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Mirhosseini N, Shoorgashti R, Lesan S. The evaluation of clinical factors affecting oral health impacts on the quality of life of Iranian elderly patients visiting dental clinics: A cross-sectional study. Spec Care Dentist 2024. [PMID: 38430466 DOI: 10.1111/scd.12980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Iran will soon have an aging population. Healthcare providers must consider factors affecting the quality of life for those 60 and older. Understanding oral health as one of these factors can improve the elderly's quality of life. Oral health-related quality of life (OHRQoL) is a crucial reflection of individuals' general well-being and their overall quality of life linked to health. This study aimed to evaluate the OHRQoL among elderly Iranians referring to Azad University of Medical Sciences in Tehran. METHODS In this cross-sectional study, 171 individuals over 65 (93 men and 78 women) were evaluated using OHIP-14 and GOHAI-12 questionnaires to analyze their quality of life. Gender, age, systemic diseases, using medications and dentures, the number of remaining teeth, and oral lesions were recorded. Salivary flow and xerostomia were analyzed with the spitting method and xerostomia index questionnaire, respectively. Also, four main flavor solutions were used to evaluate the taste perception. Data were analyzed using PASS11 and p value < .05 was the significance level. RESULTS Based on OHIP-14 and GOHAI-12, Iranian older people's quality of life can be affected by cardiovascular diseases, hypertension, xerostomia, and the number of remaining teeth (p < .05). The results also showed a significant correlation between the OHIP-14 and GOHAI-12 scores (p < .001). Both indexes revealed that the number of remaining teeth, xerostomia, salivary flow, and taste perception greatly influenced participants' quality of life. More remaining teeth, improved salivary flow, and better perception of sweetness and sourness were all linked to a higher quality of life, while increased xerostomia, reduced salivary flow, and bitter taste perception were linked to a decline in overall well-being. Cardiovascular diseases, hypertension, and medication use were also found to significantly impact quality of life. CONCLUSION This study's results indicate that cardiovascular diseases, hypertension, dry mouth, and tooth loss can negatively impact the elderly's quality of life. So, improving both systemic and oral health is vital for enhancing life quality in this age group.
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Affiliation(s)
- Nazanin Mirhosseini
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Islamic Azad University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Reyhaneh Shoorgashti
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Islamic Azad University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Simin Lesan
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Islamic Azad University of Medical Sciences, Tehran, Islamic Republic of Iran
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Dzikowicz DJ, Saoji SB, Tam WC, Brunner WM, Carey MG. The Effect of Mandatory Fitness Requirements on Cardiovascular Events: A State-by-State Analysis Using a National Database. Workplace Health Saf 2024; 72:101-107. [PMID: 38217417 DOI: 10.1177/21650799231221575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
BACKGROUND Cardiovascular events are known to be the leading cause of death among on-duty firefighters. Implementing fitness standards may help reduce the incidence of cardiovascular deaths; however, standards vary between firefighter type and states. We aimed to investigate the rate of cardiovascular events among firefighters across states. METHODS Using publicly available data from the United States Fire Administration, we explored the rates of cardiovascular deaths between firefighter type (e.g., career, volunteer, and wildland) and state. Specifically, we examined rates of cardiovascular deaths between California and Tennessee, which have fitness standards for all firefighters, and New York, which does not have fitness standards for volunteer firefighters. We used descriptive statistics and trend analysis to examine the data. FINDINGS Most cardiovascular events occur among volunteer firefighters (60.6%, n = 877). Volunteer firefighters had 7.5 (95% CI = [4.8, 11.7], p < .001) greater odds of cardiovascular events compared to wildland firefighters, who had the lowest incidence of cardiovascular events (1.7%, n = 24). New York reported the most cardiovascular events (n = 161), primarily among volunteer firefighters (73.9%, n = 119). After the passage of legislation mandating fitness standards in California, a downtrend in the number of volunteer firefighter fatalities is observed. However, a null effect was observed in Tennessee after the passage of similar fitness standards as in California. CONCLUSIONS/APPLICATIONS TO PRACTICE Volunteer firefighters are significantly more likely to die of a cardiovascular event than career and wildland firefighters, both of which have stricter fitness standards. However, the effect of legislation mandating stricter fitness standards among volunteers did not produce a clear benefit for preventing fatalities. Nurses need to promote cardiovascular health among volunteer firefighters.
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Affiliation(s)
- Dillon J Dzikowicz
- School of Nursing, University of Rochester
- University of Rochester Medical Center
- Clinical Cardiovascular Research Center
| | | | - Wai Cheong Tam
- Fire Research Division, National Institute of Standards and Technology
| | | | - Mary G Carey
- School of Nursing, University of Rochester
- University of Rochester Medical Center
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Zadey S, Rao S, Gondi I, Sheneman N, Patil C, Nayan A, Iyer H, Kumar AR, Prasad A, Finley GA, Prasad CRK, Chintamani, Sharma D, Ghosh D, Jesudian G, Fatima I, Pattisapu J, Ko JS, Bains L, Shah M, Alam MS, Hadigal N, Malhotra N, Wijesuriya N, Shukla P, Khan S, Pandya S, Khan T, Tenzin T, Hadiga VR, Peterson D. Achieving Surgical, Obstetric, Trauma, and Anesthesia (SOTA) care for all in South Asia. Front Public Health 2024; 12:1325922. [PMID: 38450144 PMCID: PMC10915281 DOI: 10.3389/fpubh.2024.1325922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
South Asia is a demographically crucial, economically aspiring, and socio-culturally diverse region in the world. The region contributes to a large burden of surgically-treatable disease conditions. A large number of people in South Asia cannot access safe and affordable surgical, obstetric, trauma, and anesthesia (SOTA) care when in need. Yet, attention to the region in Global Surgery and Global Health is limited. Here, we assess the status of SOTA care in South Asia. We summarize the evidence on SOTA care indicators and planning. Region-wide, as well as country-specific challenges are highlighted. We also discuss potential directions-initiatives and innovations-toward addressing these challenges. Local partnerships, sustained research and advocacy efforts, and politics can be aligned with evidence-based policymaking and health planning to achieve equitable SOTA care access in the South Asian region under the South Asian Association for Regional Cooperation (SAARC).
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Affiliation(s)
- Siddhesh Zadey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- GEMINI Research Center, Duke University School of Medicine, Durham, NC, United States
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India
| | - Shirish Rao
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Isha Gondi
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Health and Human Sciences, Baylor University, Waco, TX, United States
| | - Natalie Sheneman
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
| | - Chaitrali Patil
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Biology and Statistics, George Washington University, Washington, DC, United States
| | - Anveshi Nayan
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Himanshu Iyer
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
| | - Arti Raj Kumar
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Arun Prasad
- Indraprastha Apollo Hospital, New Delhi, India
| | - G. Allen Finley
- Department of Anesthesiology, Dalhousie University, Halifax, NS, Canada
| | | | - Chintamani
- Department of Surgery, Vardhman Mahavir Medical College Safdarjung Hospital, New Delhi, India
| | - Dhananjaya Sharma
- Department of Surgery, NSCB Government Medical College, Jabalpur, India
| | - Dhruva Ghosh
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Gnanaraj Jesudian
- Karunya Rural Community Hospital Karunya Nagar, Coimbatore, Tamil Nadu, India
- Association of Rural Surgeons of India, Wardha, India
- International Federation of Rural Surgeons, Ujjain, India
- Rural Surgery Innovations Private Limited, Dimapur, Nagaland, India
| | - Irum Fatima
- IRD Pakistan and the Global Surgery Foundation, Karachi, Sindh, Pakistan
| | - Jogi Pattisapu
- University of Central Florida College of Medicine, Orlando, FL, United States
| | - Justin Sangwook Ko
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, Maharashtra, India
| | - Mashal Shah
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Mohammed Shadrul Alam
- Department of Pediatric Surgery, Mugda Medical College, Dhaka, Bangladesh
- American College of Surgeons: Bangladesh Chapter, Dhaka, Bangladesh
- Bangladesh Health Economist Forum, Dhaka, Bangladesh
- Association of Pediatric Surgeons of Bangladesh (APSB), DMCH, Dhaka, Bangladesh
| | - Narmada Hadigal
- Narmada Fertility Centre, Hyderabad, Telangana, India
- International Trauma Anesthesia and Critical Care Society, Stavander, Stavanger, Norway
| | - Naveen Malhotra
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Nilmini Wijesuriya
- College of Anaesthesiologists and Intensivists of Sri Lanka, Rajagiriya, Sri Lanka
| | - Prateek Shukla
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Sadaf Khan
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sunil Pandya
- Department of Anaesthesia, Perioperative Medicine and Critical Care, AIG Hospitals, Hyderabad, Telangana, India
| | - Tariq Khan
- Department of Neurosurgery, Northwest School of Medicine, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Tashi Tenzin
- Army Medical Services, Military Hospital, Thimphu, Bhutan
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | | | - Daniel Peterson
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
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Dubas-Jakóbczyk K, Gonzalez AI, Domagała A, Astier-Peña MP, Vicente VC, Planet AG, Quadrado A, Serrano RM, Abellán IS, Ramos A, Ballester M, Seils L, Dan S, Flinterman L, Likic R, Batenburg R. Medical deserts in Spain-Insights from an international project. Int J Health Plann Manage 2024. [PMID: 38358842 DOI: 10.1002/hpm.3782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/08/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Medical deserts are a growing phenomenon across many European countries. They are usually defined as (i) rural areas, (ii) underserved areas or (iii) by applying a measure of distance/time to a facility or a combination of the three characteristics. The objective was to define medical deserts in Spain as well as map their driving factors and approaches to mitigate them. METHODS A mixed methods approach was applied following the project "A Roadmap out of medical deserts into supportive health workforce initiatives and policies" work plan. It included the following elements: (i) a scoping literature review; (ii) a questionnaire survey; (iii) national stakeholders' workshop; (iv) a descriptive case study on medical deserts in Spain. RESULTS Medical deserts in Spain exist in the form of mostly rural areas with limited access to health care. The main challenge in their identification and monitoring is local data availability. Diversity of both factors contributing to medical deserts and solutions applied to eliminate or mitigate them can be identified in Spain. They can be related to demand for or supply of health care services. More national data, analyses and/or initiatives seem to be focused on the health care supply dimension. CONCLUSIONS Addressing medical deserts in Spain requires a comprehensive and multidimensional approach. Effective policies are needed to address both the medical staff education and planning system, working conditions, as well as more intersectoral approach to the population health management.
