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ADad 11: Needs and Service Provisions for Anxiety Disorders Among Adolescents in a Rural Community Population in India

Vie, 01/11/2013 - 01:00
Abstract Objective

Despite the need to have adolescent-centric policies and mental health services, India is yet far from having one. The authors aimed at generating opinions on the need to have adolescent focused policies and clinical services using the data on Anxiety Disorders they collected from the community.

Methods

This qualitative study used Focus Group Discussions (FGD) to generate opinions on the various needs to enhance better mental health services and policies for adolescents in India. A Modified Delphi technique was used with experts in mental health to prioritize these needs. Experts gave their plans on how to approach the needs during the in-depth interviews.

Results

The mental health professionals viewed scaled-up mental health services to include adolescent mental health services; improve the consumer opinion about public sector health providers; strengthening the government hospitals; capacity building among the health sector and non-health sector; research in service delivery models and policy changes as the needs. The parents felt the need to address the stigma associated with their children’s mental illness, minimize the barriers in approaching mental health services and involve non-medical agencies in mental health care. These needs were prioritized and solutions to these problems were discussed.

Conclusions

India-centric and adolescent specific mental health policies and services need to be developed as well as integrated into the existing health system in India.

Categorías: Investigaciones

Preservice laboratory education strengthening enhances sustainable laboratory workforce in Ethiopia

Lun, 28/10/2013 - 01:00
Abstract Background

There is a severe healthcare workforce shortage in sub Saharan Africa, which threatens achieving the Millennium Development Goals and attaining an AIDS-free generation. The strength of a healthcare system depends on the skills, competencies, values and availability of its workforce. A well-trained and competent laboratory technologist ensures accurate and reliable results for use in prevention, diagnosis, care and treatment of diseases.

Methods

An assessment of existing preservice education of five medical laboratory schools, followed by remedial intervention and monitoring was conducted. The remedial interventions included 1) standardizing curriculum and implementation; 2) training faculty staff on pedagogical methods and quality management systems; 3) providing teaching materials; and 4) procuring equipment for teaching laboratories to provide practical skills to complement didactic education.

Results

A total of 2,230 undergraduate students from the five universities benefitted from the standardized curriculum. University of Gondar accounted for 252 of 2,230 (11.3%) of the students, Addis Ababa University for 663 (29.7%), Jimma University for 649 (29.1%), Haramaya University for 429 (19.2%) and Hawassa University for 237 (10.6%) of the students. Together the universities graduated 388 and 312 laboratory technologists in 2010/2011 and 2011/2012 academic year, respectively. Practical hands-on training and experience with well-equipped laboratories enhanced and ensured skilled, confident and competent laboratory technologists upon graduation.

Conclusions

Strengthening preservice laboratory education is feasible in resource-limited settings, and emphasizing its merits (ample local capacity, country ownership and sustainability) provides a valuable source of competent laboratory technologists to relieve an overstretched healthcare system.

Categorías: Investigaciones

Measuring governance at health facility level: developing and validation of simple governance tool in Zambia

Vie, 09/08/2013 - 01:00
Abstract Background

Governance has been cited as a key determinant of economic growth, social advancement and overall development. Achievement of millennium development goals is partly dependant on governance practices. In 2007, Health Systems 20/20 conducted an Internet-based survey on the practice of good governance. The survey posed a set of good practices related to health governance and asked respondents to indicate whether their experience confirmed or disconfirmed those practices. We applied the 17 governance statements in rural health facilities of Zambia. The aim was to establish whether the statements were reliable and valid for assessing governance practices at primary care level.

Methods

Both quantitative and qualitative methods were used. We first applied the governance statements developed by the health system 20/20 and then conducted focus group discussion and In-depth interviews to explore some elements of governance including accountability and community participation. The target respondents were the health facility management team and community members. The sample size include 42 health facilities. Data was analyzed using SPSS version 17 and Nvivo version 9.

Results

The 95% one-sided confidence interval for Cronbach’s alpha was between 0.69 and 0.74 for the 16 items.

The mean score for most of the items was above 3. Factor analysis yielded five principle components: Transparency, community participation, Intelligence & vision, Accountability and Regulation & oversight. Most of the items (6) clustered around the transparency latent factor. Chongwe district performed poorly in overall mean governance score and across the five domains of governance. The overall scores in Chongwe ranged between 51 and 94% with the mean of 80%. Kafue and Luangwa districts had similar overall mean governance scores (88%). Community participation was generally low. Generally, it was noted that community members lacked capacity to hold health workers accountable for drugs and medical supplies.

