Literacy for Health Sciences Students: A Systematic Review of the Literature

Dom, 28/01/2018 - 19:20
Publication date: Available online 10 January 2018
Source:The Journal of Academic Librarianship

Author(s): Hussein Haruna, Xiao Hu

The Internet has become a crucial source of health information for health sciences students. They increasingly rely on the Internet for health information to support their educational projects, academic activities, clinical practice and research. Surprisingly, it has been shown that students' health information skills for conducting research on the Internet are inadequate. Indeed, developing and improving the health information skill set of health sciences students is required in order for students to effectively locate, critically evaluate, and efficiently use online health information for the effective location, critical evaluation and efficient use of online health information. This paper undertakes a systematic review of the literature with a focus on electronic health information literacy skills with the aim of identifying the current trends, contributions to, and practices in health sciences students' education, and informing researchers in the field universally about the essential baseline for the design and development of effective course contents, pedagogy and assessment approaches. However, majority of students have limited skills for the location, evaluation and effective use of health information on the Internet. Other articles suggest that health sciences students need fully fledged health information skills programs that are integrated with their health sciences education curricula.

Categorías: Investigaciones

Access and utilisation of antenatal care services in a rural community of eThekwini district in KwaZulu-Natal

Dom, 28/01/2018 - 19:20
Publication date: 2018
Source:International Journal of Africa Nursing Sciences, Volume 8

Author(s): Maureen Nokuthula Sibiya, Thembelihle Sylvia Patience Ngxongo, Thandeka Jacqueline Bhengu

Although the South African government adopted a primary health care approach to health care service provision in order to ensure equitable access to and utilisation of health care services to all communities, the country continues to face challenges regarding access and utilisation of health care services especially in the rural communities. Antenatal care which is mostly provided at primary health care level is regarded as the cornerstone for the success of the maternal and child health care programme. Therefore, the need to highlight issues of access and utilisation of antenatal care services was significant because poor access to and under-utilisation of health care services could potentially influence the success of this programme and pregnancy outcomes. A qualitative, exploratory, descriptive and contextual study was conducted guided by Thaddeus and Maine’s Three Delays Model. The majority of the study participants who were pregnant women reported limited access to health care, with under-utilisation of antenatal services while nurse participants recognised the challenges facing pregnant women regarding the access and utilisation of antenatal care services. Recommendations were made to consider building a centrally located fixed primary health care clinic that would ensure equal access to health care services, strengthening the implementation of policies regarding the referral system and ambulance services, ensuring sustainable availability of human and material resources, developing strategies to ensure that the antenatal care services delivered are in line with the South African Department of Health Guidelines.

Categorías: Investigaciones

Training the Next Generation of African Pathologists

Sáb, 30/12/2017 - 16:02
Publication date: Available online 29 December 2017
Source:Clinics in Laboratory Medicine

Author(s): Ann Marie Nelson, Martin Hale, Mohenou Isidore Jean-Marie Diomande, Quentin Eichbaum, Yawale Iliyasu, Raphael M. Kalengayi, Belson Rugwizangoga, Shahin Sayed

Teaser Quality patient care requires correct and timely evidence-based diagnoses. Pathology and laboratory medicine training varies significantly across the continent, but is inadequate to serve the needs of the population. This article summarizes the current state of pathology workforce and training in sub-Saharan Africa; discusses challenges to recruitment and retention; and outlines the necessary elements for training and sustaining a robust workforce in pathology and laboratory medicine. The authors provide several case studies of institutions around the continent that include expansion of existing programs, a de novo program, South-South collaborations, and skill building for the existing workforce.

Categorías: Investigaciones

The Midwifery Services Framework: The process of implementation

Mar, 26/12/2017 - 14:24
Publication date: Available online 26 December 2017

Author(s): Andrea Nove, Nester T Moyo, Martha Bokosi, Shantanu Garg

In 2015, the International Confederation of Midwives launched the Midwifery Services Framework: a new evidence-based tool to guide countries through the process of improving their sexual, reproductive, maternal and newborn health services through strengthening and developing the midwifery workforce. The Midwifery Services Framework is aligned with key global architecture for sexual, reproductive, maternal and newborn health and human resources for health, and with the recommendations of the 2014 Lancet Series on Midwifery. This second in a series of three papers describes the process of implementing the Midwifery Services Framework: the preparatory work, what happens at each stage of implementation and who should be involved at each stage. It gives an idea of the scale of the task, and the resources that will be required to implement the Midwifery Services Framework in a given country context. The paper will be of interest to health policy-makers, development partners and professional associations in countries considering different approaches to strengthening their sexual, reproductive, maternal and newborn health services, and it will help them to decide whether and when either full or partial/staged implementation of the Midwifery Services Framework will be an appropriate initiative to address identified deficits in their specific context, given the current and projected availability of resources.

