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An Assessment of Rehabilitation Infrastructure in Peru

Hace 9 horas 5 mins
Publication date: Available online 21 November 2017
Source:Archives of Physical Medicine and Rehabilitation

Author(s): Amy K. Fuhs, Lacey N. LaGrone, Miguel G. Moscoso Porras, Manuel J.A. Rodríguez Castro, Rosa Lizbeth Ecos Quispe, Charles N. Mock

Objective To assess rehabilitation infrastructure in Peru in terms of WHO Health System Building Blocks. Design Anonymous quantitative survey. Questions were based on WHO Guidelines for Essential Trauma Care and rehabilitation professionals’ input. Setting Nine large public hospitals and referral centers in Lima and an online survey platform. Participants Convenience sample of hospital personnel working in rehabilitation and neurology, recruited through existing contacts and professional societies. Interventions Not applicable. Main Outcome Measure Outcome measures were for four WHO domains: Health Workforce, Health Service Delivery, Essential Medical Products and Technologies, and Health Information Systems. Results There were 239 survey participants. Regarding ‘Health Workforce,’ 47% of PTs, 50% of OTs, and 22% of physiatrists never see inpatients. Few reported rehabilitative nurses (15%) or prosthetist/orthotists (14%) at their hospitals. Even at the largest hospitals, most reported three or fewer occupational therapists (OTs, 54%) and speech language pathologists (SLPs, 70%). At hospitals without SLPs, PTs (49%) or nobody (34%) performs SLP roles. At hospitals without OTs, PTs most commonly (59%) perform OT tasks. Alternate prosthetist/orthotist task performers are OTs (26%), PTs (19%), and physicians (16%). Forty-four percent reported interdisciplinary collaboration. Regarding ‘Health Services,’ the most frequent inpatient and outpatient rehabilitation barriers were referral delays (50%) and distance/transportation (39%), respectively. Regarding ‘Health Information Systems,’ 28% reported rehabilitation service data collection. Regarding ‘Essential Medical Products and Technologies,’ electrophysical agents (88%), gyms (81%), and electromyography (76%) were most common; thickened liquids (19%), swallow studies (24%), and cognitive training tools (28%) were least frequent. Conclusions Rehabilitation emphasis is on outpatient services, and there are comparatively adequate numbers of PTs and physiatrists relative to rehabilitation personnel. Financial barriers seem low for accessing existing services. There appear to be shortages of inpatient rehabilitation, specialized services, and interdisciplinary collaboration. These may be addressed by redistributing personnel and investing in education and equipment for specialized services. Further examination of task sharing’s role in Peru’s rehabilitation services is necessary to evaluate its potential to address deficiencies.





Categorías: Investigaciones

Investigation of the practices, legislation, supply chain and regulation of opioids for clinical pain management in Southern Africa: A multi-sectoral, cross-national, mixed methods study

Jue, 16/11/2017 - 17:11
Publication date: Available online 16 November 2017
Source:Journal of Pain and Symptom Management

Author(s): Eve Namisango, Matthew J. Allsop, Richard A. Powell, Stefan J. Friedrichsdorf, Emmanuel BK. Luyirika, Fatia Kiyange, Edward Mukooza, Chris Ntege, Eunice Garanganga, Mavis Ntombifuthi Ginindza – Mdluli, Faith Mwangi-Powell, Lidia Justino Mondlane, Richard Harding

Context Sub-Saharan Africa faces an increasing incidence and prevalence of life-limiting and life-threatening conditions. These conditions are associated with a significant burden of pain linked to high morbidity and disability that is poorly assessed and undertreated. Barriers to effective pain management partly relate to lack of access to opioid analgesia and challenges in their administration. Objectives To identify country-specific and broader regional barriers to access, as well as the administration of opioids, and generate recommendations for advancing pain management in Southern Africa. Methods A parallel mixed methods design was used across three countries: Mozambique, Swaziland and Zimbabwe. Three activities were undertaken: (i) a review of regulatory and policy documentation; (ii) group interviews, and; (iii) a self-administered key informant survey. Results Barriers to accessing opioid analgesics for medical use include: overly restrictive controlled medicines’ laws; use of stigmatizing language in key documents; inaccurate actual opioid consumption estimation practices; knowledge gaps in the distribution, storage and prescription of opioids; critical shortage of prescribers, and; high out-of-pocket financial expenditures for patients against a backdrop of high levels of poverty. Conclusion Policies and relevant laws should be updated to ensure the legislative environment supports opioid access for pain management. Action plans for improving pain treatment for patients suffering from HIV or non-communicable diseases should address barriers at the different levels of the supply chain that involve policymakers, administrators and service providers.