Conclusions

The study successfully validated and applied the new tool for evaluating health system governance at health facility level. The results have shown that it is feasible to measure governance practices at health facility level and that the adapted tool is fairly reliable with the 95% one-sided confidence interval for Cronbach’s alpha laying between 0.69 and 0.74 for the 16 items. Caution should be taken when interpreting overall scores as they tended to mask domain specific variations.

Categorías: Investigaciones

Safety Culture: A Catalyst for Sustainable Development

Mar, 06/08/2013 - 01:00
Abstract

The present paper investigates the potential benefits of a strong safety culture (SC). Specifically, we build on the organizational support theory to explore the direct and indirect effects of SC on firm performance. Partial least squares method is used to analyze the data collected from a survey among 251 Canadian plants. The results show that SC is associated with several performance indicators all linked to sustainable development (i.e., environmental, financial, and safety performance). Importantly, our findings also suggest that the relationships between SC and environmental/safety performance are mediated by the actual level of implemented environmental/safety practices within plants. We conclude the paper by highlighting the study’s limitations and contributions as well as theoretical and managerial implications.

Categorías: Investigaciones

The interface between the national tuberculosis control programme and district hospitals in Cameroon: missed opportunities for strengthening the local health system –a multiple case study

Vie, 22/03/2013 - 01:00
Abstract Background

Tuberculosis remains a major public health problem in sub-Saharan Africa. District hospitals (DHs) play a central role in district-based health systems, and their relation with vertical programmes is very important. Studies on the impact of vertical programmes on DHs are rare. This study aims to fill this gap. Its purpose is to analyse the interaction between the National Tuberculosis Control Programme (NTCP) and DHs in Cameroon, especially its effects on the human resources, routine health information system (HIS) and technical capacity at the hospital level.

Methods

We used a multiple case study methodology. From the Adamaoua Region, we selected two DHs, one public and one faith-based. We collected qualitative and quantitative data through document reviews, semi-structured interviews with district and regional staff, and observations in the two DHs.

Results

The NTCP trained and supervised staff, designed and provided tuberculosis data collection and reporting tools, and provided anti-tuberculosis drugs, reagents and microscopes to DHs. However, these interventions were limited to the hospital units designated as Tuberculosis Diagnostic and Treatment Centres and to staff dedicated to tuberculosis control activities. The NTCP installed a parallel HIS that bypassed the District Health Services. The DH that performs well in terms of general hospital care and that is well managed was successful in tuberculosis control. Based on the available resources, the two hospitals adapt the organisation of tuberculosis control to their settings. The management teams in charge of the District Health Services are not involved in tuberculosis control. In our study, we identified several opportunities to strengthen the local health system that have been missed by the NTCP and the health system managers.

Conclusion

Well-managed DHs perform better in terms of tuberculosis control than DHs that are not well managed. The analysis of the effects of the NTCP on the human resources, HIS and technical capacity of DHs indicates that the NTCP supports, rather than strengthens, the local health system. Moreover, there is potential for this support to be enhanced. Positive synergies between the NTCP and district health systems can be achieved if opportunities to strengthen the district health system are seized. The question remains, however, of why managers do not take advantage of the opportunities to strengthen the health system.

Categorías: Investigaciones

The Alabama Coalition for a Healthier Black Belt: A Proof of Concept Project

Vie, 01/02/2013 - 00:00
Abstract

The Alabama Coalition for a Healthier Black was a demonstration of concept project. This paper is a descriptive and qualitative overview of this 2.5 year project. Limited key project results are reported here. Located in the rural Black Belt region of Alabama this coalition had several key aims: to develop a collaboration between primary care and mental health care through co-location of services; use of video-conferencing capability to provide mental health services more efficiently; enhanced training in rural healthcare; and development of stigma reduction campaigns along with other coalition partner specific initiatives. Co-location and telepsychiatry implementation produced the major challenges and resulting adaptations to original aims. Despite many challenges these new service patterns were put into place and appear to be sustainable.

