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The Triple Impact of Nursing

Vie, 12/05/2017 - 01:35
Publication date: Available online 11 May 2017
Source:International Journal of Nursing Studies

Author(s): Lord Crisp, Mary Watkins







Categorías: Investigaciones

Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: a systematic review and meta-analysis

Vie, 12/05/2017 - 01:35
Publication date: Available online 11 May 2017
Source:International Journal of Nursing Studies

Author(s): Matthias Hoben, Alix Clarke, Kha Tu Huynh, Nadia Kobagi, Angelle Kent, Huimin Hu, Raissa A.C. Pereira, Tianyuan Xiong, Kexin Yu, Hongjin Xiang, Minn N. Yoon

Background Oral health of nursing home residents is generally poor, with severe consequences for residents’ general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents. Methods We systematically searched the databases MEDLINE, Embase, Evidence Based Reviews—Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We also searched by hand the contents of key journals, publications of key authors, and reference lists of all studies included. We included qualitative and quantitative research studies that assess barriers and facilitators, as perceived by care aides, to providing oral care to nursing home residents. We conducted a thematic analysis of barriers and facilitators, extracted prevalence of care aides reporting certain barriers and facilitators from studies reporting quantitative data, and conducted random-effects meta-analyses of prevalence. Results We included 45 references that represent 41 unique studies: 15 cross-sectional studies, 13 qualitative studies, 7 mixed methods studies, 3 one-group pre-post studies, and 3 randomized controlled trials. Methodological quality was generally weak. We identified barriers and facilitators related to residents, their family members, care providers, organization of care services, and social interactions. Pooled estimates (95% confidence intervals) of barriers were: residents resisting care=45% (15%–77%); care providers’ lack of knowledge, education or training in providing oral care=24% (7%–47%); general difficulties in providing oral care=26% (19%–33%); lack of time=31% (17%–47%); general dislike of oral care=19% (8%–33%); and lack of staff=22% (13%–31%). Conclusions We found a lack of robust evidence on barriers and facilitators that care aides perceive in providing oral care to nursing home residents, suggesting a need for robust research studies in this area. Effective strategies to overcome barriers and to increase facilitators in providing oral care are one of the most critical research gaps in the area of improving oral care for nursing home residents. Strategies to prevent or manage residents’ responsive behaviors and to improve care aides’ oral care knowledge are especially needed.





Categorías: Investigaciones

Health Information Needs and Reliability of Sources Among Nondegree Health Sciences Students: A Prerequisite for Designing eHealth Literacy

Jue, 11/05/2017 - 01:23
Publication date: Available online 11 May 2017
Source:Annals of Global Health

Author(s): Hussein Haruna, Ndumiso Tshuma, Xiao Hu

Background Understanding health information needs and health-seeking behavior is a prerequisite for developing an electronic health information literacy (EHIL) or eHealth literacy program for nondegree health sciences students. At present, interest in researching health information needs and reliable sources paradigms has gained momentum in many countries. However, most studies focus on health professionals and students in higher education institutions. Objective The present study was aimed at providing new insight and filling the existing gap by examining health information needs and reliability of sources among nondegree health sciences students in Tanzania. Method A cross-sectional study was conducted in 15 conveniently selected health training institutions, where 403 health sciences students were participated. Thirty health sciences students were both purposely and conveniently chosen from each health-training institution. The selected students were pursuing nursing and midwifery, clinical medicine, dentistry, environmental health sciences, pharmacy, and medical laboratory sciences courses. Involved students were either in their first year, second year, or third year of study. Results Health sciences students' health information needs focus on their educational requirements, clinical practice, and personal information. They use print, human, and electronic health information. They lack eHealth research skills in navigating health information resources and have insufficient facilities for accessing eHealth information, a lack of specialists in health information, high costs for subscription electronic information, and unawareness of the availability of free Internet and other online health-related databases. Conclusion This study found that nondegree health sciences students have limited skills in EHIL. Thus, designing and incorporating EHIL skills programs into the curriculum of nondegree health sciences students is vital. EHIL is a requirement common to all health settings, learning environments, and levels of study. Our future intention is to design EHIL to support nondegree health sciences students to retrieve and use available health information resources on the Internet.