Categorías: Investigaciones

Achieving universal coverage: understanding barriers to rural placement for final year midwifery students

Dom, 17/12/2017 - 13:50
Publication date: Available online 15 December 2017

Author(s): Jody R. Lori, Cheryl A. Moyer, Veronica Dzomeku, Emmanuel Kweku Nakua, Peter Agyei-Baffour, Sarah Rominski

Objective The objective of this study is to understand the barriers final year midwifery students face when deciding to practice in a rural, deprived area. Design A cross-sectional study design using a computer based structured survey. Setting 15 of the 16 publicly funded midwifery colleges across all ten regions in Ghana. Participants A national sample of final-year midwifery students from publically funded midwifery colleges in Ghana. Measurements Basic frequencies and percentages were calculated for the variables cited as the top three factors motivating participants to study midwifery stratified by student type (post-basic verses diploma) and program location (urban, peri-urban, and rural). Odds ratios were calculated using separate logistic regression models to analyze the relationship between students' experience with rural communities and how it affected their willingness to work in a rural area following graduation. Findings Eight hundred and fifty-six midwifery students (N=856) completed a computerized survey for a response rate of 91.8%. The top motivation to study midwifery was a "desire to help others". Over half (55%) of participants reported they will "definitely work" (11%) or "were likely to work" (44%) in a deprived area. When examined by student type and location of school, the top reason cited by participants was "to serve humanity". Those born in a rural area, currently living in a rural area, or under obligation to return to a rural or peri-urban area had greater odds of being willing to work in a deprived area after graduation. Key Conclusions Findings from our study are unique in that they examine the distinct motivational factors from a national sample of midwifery students about to join the workforce. Regardless of the type of student or the location of the school, midwifery students in Ghana were highly motivated by altruistic values. Strategies to address the rural shortage of midwifery providers in Ghana is presented. Implication for Practice Understanding the factors that motivate midwifery students to work in rural, deprived areas will help develop effective policy interventions affecting practice.

Categorías: Investigaciones

Transcultural Pain Management: Theory, Practice, and Nurse-Client Partnerships

Dom, 17/12/2017 - 13:50
Publication date: Available online 15 December 2017
Source:Pain Management Nursing

Author(s): William E. Rosa

Nursing is becoming increasingly aware of its impact as a global profession. Part of this evolution is the understanding that the Western evidence-based construct may not be reliably or universally applicable to transcultural settings and clients. In a global world, no ‘one size fits all’ and no singular approach to pain management is appropriate; there are, quite literally, infinite variations in cross-cultural dynamics. Nurses working in the field of pain management must be able to navigate their responsibilities within the global health context. The role of the pain management nurse in the global world is to provide individualized and culturally relevant pain management for clients, which is mindful of multifactorial contributors to the pain experience, such as the physiologic, affective, cognitive, behavioral, sociocultural, and environmental, and to view adequate pain management as an international human right. Through the skillful integration of theory, practice, and the ability to build respectful and responsible nurse-client partnerships, pain management nurses can deliver contextually relevant care that promotes safety, quality, and healing.

Categorías: Investigaciones

Developing an adequate supply of health services: Taiwan's path to Universal Health Coverage

Dom, 17/12/2017 - 13:50
Publication date: Available online 15 December 2017
Source:Social Science & Medicine

Author(s): Jui-fen Rachel Lu, Tung-liang Chiang

Universal Health Coverage (UHC) calls for universal effective coverage, which emphasizes that people must have reasonably equal access to covered services. A critical question then arises: what policies can a nation adopt to assure an adequate supply of services and distribute them reasonably to each community and socioeconomic strata? Taiwan relied on incentives, public and private partnership and effective regulations to produce the adequate supply for UHC and distributed them. Taiwan's experience holds a valuable lesson for other nations. Taiwan was the last state in the 20th century to achieve UHC when it implemented the National Health Insurance (NHI) program in 1995. Political timing was crucial in the government's decision to achieve UHC, but the key to its success in providing effective coverage to its 23 million population was the readiness of the health service sector, the result of two decades of planning and development in the pre-NHI period. This paper analyzes how Taiwan historically built up the supply of health services that made achieving UHC possible. We identified four key strategies adopted in the health service sector development, namely: 1) enhancing public-private partnerships in developing medical resources with tax incentives and subsidies; 2) ameliorating regional disparities in medical resource distribution through incentives and effective regulation; 3) safeguarding quality of care by regulating providers through licensing and accreditation programs; and 4) promoting an evidence-based policy-making process.

Categorías: Investigaciones