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Affiliation(s)
| | - Ana Isabel Gonzalez
- Avedis Donabedian Instituto Universitario-UAB, Barcelona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Alicja Domagała
- Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Maria Pilar Astier-Peña
- Centro de Salud de Universitas, Servicio Aragonés de Salud, Zaragoza, Spain
- Grupo H36_23D H36_23D Feminización y Ética de las Profesiones Sanitarias (FEPS), IIS_Aragón, Zaragoza, Spain
| | - Veronica Casado Vicente
- Centro de Salud Universitario Parquesol, Sanidad de Castilla y León, Valladolid, Spain
- Unidad Docente Universitaria de Medicina Familiar y Comunitaria, Facultad de Medicina, Valladolid, Spain
| | - Antonia-Gema Planet
- Unidad de Apoyo Técnico DA Noroeste y DA Centro, Dirección Técnica de Sistemas de Información, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de la Salud, Madrid, Spain
| | - Agueda Quadrado
- Centro de Salud de Navas Del Rey, Navas del Rey, Servicio Madrileño de la Salud, Tres Cantos, Madrid, Spain
| | - Rosa Mari Serrano
- Centre d'Atenció Primària Marià Fortuny, L'Entitat de Dret Públic Salut Sant Joan de Reus - Baix Camp, CatSalut, Servei Català de la Salut, Reus, Tarragona, Spain
| | | | - Alba Ramos
- Punto de Atención Continuada Tres Cantos, Servicio Madrileño de la Salud, Tres Cantos, Madrid, Spain
| | - Marta Ballester
- Avedis Donabedian Instituto Universitario-UAB, Barcelona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Laura Seils
- Avedis Donabedian Instituto Universitario-UAB, Barcelona, Spain
| | - Sorin Dan
- School of Management, University of Vaasa, Vaasa, Finland
| | - Linda Flinterman
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Robert Likic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Sociology, Radboud University, Nijmegen, The Netherlands
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Manea S, Visonà Dalla Pozza L, Minichiello C, Altieri L, Mazzucato M, Bonin M, De Ambrosis P, Borgonovi E, Facchin P. High-cost drugs for rare diseases: their expenditure and value based on a regional area-based study. Health Serv Manage Res 2024; 37:52-60. [PMID: 36627202 DOI: 10.1177/09514848231151814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: in the field of rare diseases (RDs) most of the European studies on budget impact analysis of drugs that have been conducted often lay on theoretical assumptions and focus only on Orphan drugs (ODs). Objectives: we aimed to estimate the budget impact of specific drugs for non-oncological RDs, both ODs and non-ODs, using real-world data about patients residing in Veneto Region (Italy) and to describe its expenditure structure and dynamics. Methods: a population-based multi-source observational study was conducted using data from Regional administrative databases; an ad-hoc drugs' list specific for RDs including both ODs and non-ODs and classifying them by ATC codes has been created. Results: In 2019, the total expenditure for drugs specific for RDs was EUR 97.2 million (6.6% of the total Regional budget). The RD drug list included 58 ATC codes, of which 15 ATC had an annual budget impact over EUR 1 million ("blockbuster drugs"). The most expensive treatment was a non-OD drug (Coagulation factor VIII). The two most represented therapeutical areas were the metabolic and the hematological ones. Conclusions: Cost analyses on RD high-cost drugs expenditure should consider any specific RD drug, not only ODs. Expenditure dynamics for RD drugs are peculiar showing "blockbuster drugs". Some therapeutical areas seem to be lacking in the drug research field.
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Affiliation(s)
- Silvia Manea
- Department of Women's and Children's Health, Coordinating Centre for Rare Diseases, Padova, Italy
| | - Laura Visonà Dalla Pozza
- Department of Women's and Children's Health, Coordinating Centre for Rare Diseases, Padova, Italy
| | - Cinzia Minichiello
- Department of Women's and Children's Health, Coordinating Centre for Rare Diseases, Padova, Italy
| | - Linda Altieri
- Department of Women's and Children's Health, Coordinating Centre for Rare Diseases, Padova, Italy
| | - Monica Mazzucato
- Department of Women's and Children's Health, Coordinating Centre for Rare Diseases, Padova, Italy
| | - Mauro Bonin
- Instrumental Resources Office, Veneto Region Health Service Administration, Venezia, Italy
| | - Paola De Ambrosis
- Regional Pharmaceutical Office, Veneto Region Health Service Administration, Venice, Italy
| | - Elio Borgonovi
- Director of Institute of Public Administration and Health Care Management, Bocconi University, Milano, Italy
| | - Paola Facchin
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
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Espinoza MA, Cabieses B, Goic C, Andrade A. The legal path for priority setting in Chile: a critical analysis to improve health planning and stewardship. Front Public Health 2024; 11:1302640. [PMID: 38259787 PMCID: PMC10801194 DOI: 10.3389/fpubh.2023.1302640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
Health systems have committed their path to universal health coverage using health planning to accomplish their goals of efficiency, equity and sustainability. Chile, a high-income country with a public-private mix health system, has made significant progress through several successive health policies implemented in the last 20 years which have been consistent with this approach. However, in the last 5 years, the national congress has produced several disease-specific laws, which have been mainly promoted by the civil society. These laws indicate the actions the health authority must perform to tackle the needs of the affected population, which ultimately determine the priorities of the health system. We argue that this legal pattern has become an alternative path to priority-setting, as opposed to health planning. We claim this "legal path" is a mechanism used by civil society in a context where the health authority fails to implement a robust and legitimate prioritization process. Although these laws have brought benefits to patients suffering the corresponding conditions, we highlight this approach does not guarantee improvements in equity, efficiency and health system performance. Instead, we advocate for taking back the control of the priority-setting based on health planning, through a new institutionalization of health technology assessment and quality of care.
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Affiliation(s)
- Manuel Antonio Espinoza
- Departamento de Salud Pública, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Centro para la Prevención y Control del Cancer (CECAN) & Departamento de Hemotaologia y Oncología, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Baltica Cabieses
- Centro para la Prevención y Control del Cancer (CECAN) & Departamento de Hemotaologia y Oncología, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Center for Global Intercultural Health, University for Development, Santiago, Chile
| | - Carolina Goic
- Centro para la Prevención y Control del Cancer (CECAN) & Departamento de Hemotaologia y Oncología, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Phuangmali K, Sukprakun C. Agreement between Thai Cardiovascular Risk Scores and Myocardial Perfusion Imaging: Exploring Associations and Clinical Implications. Indian J Nucl Med 2023; 38:350-353. [PMID: 38390529 PMCID: PMC10880838 DOI: 10.4103/ijnm.ijnm_61_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/14/2023] [Accepted: 09/25/2023] [Indexed: 02/24/2024] Open
Abstract
Purpose This study aimed to assess the agreement between the Thai cardiovascular (CV) risk score or pretest probability (PTP), and myocardial perfusion imaging (MPI), and to explore the association between abnormal MPI results and higher Thai CV risk scores or PTP risk. Materials and Methods The study was conducted between March 2017 and December 2021, and included 128 patients. Myocardial perfusion gated single photon emission computed tomography imaging was performed on all patients, and agreement between the Thai CV risk score, PTP, and MPI was measured using weighted Cohen's kappa statistic. Logistic regression was used to calculate odds ratios (OR) and explore the association. Results Fair agreement was observed between MPI and the Thai CV risk score (κ =0.269, P = 0.010), including patients with clinical chest pain (κ =0.367, P < 0.001). Subgroup analysis of patients with intermediate PTP revealed moderate agreement between MPI and the Thai CV risk score (κ =0.428, P = 0.002). Patients with intermediate (OR = 3.25, P = 0.010) or high (OR = 4.78, P = 0.001) Thai CV risk scores had significantly higher odds of having intermediate or high MPI results compared to those with low Thai CV risk scores. Conclusion This study highlights the agreement between MPI and the Thai CV risk score and PTP. Higher Thai CV risk scores are associated with increased odds of abnormal MPI results. These findings provide valuable insights for clinical decision-making and patient management.
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Affiliation(s)
- Kitwiwat Phuangmali
- Department of Radiology, Division of Nuclear Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chanan Sukprakun
- Department of Radiology, Division of Nuclear Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Lin MH, Chen TJ, Chou YJ. Changes in the Place of Death and Implications for End-of-Life Care Policy: A Population-Based Observational Study. J Palliat Med 2023; 26:1340-1347. [PMID: 37163202 DOI: 10.1089/jpm.2022.0567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Background: Death in hospital rather than at home is becoming more prevalent, even among terminally ill patients receiving home-based care. Identifying trends in places of death is crucial to care policy, especially for aging populations as in Taiwan. Aim: To identify changes in the places of natural death of Taiwanese individuals for various causes of death. Design: A population-based observational study was conducted. Setting: Anonymous data for the period 2000-2020 from the Death Database of Taiwan's National Center for Health Statistics Data were obtained and analyzed. Results: In 2000, 60.1% of natural deaths occurred in the home, whereas in 2020, this percentage was only 36.8%; conversely, the percentage of deaths in hospital increased from 34.4% in 2000 to 56.1% in 2020. Deaths in a nursing home or long-term care facility were found to account for only 3.8% of all natural deaths in 2020. Dementia was the cause of death for which the proportion of institutional deaths was highest, although this proportion was <10% for most years. We applied the joinpoint regression model to estimate trend changes in places of death. During the study period, the places of death in Taiwan changed significantly, the average annual percent changes for hospital deaths over the 21-year period was 2.54% (confidence interval [CI]: 2.04 to 3.03), and for home deaths was -2.69% (CI: -3.26 to -2.13). Conclusions: The detailed findings of this national study can offer insight into potential future clinical burdens and lead to better health policy decisions for Taiwan.
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Affiliation(s)
- Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Family Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Office of the Superintendent, Taipei Veterans General Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Yiing-Jenq Chou
- Department of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Ilan, Taiwan
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Loggetto P, Jarquin-Pardo M, Fuentes-Alabi S, Vasquez L, Benitez Majano S, Gonzalez Ruiz A, Maza M, Metzger ML, Friedrich P, Luciani S, Lam CG. Regional collaboration for the development of national childhood cancer plans in Latin America and the Caribbean. Rev Panam Salud Publica 2023; 47:e125. [PMID: 37750054 PMCID: PMC10516325 DOI: 10.26633/rpsp.2023.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/21/2023] [Indexed: 09/27/2023] Open
Abstract
This article aims to describe the activities conducted by the National Childhood Cancer Plan Working Group to support the development of national childhood cancer plans in Latin America and the Caribbean in the period 2019-2022, and to present the stage of plan development. The Working Group activities were supported by the Pan American Health Organization and St. Jude Children's Research Hospital, which is the World Health Organization (WHO) Collaborating Centre for Childhood Cancer. Year after year, the workshops and activities developed with the Working Group mobilized key stakeholders: pediatric oncologists, representatives of the Ministry of Health, foundations supporting childhood cancer initiatives, and hospital administrators. As of February 2023, one regional framework is in place, approved by the Council of Ministries of Health of Central America and the Dominican Republic, nine countries are currently implementing national plans or laws that include childhood cancer, and ten countries are writing new plans. The WHO three-step framework helped to guide the Working Group activities. All plans were supported by a situational analysis, which highlighted the importance of having systematized data for evidence-based policies. To increase implementation success, an accompanying budget and timeline help to ensure the adequate implementation of the interventions. More than anything, committed stakeholders remain the most fundamental element to successfully write and approve a national childhood cancer plan. This is an opportunity to share these countries' experience so the strategy can be adapted to support other countries developing a childhood cancer plan and extended to other public health areas.