Categorías: Investigaciones

The challenges of physician retirement

Mié, 10/05/2017 - 01:08
Publication date: 16 January 2017
Source:Canadian Medical Association Journal, Volume 189, Issue 2

Author(s): Roger Collier







Categorías: Investigaciones

Trainers’ perception of the learning environment and student competency: A qualitative investigation of midwifery and anesthesia training programs in Ethiopia

Lun, 01/05/2017 - 23:12
Publication date: Available online 1 May 2017
Source:Nurse Education Today

Author(s): Sharon Kibwana, Rachel Haws, Adrienne Kols, Firew Ayalew, Young-Mi Kim, Jos van Roosmalen, Jelle Stekelenburg

Background Ethiopia has successfully expanded training for midwives and anesthetists in public institutions. This study explored the perceptions of trainers (instructors, clinical lab assistants and preceptors) towards the adequacy of students’ learning experience and implications for achieving mastery of core competencies. Methods In-depth interviews with 96 trainers at 9 public universities and 17 regional health science colleges across Ethiopia were conducted to elicit their opinions about available resources, program curriculum suitability, and competence of graduating students. Using Dedoose, data were thematically analyzed using grounded theory. Results Perceptions of anesthesia and midwifery programs were similar. Common challenges included unpreparedness and poor motivation of students, shortages of skills lab space and equipment, difficulties ensuring students’ exposure to sufficient and varied enough cases to develop competence, and lack of coordination between academic training institutions and clinical attachment sites. Additional logistical barriers included lack of student transport to clinical sites. Informants recommended improved recruitment strategies, curriculum adjustments, increased time in skills labs, and better communication across academic and clinical sites. Conclusions An adequate learning environment ensures that graduating midwives and anesthetists are competent to provide quality services. Minimizing the human resource, infrastructural and logistical gaps identified in this study requires continued, targeted investment in health systems strengthening.





Categorías: Investigaciones

Community health workers: emerging from the shadows?

Sáb, 08/04/2017 - 19:07
Publication date: May 2017
Source:The Lancet Global Health, Volume 5, Issue 5

Author(s): The Lancet Global Health







Categorías: Investigaciones

The strategic geographies of global health partnerships

Vie, 07/04/2017 - 19:01
Publication date: May 2017
Source:Health & Place, Volume 45

Author(s): Clare Herrick

Global health partnerships have been hailed as a means of addressing the global health worker shortage, bringing forth health systems strengthening and, therefore, the universal health coverage aspirations of the Sustainable Development Goals. In contrast to other critical engagements with partnerships which have tended to focus on experiences and effects of these partnerships in situ; this paper draws on the example of the UK to explore how partnership working and development agendas have become entwined. Moreover, this entwinement has ensured that GHPs are far from the "global" endeavour that might be expected of global health and instead exhibit geographies that are far more representative of the geopolitics of overseas development assistance than biomedical need.





Categorías: Investigaciones

Changing health care provider performance through measurement

Vie, 07/04/2017 - 19:01
Publication date: May 2017
Source:Social Science & Medicine, Volume 181

Author(s): Kenneth L. Leonard, Melkiory C. Masatu

Can the quality of care be improved by repeated measurement? We show that measuring protocol adherence repeatedly over ten weeks leads to significant improvements in quality immediately and up to 18 months later without any additional training, equipment, supplies or material incentives. 96 clinicians took part in a study which included information, encouragement, scrutiny and repeated contact with the research team measuring quality. We examine protocol adherence over the course of the study and for 45 of the original clinicians 18 months after the conclusion of the project. Health workers change their behavior significantly over the course of the study, and even eighteen months later demonstrate a five percentage point improvement in quality. The dynamics of clinicians’ reactions to this intervention suggest that quality can be improved by the repeated measurement by external peers in a way that provides reminders of expectations.