Categorías: Investigaciones

The Midwifery Services Framework: What is it, and why is it needed?

Jue, 16/11/2017 - 17:11
Publication date: Available online 15 November 2017
Source:Midwifery

Author(s): Andrea Nove, Petra ten Hoope-Bender, Nester T. Moyo, Martha Bokosi

Most low- and middle-income countries failed to meet the Millennium Develop Goal targets for maternal, newborn and child health, and even more ambitious targets have been set under the Sustainable Development Goals and the Ending Preventable Maternal Mortality initiative. This means that many countries will need to accelerate progress on sexual, reproductive, maternal and newborn health over the next few years. Recent years have seen the publication of a large and convincing body of evidence about the potential of midwifery to make a significant contribution to this acceleration, but little practical guidance has emerged to help countries invest in midwifery services so that their health systems can meet the increasing need for sexual, reproductive, maternal and newborn health care. To help fill this gap, the International Confederation of Midwives designed and launched the Midwifery Services Framework, a new tool to guide countries through the process of strengthening and developing their midwifery services. This first of a series of three papers introduces the MSF, explains why it is needed, how it was developed, its guiding principles and its anticipated outcomes and impact. The other two papers explain the process of implementing the Midwifery Services Framework, and lessons learned in the first countries to start implementation.





Categorías: Investigaciones

Healthcare Reforms in Cyprus 2013-2017: Does the crisis mark the end of the healthcare sector as we know it?

Sáb, 11/11/2017 - 13:00
Publication date: Available online 11 November 2017
Source:Health Policy

Author(s): Panagiotis Petrou, Sotiris Vandoros

As part of a bailout agreement with the International Monetary Fund, the European Commission and the European Central Bank (known as the Troika), Cyprus had to achieve a fiscal surplus through budget constraints and efficiency enhancement. As a result, a number of policy changes were implemented, including a reform of the healthcare sector, and major healthcare reforms are planned for the upcoming years, mainly via the introduction of a National Health System. This paper presents the healthcare sector, provides an overview of recent reforms, assesses the recently implemented policies and proposes further interventions. Recent reforms targeting the demand and supply side included the introduction of clinical guidelines, user charges, introduction of coding for Diagnosis Related Groups (DRGs) and the revision of public healthcare coverage criteria. The latter led to a reduction in the number of people with public healthcare coverage in a time of financial crises, when this is needed the most, while co-payments must be reassessed to avoid creating barriers to access. However, DRGs and clinical guidelines can help improve performance and efficiency. The changes so far are yet to mark the end of the healthcare sector as we know it. A universal public healthcare system must remain a priority and must be introduced swiftly to address important existing coverage gaps.





Categorías: Investigaciones

Chapter 23 Problems and Obstacles of Poorest Countries in Having Good Governance and Quality and Effective Pharmaceutical Policy

Vie, 10/11/2017 - 12:46
Publication date: 2018
Source:Social and Administrative Aspects of Pharmacy in Low- and Middle-Income Countries

Author(s): Sonak Pastakia, Benson Njuguna, Dan N. Tran

Pharmaceutical policy is the framework, which guides the practice of global and regional health organizations, country governments, and hospitals in their quest to promote access to and rational use of quality-assured medicines to the populations they serve. Good governance, which is defined as a fundamental need to have in place laws, regulations, policies, and procedures based on ethical principles to improve the management of pharmaceutical systems and create a corrupt-free environment, is crucial to promote effective pharmaceutical policies. In most low-income and lower-middle-income countries, corruption, lack of implementation framework, and implementation gaps present as barriers to effective policies and good governance. This chapter explores these challenges and obstacles in detail. The chapter will conclude with a practical assessment of the interaction of policy, governance, and implementation as seen through the ongoing fight to address the ongoing HIV epidemic in sub-Saharan Africa.