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Affiliation(s)
- Patrícia Loggetto
- St. Jude Children’s Research HospitalWHO Collaborating Centre for Childhood CancerMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, WHO Collaborating Centre for Childhood Cancer, Memphis, United States of America
| | - Marta Jarquin-Pardo
- St. Jude Children’s Research HospitalWHO Collaborating Centre for Childhood CancerMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, WHO Collaborating Centre for Childhood Cancer, Memphis, United States of America
| | - Soad Fuentes-Alabi
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Liliana Vasquez
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Sara Benitez Majano
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Alejandra Gonzalez Ruiz
- St. Jude Children’s Research HospitalWHO Collaborating Centre for Childhood CancerMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, WHO Collaborating Centre for Childhood Cancer, Memphis, United States of America
| | - Mauricio Maza
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Monika L. Metzger
- Médecins Sans FrontièresGenevaSwitzerlandMédecins Sans Frontières, Geneva, Switzerland
| | - Paola Friedrich
- St. Jude Children’s Research HospitalWHO Collaborating Centre for Childhood CancerMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, WHO Collaborating Centre for Childhood Cancer, Memphis, United States of America
| | - Silvana Luciani
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Catherine G. Lam
- St. Jude Children’s Research HospitalWHO Collaborating Centre for Childhood CancerMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, WHO Collaborating Centre for Childhood Cancer, Memphis, United States of America
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10
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Belt RV, Abdullah S, Mounier-Jack S, Sodha SV, Danielson N, Dadari I, Olayinka F, Ray A, Crocker-Buque T. Improving Equity in Urban Immunization in Low- and Middle-Income Countries: A Qualitative Document Review. Vaccines (Basel) 2023; 11:1200. [PMID: 37515016 PMCID: PMC10386579 DOI: 10.3390/vaccines11071200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION As the world continues to urbanize, particularly in low- and middle-income countries, understanding the barriers and effective interventions to improve urban immunization equity is critical to achieving both Immunization Agenda 2030 targets and the Sustainable Development Goals. Approximately 25 million children missed one or more doses of the diphtheria, tetanus and pertussis (DTP3) vaccine in 2021 and it is estimated that close to 30% of the world's children missing the first dose of DTP, known as zero-dose, live in urban and peri-urban settings. METHODS The aim of this research is to improve understanding of urban immunization equity through a qualitative review of mixed method studies, urban immunization strategies and funding proposals across more than 70 urban areas developed between 2016 and 2020, supported by Gavi, the Vaccine Alliance. These research studies and strategies created a body of evidence regarding the barriers to vaccination in urban settings and potential interventions relevant to low- and middle-income countries (LMICs) with a focus on the vaccination of urban poor, populations of concern and residents of informal settlements. Through the document review we identified common challenges to achieving equitable coverage in urban areas and mapped proposed interventions. RESULTS We identified 70 documents as part of the review and categorized results across (1) social determinants of health, (2) immunization service-delivery barriers and (3) quality of services. Barriers and solutions identified in the documents were categorized in these thematic areas, drawing information from results in more than 21 countries. CONCLUSION Populations of concern such as migrants, refugees, residents of informal settlements and the urban poor face barriers to accessing care which include poor availability and quality of service. Example solutions proposed to these challenges include tailored delivery strategies, improved use of digital data collection and child-friendly services. More research is required on the efficacy of the proposed interventions identified and on gender-specific dynamics in urban poor areas affecting equitable immunization coverage.
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Affiliation(s)
- Rachel Victoria Belt
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, 75 George Street, Oxford OX1 2RL, UK
| | - Shakil Abdullah
- Department of Anthropology, University of Connecticut, Storrs, CT 06269, USA
| | - Sandra Mounier-Jack
- Department of Global Health Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Samir V. Sodha
- Department of Immunization Vaccines and Biologicals, WHO Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Niklas Danielson
- Coverage & Equity Unit, Immunization Section, PG-Health, UNICEF Headquarters, 3 UN Plaza, New York, NY 10017, USA
| | - Ibrahim Dadari
- Coverage & Equity Unit, Immunization Section, PG-Health, UNICEF Headquarters, 3 UN Plaza, New York, NY 10017, USA
| | - Folake Olayinka
- Public Health Institute, STAR Fellow Department, 901 D St, SW, Suite 1040, Washington, DC 20024, USA
| | - Arindam Ray
- Bill & Melinda Gates Foundation, New Delhi 110075, India
| | - Tim Crocker-Buque
- Department of Global Health Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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11
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Davis CS, Meyers P, Bazemore AW, Peterson LE. Impact of Service-Based Student Loan Repayment Program on the Primary Care Workforce. Ann Fam Med 2023; 21:327-331. [PMID: 37487722 PMCID: PMC10365874 DOI: 10.1370/afm.3002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/15/2023] [Accepted: 03/15/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE As the average level of medical education indebtedness rises, physicians look to programs such as Public Service Loan Forgiveness (PSLF) and National Health Service Corps (NHSC) to manage debt burden. Both represent service-dependent loan repayment programs, but the requirements and program outcomes diverge, and assessing the relative uptake of each program may help to inform health workforce policy decisions. We sought to describe variation in the composition of repayment program participant groups and measure relative impact on patient access to care. METHODS In this bivariate analysis, we analyzed data from 10,677 respondents to the American Board of Family Medicine's National Graduate Survey to study differences in loan repayment program uptake as well as the unique participant demographics, scope of practice, and likelihood of practicing with a medically underserved or rural population in each program cohort. RESULTS The rate of PSLF uptake tripled between 2016 and 2020, from 7% to 22% of early career family physicians, while NHSC uptake remained static at 4% to 5%. Family physicians reporting NHSC assistance were more likely than those reporting PSLF assistance to come from underrepresented groups, demonstrated a broader scope of practice, and were more likely to practice in rural areas (23.3% vs 10.8%) or whole-county Health Professional Shortage Areas (12.5% vs 3.7%) and with medically underserved populations (82.2% vs 24.2%). CONCLUSIONS Although PSLF supports family physicians intending to work in public service, their peers who choose NHSC are much more likely to work in underserved settings. Our findings may prompt a review of the goals of service loan forgiveness programs with potential to better serve health workforce needs.
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Affiliation(s)
- Caitlin S Davis
- Fairfax Family Medicine Program, Fairfax, VA, and a past postdoctoral fellow at the American Board of Family Medicine, Washington, DC
| | - Peter Meyers
- The University of Minnesota Medical School, Minneapolis, Minnesota
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12
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Lawton T, Corp A, Horsfield C, McCooe M, Stonelake P, Whiteley S. Building on a novel bootstrapping modelling technique to predict region-wide critical care capacity requirements over the next decade. Future Healthc J 2023; 10:50-55. [PMID: 37786497 PMCID: PMC10538684 DOI: 10.7861/fhj.2022-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
We have previously described an open-source data-driven modelling technique that has been used to model critical care resource provision as well as expanded to elective surgery and even whole-hospital modelling. Here, we describe the use of this technique to model patient flow and resource use across the West Yorkshire Critical Care Network, with the advantage that recommendations can be made at an individual unit level for future resource provision, taking into account changes in population numbers and demography over the coming decade. We will be using this approach in other regions around the UK to help predict future critical care capacity requirements.
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Affiliation(s)
- Tom Lawton
- Bradford Institute for Health Research, Bradford, UK
| | - Aaron Corp
- Bradford Institute for Health Research, Bradford, UK
| | - Claire Horsfield
- West Yorkshire Critical Care and Major Trauma Operational Delivery Network, Leeds, UK
| | - Michael McCooe
- Improvement Academy, Bradford Institute for Health Research, Bradford, UK
| | - Paul Stonelake
- West Yorkshire Critical Care and Major Trauma Operational Delivery Network, Leeds, UK
| | - Simon Whiteley
- West Yorkshire Critical Care and Major Trauma Operational Delivery Network, Leeds, UK
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Salinas-Perez JA, Gutierrez-Colosia MR, Garcia-Alonso CR, Furst MA, Tabatabaei-Jafari H, Kalseth J, Perkins D, Rosen A, Rock D, Salvador-Carulla L. Patterns of mental healthcare provision in rural areas: A demonstration study in Australia and Europe. Front Psychiatry 2023; 14:993197. [PMID: 36815193 PMCID: PMC9939444 DOI: 10.3389/fpsyt.2023.993197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Mental healthcare systems are primarily designed to urban populations. However, the specific characteristics of rural areas require specific strategies, resource allocation, and indicators which fit their local conditions. This planning process requires comparison with other rural areas. This demonstration study aimed to describe and compare specialized rural adult mental health services in Australia, Norway, and Spain; and to demonstrate the readiness of the healthcare ecosystem approach and the DESDE-LTC mapping tool (Description and Evaluation of Services and Directories of Long Term Care) for comparing rural care between countries and across areas. METHODS The study described and classified the services using the DESDE-LTC. The analyses included context analysis, care availability, placement capacity, balance of care, and diversity of care. Additionally, readiness (Technology Readiness Levels - TRL) and impact analyses (Adoption Impact Ladder - AIL) were also assessed by two independent raters. RESULTS The findings demonstrated the usability of the healthcare ecosystem approach and the DESDE-LTC to map and identify differences and similarities in the pattern of care of highly divergent rural areas. Day care had a greater weight in the European pattern of care, while it was replaced by social outpatient care in Australian areas. In contrast, care coordination was more common in Australia, pointing to a more fragmented system that requires navigation services. The share between hospital and community residential care showed no differences between the two regions, but there were differences between catchment areas. The healthcare ecosystem approach showed a TRL 8 (the tool has been demonstrated in a real-world environment and it is ready for release and general use) and an AIL of 5 (the target public agencies provided resources for its completion). Two experts evaluated the readiness of the use of DESDE-LTC in their respective regional studies. All of them were classified using the TRL. DISCUSSION In conclusion, this study strongly supports gathering data on the provision of care in rural areas using standardized methods to inform rural service planning. It provides information on context and service availability, capacity and balance of care that may improve, directly or through subsequent analyses, the management and planning of services in rural areas.
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Affiliation(s)
- Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain.,Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | | | - Carlos R Garcia-Alonso
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain.,Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Mary Anne Furst
- Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | | | | | - David Perkins
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,Centre for Rural and Remote Mental Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alan Rosen
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Daniel Rock
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,WA Primary Health Alliance, Subiaco, WA, Australia.,Discipline of Psychiatry, The University of Western Australia, Perth, WA, Australia
| | - Luis Salvador-Carulla
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,National Centre for Epidemiology and Population Health (NCEPH), Faculty of Health and Medicine, Australian National University, Canberra, Australia
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Alcalde-Rabanal JE, Torres-Grimaldo A, Becerril-Montekio V, Garcia-Cerde R, Reveiz L, Torres-Pereda P. Relevance and quality of implementation research proposals to face the challenges of public health in Latin-America and the Caribbean. Int J Health Plann Manage 2023; 38:162-178. [PMID: 36134742 DOI: 10.1002/hpm.3577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 06/17/2022] [Accepted: 08/31/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To analyse the relevance and quality of the research proposals submitted to the 2016 call for proposals for the initiative Improving Programme Implementation through Embedded Research (iPIER-2016) to address current public health challenges in Latin America and the Caribbean. METHODS We performed a cross-sectional study using information from 108 research proposals using quantitative and qualitative methods. We used three frameworks to analyse the relevance of the proposals: The Global Burden of Disease, the WHO Health Systems Conceptual Framework and the Sustainable Development Goals proposed in 2015 by the United Nations. We performed an index to analyse the relevance and quality of the proposals. RESULTS Twenty seven percent of the proposals have very good relevance, one third of the proposals have quality flaws. This means their research questions are not related to implementation research or their methods are insufficient or inadequate to respond to the objective. CONCLUSIONS The response to this call is proof of health authorities' interest in research as a tool to improve the implementation of health programs in the region. However, proposals show important variations in terms of relevance and quality among countries and training health staff in programme implementation seems a central requirement.