Categorías: Investigaciones

National logistics working groups: A landscape analysis study

Vie, 07/04/2017 - 19:01
Publication date: 19 April 2017
Source:Vaccine, Volume 35, Issue 17

Author(s): Dorothy Leab, Benjamin Schreiber, Musonda Kasonde, Olivia Bessat, Son Bui, Carine Loisel

Several countries have acknowledged the contributions made by national logistics working groups (NLWG) to ensure equitable access to the expanded program on immunization’s (EPI) vaccines against preventable diseases. In order to provide key insights to the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) supply chain hub – as well as other players, including national EPI – a landscape analysis study was conducted from September 2015 to February 2016. This is a cross-sectional survey taken by 43 countries that combines qualitative and quantitative approaches. Data was collected through a desk review, consultation, interviews, and distance questioning. References and guidance were used to determine and specify the underlying mechanisms of NLWGs. The key findings are: • Mandate of NLWG commonly declared by countries is improving immunization logistics and supply chain. • Of the 43 countries surveyed, 10 have formal NLWGs, 8 have informal or ad hoc NLWGs, and 25 have none. • The immunization supply chain and logistics (iSCL) decision-making process in countries, regardless of NLWG status, mainly depends on the EPI manager. • In countries with an NLWG, members with logistics and supply chain backgrounds are relatively common; they are mostly from EPI, UNICEF, and WHO. • Almost all NLWGs have terms of reference and primarily operate under EPI governance; however, three NLWGs have standard operation procedures (SOP), and four use monitoring and evaluation tools. • The coordination mechanism of these iSCL activities is mainly built into the immunization Comprehensive Multi-Year Plan (cMYP) and annual EPI plans, and organized by EPI/Immunization Coordination Committee (ICC). • Most countries that participated in this survey expressed their technical requirement for improving the function, positioning and influence of the immunization logistics working group, and capacity building for the group’s members. This study has provided a general overview of the status of NLWGs for immunization in various countries. Based on the key insights of the study, technical assistance needs have been identified, and immunization partners will be required to help countries create and reinforce their NLWGs.





Categorías: Investigaciones

Measuring Iran's success in achieving Millennium Development Goal 4: a systematic analysis of under-5 mortality at national and subnational levels from 1990 to 2015

Vie, 07/04/2017 - 19:01
Publication date: Available online 28 March 2017
Source:The Lancet Global Health

Author(s): Younes Mohammadi, Mahboubeh Parsaeian, Parinaz Mehdipour, Ardeshir Khosravi, Bagher Larijani, Ali Sheidaei, Anita Mansouri, Amir Kasaeian, Kamran Yazdani, Maziar Moradi-Lake, Elaheh Kazemi, Saeideh Aghamohammadi, Nazila Rezaei, Maryam Chegini, Rosa Haghshenas, Hamidreza Jamshidi, Farnaz Delavari, Mohsen Asadi-Lari, Farshad Farzadfar