Categorías: Investigaciones

The Role of Digital Health in Making Progress toward Sustainable Development Goal (SDG) 3 in Conflict-Affected Populations

Mar, 07/11/2017 - 07:29
Publication date: Available online 6 November 2017
Source:International Journal of Medical Informatics

Author(s): Yara M. Asi, Cynthia Williams

Purpose The progress of the Millennium Development Goals (MDGs) shows that sustained global action can achieve success. Despite the unprecedented achievements in health and education, more than one billion people, many of them in conflict-affected areas, were unable to reap the benefits of the MDG gains. The recently developed Sustainable Development Goals (SDGs) are even more ambitious then their predecessor. SDG 3 prioritizes health and well-being for all ages in specific areas such as maternal mortality, communicable diseases, mental health, and healthcare workforce. However, without a shift in the approach used for conflict-affected areas, the world’s most vulnerable people risk being left behind in global development yet again. We must engage in meaningful discussions about employing innovative strategies to address health challenges fragile, low-resource, and often remote settings. In this paper, we will argue that to meet the ambitious health goals of SDG 3, digital health can help to bridge healthcare gaps in conflict-affected areas. Methods First, we describe the health needs of populations in conflict-affected environments, and how they overlap with the SDG 3 targets. Secondly, we discuss how digital health can address the unique needs of conflict-affected areas. Finally, we evaluate the various challenges in deploying digital technologies in fragile environments, and discuss potential policy solutions. Discussion Persons in conflict-affected areas may benefit from the diffusive nature of digital health tools. Innovations using cellular technology or cloud-based solutions overcome physical barriers. Additionally, many of the targets of SDG 3 could see significant progress if efficacious education and outreach efforts were supported, and digital health in the form of mHealth and telehealth offers a relatively low-resource platform for these initiatives. Lastly, lack of data collection, especially in conflict-affected or otherwise fragile states, was one of the primary limitations of the MDGs. Greater investment in data collection efforts, supported by digital health technologies, is necessary if SDG 3 targets are to be measured and progress assessed. Standardized EMR systems as well as context-specific data warehousing efforts will assist in collecting and managing accurate data. Stakeholders such as patients, providers, and NGOs, must be proactive and collaborative in their efforts for continuous progress toward SDG 3. Digital health can assist in these inter-organizational communication efforts. Conclusion The SDGS are complex, ambitious, and comprehensive; even in the most stable environments, achieving full completion towards every goal will be difficult, and in conflict-affected environments, this challenge is much greater. By engaging in a collaborative framework and using the appropriate digital health tools, we can support humanitarian efforts to realize sustained progress in SDG 3 outcomes.





Categorías: Investigaciones

ADEQUACY OF UTAUT IN CLINICIAN ADOPTION OF HEALTH INFORMATION SYSTEMS IN DEVELOPING COUNTRIES: THE CASE OF CAMEROON

Mié, 01/11/2017 - 03:53
Publication date: Available online 31 October 2017
Source:International Journal of Medical Informatics