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Affiliation(s)
| | - Alejandro Torres-Grimaldo
- Direction of Health Systems Determinants and Challenges, Health Systems Research Center, National Institute of Public Health, Morelos, Mexico
| | - Victor Becerril-Montekio
- Direction of Health Systems Determinants and Challenges, Health Systems Research Center, National Institute of Public Health, Morelos, Mexico
| | - Rodrigo Garcia-Cerde
- Direction of Health Systems Determinants and Challenges, Health Systems Research Center, National Institute of Public Health, Morelos, Mexico
| | - Ludovic Reveiz
- Public Health Evidence, Evidence and Intelligence for Action in Health Department, PAHO, Washington, District of Columbia, USA
| | - Pilar Torres-Pereda
- Direction of Health Systems Determinants and Challenges, Health Systems Research Center, National Institute of Public Health, Morelos, Mexico
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15
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Askari A, Poursadeqiyan M, Sahl Abadi AS, Mahdinasab L, Farhadi AR. Semi-quantitative risk assessment for workers exposed to occupational harmful agents in an oilfield in Iran. Work 2023; 76:147-157. [PMID: 36872822 DOI: 10.3233/wor-220077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Workers are exposed to occupational health hazards from physical, chemical, biological, ergonomic, and psychological agents. Assessing occupational health risks is vital for executing control measures to protect employees' health against harmful occupational agents. OBJECTIVE The present study aimed to identify, evaluate, and prioritize occupational health risks to assist senior management in determining where to allocate the budget to carry out the required corrective actions in the oilfields project. METHODS This descriptive-analytical cross-sectional study was performed in 2021 among Iran's Sarvak Azar oil field job groups. The occupational health risk was assessed using the Harmful Agents Risk Priority Index (HARPI) as a semi-quantitative method. Then, to simplify decision-making and budget allocation, we reported HARPI final score in the Pareto principle format. RESULTS The results show that in this oil field, controlling exposure to adverse lighting, improving the thermal conditions and ergonomics, and preventing noise exposure has the highest priority, with scores of 6342, 5269, 5629, and 5050, respectively. Production, HSE, laboratory, and commissioning need the most health care measures with scores of 8683, 5815, 5394, and 4060, respectively. CONCLUSION HARPI could be used to prioritize occupational health hazards, and this method can simplify managers' decisions to allocate resources to implement control measures.
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Affiliation(s)
- Ali Askari
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Health, Safety, and Environment, OICO Occupational Health Division, Azar Oilfield, Ilam, Iran
| | - Mohsen Poursadeqiyan
- Department of Occupational Health Engineering, School of Public Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ali Salehi Sahl Abadi
- Workplace Health Promotion Research Center, Department of Occupational Health and Safety at Work, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Laila Mahdinasab
- Department of Work and Knowledge, Work and Education School, Mehran Education Office, Ilam, Iran
| | - Ali Reza Farhadi
- Department of Medical Education, Kermanshah University of Medical Sciences. Kermanshah, Iran
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Farinha CS, Nogueira PJ, Feteira-Santos R, Costa AS. Editorial: Public Health Data Challenges of the COVID-19 pandemic: A Sisyphean task! Front Public Health 2022; 10:1010055. [PMID: 36311629 PMCID: PMC9611197 DOI: 10.3389/fpubh.2022.1010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/30/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Carla Sofia Farinha
- Statistics Portugal, Presidência dop Conselho de Ministros, Lisboa, Portugal,Center for Environmental and Sustainability Research (CENSE), NOVA School of Science and Technology (FCT), NOVA University of Lisbon, Lisbon, Portugal,*Correspondence: Carla Sofia Farinha
| | - Paulo Jorge Nogueira
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal,Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal,Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Rodrigo Feteira-Santos
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal,Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Andreia Silva Costa
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal,Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal,Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Recchia V, Aloisi A, Zizza A. Risk management and communication plans from SARS to COVID-19 and beyond. Int J Health Plann Manage 2022; 37:3039-3060. [PMID: 35983693 PMCID: PMC9559595 DOI: 10.1002/hpm.3545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Nowadays, due to globalisation, the likelihood that infectious
diseases spread rapidly is extraordinarily high. SARS and COVID‐19 are two
diseases of the Coronavirus family, which developed in China and then spread
internationally, causing global public health emergencies. This study investigates
the role that risk management and communication systems played in mitigating these
emergencies, to establish how they should be improved in the future. Methods A narrative review was carried out to investigate different
knowledge domains, such as risk management and communication, risk assessment and
indicators, epidemiological and clinical data, diagnostic methods, vaccines,
public health and social measures. Results On one side, risk management systems assess the main data,
knowledge, and indicators on epidemiology, diagnostics, and vaccines
(science‐based); on the other side, they apply public health and social measures
(socially‐based). Decision‐makers, in fact, implement their actions by constantly
balancing these two sides (policy‐based). Conclusions A correct crisis management approach should support the governance
of pandemics, by harmonising the actual risks assessed by experts with those
perceived by the general population. It should incorporate not only the
biological, but even the environmental, social and economic aspects of virus
emergencies, towards establishing a suitable framework to deal with possible
future pandemics. COVID‐19 and SARS enhanced rapid research on specific
diagnostics and vaccines. Public health and social measures remain the primary response
to virus outbreaks. Risk perception affects people's behaviour and public health
measures' application. Risk management and communication plans are crucial to cope
with pandemics. SARS and COVID‐19 experiences should help to deal with future
virus emergencie.
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Affiliation(s)
- Virginia Recchia
- CNR-IFC National Research Council-Institute of Clinical Physiology, Lecce, Italy
| | - Alessandra Aloisi
- CNR-IMM National Research Council-Institute for Microelectronics and Microsystems, Lecce, Italy
| | - Antonella Zizza
- CNR-IFC National Research Council-Institute of Clinical Physiology, Lecce, Italy
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Samaan F, Gutierrez M, Kirsztajn GM, Sesso RC. Supply/demand ratio for medical consultations, diagnostic tests and chronic kidney disease monitoring in the Brazilian National Health System: a descriptive study, state of São Paulo, Brazil, 2019. Epidemiol Serv Saude 2022; 31:e20211050. [PMID: 35830061 PMCID: PMC9887954 DOI: 10.1590/s2237-96222022000200014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/22/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To determine the supply/demand ratio for procedures related to diagnosis and treatment for chronic kidney disease in the Brazilian National Health System (SUS), in the state of São Paulo, Brazil, 2019. METHODS This was a descriptive study, using data from the SUS outpatient and hospital information systems. The numbers of medical consultations, diagnostic and chronic kidney disease monitoring tests, performed in the period, were compared with the demand estimation, obtained through ministerial guidelines. RESULTS Exclusive SUS users were 28,791,244, and individuals with arterial hypertension and/or diabetes mellitus, 5,176,188. The number of procedures performed and the ratio between this number and the needs of the population were 389,414 consultations with nephrologists (85%); 11,540,371 serum creatinine tests (223%); 705,709 proteinuria tests (14%); 438,123 kidney ultrasounds (190%); and 1,045 kidney biopsies (36%). CONCLUSION In the chronic kidney disease care in the SUS it could be seen simultaneous existence of lack of supply, waste and inadequate screening of important procedures.
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Affiliation(s)
- Farid Samaan
- Secretaria de Estado da Saúde de São Paulo, Grupo de Planejamento e
Avaliação, São Paulo, SP, Brazil
| | - Marcelo Gutierrez
- Secretaria de Estado da Saúde de São Paulo, Grupo de Planejamento e
Avaliação, São Paulo, SP, Brazil
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Gupta M, Verma M, Chaudhary K, Bashar MDA, Bhag C, Kumar R. Effectiveness of a collaborative model in improving maternal and child health outcomes among urban poor in Chandigarh, a North Indian city. J Educ Health Promot 2022; 11:212. [PMID: 36003231 PMCID: PMC9393963 DOI: 10.4103/jehp.jehp_668_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND To ascertain the effectiveness of a collaborative model between the Department of Community Medicine and state health department to improve MCH outcomes among the urban poor in Chandigarh. MATERIALS AND METHODS A quasi-experimental study was conducted from 2011-12 to 2015-16 in the intervention and control areas. A collaboration was established between the state health department and the Department of Community Medicine of an autonomous institute. The intervention and control areas were mainly inhabited by the poor migrant population. Critical elements of an efficient collaboration such as the early engagement of partners, clearly stated purpose with common goals, effective communication, and no financial conflict were implemented in the intervention area. MCH program's implementation was strengthened through supportive supervision, enhanced community engagement, male partner involvement, tracking of high-risk pregnant women, and identification of problem families. Trend analysis of MCH indicators was done. The difference-in-difference (DID) analysis was done to measure the net effect of the intervention. RESULTS All the MCH indicators improved significantly in the intervention area compared to the control area (P < 0.05). DID analysis depicted a net increase in the early registration of pregnancies by 18%, tetanus toxoid immunization by 9.2%, and fully immunized children by 8.6%. There was also an improvement in the maternal mortality ratio by 121.1 points, infant mortality rate by 2.2 points, and neonatal mortality rate by 2.6 points in the intervention area. CONCLUSION An innovative, collaborative model between the state health department and the Department of Community Medicine effectively improved the MCH outcomes in Chandigarh.
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Affiliation(s)
- Madhu Gupta
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhur Verma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Krishna Chaudhary
- Civil Hospital (Sector 45), Chandigarh Administration, Chandigarh, India
| | - MD. Abu Bashar
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Chering Bhag
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Kumar
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Chernick LS, Konja A, Gonzalez A, Stockwell MS, Ehrhardt A, Bakken S, Westhoff CL, Dayan PS, Santelli J. Designing illustrative social media stories to promote adolescent peer support and healthy sexual behaviors. Digit Health 2022; 8:20552076221104660. [PMID: 35707267 PMCID: PMC9189520 DOI: 10.1177/20552076221104660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/14/2022] [Indexed: 12/31/2022] Open
Abstract
Objective Adolescent females in the United States continue to have unmet sexual and reproductive healthcare needs. Research shows that interventions incorporating peer support can augment perceived self-efficacy and reinforce healthy behaviors. Yet, few user-centered digital sexual health interventions incorporate peer support, and aim to change perceptions of peer norms and model social skills. The objective of this study was to design and demonstrate the receptivity of adolescent females to illustrated digital social media stories that promote healthy sexual behaviors and peer social support. Methods We conducted a three-phase study approved by our Institutional Review Board. In Phase 1, we presented sexually active adolescent female emergency department patients aged 14-19 with eight sexual health scenarios via a survey study. Participants wrote three text messages addressed to the protagonist of each scenario which motivated and encouraged her to consider the use of contraceptives. Messages were scored based on the construct of peer support (emotional, tangible, informational, and belonging). In Phase 2, we worked with a professional artist and screenwriter to design digital sexual health comics using the gathered messages. In Phase 3, we gathered feedback on the comics from adolescent female emergency department patients. Results Females (n = 22) provided 352 messages. Using top rated messages, we designed five digital visualizations in a running story called Mari tells it like it is. Each story incorporated 5-12 peer-authored quotes. We inserted the final images into Instagram®. Additional females (n = 39) found the images "relatable," "super-realistic," and "educational." Conclusion Collecting peer-authored texts from our local adolescent community led to the creation of well-received sexual health visualizations. This novel method of design incorporated adolescent voices to promote peer support and healthy behaviors.
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Affiliation(s)
- Lauren S Chernick
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA,Lauren S Chernick, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, 3959 Broadway, CHN 1-116, New York, NY, USA.
| | - Alexis Konja
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Ariana Gonzalez
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA
| | - Melissa S Stockwell
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA,Department of Child and Adolescent Health, Columbia University Medical Center, New York, NY, USA
| | - Anke Ehrhardt
- Department of Psychology, Columbia University Medical Center, New York, NY, USA
| | - Susanne Bakken
- Department of Nursing and Bioinformatics, Columbia University Medical Center, New York, NY, USA
| | - Carolyn L Westhoff
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA,Department of Obstetrics-Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Peter S Dayan
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA
| | - John Santelli
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA,Department of Child and Adolescent Health, Columbia University Medical Center, New York, NY, USA
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D'Agostino M, Marti MC, Jaime F, Garcia Saiso S. [Information systems for health: an analysis of design from a public policy perspectiveSistemas de informação para a saúde: uma análise do design na perspectiva das políticas públicas]. Rev Panam Salud Publica 2022; 46:e35. [PMID: 35509643 PMCID: PMC9063853 DOI: 10.26633/rpsp.2022.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 01/25/2022] [Indexed: 11/24/2022] Open
Abstract
In 2019, the Pan American Health Organization approved a regional policy known as the Plan of Action for Strengthening Information Systems for Health 2019-2023, the design of which is the subject of this article. This analysis was carried out from the point of view of the development of the plan of action, as well as its implementation, in the light of the theoretical concepts of Harold Lasswell and Charles Lindblom. In the study of this policy, consideration was given to context, focus on problems, diversity, and the variety of methods used. The impartial search for the public interest, design of practical policies, needs of public officials, and provision of recommendations are discussed. The policy can be implemented regardless of the administrative configuration of countries and territories, or the political power that other institutions may exercise. Its design is oriented toward universal access to health services in the countries of the Americas, taking into account cultural and linguistic diversity, including indigenous populations, which shows that it was contextualized for a region with high rates of inequities.