Background Child mortality as one of the key Millennium Development Goals (MDG 4—to reduce child mortality by two-thirds from 1990 to 2015), is included in the Sustainable Development Goals (SDG 3, target 2—to reduce child mortality to fewer than 25 deaths per 1000 livebirths for all countries by 2030), and is a key indicator of the health system in every country. In this study, we aimed to estimate the level and trend of child mortality from 1990 to 2015 in Iran, to assess the progress of the country and its provinces toward these goals. Methods We used three different data sources: three censuses, a Demographic and Health Survey (DHS), and 5-year data from the death registration system. We used the summary birth history data from four data sources (the three censuses and DHS) and used maternal age cohort and maternal age period methods to estimate the trends in child mortality rates, combining the estimates of these two indirect methods using Loess regression. We also used the complete birth history method to estimate child mortality rate directly from DHS data. Finally, to synthesise different trends into a single trend and calculate uncertainty intervals (UI), we used Gaussian process regression. Findings Under-5 mortality rates (deaths per 1000 livebirths) at the national level in Iran in 1990, 2000, 2010, and 2015 were 63·6 (95% UI 63·1–64·0), 38·8 (38·5–39·2), 24·9 (24·3–25·4), and 19·4 (18·6–20·2), respectively. Between 1990 and 2015, the median annual reduction and total overall reduction in these rates were 4·9% and 70%, respectively. At the provincial level, the difference between the highest and lowest child mortality rates in 1990, 2000, and 2015 were 65·6, 40·4, and 38·1 per 1000 livebirths, respectively. Based on the MDG 4 goal, five provinces had not decreased child mortality by two-thirds by 2015. Furthermore, six provinces had not reached SDG 3 (target 2). Interpretation Iran and most of its provinces achieved MDG 4 and SDG 3 (target 2) goals by 2015. However, at the subnational level in some provinces, there is substantial inequity. Local policy makers should use effective strategies to accelerate the reduction of child mortality for these provinces by 2030. Possible recommendations for such strategies include enhancing the level of education and health literacy among women, tackling sex discrimination, and improving incomes for families. Funding Iran Ministry of Health and Education.





Categorías: Investigaciones

Quality of Life among Women Living with HIV in Rural India

Vie, 07/04/2017 - 19:01
Publication date: Available online 24 March 2017
Source:Journal of the Association of Nurses in AIDS Care

Author(s): Adeline M. Nyamathi, Maria Ekstrand, Kartik Yadav, Padma Ramakrishna, Elsa Heylen, Catherine Carpenter, Sarah Wall, Tanya Oleskowicz, Lenore Arab, Sanjeev Sinha

A cross-sectional examination was conducted on Quality of Life (QOL) among Women Living with HIV (WLWH) in rural Andhra Pradesh, India. Baseline data were collected from 400 WLWH and their children. QOL was measured with 10 items from the Quality of Life Enjoyment and Satisfaction Questionnaire. Findings revealed low QOL scores; on a scale from 0 to 3, the mean QOL score was 0.38 (SD = 0.30). Depression symptoms were reported by 25.5%, internalized stigma was high, and most reported little to no social support. Multivariable analysis revealed positive associations between QOL and CD4+ T cells (b = .0011, p = .021) and social support (b = .260, p < .0001) and a negative relationship between QOL and internalized stigma (b = -.232, p < .0001). Interventions focused on improving QOL for WLWH should incorporate strategies to improve social support and adherence to antiretroviral therapy, while mitigating internalized stigma.





Categorías: Investigaciones

Geographic disparities in pneumonia-specific under-five mortality rates in Mainland China from 1996 to 2015: a population-based study

Vie, 07/04/2017 - 19:01
Publication date: Available online 22 March 2017
Source:International Journal of Infectious Diseases

Author(s): Leni Kang, Chunhua He, Lei Miao, Juan Liang, Jun Zhu, Xiaohong Li, Qi Li, Yanping Wang

Objectives This study aimed to investigate the disparities in pneumonia-specific under-five mortality rates (U5MRs) among and within three geographic regions in Mainland China from 1996 to 2015. Methods Data were obtained from the national Under-Five Child Mortality Surveillance System and grouped into 2-year periods. The Cochran–Armitage trend test and Cochran–Mantel–Haenszel test were used to assess trends and differences in the pneumonia-specific U5MRs among and within geographic regions. Relative risks (RRs) and 95% confidence intervals (95% CIs) were calculated. Results The pneumonia-specific U5MR decreased by 90.6%, 89.0%, and 83.5% in East, Middle, and West China, respectively, with a larger decrease in rural areas. The pneumonia-specific U5MR was highest in West China, and was 7.2 (95% CI 5.9–8.7) times higher than that in East China in 2014–2015. In 2014–2015, the RRs were 1.7 (95% CI 1.2–2.5), 1.6 (95% CI 1.1–2.1), and 3.4 (95% CI 2.8–4.0) between rural and urban areas in East, Middle, and West China, respectively. Conclusions Pneumonia-specific U5MRs decreased from 1996 to 2015 across China, particularly in rural areas. However, disparities remained among and within geographic regions. Additional strategies and interventions should be introduced in West China, especially the rural areas, to further reduce the pneumonia-specific U5MR.





