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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

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

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

Author(s): GBD 2016 DALYs and HALE CollaboratorsAmanuel AlemuAbajobirKalkidan HassenAbateCristianaAbbafatiKaja MAbbasFoadAbd-AllahRizwan SuliankatchiAbdulkaderAbdishakur MAbdulleTeshome AbukaAbeboSemaw FeredeAberaVictorAboyansLaith JAbu-RaddadIlana NAckermanIsaac AAdedejiOlatunjiAdetokunbohAshkanAfshinRakeshAggarwalSutapaAgrawalAnuragAgrawalMuktar BeshirAhmedMiloud Taki EddineAichourAmani NidhalAichourIbtihelAichourSnehaAiyarTomi FAkinyemijuNadiaAkseerFaris HasanAl LamiFaresAlahdabZiyadAl-AlyKhurshidAlamNooreAlamTahiyaAlamDeenaAlasfoorKefyalew AddisAleneRaghibAliRezaAlizadeh-NavaeiJuma MAlkaabiAla'aAlkerwiFrançoisAllaPeterAllebeckChristineAllenFatmaAl-MaskariMohammad AbdulAzizAlMazroaRajaaAl-RaddadiUbaiAlsharifShirinaAlsowaidiBenjamin MAlthouseKhalid AAltirkawiNelsonAlvis-GuzmanAzmeraw TAmareErfanAminiWalidAmmarYaw AmpemAmoakoMustafa GeletoAnshaCarl Abelardo TAntonioPalwashaAnwariJohanÄrnlövMeghaAroraAlArtamanKrishna KumarAryalSolomon WAsgedomTesfay MehariAteyNiguse 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AzizRahmanMahfuzarRahmanRajesh KumarRaiSasaRajsicUshaRamChhabi LalRanabhatTharaRangaswamyZaneRankinPaturi VishnupriyaRaoPuja CRaoSalmanRawafSarah ERayRobert CReinerNikolasReinigMarissaReitsmaGiuseppeRemuzziAndre M NRenzahoSergeResnikoffSatarRezaeiAntonio LRibeiroJacqueline CastilloRivasHirbo ShoreRobaStephen RRobinsonDavidRojas-RuedaMohammad BagherRokniLucaRonfaniGholamrezaRoshandelGregory ARothDietrichRothenbacherAmbujRoyEnricoRubagottiGeorge MugambageRuhagoSoheilSaadatMahdiSafdarianSaeidSafiriRajeshSagarRameshSahathevanMohammad AliSahraianJosephSalamaMuhammad MuhammadSalehJoshua ASalomonSundeep SantoshSalviAbdallah MSamyJuan RamonSanabriaMaria DoloresSanchez-NiñoDamianSantomauroJoão VascoSantosItamar SSantosMilena MSantric MilicevicBennSartoriusMaheswarSatpathyMonikaSawhneySoniaSaxenaKathrynSchelonkaMaria InêsSchmidtIone J CSchneiderBenSchöttkerAletta ESchutteDavid CSchwebelFalkSchwendickeSorayaSeedatSadaf GSepanlouEdson EServan-MoriAmiraShaheenMasood 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LTarekegnMohammadTavakkoliNunoTaveiraHugh RTaylorTeketo KassawTegegneArashTehrani-BanihashemiTesfalidetTekelabAbdullah SuliemanTerkawiDawit JemberTesfayeBelayTesssemaJSThakurOrnwipaThamsuwanAlice MTheadomAndrew MTheisKatie EThomasNihalThomasRobertThompsonAmanda GThriftRuoyanTobe-GaiMyriamTobollikMarcelloTonelliRomanTopor-MadryMiguelTortajadaMathildeTouvierJeffersonTraebertBach XuanTranChristopherTroegerThomasTruelsenDerrickTsoiEmin MuratTuzcuHayleyTymesonStefanosTyrovolasKingsley NnannaUkwajaEduardo AUndurragaChigozie JesseUnekeRachelUpdikeOlalekan AUthmanBenjamin S ChudiUzochukwuJob F Mvan BovenSantoshVarugheseTommiVasankariLennert JVeermanSVenkateshNarayanaswamyVenketasubramanianRameshVidavalurLakshmiVijayakumarFrancesco SViolanteAbhishekVishnuSergey KVladimirovVasiliy VictorovichVlassovStein EmilVollsetTheoVosFisehaWadiloTolassaWakayoMitchell TWallinYuan-PangWangScottWeichenthalElisabeteWeiderpassRobert GWeintraubDaniel JWeissAndreaWerdeckerRonnyWestermanHarvey AWhitefordTissaWijeratneHywel CWilliamsCharles SheyWiysongeBelete GetahunWoldeyesCharles D AWolfeRachelWoodbrookAnthony DWoolfAbdulhalikWorkichoDenisXavierGelinXuSimonYadgirMohsenYaghoubiBereketYakobLijing LYanYuichiroYanoPengpengYeMahari GideyYihdegoHassen HamidYimamPaulYipNaohiroYonemotoSeok-JunYoonMarcelYotebiengMustafa ZYounisChuanhuaYuZoubidaZaidiMaysaa El SayedZakiElias AsfawZegeyeZerihun MenlkalewZenebeXueyingZhangYingfengZhengMaigengZhouBenZipkinSanjayZodpeyLeoZoecklerLiesl JoannaZuhlke

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





Categorías: Investigaciones

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

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

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







Categorías: Investigaciones

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

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

Author(s): Matshidiso Moeti







Categorías: Investigaciones

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

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

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

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





Categorías: Investigaciones

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

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

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

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





Categorías: Investigaciones

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

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

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

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





Categorías: Investigaciones

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

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

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

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





Categorías: Investigaciones

Palliative Care in Rwanda: Aiming for Universal Access

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

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

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





Categorías: Investigaciones

Second-line antiretroviral therapy: so much to be done

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

Author(s): Yibeltal Assefa, Charles F Gilks







Categorías: Investigaciones

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