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Affiliation(s)
- Marcelo D'Agostino
- Organización Panamericana de la Salud Washington D.C. Estados Unidos Organización Panamericana de la Salud, Washington D.C. Estados Unidos
| | - Myrna C Marti
- Consultora Internacional Buenos Aires Argentina Consultora Internacional, Buenos Aires, Argentina
| | - Fernando Jaime
- Universidad Nacional del Litoral Buenos Aires Argentina Universidad Nacional del Litoral, Buenos Aires, Argentina
| | - Sebastian Garcia Saiso
- Organización Panamericana de la Salud Washington D.C. Estados Unidos Organización Panamericana de la Salud, Washington D.C. Estados Unidos
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22
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Chernick LS, Santelli J, Stockwell MS, Gonzalez A, Ehrhardt A, Thompson JL, Leu CS, Bakken S, Westhoff CL, Dayan PS. A multi-media digital intervention to improve the sexual and reproductive health of female adolescent emergency department patients. Acad Emerg Med 2022; 29:308-316. [PMID: 34738284 PMCID: PMC8960324 DOI: 10.1111/acem.14411] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adolescent females presenting to emergency departments (EDs) inconsistently use contraceptives. We aimed to assess implementation outcomes and potential efficacy of a user-informed, theory-based digital health intervention developed to improve sexual and reproductive health for adolescent females in the ED. METHODS We conducted a pilot-randomized controlled trial of sexually active female ED patients age 14-19 years. Participants were randomized to the intervention Dr. Erica (Emergency Room Interventions to improve the Care of Adolescents) or usual care. Dr. Erica consists of an ED-based digital intervention along with 3 months of personalized and interactive multimedia messaging. We assessed the feasibility, adoption, and fidelity of Dr. Erica among adolescent female users. Initiation of highly effective contraception was the primary efficacy outcome. RESULTS We enrolled 146 patients; mean (±SD) age was 17.7 (±1.27) years and 87% were Hispanic. Dr. Erica demonstrated feasibility, with high rates of consent (84.4%) and follow-up (82.9%). Intervention participants found Dr. Erica acceptable, liking (98.0%, on Likert scale) and recommending (83.7%) the program. A total of 87.5% adopted the program, responding to at least one text; a total of 289 weblinks were clicked. Dr. Erica demonstrated fidelity; few participants opted out (6.9%) and failed to receive texts (1.4%). Contraception was initiated by 24.6% (14/57) in the intervention and 21.9% (14/64) in the control arms (absolute risk difference [ARD] = 2.7%, 95% confidence interval [CI] = -12.4% to 17.8%). Participants receiving Dr. Erica were more likely to choose a method to start in the future (65.9% [27/41]) than controls (30.0% [15/50]); ARD = 35.9%, 95% CI = 16.6% to 55.1%). CONCLUSIONS A personalized, interactive digital intervention was feasible to implement, acceptable to female ED patients and demonstrated high fidelity and adoption. This ED-based intervention shows potential to improve contraception decision making.
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Affiliation(s)
- Lauren S Chernick
- Department of Emergency Medicine, Columbia University Medical Center
| | - John Santelli
- Department of Population and Family Health, Columbia Mailman School of Public Health, Columbia University Medical Center,Department of Pediatrics, Columbia University Medical Center
| | - Melissa S Stockwell
- Department of Population and Family Health, Columbia Mailman School of Public Health, Columbia University Medical Center,Department of Pediatrics, Columbia University Medical Center
| | - Ariana Gonzalez
- Department of Emergency Medicine, Columbia University Medical Center
| | - Anke Ehrhardt
- Department of Psychology, Columbia University Medical Center
| | - John L.P. Thompson
- Department of Biostatistics, Columbia Mailman School of Public Health and Department of Neurology, Columbia University Medical Center
| | - Cheng-Shiun Leu
- Department of Biostatistics, Columbia Mailman School of Public Health
| | - Susanne Bakken
- Department of Nursing and Bioinformatics, Columbia University Medical Center
| | - Carolyn L. Westhoff
- Department of Obstetrics-Gynecology and Department of Population and Family Health, Columbia Mailman School of Public Health, Columbia University Medical Center
| | - Peter S Dayan
- Department of Emergency Medicine, Columbia University Medical Center
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23
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Karamagi H, Titi-Ofei R, Amri M, Zombre S, Kipruto H, Seydi ABW, Avortri G, Nabyonga J, Tumusiime P. Cross country lessons sharing on practices, challenges and innovation in primary health care revitalization and universal health coverage implementation among 18 countries in the WHO African Region. Pan Afr Med J 2022; 41:159. [PMID: 35573441 PMCID: PMC9058992 DOI: 10.11604/pamj.2022.41.159.28913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 02/07/2022] [Indexed: 01/13/2023] Open
Abstract
The fifth health sector directors´ policy and planning meeting for the World Health Organization (WHO) regional office for Africa convened to focus on building health system resilience during the COVID-19 pandemic to ensure continuity of essential health services, primary health care (PHC) revitalization, and health system strengthening towards achieving universal health coverage (UHC). In this paper, we present short summaries and experiences shared by 18 countries, for which their practices and outcomes have been documented in this manuscript. These actions are aligned with six key themes: (i) defining and making more essential health services available, (ii) increasing service coverage targeting hard to reach populations, (iii) financial risk protection, (iv) improving user satisfaction with services, (v) improving health security, and (vi) improving coverage with health-related sector services. It is through these shared country experiences that lessons are learned that can influence the region´s work and advancement to achieve UHC through a PHC approach.
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Affiliation(s)
- Humphrey Karamagi
- WHO Regional Office for Africa,,Corresponding author: Humphrey Karamagi, WHO Regional Office for Africa.
| | | | - Michelle Amri
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 1P8, Canada,,Takemi Program in International Health, Harvard School of Public Health, Harvard University, 665 Huntington Avenue, Bldg 1, Room 1210, Boston, MA, 02115-6021, USA
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24
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Summers BE, Laver KE, Nicks RJ, Andrew NE, Barr CJ, Jolliffe L, Lannin NA. Patient functional independence and occupational therapist time-use in inpatient services: Patient demographic and clinical correlates. Hong Kong J Occup Ther 2022; 34:73-82. [PMID: 34987345 PMCID: PMC8721581 DOI: 10.1177/15691861211018758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Health care expenditure has rapidly increased in Australia. Effective management of occupational therapy services is required to meet clinical demand. Improving our understanding of factors which influence occupational therapy service delivery is a vital step to manage workload distribution and optimise service efficiency. This study aims to examine the influence of patient sociodemographic characteristics, diagnosis and functional independence on the utilisation of occupational therapy resources in hospital inpatients over 18 years old. Methods Prospective, cross-sectional, observational cohort study of 4549 inpatients from three hospital sites in Melbourne, Australia. Data extracted from organisational databases and included in this study were: patient demographics, diagnosis, functional level assessed using the SMAF (Functional Autonomy Measurement System) and occupational therapy time-use. Data were analysed using univariable and multivariable modelling. Results Occupational therapy time-use was significantly associated with all variables included in analysis (p < 0.05). For each variable the amount and direction of effect differed between hospital sites. The SMAF was the only variable consistently associated with occupational therapy time-use. Higher occupational therapy time-use was associated with lower functional independence (leading to a 3.5 min increase in median occupational therapy time for every unit decrease in SMAF score). Conclusions Management of resources within busy hospitals require knowledge of factors associated with occupational therapist time-use. This study identified that time-use could in part be predicted by functional independence, diagnosis and sociodemographic characteristics. Occupational therapy managers can use this information to support decision making while acknowledging other patient and therapist level factors also influence time-use.
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Affiliation(s)
| | | | | | | | | | - Laura Jolliffe
- Alfred Health, Australia.,La Trobe University, Australia
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25
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O’Malley L, Macey R, Allen T, Brocklehurst P, Thomson F, Rigby J, Lalloo R, Tomblin Murphy G, Birch S, Tickle M. Workforce Planning Models for Oral Health Care: A Scoping Review. JDR Clin Trans Res 2022; 7:16-24. [PMID: 33323035 PMCID: PMC8674798 DOI: 10.1177/2380084420979585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND For health care services to address the health care needs of populations and respond to changes in needs over time, workforces must be planned. This requires quantitative models to estimate future workforce requirements that take account of population size, oral health needs, evidence-based approaches to addressing needs, and methods of service provision that maximize productivity. The aim of this scoping review was to assess whether and how these 4 elements contribute to existing models of oral health workforce planning. METHODS A scoping review was conducted. MEDLINE, Embase, HMIC, and EconLit were searched, all via OVID. Additionally, gray literature databases were searched and key bodies and policy makers contacted. Workforce planning models were included if they projected workforce numbers and were specific to oral health. No limits were placed on country. A single reviewer completed initial screening of abstracts; 2 independent reviewers completed secondary screening and data extraction. A narrative synthesis was conducted. RESULTS A total of 4,009 records were screened, resulting in 42 included articles detailing 47 models. The workforce planning models varied significantly in their use of data on oral health needs, evidence-based services, and provider productivity, with most models relying on observed levels of service utilization and demand. CONCLUSIONS This review has identified quantitative workforce planning models that aim to estimate future workforce requirements. Approaches to planning the oral health workforce are not always based on deriving workforce requirements from population oral health needs. In many cases, requirements are not linked to population needs, while in models where needs are included, they are constrained by the existence and availability of the required data. It is critical that information systems be developed to effectively capture data necessary to plan future oral health care workforces in ways that relate directly to the needs of the populations being served. KNOWLEDGE TRANSFER STATEMENT Policy makers can use the results of this study when making decisions about the planning of oral health care workforces and about the data to routinely collect within health services. Collection of suitable data will allow for the continual improvement of workforce planning, leading to a responsive health service and likely future cost savings.