Author(s): Ransome Epie Bawack, Jean Robert Kala Kamdjoug

Purpose Despite the great potential Health Information Systems (HIS) have in improving the quality of healthcare delivery services, very few studies have been carried out on the adoption of such systems in developing countries. This article is concerned with investigating the adequacy of UTAUT 1 1 Unified Theory of Acceptance and Use of Technology. in determining factors that influence the adoption of HIS by clinicians in developing countries, based on the case of Cameroon. Methods A paper-based questionnaire was distributed to clinicians in 4 out of 7 major public hospitals in Cameroon. A modified UTAUT was tested using structural equation modeling (SEM) method to identify the determinants of clinicians’ intention to use HIS. Self-efficacy and cost-effectiveness were determinants used to extend the original UTAUT. Results 228 out of 286 questionnaires were validated for this study. The original UTAUT performed poorly, explaining 12% of the variance in clinicians’ intention to use HIS. Age was the only significant moderating factor, improving the model to 46%. Self-efficacy and cost effectiveness has no direct significant effect on HIS adoption in the context of this study. Conclusions The original UTAUT is not adequate in identifying factors that influence the adoption of HIS by clinicians in developing countries. Simplifying the model by using age as the only moderating factor significantly increases the model’s ability to predict HIS adoption in this context. Thus, the younger clinicians are more likely and ready to adopt HIS than the older ones. Context-specific should also be used to increase the explanatory power of UTAUT in any given context.





Categorías: Investigaciones

Health and nursing policies, laws and in-service, governance and management, nursing leadership

Mié, 01/11/2017 - 03:53
Publication date: Available online 31 October 2017
Source:International Journal of Nursing Sciences

Author(s): Simon Hlungwani







Categorías: Investigaciones

WHAT IS THE IMPACT OF PROFESSIONAL NURSING ON PATIENTS’ OUTCOMES GLOBALLY? AN OVERVIEW OF RESEARCH EVIDENCE

Jue, 19/10/2017 - 16:04
Publication date: Available online 19 October 2017
Source:International Journal of Nursing Studies

Author(s): S Coster, M Watkins, I.J Norman

BACKGROUND Nursing is an integral part of all healthcare services, and has the potential of having a wide and enduring impact on health outcomes for a global ageing population. Over time nurses have developed new roles and assumed greater responsibilities. It is increasingly important to demonstrate the safety and overall impact of nurses’ practice through research, to support the case for greater investment and development of nursing services around the world. OBJECTIVE To provide an overview of existing research evidence on the impact of nursing on patient outcomes, identify gaps in evidence, and point to future priorities for global research. Specifically to address two questions: what is the evidence that nursing contributes to improving the health and well-being of populations?; and where should research activity be focused to strengthen the evidence base for the impact of nursing? METHODS A search of the literature from 1996 using CINAHL, MEDLINE, the Cochrane Library, Google Scholar and the NICE evidence databases using the key words: nursing, nurse led, nursing interventions and patient outcomes. Initial analysis of the retrieved citations to reveal clusters of evidence of nursing impact in clinical areas which had been subject to systematic/integrative reviews or meta-analyses. Further analysis of these reviews to provide an overview of the research evidence for nurses’ contributions to healthcare to inform discussion on future research agendas. We use the terms low, moderate and high quality evidence to reflect the assessments made by the review authors whose work is presented throughout. RESULTS : Analysis of 61 reviews, including ten Cochrane reviews and two scoping/selective reviews to provide a summary of the research evidence for nurses’ contributions to healthcare in the following areas of practice: nursing in acute care settings; nurses’ involvement in public health; the contribution of specialist nurse and nurse-led services to the management of chronic disease; comparison of care provided by nurses and doctors; and task shifting to invasive procedures. CONCLUSIONS There is evidence that adequate numbers of well-educated nurses working in acute care areas can reduce the risk of patient mortality, although the evidence for this is confined to studies in high income countries and the evidence is not sufficiently robust to draw up definitive nurse: patient ratios. There is also moderate evidence that well trained nurses can produce health outcomes that are equivalent to those of doctors for patients with a range of chronic health problems, particularly for those patients managed in primary care, and that nurse-led care may be more effective than medical care in promoting patient adherence to treatment and patient satisfaction. There is low to moderate evidence for the benefits of parenting support programmes delivered by nurses on a range of health outcomes; and for the impact of home visiting on improving function and other health service outcomes for older people. The wider societal benefits of home visiting by nurses and the impact of this on long term outcomes and related cost-effectiveness of home visiting has not been established. There is limited available information regarding the wider global impact of increasing the numbers of nurses and their contribution to healthcare through improved education. Moreover is very little evidence for the cost-effectiveness of changing care providers from doctors to nurses and as the majority of cost data available has tended to come from studies based in higher income countries, their external validity in terms of applicability to settings in low and middle income countries is questionable. In addition to effectiveness, cost and safety, future research needs to address how implementing expanded nursing roles and task shifting impacts on the morale, retention, and professional development of nurses and the other workforces, and the longer term implications of these developments both locally and internationally.