Categorías: Investigaciones

Livelihoods and Disasters

Mar, 01/01/2013 - 00:00
Categorías: Investigaciones

The Implementation of the Guidelines for Environmental Labels and Declarations in Agri-Food SMEs

Mar, 01/01/2013 - 00:00
Abstract

In order to test the implementation of the guidelines for environmental labels and declarations in agri-food SMEs, a firm which operates in the pasta chain was chosen as it was considered representative of the Sicilian economic system. After a brief description of the sector and the pilot firm, the path followed by the firm towards the choice of a voluntary environmental labelling system which suited its peculiarities will be reported. Following the iterative procedural steps and making use of decision support instruments, the organisation has given to its distributors and consumers the necessary information for a conscious choice of eco-compatible products and the relevant information connected with the phases of the productive process, the product itself and the performance in terms of environmental impact. The experience resulting from the application of the guidelines proposed to the pilot firm has shown how it is possible to choose the voluntary communication system, closer to the business reality, by starting from the analysis of the company activities and of the expectations of the management, the stakeholders and their environmental awareness.

Categorías: Investigaciones

The WHO Policy of Primary Health Care

Mar, 01/01/2013 - 00:00
Abstract

The right to health is proclaimed by the United Nations in the Declaration of Human Rights of 1948. In 1981, the right to health became a goal of the new Millennium. Nevertheless, in the Millennium goals, the concern for health occupies only the fourth position. Why is health not, for the Millennium, a priority goal and, more precisely, the first? What are the implications of a “secondarization” of health care? Our point will be to demonstrate why we should not count on the Millennium goals to achieve “health for all,” In this paper, we will first refer to the theories of justice implicitly evocated by policies that give or do not give a priority to health care. Secondly, we will describe the ethical basis which supports the primary health care definition and the policies which pursue this aim. Finally, we will show that we would take a better account of both poverty and “health for all,” if we would conceive primary health care not only as fundamental needs but also as capabilities (as A. Sen or M. Nussbaum does).

Categorías: Investigaciones

The Decline and Possible Demise of Family Psychology: Families Without Personalities

Mar, 01/01/2013 - 00:00
Abstract

The purpose of this chapter is to argue that the past sociological notion of the intact family-qua-family composed of two parents of the opposite gender and two children, is not longer tenable. This argument, of course, about the decline of the family, as conceived in the past, does not mean that the profession of Family Psychology should decline as well. It means that different conceptions about the family unit have evolved in the last half a century. Those conceptions will remain of interest to such a professional organization.

Categorías: Investigaciones

Attention to Prevention

Mar, 01/01/2013 - 00:00
Abstract

A major cause for excessive medical costs in the USA is excessive attention to predictive factors and neglect of causal factors. It is much better to prevent the cause than just the symptoms created by the cause. We use signs and symptoms associated with past harmful events as factors for predicting possible risk of future harm. Predicting future outcomes allows us to hope for ways that we might prevent future harm.

Categorías: Investigaciones

A qualitative study of governance of evolving response to non-communicable diseases in low-and middle- income countries: current status, risks and options

Mar, 16/10/2012 - 01:00
Abstract Background

Segmented service delivery with consequent inefficiencies in health systems was one of the main concerns raised during scaling up of disease-specific programs in the last two decades. The organized response to NCD is in infancy in most LMICs with little evidence on how the response is evolving in terms of institutional arrangements and policy development processes.

Methods

Drawing on qualitative review of policy and program documents from five LMICs and data from global key-informant surveys conducted in 2004 and 2010, we examine current status of governance of response to NCDs at national level along three dimensions— institutional arrangements for stewardship and program management and implementation; policies/plans; and multisectoral coordination and partnerships.

Results

Several positive trends were noted in the organization and governance of response to NCDs: shift from specific NCD-based programs to integrated NCD programs, increasing inclusion of NCDs in sector-wide health plans, and establishment of high-level multisectoral coordination mechanisms.

Several areas of concern were identified. The evolving NCD-specific institutional structures are being treated as ‘program management and implementation’ entities rather than as lead ‘technical advisory’ bodies, with unclear division of roles and responsibilities between NCD-specific and sector-wide structures. NCD-specific and sector-wide plans are poorly aligned and lack prioritization, costing, and appropriate targets. Finally, the effectiveness of existing multisectoral coordination mechanisms remains questionable.

Conclusions

The ‘technical functions’ and ‘implementation and management functions’ should be clearly separated between NCD-specific units and sector-wide institutional structures to avoid duplicative segmented service delivery systems. Institutional capacity building efforts for NCDs should target both NCD-specific units (for building technical and analytical capacity) and sector-wide organizational units (for building program management and implementation capacity) in MOH.

The sector-wide health plans should reflect NCDs in proportion to their public health importance. NCD specific plans should be developed in close consultation with sector-wide health- and non-health stakeholders. These plans should expand on the directions provided by sector-wide health plans specifying strategically prioritized, fully costed activities, and realistic quantifiable targets for NCD control linked with sector-wide expenditure framework. Multisectoral coordination mechanisms need to be strengthened with optimal decision-making powers and resource commitment and monitoring of their outputs.