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Affiliation(s)
- L. O’Malley
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - R. Macey
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - T. Allen
- Centre for Health Economics, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - P. Brocklehurst
- NWORTH Clinical Trials Unit, University of Bangor, Bangor, UK
| | - F. Thomson
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - J. Rigby
- WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Canada
- Research, Innovation and Discovery, Nova Scotia Health Authority, Halifax, Canada
| | - R. Lalloo
- School of Dentistry, The University of Queensland, Brisbane, Australia
| | - G. Tomblin Murphy
- WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Canada
- Research, Innovation and Discovery, Nova Scotia Health Authority, Halifax, Canada
| | - S. Birch
- Centre for the Business and Economics of Health, Faculty of Business Economics and Law, The University of Queensland, Brisbane, Australia
| | - M. Tickle
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
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Salinas-Perez JA, Ghuloum S, Gutierrez-Colosia MR, Bagheri N, Salvador-Carulla L. Analysis of the mental health service provision in Qatar: Progressing in community mental health in a Middle East country. Front Psychiatry 2022; 13:1095788. [PMID: 36590608 PMCID: PMC9800284 DOI: 10.3389/fpsyt.2022.1095788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Qatari health planning in the last decade aimed to make the transition from the traditional hospital-based psychiatric care to a community-based care, building an integrated and comprehensive mental health system. The objective of this study was to explore the mental health service provision in Qatar in 2018 and 2022. This time span coincided with two mental health plans (2013-2018 and 2019-2022) and one health plan (2018-2022). METHODS This study followed a healthcare ecosystem approach, including context analysis and the standard description and classification of mental health services. Service provision was studied applying DESDE-LTC system (Description and Evaluation of Services and DirectoriEs-Long Term Care), an internationally validated methodology to assess and describe mental health services. Service data were analyzed along with sociodemographic indicators from public statistics to know the care context. RESULTS The availability of specialized mental health services increased for adults, although it remained the same for other age groups. The diversity of care and the weight of health-related care over social-related care also remained quite similar. It was noteworthy the development of new services for young adults, migrant workers, and female populations. CONCLUSION This was the first time that this service research methodology has been applied in a Middle East country to study its mental healthcare pattern. The analysis of the mental healthcare pattern in the study time period showed the continued progress toward community-based care in Qatar in the framework of three health plans and despite the unexpected COVID-19 world pandemic.
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Affiliation(s)
- Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Dos Hermanas, Seville, Spain.,Mental Health Policy Unit, Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Suhaila Ghuloum
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | | | - Nasser Bagheri
- Mental Health Policy Unit, Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Luis Salvador-Carulla
- Mental Health Policy Unit, Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia.,Menzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Sydney, NSW, Australia
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27
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Santos JV, Martins FS, Vidal-Castro J, Silva-Rocha S, Areias R, Oliveira A, Santos S, Lamelas C, Amorim H, Martins A, Vieira M, Ramos JP, Pinto M. Indicators for local health plan monitoring and evaluation: A modified Delphi consensus. Public Health Nurs 2021; 39:752-759. [PMID: 34935199 DOI: 10.1111/phn.13036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/24/2021] [Accepted: 12/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There is still a lack of health indicators for monitoring and evaluating health planning at the local level. In Portugal, local health plans (LHP) include a prioritized set of health priorities, which should be monitored and evaluated. This study is an example of a low-resource method to identify and reuse indicators for LHP monitoring and evaluation already collected for other purposes. DESIGN AND SAMPLE A modified Delphi consensus method was applied, with three rounds of email rating questionnaires and a final meeting, between January 2018 and January 2019. The Delphi panel consisted of eight members from the Planning and Administration Group of the Espinho/Gaia Local Public Health Unit. MEASUREMENTS Panelists were asked to assess the indicators' validity for monitoring diseases/determinants from a pre-selected list of potential binomials between 140 PHC indicators and 15 diseases/determinants. RESULTS After four rounds, there was consensus in considering 141 binomials (34.0%) as appropriate, diabetes mellitus being the disease with more appropriate indicators. CONCLUSION This study portrays the applicability of a commonly used, easy and low-resource method in a Portuguese Local Public Health Unit to select and reuse primary health care indicators for LHP monitoring and evaluation.
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Affiliation(s)
- João Vasco Santos
- Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, ARS Norte, Vila Nova de Gaia, Portugal.,MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | | | - Joana Vidal-Castro
- Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, ARS Norte, Vila Nova de Gaia, Portugal
| | - Sofia Silva-Rocha
- Public Health Unit, ACES Entre Douro e Vouga II - Aveiro Norte, ARS Norte, Porto, Portugal
| | - Rita Areias
- Public Health Unit, ACES Alto Ave - Guimarães, Vizela e Terras de Basto, ARS Norte, Porto, Portugal
| | - António Oliveira
- Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, ARS Norte, Vila Nova de Gaia, Portugal
| | - Sandra Santos
- Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, ARS Norte, Vila Nova de Gaia, Portugal
| | - Cristina Lamelas
- Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, ARS Norte, Vila Nova de Gaia, Portugal
| | - Helena Amorim
- Public Health Unit, ACES Entre Douro e Vouga I - Feira/Arouca, ARS Norte, Porto, Portugal
| | - Alexandra Martins
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Mariana Vieira
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - João Pedro Ramos
- Subgroup of Terrorism and Security of the Crime and Justice Group of Campbell Collaboration, Porto, Portugal
| | - Marta Pinto
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal.,Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.,Subgroup of Terrorism and Security of the Crime and Justice Group of Campbell Collaboration, Porto, Portugal
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28
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Barbieri S, Mehta S, Wu B, Bharat C, Poppe K, Jorm L, Jackson R. Predicting cardiovascular risk from national administrative databases using a combined survival analysis and deep learning approach. Int J Epidemiol 2021; 51:931-944. [PMID: 34910160 PMCID: PMC9189958 DOI: 10.1093/ije/dyab258] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/26/2021] [Indexed: 01/02/2023] Open
Abstract
Background Machine learning-based risk prediction models may outperform traditional statistical models in large datasets with many variables, by identifying both novel predictors and the complex interactions between them. This study compared deep learning extensions of survival analysis models with Cox proportional hazards models for predicting cardiovascular disease (CVD) risk in national health administrative datasets. Methods Using individual person linkage of administrative datasets, we constructed a cohort of all New Zealanders aged 30–74 who interacted with public health services during 2012. After excluding people with prior CVD, we developed sex-specific deep learning and Cox proportional hazards models to estimate the risk of CVD events within 5 years. Models were compared based on the proportion of explained variance, model calibration and discrimination, and hazard ratios for predictor variables. Results First CVD events occurred in 61 927 of 2 164 872 people. Within the reference group, the largest hazard ratios estimated by the deep learning models were for tobacco use in women (2.04, 95% CI: 1.99, 2.10) and chronic obstructive pulmonary disease with acute lower respiratory infection in men (1.56, 95% CI: 1.50, 1.62). Other identified predictors (e.g. hypertension, chest pain, diabetes) aligned with current knowledge about CVD risk factors. Deep learning outperformed Cox proportional hazards models on the basis of proportion of explained variance (R2: 0.468 vs 0.425 in women and 0.383 vs 0.348 in men), calibration and discrimination (all P <0.0001). Conclusions Deep learning extensions of survival analysis models can be applied to large health administrative datasets to derive interpretable CVD risk prediction equations that are more accurate than traditional Cox proportional hazards models.
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Affiliation(s)
- Sebastiano Barbieri
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Suneela Mehta
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Billy Wu
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Katrina Poppe
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Rod Jackson
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
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29
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Lobo EH, Abdelrazek M, Grundy J, Kensing F, Livingston PM, Rasmussen LJ, Islam SMS, Frølich A. Caregiver Engagement in Stroke Care: Opportunities and Challenges in Australia and Denmark. Front Public Health 2021; 9:758808. [PMID: 34900907 PMCID: PMC8661098 DOI: 10.3389/fpubh.2021.758808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/04/2021] [Indexed: 01/01/2023] Open
Abstract
Globally, there is a rise in incident cases of stroke, particularly in low- and middle-income countries, due to obesity-related and lifestyle risk factors, including health issues such as high cholesterol, diabetes and hypertension. Since the early 20th century, stroke mortality has declined due to proper management of the risk factors and improved treatment practices. However, despite the decline in mortality, there is an increase in the levels of disability that requires long-term support. In countries such as Australia and Denmark, where most care is provided within the community; family members, generally spouses, assume the role of caregiver, with little to no preparation that affects the quality of care provided to the person living with stroke. While past research has highlighted aspects to improve caregiver preparedness of stroke and its impact on care; health planning, recovery, and public health policies rarely consider these factors, reducing engagement and increasing uncertainty. Hence, there is a need to focus on improving strategies during recovery to promote caregiver engagement. In this study, we, therefore, try to understand the needs of the caregiver in stroke that limit engagement, and processes employed in countries such as Australia and Denmark to provide care for the person with stroke. Based on our understanding of these factors, we highlight the potential opportunities and challenges to promote caregiving engagement in these countries.
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Affiliation(s)
- Elton H. Lobo
- School of Information Technology, Deakin University, Geelong, VIC, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - John Grundy
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | | | - Lene J. Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
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Garcia AC, Beja A, Cupertino de Barros FP, Delgado AP, Ferrinho P. The Covid-19 pandemic reinforces the need for sustainable health planning. Int J Health Plann Manage 2021; 37:643-649. [PMID: 34825408 PMCID: PMC9015575 DOI: 10.1002/hpm.3389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 11/04/2021] [Indexed: 11/06/2022] Open
Abstract
The 2030 Agenda for Sustainable Development highlighted the growing attention to the adequacy of health planning models to sustainable development. A re-reading of the results of a round table debate on "sustainable planning", which took place at the 5th National Congress of Tropical Medicine (Portugal, 2019) under a participant observation strategy, framed by the findings of a "synthesis of better evidence" literature review and cross-referenced with the reflections of different authors and experts about the momentum created by the COVID-19 pandemic, underlined the challenges to sustainable health planning that have emerged and are projected beyond the current pandemic context. Variable perceptions of the term "sustainable health development", leading to the potential loss of their relevance in guiding the elaboration of policies and strategic plans, and the potential higher effectiveness of the participatory approaches of health planning in achieving sustainable health were highlighted in the debate and literature, in general and in public health emergency contexts. Those results gained new relevance during the current COVID-19 pandemic, bringing back to the forefront a reflection of the inadequate planning framework that has usually been used to understand and respond to global health challenges, despite the already existing experience, evidence and support instruments.
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Affiliation(s)
- Ana Cristina Garcia
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal.,Department of Epidemiology, National Institute of Health Doctor Ricardo Jorge, Lisbon, Portugal
| | - André Beja
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
| | | | - António Pedro Delgado
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal.,University of Cape Verde, Praia, Cape Verde
| | - Paulo Ferrinho
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
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Garcia Saiso S, Marti MC, Malek Pascha V, Pacheco A, Luna D, Plazzotta F, Nelson J, Tejerina L, Bagolle A, Savignano MC, Baum A, Orefice PJ, Haddad AE, Messina LA, Lopes P, Rubió FS, Otzoy D, Curioso WH, Luna A, Medina FM, Sommer J, Otero P, De Quiros FGB, D'Agostino M. [Implementation of telemedicine in the Americas: Barriers and facilitatorsBarreiras e facilitadores para a implementação da telemedicina nas Américas]. Rev Panam Salud Publica 2021; 45:e131. [PMID: 34703460 PMCID: PMC8530000 DOI: 10.26633/rpsp.2021.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022] Open
Abstract
Con millones de personas en el mundo en situación de distanciamiento físico por el COVID-19, las tecnologías de la información y comunicaciones (TICs) se han posicionado como uno de los medios principales de interacción y colaboración. Ya al inicio de este milenio se empezaban a mencionar las siguientes ventajas: mayor acceso a la información y a la prestación de servicios; fortalecimiento educativo; control de calidad de los programas de detección y reducción de los costos de la atención de en salud. Sin embargo, entre las principales barreras de adopción de la telemedicina se encuentran las de índole: tecnológicas; humanas y sociales; psico-sociales y antropológicas; de Gobernanza y económicas. En estos 20 años se logró un aumento en los recursos y capacidad técnica, una mejora en la educación digital, un empoderamiento del paciente en su tratamiento y un mayor interés público en esta área. En especial se considera exitosa la conformación de equipos interdisciplinarios, las redes académicas y profesionales y las consultas médicas virtuales. Después de revisar el estado de la telemedicina en la Región de las Américas, los autores recomiendan adoptar medidas urgentes para poner en práctica políticas y programas nacionales de telemedicina, incluyendo el marco normativo y presupuesto necesario, cuya implementación se realice de manera integral e interoperable y que se sustente de redes académicas, de colaboración e instituciones especializadas. Dichas políticas deben generar un contexto habilitante que den sostenibilidad al avance logrado, considerando los aspectos mencionados en las posibles barreras.