Categorías: Investigaciones

Student and preceptor perceptions of primary health care clinical placements during pre-service education: Qualitative results from a quasi-experimental study

Jue, 19/10/2017 - 16:04
Publication date: Available online 19 October 2017
Source:Nurse Education in Practice

Author(s): Semakaleng H. Phafoli, Alice Christensen-Majid, Laura Skolnik, Stephanie Reinhardt, Isabel Nyangu, Madeleine Whalen, Stacie C. Stender

As a practice discipline, nursing education has a mandate to collaborate with all clinical settings, including primary health care (PHC), to prepare nursing students to function effectively in different settings upon deployment. Prior to 2011, nursing and midwifery students received minimal exposure to PHC settings in Lesotho. In 2010, the Maternal and Child Health Integrated Program began working with nurses' training institutions to support PHC clinical placements. Between April 2013 and June 2014, a multi-methods study was conducted to describe the effect of PHC placements on students and preceptors. The study employed qualitative methods, namely seven focus group discussions (FGDs), held with 69 students and preceptors. Data analysis followed the principles of grounded theory. Students, nurse educators and preceptors perceived PHC clinical placements as appropriate settings for acquisition of a variety of country relevant clinical experiences for nurses and midwives in Lesotho. Students expressed their likelihood to accept deployment at PHC settings post-graduation. Preceptors indicated that PHC clinical placements re-enforced the importance of continuing education for practicing clinicians. The placements supported an increase in competence and confidence of nursing and midwifery students, which will likely aid their transition into the workforce and perhaps increase the likelihood for the young professionals to accept deployment to these areas post-graduation. Given the disease burden in Lesotho and that majority of Basotho people access healthcare at the PHC level, every effort should be taken to ensure that nursing and midwifery students get adequate exposure to health care provision at these facilities.





Categorías: Investigaciones

Contraception, pregnancy, and peripartum experiences among women with epilepsy in Bhutan

Mié, 18/10/2017 - 15:26
Publication date: Available online 18 October 2017
Source:Epilepsy Research

Author(s): Sheliza Halani, Lhab Tshering, Esther Bui, Sarah J. Clark, Sara J. Grundy, Tandin Pem, Sonam Lhamo, Ugyen Dema, Damber K. Nirola, Chencho Dorji, Farrah J. Mateen