Categorías: Investigaciones

Management of Long Term Sickness Absence: A Systematic Realist Review

Sáb, 01/09/2012 - 01:00
Abstract

Purpose The increasing impact and costs of long term sickness absence have been well documented. However, the diversity and complexity of interventions and of the contexts in which these take place makes a traditional review problematic. Therefore, we undertook a systematic realist review to identify the dominant programme theories underlying best practice, to assess the evidence for these theories, and to throw light on important enabling or disabling contextual factors. Method A search of the scholarly literature from 1950 to 2011 identified 5,576 articles, of which 269 formed the basis of the review. Results We found that the dominant programme theories in relation to effective management related to: early intervention or referral by employers; having proactive organisational procedures; good communication and cooperation between stakeholders; and workplace-based occupational rehabilitation. Significant contextual factors were identified as the level of support for interventions from top management, the size and structure of the organisation, the level of financial and organisational investment in the management of long-term sickness absence, and the quality of relationships between managers and staff. Conclusions Consequently, those with responsibility for managing absence should bear in mind the contextual factors that are likely to have an impact on interventions, and do what they can to ensure stakeholders have at least a mutual understanding (if not a common purpose) in relation to their perceptions of interventions, goals, culture and practice in the management of long term sickness absence.

Categorías: Investigaciones

Building health systems capacity in global health graduate programs: reflections from Australian educators

Vie, 24/08/2012 - 01:00
Abstract

There has been increasing focus on the role of health systems in low and middle-income countries. Despite this, very little evidence exists on how best to build health systems program and research capacity in educational programs. The current experiences in building capacity in health systems in five of the most prominent global health programs at Australian universities are outlined. The strengths and weaknesses of various approaches and techniques are provided along with examples of global practice in order to provide a foundation for future discussion and thus improvements in global health systems education.

Categorías: Investigaciones

Local perceptions of intermittent screening and treatment for malaria in school children on the south coast of Kenya

Vie, 08/06/2012 - 01:00
Abstract Background

The intermittent screening and treatment (IST) of school children for malaria is one possible intervention strategy that could help reduce the burden of malaria among school children. Future implementation of IST will not only depend on its efficacy and cost-effectiveness but also on its acceptability to parents of the children who receive IST, as well as those responsible for its delivery. This study was conducted alongside a cluster-randomized trial to investigate local perceptions of school-based IST among parents and other stakeholders on the Kenyan south coast.

Methods

Six out of the 51 schools receiving the IST intervention were purposively sampled, based on the prevalence of Plasmodium infection, to participate in the qualitative study. Twenty-two focus group discussions and 17 in-depth interviews were conducted with parents and other key stakeholders involved in the implementation of school health programmes in the district. Data analysis was guided by the framework analysis method.

Results

High knowledge of the burden of clinical malaria on school children, the perceived benefits of preventing clinical disease through IST and previous positive experiences and interactions with other school health programmes facilitated the acceptability of IST. However, lack of understanding of the consequences of asymptomatic parasitaemia for apparently healthy school children could potentially contribute to non-adherence to treatment, and use of alternative anti-malarial drugs with simpler regimens was generally preferred. The general consensus of stakeholders was that health workers were best placed to undertake the screening and provide treatment, and although teachers’ involvement in the programme is critical, most participants were opposed to teachers taking finger-prick blood samples from children. There was also a strong demand for the distribution of mosquito nets to augment IST.

Conclusion

School-based malaria control through IST was acceptable to most parents and other stakeholders, but careful consideration of the various roles of teachers, community health workers, and health workers, and the use of anti-malarial drugs with simpler regimens are critical to its future implementation.

Categorías: Investigaciones

A spatial and temporal analysis of notifiable gastrointestinal illness in the Northwest Territories, Canada, 1991-2008

Mar, 29/05/2012 - 01:00
Abstract Background

This is the first study to describe the geographical and temporal distribution of notifiable gastrointestinal illness (NGI) in the Northwest Territories (NWT), Canada. Understanding the distribution of NGI in space and time is important for identifying communities at high risk. Using data derived from the Northwest Territories Communicable Disease Registry (NWT CDR), a number of spatial and temporal techniques were used to explore and analyze NGI incidence from the years 1991 to 2008. Relative risk mapping was used to investigate the variation of disease risk. Scan test statistics were applied to conduct cluster identification in space, time and space-time. Seasonal decomposition of the time series was used to assess seasonal variation and trends in the data.