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Affiliation(s)
- Sebastian Garcia Saiso
- Organización Panamericana de la Salud Washington D.C. Estados Unidos Organización Panamericana de la Salud, Washington D.C., Estados Unidos
| | - Myrna C Marti
- Consultora internacional Argentina Consultora internacional, Argentina
| | | | - Adrian Pacheco
- CENETEC Ciudad de México México CENETEC, Ciudad de México. México
| | - Daniel Luna
- Hospital Italiano de Buenos Aires Ciudad Autónoma de Buenos Aires Argentina Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Fernando Plazzotta
- Hospital Italiano de Buenos Aires Ciudad Autónoma de Buenos Aires Argentina Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Jennifer Nelson
- Banco Interamericano de Desarrollo Washington D.C. Estados Unidos Banco Interamericano de Desarrollo, Washington D.C., Estados Unidos
| | - Luis Tejerina
- Banco Interamericano de Desarrollo Washington D.C. Estados Unidos Banco Interamericano de Desarrollo, Washington D.C., Estados Unidos
| | - Alexandre Bagolle
- Banco Interamericano de Desarrollo Washington D.C. Estados Unidos Banco Interamericano de Desarrollo, Washington D.C., Estados Unidos
| | - Maria Celeste Savignano
- Hospital de Pediatría "Prof Dr. Juan P. Garrahan" Ciudad Autónoma de Buenos Aires Argentina Hospital de Pediatría "Prof Dr. Juan P. Garrahan", Ciudad Autónoma de Buenos Aires, Argentina
| | - Analia Baum
- Ministerio de Salud de la Ciudad Autónoma de Buenos Aires Argentina Ministerio de Salud de la Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Ana Estela Haddad
- Universidad de Sao Paulo San Pablo Brasil Universidad de Sao Paulo, San Pablo, Brasil
| | - Luiz Ary Messina
- Rede Nacional de Ensino e Pesquisa Rio de Janeiro Brasil Rede Nacional de Ensino e Pesquisa, Rio de Janeiro, Brasil
| | - Paulo Lopes
- Rede Nacional de Ensino e Pesquisa Rio de Janeiro Brasil Rede Nacional de Ensino e Pesquisa, Rio de Janeiro, Brasil
| | - Francesc Saigí Rubió
- Universitat Oberta de Catalunya Barcelona España Universitat Oberta de Catalunya, Barcelona, España
| | - Daniel Otzoy
- Red Centroamericana de Informática en Salud Guatemala Red Centroamericana de Informática en Salud, Guatemala, Guatemala
| | - Walter H Curioso
- Universidad Continental Lima Perú Universidad Continental, Lima, Perú
| | - Antonio Luna
- Hospital de Pediatría "Prof Dr. Juan P. Garrahan" Ciudad Autónoma de Buenos Aires Argentina Hospital de Pediatría "Prof Dr. Juan P. Garrahan", Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Janine Sommer
- Hospital Italiano de Buenos Aires Ciudad Autónoma de Buenos Aires Argentina Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Paula Otero
- Hospital Italiano de Buenos Aires Ciudad Autónoma de Buenos Aires Argentina Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Fernán González Bernaldo De Quiros
- Ministerio de Salud de la Ciudad Autónoma de Buenos Aires Argentina Ministerio de Salud de la Ciudad Autónoma de Buenos Aires, Argentina
| | - Marcelo D'Agostino
- Organización Panamericana de la Salud Washington D.C. Estados Unidos Organización Panamericana de la Salud, Washington D.C., Estados Unidos
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Uygun M. An evaluation of Turkey's health tourism policies using a social network analysis approach. Int J Health Plann Manage 2021; 37:804-823. [PMID: 34713521 DOI: 10.1002/hpm.3362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 08/12/2021] [Accepted: 10/05/2021] [Indexed: 11/11/2022] Open
Abstract
Despite the health tourism sector's rapid growth in the past decade due to globalisation, there is little research analysing countries' health tourism policies. This study aimed to examine the relationships between stakeholders in the health tourism sector in Turkey in the context of Turkey's health tourism policies. This study connects theory and practice in multidisciplinary sectors, including health, tourism, and business, through an evaluation of major issues from a health management perspective. Social network analysis was used to assess the role of 107 stakeholders in Ankara and determine the extent of weak and strong ties among them. Issues confronting these stakeholders and the obstacles they faced in practice were also identified. The study found that, the relevant stakeholders faced comprehensive sectoral deficiencies and issues in building positive relationships. Governmental stakeholders as policymakers need to develop effective strategies to improve stakeholder collaboration and encourage greater inclusiveness through better-targeted health tourism policies. The study contributes to social network theory, resource dependency theory, and stakeholder theory, and is, to our knowledge, the first study to use social network analysis to examine the role of stakeholders in the health tourism sector.
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Affiliation(s)
- Meltem Uygun
- EU Expert, O.H.M. Project Management & Consultancy, Ankara, Turkey
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Corrêa RP, Castro HC, Quaresma BMCS, Stephens PRS, Araujo-Jorge TC, Ferreira RR. Perceptions and Feelings of Brazilian Health Care Professionals Regarding the Effects of COVID-19: Cross-sectional Web-Based Survey. JMIR Form Res 2021; 5:e28088. [PMID: 34519656 PMCID: PMC8544742 DOI: 10.2196/28088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/19/2021] [Accepted: 08/01/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The importance of health professionals has been recognized in COVID-19 pandemic-affected countries, especially in those such as Brazil, which is one of the top 3 countries that have been affected in the world. However, the workers' perception of the stress and the changes that the pandemic has caused in their lives vary according to the conditions offered by these affected countries, including salaries, individual protection equipment, and psychological support. OBJECTIVE The purpose of this study was to identify the perceptions of Brazilian health workers regarding the COVID-19 pandemic impact on their lives, including possible self-contamination and mental health. METHODS This cross-sectional web-based survey was conducted in Brazil by applying a 32-item questionnaire, including multiple-choice questions by using the Google Forms electronic assessment. This study was designed to capture spontaneous perceptions from health professionals. All questions were mandatory and divided into 2 blocks with different proposals: personal profile and COVID-19 pandemic impact. RESULTS We interviewed Brazilian health professionals from all 5 Brazilian regions (N=1376). Our study revealed that 1 in 5 (23%) complained about inadequate personal protective equipment, including face shields (234/1376, 17.0%), masks (206/1376, 14.9%), and laboratory coats (138/1376, 10.0%), whereas 1 in 4 health professionals did not have enough information to protect themselves from the coronavirus disease. These professionals had anxiety due to COVID-19 (604/1376, 43.9%), difficulties in sleep (593/1376, 43.1%), and concentrating on work (453/1376, 32.9%). Almost one-third experienced traumatic situations at work (385/1376, 28.0%), which may have led to negative feelings of fear of COVID-19 and sadness. Despite this situation, there was hope and empathy among their positive feelings. The survey also showed that 1 in 5 acquired COVID-19 with the most classic and minor symptoms, including headache (274/315, 87.0%), body pain (231/315, 73.3%), tiredness (228/315, 72.4%), and loss of taste and smell (208/315, 66.0%). Some of their negative feelings were higher than those of noninfected professionals (fear of COVID-19, 243/315, 77.1% vs 509/1061, 48.0%; impotence, 142/315, 45.1% vs 297/1061, 28.0%; and fault, 38/315, 12.1% vs 567/1061, 53.4%, respectively). Another worrying outcome was that 61.3% (193/315) reported acquiring an infection while working at a health facility and as expected, most of the respondents felt affected (344/1376, 25.0%) or very affected (619/1376, 45.0%) by the COVID-19. CONCLUSIONS In Brazil, the health professionals were exposed to a stressful situation and to the risk of self-contamination-conditions that can spell future psychological problems for these workers. Our survey findings showed that the psychological support for this group should be included in the future health planning of Brazil and of other hugely affected countries to assure a good mental health condition for the medical teams in the near future.
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Affiliation(s)
- Roberta Pires Corrêa
- Program in Education in Biosciences and Health, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Helena Carla Castro
- Program in Education in Biosciences and Health, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil.,Sciences, Technology and Inclusion, Federal Fluminense University, Niterói, Brazil
| | | | - Paulo Roberto Soares Stephens
- Program in Education in Biosciences and Health, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil.,Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Tania Cremonini Araujo-Jorge
- Program in Education in Biosciences and Health, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil.,Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Roberto Rodrigues Ferreira
- Program in Education in Biosciences and Health, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil.,Laboratory of Functional Genomics and Bioinformatics, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil.,Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
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Coile A, Wun J, Kothari MT, Hemminger C, Fracassi P, Di Dio D. Scaling up nutrition through multisectoral planning: An exploratory review of 26 national nutrition plans. Matern Child Nutr 2021; 17:e13225. [PMID: 34101997 PMCID: PMC8518575 DOI: 10.1111/mcn.13225] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/27/2022]
Abstract
With a growing consensus on the need to address malnutrition in a comprehensive and multisectoral way, there has been increased attention on the processes and factors for multisectoral nutrition planning to be successful. To guide countries, the Scaling Up Nutrition (SUN) Movement developed a checklist that defined characteristics of good national nutrition plans. This exploratory review used the framework of the Checklist to assess 26 national multisectoral nutrition plans (MSNPs) developed between 2014 and 2020. The MSNPs were assessed against a subset of 31 Checklist characteristics defined as basic plan components. Although the level of detail varied across the reviewed plans, the majority included core components that are important to facilitate effective planning and implementation, such as an assessment of the nutritional status and determinants of malnutrition for children under 5 years of age, a commitment to global recommendations related to reducing malnutrition, actions consistent with global evidence and responding to identified issues/gaps, governance arrangements to facilitate coordination, and identification of capacity-building needs/actions to support effective implementation. Common gaps across plans included risk analysis and mitigation, defined responsible agencies for each action, an assessment of the financial gap and defined mechanisms for financial tracking and resource allocation, and mechanisms to coordinate operational research. These findings provide a high-level, multi-country review of multisectoral nutrition planning that can support future policymakers, technical assistance providers and regional and global stakeholders to consider the foundational elements of and further validate and address common shortcomings in developing such a plan.
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Affiliation(s)
- Amanda Coile
- PATHWashingtonDistrict of ColumbiaUSA
- JSI Research and Training Institute Inc.ArlingtonVirginiaUSA
| | | | | | | | - Patrizia Fracassi
- Scaling Up Nutrition Movement SecretariatGenevaSwitzerland
- Food and Agriculture Organization of the United NationsRomeItaly
| | - Debora Di Dio
- Scaling Up Nutrition Movement SecretariatGenevaSwitzerland
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35
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Topmiller M, Mallow PJ, Shaak K, Kieber-Emmons AM. Identifying priority and bright spot areas for improving diabetes care: a geospatial approach. Fam Med Community Health 2021; 9:e001259. [PMID: 34649983 PMCID: PMC8522662 DOI: 10.1136/fmch-2021-001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The objective of this study was to describe a novel geospatial methodology for identifying poor-performing (priority) and well-performing (bright spot) communities with respect to diabetes management at the ZIP Code Tabulation Area (ZCTA) level. This research was the first phase of a mixed-methods approach known as the focused rapid assessment process (fRAP). Using data from the Lehigh Valley Health Network in eastern Pennsylvania, geographical information systems mapping and spatial analyses were performed to identify diabetes prevalence and A1c control spatial clusters and outliers. We used a spatial empirical Bayes approach to adjust diabetes-related measures, mapped outliers and used the Local Moran's I to identify spatial clusters and outliers. Patients with diabetes were identified from the Lehigh Valley Practice and Community-Based Research Network (LVPBRN), which comprised primary care practices that included a hospital-owned practice, a regional practice association, independent small groups, clinics, solo practitioners and federally qualified health centres. Using this novel approach, we identified five priority ZCTAs and three bright spot ZCTAs in LVPBRN. Three of the priority ZCTAs were located in the urban core of Lehigh Valley and have large Hispanic populations. The other two bright spot ZCTAs have fewer patients and were located in rural areas. As the first phase of fRAP, this method of identifying high-performing and low-performing areas offers potential to mitigate health disparities related to diabetes through targeted exploration of local factors contributing to diabetes management. This novel approach to identification of populations with diabetes performing well or poor at the local community level may allow practitioners to target focused qualitative assessments where the most can be learnt to improve diabetic management of the community.