Introduction Reports on the reproductive health of women with epilepsy (WWE) in low- and middle-income countries (LMICs) are limited. Bhutan is a lower income country with a high estimated prevalence of epilepsy and no out-of-pocket payment requirements for health visits or medications. Methods We developed a 10-category survey to interview WWE ages 20–59 years in the Kingdom of Bhutan to understand their contraceptive use and peripartum experiences. WWE were recruited from 2016–2017 from an existing epilepsy cohort and their reproductive health data were merged with epilepsy and socioeconomic data obtained from initial clinical evaluations performed between 2014 and 2016. Results Of the 134 WWE eligible for the study, 94 were reachable and there was 1 refusal to participate (response rate 99% among reachable WWE; 69% of all WWE in the cohort). Of the 93 WWE (median age 27 years, range 20–52), 50 (54%) reported prior pregnancies. Of the entire cohort, 55 women responded on contraception: 26 (47%) WWE had never used contraception in their lifetime. Of the 29 WWE who had ever used contraception, the most commonly reported form was male condoms (14/29, 48%), followed by depot medroxyprogesterone acetate injections (13/29, 45%), and intrauterine devices (5/29, 17%). Sixty-three percent of WWE recalled receiving information on family planning (31 of 49). Of the 50 WWE with prior pregnancies, 37 of 46 (80%) used folic acid; 6 WWE reported commencing it in the first trimester while 29 WWE began supplementation in the second trimester. Primary school education or higher was associated with folic acid supplementation during pregnancy (26/29 vs. 11/17, p=0.040). Epilepsy affected at least one of the pregnancies in 38 of the cases (76%) with an average of 2.3 pregnancies per woman). There was a total of 86 pregnancies and an average inter-pregnancy interval of 3.5 years. Ninety-five percent of women attended prenatal care (36/38), 22% had at least one miscarriage (8/37), 14% had at least one pre-term delivery (5/36), and 21% had Caesarean sections (8/38). 17/38 (45%) of WWE had seizures during pregnancy. A majority of WWE (97%, 37 of 38) with a prior pregnancy reported breastfeeding their infant. Conclusions Nearly half of Bhutanese WWE did not use contraception; among those who used it, male condoms were most common but 11% were at risk of potential drug-drug interactions between oral contraception and enzyme-inducing AEDs. Bhutanese WWE had a high rate of prenatal visits. Folic acid was prescribed in most pregnant WWE but the majority began supplementation in the second trimester. The number of pregnancies in WWE in Bhutan (2.3 per woman) was comparable to the number of children per women in Bhutan (2.3). Breastfeeding was practiced almost universally. Points of intervention may include pre-conception initiation of folic acid, optimization of dosing of AEDs with contraceptives, guidelines for peripartum seizure treatment, and establishment of a prospective registry for WWE and their offspring.





Categorías: Investigaciones

Specialty training for the retention of Malawian doctors: A cost-effectiveness analysis

Lun, 16/10/2017 - 13:37
Publication date: Available online 16 October 2017
Source:Social Science & Medicine

Author(s): Kate L. Mandeville, Kara Hanson, Adamson S. Muula, Titha Dzowela, Godwin Ulaya, Mylène Lagarde

Few medical schools and sustained emigration have led to low numbers of doctors in many sub-Saharan African countries. The opportunity to undertake specialty training has been shown to be particularly important in retaining doctors. Yet limited training capacity means that doctors are often sent to other countries to specialise, increasing the risk that they may not return. Expanding domestic training, however, may be constrained by the reluctance of doctors to accept training in their home country. We modelled different policy options in an example country, Malawi, to examine the cost-effectiveness of expanding specialty training to retain doctors in sub-Saharan Africa. We designed a Markov model of the physician labour market in Malawi, incorporating data from 2006 and 2012 graduate tracing studies, a 2013 discrete choice experiment on 148 Malawian doctors and 2015 cost data. A government perspective was taken with a time horizon of 40 years. Expanded specialty training in Malawi or South Africa with increasing mandatory service before training was compared against baseline conditions. The outcome measures were cost per doctor-year and cost per specialist-year spent working in the Malawian public sector. Expanding specialty training in Malawi is more cost-effective than training outside Malawi. At least two years of mandatory service would be more cost-effective, with five years adding the most value in terms of doctor-years. After 40 years of expanded specialty training in Malawi, the medical workforce would be over fifty percent larger with over six times the number of specialists compared to current trends. However, the government would need to be willing to pay at least 3.5 times more per doctor-year for a 5% increase and a third more per specialist-year for a four-fold increase. Greater returns are possible from doctors with more flexible training preferences. Sustained funding of specialty training may improve retention in sub-Saharan Africa.





Categorías: Investigaciones

Best practice in clinical simulation education − are we there yet? A cross-sectional survey of simulation in Australian and New Zealand undergraduate nursing education

Jue, 12/10/2017 - 10:50
Publication date: Available online 9 October 2017
Source:Collegian

Author(s): Fiona Bogossian, Simon Cooper, Michelle Kelly, Tracy Levett-Jones, Lisa McKenna, Julia Slark, Philippa Seaton