Categorías: Investigaciones

Mortality Associated Characteristics of Traumatic Brain Injury Patients at the University Teaching Hospital of Kigali, Rwanda

Vie, 07/04/2017 - 19:01
Publication date: Available online 21 March 2017
Source:World Neurosurgery

Author(s): Elizabeth Krebs, Charles J. Gerardo, Lawrence P. Park, Joao Ricardo Nickenig Vissoci, Jean Claude Byiringiro, Fidele Byiringiro, Stephen Rulisa, Nathan Thielman, Catherine Staton

Objective Traumatic Brain Injury (TBI) is a leading cause of death and disability. TBI patients in low and middle- income countries have worse outcomes than those in high-income countries. We aimed to evaluate important clinical indicators associated with mortality for TBI patients at the University Teaching Hospital of Kigali (UTHK) Kigali, Rwanda. Methods Prospective consecutive sampling of TBI patients presenting to UTHK Accident and Emergency Department were screened for inclusion criteria: reported head trauma, alteration in consciousness, headache, or visible head trauma. Exclusion criteria were age <10 years, >48 hours after injury, or repeat visit. Data were assessed for association with death using logistic regression. Significant variables were included in an adjusted multivariable logistic regression model then refined via backwards elimination. Results Six hundred and eighty-four patients were enrolled between October 7, 2013 and April 6, 2014, 14 (2%) were excluded due to incomplete data. Eighty-one percent were male with mean age of 31 years (range, 10 – 89, SD 11.8). Most patients (80%) suffered mild TBI (Glasgow Coma Score (GCS) 13-15), 10% suffered moderate (GCS 9-12) and 10% sustained severe TBI (GCS 3-8). Multivariable logistic regression determined that GCS <13, hypoxia, bradycardia, tachycardia and age >50 years were significantly associated with death. Conclusion GCS <13, hypoxia, bradycardia, tachycardia and age >50 years were associated with mortality. These findings inform future research that may guide clinicians in prioritizing care for patients at highest risk of mortality.





Categorías: Investigaciones

Migration and infectious diseases

Vie, 07/04/2017 - 19:01
Publication date: Available online 20 March 2017
Source:Clinical Microbiology and Infection

Author(s): F. Castelli, G. Sulis

Background Infectious diseases still represent an important cause of morbidity and mortality among foreign-born individuals. The rising migration flows towards Europe throughout the last few years are raising renewed concerns about management issues and the potential associated risk for the native population. Aims To discuss the health implications and challenges related to the four phases of migration, from first arrival to stable resettlement. Sources Scientific literature and relevant statistical reports. Content Although infectious diseases are not a health priority at first arrival, a syndromic screening to identify the most common communicable conditions (pulmonary tuberculosis above all) should be promptly conducted. Reception centres where asylum seekers are gathered after arrival may be crowded, so favouring epidemic outbreaks, sometimes caused by incomplete vaccine coverage for preventable diseases. After resettlement, the prevalence of some chronic infections such as human immunodeficiency virus, viral hepatitis or tuberculosis largely reflects the epidemiological pattern in the country of origin, with poor living conditions being an additional driver. Once resettled, migrants usually travel back to their country of origin without seeking pre-travel advice, which results in a high incidence of malaria and other infections. Implications Although infectious diseases among migrants are known to have a negligible impact on European epidemiology, screening programmes need to be implemented and adapted to the different stages of the migratory process to better understand the trends and set priorities for action. Appropriate access to care regardless of the legal status is crucial to improve the health status and prevent the spread of contagious conditions.