Results

There was geographic variability in the rates of NGI with higher notifications in the south compared to the north. Incidence of NGI exhibited seasonality with peaks in the fall months for most years. Two possible outbreaks were detected in the fall of 1995 and 2001, of which one coincided with a previously recognized outbreak. Overall, incidence of NGI fluctuated from 1991 to 2001 followed by a tendency for rates to decrease from 2002 to 2008.

Conclusions

The distribution of NGI notifications varied widely according to geographic region, season and year. While the analyses highlighted a possible bias in the surveillance data, this information is beneficial for generating hypotheses about risk factors for infection.

Categorías: Investigaciones

Internet Health Resources Development Based on Geographic Information System

Dom, 01/01/2012 - 00:00
Abstract

This research from the health resources in terms of demand angle, analyse according to the allocation of resources situation, and configuration of the problems that exist, use of internet technology and to establish a collection and dissemination of health resources information network platforms. For the formulation of regional health planning and optimizing the allocation of resources may be provided the reference.

Categorías: Investigaciones

Overview of the Healthcare System in Turkey

Dom, 01/01/2012 - 00:00
Abstract

This is an overview of Turkey’s past and current proceedings in issues of health, offering a brief outline of political, economic and demographic issues as they relate to the subject peripherally. The role and function of the Ministry of Health, as the administrative authority and its associated departments are also reflected apropos of topics studied. The paper attempts to briefly provide insight into the track record of the Turkish health system, its practice and philosophy of public duty; the current status of major health services as maternal and infant care, health administration, with a view to the overall impact of the new transformation plan. The place of social security and health insurance, the introduction of private enterprise to the healthcare system, the newly launched family physician network are also explained briefly as innovations in the system. Statistics relating to physicians and other health personnel, and general information on their education and training are relayed. Data on hospitals and other health facilities and oral and a summation of issues concerning dental hygiene are also offered.

Categorías: Investigaciones

An AHP-Based Assessment Model for Clinical Diagnosis and Decision

Dom, 01/01/2012 - 00:00
Abstract

There are many scholars trying to diagnose the disease using intelligent computers and computer networks, in order to meet the growing needs of patients. Most of them diagnose disease based on the patients’ symptoms, the collected medical data and some algorithms, but they can’t figure out the probability of every possible disease. This paper presents an assessment model by using AHP method which can evaluate these possible diseases. The assessment model can calculate the correlation between each disease and every possible symptom by the collected medical data. According to the correlation and the actual severity of symptoms, we can evaluate the exact probability of every possible disease.

Categorías: Investigaciones

Improving the implementation of health workforce policies through governance: a review of case studies

Mar, 12/04/2011 - 01:00
Abstract Introduction

Responsible governance is crucial to national development and a catalyst for achieving the Millennium Development Goals. To date, governance seems to have been a neglected issue in the field of human resources for health (HRH), which could be an important reason why HRH policy formulation and implementation is often poor. This article aims to describe how governance issues have influenced HRH policy development and to identify governance strategies that have been used, successfully or not, to improve HRH policy implementation in low- and middle-income countries (LMIC).

Methods

We performed a descriptive literature review of HRH case studies which describe or evaluate a governance-related intervention at country or district level in LMIC. In order to systematically address the term 'governance' a framework was developed and governance aspects were regrouped into four dimensions: 'performance', 'equity and equality', 'partnership and participation' and 'oversight'.

Results and discussion

In total 16 case studies were included in the review and most of the selected studies covered several governance dimensions. The dimension 'performance' covered several elements at the core of governance of HRH, decentralization being particularly prominent. Although improved equity and/or equality was, in a number of interventions, a goal, inclusiveness in policy development and fairness and transparency in policy implementation did often not seem adequate to guarantee the corresponding desirable health workforce scenario. Forms of partnership and participation described in the case studies are numerous and offer different lessons. Strikingly, in none of the articles was 'partnerships' a core focus. A common theme in the dimension of 'oversight' is local-level corruption, affecting, amongst other things, accountability and local-level trust in governance, and its cultural guises. Experiences with accountability mechanisms for HRH policy development and implementation were lacking.

Conclusion

This review shows that the term 'governance' is neither prominent nor frequent in recent HRH literature. It provides initial lessons regarding the influence of governance on HRH policy development and implementation. The review also shows that the evidence base needs to be improved in this field in order to better understand how governance influences HRH policy development and implementation. Tentative lessons are discussed, based on the case studies.

Categorías: Investigaciones

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