Background Simulation is potentially a means of increasing clinical education capacity. Significant investments have been made in simulation but the extent to which this has improved uptake, quality and diversity of simulation use is unclear. Aim To describe the current use of simulation in tertiary nursing education programs leading to nurse registration Australia and New Zealand, and determine whether investments in simulation have improved uptake, quality and diversity of simulation experiences. Methods A cross sectional electronic survey distributed to lead nursing academics in programs leading to nurse registration in Australia and New Zealand. Findings 51.6% of institutions responded and reported wide variation in allocation of program hours to clinical and simulation learning. Simulation was embedded in curricula and positively valued as an adjunct or substitute for clinical placement. While simulation environments were adequate, staff time, training and resource development were barriers to increasing the quality, amount and range of simulation experiences. Quality assurance and robust evaluation were weak. Discussion Simulation program hours are inconsistently reported and underutilized in terms of potential contribution to clinical learning. Benefits of capital investment in simulation physical resources have been realised, but barriers persist for increasing high quality simulation in nursing programs. Conclusion Transitioning components of clinical education from the clinical to tertiary sectors has resource implications. Establishment of sustainable, high quality simulation experiences requires staff training, shared resources, best practice and robust evaluation of simulation experiences in nursing curricula.





Categorías: Investigaciones

Ethical issues in global health engagement

Jue, 12/10/2017 - 10:50
Publication date: Available online 9 October 2017
Source:Seminars in Fetal and Neonatal Medicine

Author(s): Melani Kekulawala, Timothy R.B. Johnson

With an increasing number of clinicians participating in global health work, such engagement is now more than ever in need of critical ethical scrutiny. Exemplary initiatives in research, academics and publication, and other special considerations, provide potential approaches for overcoming ethical challenges in global health work. These methods demonstrate that successful global health work includes a commitment to foundational ethical principles such as trust, honesty, open communication and transparency, sustainability, capacity building, and appreciation for multiple perspectives – principles that surpass the traditional considerations of clinical practice. From this perspective, successful interventions to reduce neonatal and perinatal mortality must be strategically focused on building in-country capacity and sustainability.





Categorías: Investigaciones

Mentoring to build midwifery and nursing capacity in the Africa region: An integrative review

Jue, 12/10/2017 - 10:50
Publication date: Available online 7 October 2017
Source:International Journal of Africa Nursing Sciences

Author(s): Paulomi Niles, Melissa Therese Ojemeni, Ntuli A. Kaplogwe, Sr. Marie. Jose Voeten, Renae Stafford, Mfaume Kibwana, Linda Deng, Sr. Theonestina, Wendy Budin, Nokk Chhun, Allison Squires







Categorías: Investigaciones

The reliability and validity of Multiple Mini Interviews (MMIs) in values based recruitment to nursing, midwifery and paramedic practice programmes: findings from an evaluation study

Jue, 12/10/2017 - 10:50
Publication date: Available online 6 October 2017
Source:International Journal of Nursing Studies

Author(s): Alison Callwood, Debbie Cooke, Sarah Bolger, Agnieszka Lemanska, Helen Allan

Background Universities in the United Kingdom (UK) are required to incorporate values based recruitment (VBR) into their healthcare student selection processes. This reflects an international drive to strengthen the quality of healthcare service provision. This paper presents novel findings in relation to the reliability and predictive validity of multiple mini interviews (MMIs); one approach to VBR widely being employed by universities. Objectives To examine the reliability (internal consistency) and predictive validity of MMIs using end of Year One practice outcomes of under-graduate pre-registration adult, child, mental health nursing, midwifery and paramedic practice students. Design Cross-discipline cohort study. Setting One university in the United Kingdom. Participants Data were collected in two streams: applicants to the A) September 2014 and 2015 Midwifery Studies programmes; B) September 2015 Adult; Child and Mental Health Nursing and Paramedic Practice programmes. Fifty-seven midwifery students commenced their programme in 2014 and 69 in 2015; 47 and 54 agreed to participate and completed Year One respectively. 333 healthcare students commenced their programmes in September 2015. Of these, 281 agreed to participate and completed their first year (180 adult, 33 child and 34 mental health nursing and 34 paramedic practice students). Methods Stream A featured a seven station four-minute model with one interviewer at each station and in Stream B a six station model was employed. Cronbach's alpha was used to assess MMI station internal consistency and Pearson's moment correlation co-efficient to explore associations between participants' admission MMI score and end of Year. One clinical practice outcomes (OSCE and mentor grading). Results Stream A: Significant correlations are reported between midwifery applicant's MMI scores and end of Year One practice outcomes. A multivariate linear regression model demonstrated that MMI score significantly predicted end of Year One practice outcomes controlling for age and academic entry level: coefficients 0.195 (p=0.002) and 0.116 (p=0.002) for OSCE and mentor grading respectively. In Stream B no significant correlations were found between MMI score and practice outcomes measured by mentor grading. Internal consistency for each MMI station was ‘excellent’ with values ranging from 0.966 − 0.974 across Streams A and B. Conclusion This novel, cross-discipline study shows that MMIs are reliable VBR tools which have predictive validity when a seven station model is used. These data are important given the current international use of different MMI models in healthcare student selection processes.