Categorías: Investigaciones

Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet–American University of Beirut Commission on Syria

Vie, 07/04/2017 - 19:01
Publication date: Available online 15 March 2017
Source:The Lancet

Author(s): Fouad M Fouad, Annie Sparrow, Ahmad Tarakji, Mohamad Alameddine, Fadi El-Jardali, Adam P Coutts, Nour El Arnaout, Lama Bou Karroum, Mohammed Jawad, Sophie Roborgh, Aula Abbara, Fadi Alhalabi, Ibrahim AlMasri, Samer Jabbour

The conflict in Syria presents new and unprecedented challenges that undermine the principles and practice of medical neutrality in armed conflict. With direct and repeated targeting of health workers, health facilities, and ambulances, Syria has become the most dangerous place on earth for health-care providers. The weaponisation of health care—a strategy of using people's need for health care as a weapon against them by violently depriving them of it—has translated into hundreds of health workers killed, hundreds more incarcerated or tortured, and hundreds of health facilities deliberately and systematically attacked. Evidence shows use of this strategy on an unprecedented scale by the Syrian Government and allied forces, in what human rights organisations described as a war-crime strategy, although all parties seem to have committed violations. Attacks on health care have sparked a large-scale exodus of experienced health workers. Formidable challenges face health workers who have stayed behind, and with no health care a major factor in the flight of refugees, the effect extends well beyond Syria. The international community has left these violations of international humanitarian and human rights law largely unanswered, despite their enormous consequences. There have been repudiated denunciations, but little action on bringing the perpetrators to justice. This inadequate response challenges the foundation of medical neutrality needed to sustain the operations of global health and humanitarian agencies in situations of armed conflict. In this Health Policy, we analyse the situation of health workers facing such systematic and serious violations of international humanitarian law. We describe the tremendous pressures that health workers have been under and continue to endure, and the remarkable resilience and resourcefulness they have displayed in response to this crisis. We propose policy imperatives to protect and support health workers working in armed conflict zones.





Categorías: Investigaciones

Bidirectional Exchange of Health Professionals’ Students; Ensuring Equity between Partners

Vie, 07/04/2017 - 19:01
Publication date: January–February 2017
Source:Annals of Global Health, Volume 83, Issue 1

Author(s): S.N. Byekwaso







Categorías: Investigaciones

Cultivating the Next Generation of Health Care Providers in Sub-Saharan Africa: The Global Health Service Partnership – Update 2016

Vie, 07/04/2017 - 19:01
Publication date: January–February 2017
Source:Annals of Global Health, Volume 83, Issue 1

Author(s): J. Anathan, E. Cunningham, L. Foradori, E. Stuart-Shor, S. Sayeed, V. Kerry







Categorías: Investigaciones

Effect of Ethiopia's Health Development Army on maternal and newborn health care practices: A multi-level cross-sectional analysis

Vie, 07/04/2017 - 19:01
Publication date: January–February 2017
Source:Annals of Global Health, Volume 83, Issue 1

Author(s): W. Betemariam, Z. Damtew, C. Tesfaye, N. Fesseha, A.M. Karim







Categorías: Investigaciones

A New Cadre of Health Worker: Meeting Health Organization Capacity Needs in East and Southern Africa and the United States via a leadership Development Fellowship program

Vie, 07/04/2017 - 19:01
Publication date: January–February 2017
Source:Annals of Global Health, Volume 83, Issue 1

Author(s): J. Gomez, B. Bush, H. Anderson







Categorías: Investigaciones

A Global Analysis of the Proportion of Surgical Specialists in Relation to Overall Human Resources for Health

Vie, 07/04/2017 - 19:01
Publication date: January–February 2017
Source:Annals of Global Health, Volume 83, Issue 1

Author(s): K. Nyberger, H. Holmer, L. Hagander, S. Mukhopadhyay







Categorías: Investigaciones

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