Categorías: Investigaciones

Public Health Eye Care: Modeling Techniques to Translate Evidence Into Effective Action

Jue, 12/10/2017 - 10:50
Publication date: Available online 28 September 2017
Source:Handbook of Statistics

Author(s): Gudlavalleti V.S. Murthy, Neena S. John

Public health measures have rightly concentrated on the reduction of mortality over the years, but the changing epidemiology of health needs an equally rigorous attention to improving quality of life by ensuring a disability-free world. With the focus on Sustainable Development goals over the next two decades which emphasize “last mile connectivity” by reaching the vulnerable populations so that equitable universal health is ensured, efforts should be made toward a disability and impairment-free social order. The mission of public health eye care is to reduce ill health and disability and preserve health with a view to promote the quality of life of populations and individuals living in a population. Public health eye care needs to provide valid evidence for interventions to be developed and rolled out. To be effective, public health eye care needs extensive use of modeling techniques whether to predict outbreaks, improve health status, or project the future needs of the health system for human resources and infrastructure. This chapter highlights the fact that blindness and visual impairment is of public health concern. Due to resource constraints in regularly collecting population-based data from the low- and middle-income countries where more than 80% of blindness and visual impairment is concentrated, a more rational approach would be to use statistical modeling techniques to maximize the benefit from the available data.





Categorías: Investigaciones

A Government Approach to Full-time Nursing Employment in Ontario, Canada: A Fiscal Stimulus

Jue, 12/10/2017 - 10:50
Publication date: Available online 22 September 2017
Source:Health Policy

Author(s): Andrea Baumann, Mabel Hunsberger, Mary Crea-Arsenio, Noori Akhtar-Danesh, Mohamad Alameddine

Purpose To evaluate the impact of a government full-time employment policy targeting new graduate nurses in the province of Ontario, Canada, by comparing participants with non-participants. Methods The Policy Impact on Nurse Employment (PINEP) survey was administered in 2014 to nurses who graduated between 2007 and 2012. Backward multiple logistic regression analysis was conducted to determine the effect of participation in the policy on key outcomes: full-time employment, retention and perceptions of clinical proficiency. Results A total of 2369 nurses responded to the survey. Policy participants were 1.5 times more likely to be employed full-time and 2.3 times more likely to be retained in their initial position at the time of survey compared to non-participants. Participants also perceived their clinical proficiency to be higher. Conclusions The evidence is converging around the importance of providing full-time employment to nurses to sustain the workforce, increase clinical proficiency and improve patient outcomes. In Ontario, the government created a policy to stimulate full-time employment for nurses. Results demonstrate that nursing employment has become more stable. Yet more needs to be done particularly in relation to the precarious employment trend.





Categorías: Investigaciones

Fences and ambulances: Intersectoral governance for health

Jue, 12/10/2017 - 10:50
Publication date: Available online 21 September 2017
Source:Health Policy

Author(s): Scott L. Greer, Nikolai Vasev, Matthias Wismar







Categorías: Investigaciones

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

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