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Affiliation(s)
- Michael Topmiller
- HealthLandscape, American Academy of Family Physicians, Cincinnati, Ohio, USA
| | - Peter J Mallow
- Health Services Administration, Xavier University, Cincinnati, Ohio, USA
| | - Kyle Shaak
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Autumn M Kieber-Emmons
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
- School of Medicine, University of South Florida, Tampa, Florida, USA
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Villalobos Dintrans P, Mathur M, González-Bautista E, Browne J, Hommes C, Vega E. Implementing long-term care systems in the Americas: a regional strategy. Rev Panam Salud Publica 2021; 45:e86. [PMID: 34475883 PMCID: PMC8369132 DOI: 10.26633/rpsp.2021.86] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/29/2021] [Indexed: 11/24/2022] Open
Abstract
The Region of the Americas is facing accelerated demographic and epidemiological changes. As these trends will continue in future years, long-term care needs are expected to rise. How can countries respond to these challenges? We propose that countries in the Region should invest in the implementation of long-term care systems. Considering the heterogeneity in the Region, we propose a strategy based on three components: (i) understanding the problem; (ii) thinking about solutions; and (iii) building support and consensus. Depending on each country's needs and capacities, these three elements suggest short-term and long-term actions and goals, from generating better information on long-term care needs to the implementation of long-term care systems. Long-term care is a relevant issue for the Region today. The task is challenging, but countries need to embrace it and move forward before it is too late.
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Affiliation(s)
| | - Mallika Mathur
- Independent consultantWashington, D.C.United States of AmericaIndependent consultant, Washington, D.C., United States of America
| | - Emmanuel González-Bautista
- Toulouse University Hospital (CHU Toulouse)ToulouseFranceToulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Jorge Browne
- Pontificia Universidad Católica de ChileSantiagoChilePontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Hommes
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Enrique Vega
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
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37
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Manguele A, Sidat M, IJsselmuiden C, Ferrinho P. Addressing conflicts of interest of ethical reviewers of health planning, management, policy and systems research proposals. Int J Health Plann Manage 2021; 36:2044-2047. [PMID: 34382265 DOI: 10.1002/hpm.3295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/09/2021] [Accepted: 07/27/2021] [Indexed: 11/05/2022] Open
Abstract
Steering health systems towards universal health coverage requires research on themes that are of particular interest to health planning, management, policy and systems researchers. Some issues, such as strikes regarded as illegal and health sector corruption, because of their social and political sensitivity have, for too long, remained outside adequate research inquiry. Their emergence in the research agenda raises some challenges for Human Research Ethics Committees, particularly related to their conflicts of interests as reviewers, that need clarification.
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Affiliation(s)
| | - Mohsin Sidat
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.,Research Centre on Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carel IJsselmuiden
- Council on Health Research for Development, Geneva, Switzerland.,School of Applied Human Sciences, Univ of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Paulo Ferrinho
- Research Centre on Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
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Bowsher G, El Achi N, Augustin K, Meagher K, Ekzayez A, Roberts B, Patel P. eHealth for service delivery in conflict: a narrative review of the application of eHealth technologies in contemporary conflict settings. Health Policy Plan 2021; 36:974-981. [PMID: 33860797 PMCID: PMC8355470 DOI: 10.1093/heapol/czab042] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 12/11/2022] Open
Abstract
The role of eHealth in conflict settings is increasingly important to address geographic, epidemiologic and clinical disparities. This study categorizes various forms of eHealth usage in conflict and aims to identify gaps in evidence to make recommendations for further research and practice. The analysis was carried out via a narrative hermeneutic review methodology. Articles that fulfilled the following screening criteria were reviewed: (1) describing an eHealth intervention in active conflict or ongoing insurgency, (2) an eHealth intervention targeting a conflict-affected population, (3) an e-learning platform for delivery in conflict settings and (4) non-interventional descriptive reviews relating to eHealth in conflict. Of the 489 papers eligible for screening, 46 merited final inclusion. Conflict settings described include Somalia, Sudan, Afghanistan, Syria, Iraq, Pakistan, Chechnya, Gaza and the Democratic Republic of Congo. Thirty-six studies described specific eHealth initiatives, while the remainder were more generic review papers exploring general principles. Analysis resulted in the elucidation of three final categories of current eHealth activity in conflict-affected settings: (1) eHealth for clinical management, (2) e-learning for healthcare in conflict and (3) eHealth for information management in conflict. Obvious disparities in the distribution of technological dividends from eHealth in conflict are demonstrated by this review. Conflict-affected populations are predominantly subject to ad hoc and voluntary initiatives delivered by diaspora and civil society organizations. While the deployment of eHealth technologies in conflict settings is increasingly normalized, there is a need for further clarification of global norms relating to practice in this context.
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Affiliation(s)
- Gemma Bowsher
- R4HC-MENA, R4HSSS & Conflict & Health Research Group, King's College London, Strand Ln, London WC2R 2LS, UK
| | - Nassim El Achi
- R4HC-MENA, Global Health Institute, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Katrin Augustin
- School of Population Health & Environmental Sciences, King's College London, Guy's Campus, Great Maze Pond, London SE1 1UL, UK
| | - Kristen Meagher
- R4HC-MENA, R4HSSS & Conflict & Health Research Group, King's College London, Strand Ln, London WC2R 2LS, UK
| | - Abdulkarim Ekzayez
- R4HC-MENA, R4HSSS & Conflict & Health Research Group, King's College London, Strand Ln, London WC2R 2LS, UK
| | - Bayard Roberts
- RECAP, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Preeti Patel
- R4HC-MENA & R4HSSS, Dept War Studies, King's College London, Strand Lane, LondonWC2R 2LS, UK
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Skempes D, Kiekens C, Malmivaara A, Michail X, Bickenbach J, Stucki G. Supporting government policies to embed and expand rehabilitation in health systems in Europe: A framework for action. Health Policy 2021; 126:158-172. [PMID: 34281701 DOI: 10.1016/j.healthpol.2021.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
Investment in action is vital to confront the challenges associated with chronic diseases and disability facing European health systems. Although relevant policy responses are being increasingly developed, most of them fail to recognize the role of rehabilitation services in achieving public health and social goals. Comprehensive guidance is thus urgently needed to support rehabilitation policy development and expand access to rehabilitation care to meet population needs effectively. This paper describes a framework to guide policy action for rehabilitation in Europe. The framework was developed in collaboration with the European Academy of Rehabilitation Medicine based on a focused literature review and expert consultations. A review in PubMed and grey literature sources identified 458 references and resulted in 135 relevant documents published between 2006 and 2019. Thematic analysis of extracted information helped summarize the findings and develop the draft policy action framework. This was circulated to a wider group of experts and discussed in three workshops in 2018-2019. The framework was revised according to their feedback. The proposed framework contains 48 options for policy action organized in six domains and twelve subdomains that address several areas of health programming. The proposed framework provides a structure to understand the policy terrain related to rehabilitation in Europe and the measures required for translating aspirational political pronouncements into targeted programmatic action and tangible health and social outcomes.
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Affiliation(s)
- Dimitrios Skempes
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola (Bologna), Italy; Physical and Rehabilitation Medicine, University Hospitals Leuven - Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Anti Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare and Orton Orthopedic Hospital and Orton Research Institute, Orton Foundation, Helsinki, Finland
| | - Xanthi Michail
- Department of Physiotherapy, University of West Attica, Athens, Greece
| | - Jerome Bickenbach
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland.
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40
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Breuer E, Comas-Herrera A, Freeman E, Albanese E, Alladi S, Amour R, Evans-Lacko S, Ferri CP, Govia I, Iveth Astudillo García C, Knapp M, Lefevre M, López-Ortega M, Lund C, Musyimi C, Ndetei D, Oliveira D, Palmer T, Pattabiraman M, Sani TP, Taylor D, Taylor E, Theresia I, Thomas PT, Turana Y, Weidner W, Schneider M. Beyond the project: Building a strategic theory of change to address dementia care, treatment and support gaps across seven middle-income countries. Dementia (London) 2021; 21:114-135. [PMID: 34196585 DOI: 10.1177/14713012211029105] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evidence from middle-income countries indicates high and increasing prevalence of dementia and need for services. However, there has been little investment in care, treatment or support for people living with dementia and their carers. The Strengthening Responses to Dementia in Developing Countries (STRiDE) project aims to build both research capacity and evidence on dementia care and services in Brazil, Indonesia, India, Jamaica, Kenya, Mexico and South Africa. This article presents the Theory of Change (ToC) approach we used to co-design our research project and to develop a strategic direction for dementia care, treatment and support, with stakeholders. ToC makes explicit the process underlying how a programme will achieve its impact. We developed ToCs in each country and across the STRiDE project with researchers, practitioners, people living with dementia, carers and policymakers at different levels of government. This involved (1) an initial ToC workshop with all project partners (43 participants); (2) ToC workshops in each STRiDE country (22-49 participants in each); (3) comparison between country-specific and overall project ToCs; (4) review of ToCs in light of WHO dementia guidelines and action plan and (5) a final review. Our experiences suggest ToC is an effective way to generate a shared vision for dementia care, treatment and support among diverse stakeholders. However, the project contribution should be clearly delineated and use additional strategies to ensure appropriate participation from people living with dementia and their carers in the ToC process.
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Affiliation(s)
- Erica Breuer
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia; Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
| | - Adelina Comas-Herrera
- Care Policy and Evaluation Centre, 4905London School of Economics and Political Science, London, UK
| | - Emily Freeman
- Care Policy and Evaluation Centre, 4905London School of Economics and Political Science, London, UK
| | - Emiliano Albanese
- Universià della Svizzerra Italiana, Lugano; Faculty of Medicine, University of Geneva, Switzerland
| | - Suvarna Alladi
- 29148National institute of Mental Health and Neuro Sciences, India
| | - Rochelle Amour
- Caribbean Institute for Health Research, 54657The University of the West Indies, Jamaica
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, 4905London School of Economics and Political Science, UK
| | - Cleusa P Ferri
- Department of Psychiatry, 28105Universidade Federal de São Paulo, Brazil
| | - Ishtar Govia
- Caribbean Institute for Health Research, The University of the West Indies, Jamaica
| | | | - Martin Knapp
- Care Policy and Evaluation Centre, 4905London School of Economics and Political Science, UK
| | | | | | - Crick Lund
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - David Ndetei
- Department of Psychiatry; 107854University of Nairobi; Africa Mental Health Research and Training Foundation, Kenya
| | - Deborah Oliveira
- Department of Psychiatry, 28105Universidade Federal de São Paulo, Brazil
| | - Tiffany Palmer
- Caribbean Institute for Health Research, 54657The University of the West Indies, Jamaica
| | | | - Tara Puspitarini Sani
- Alzheimer Indonesia and Department of Neurology, School of Medicine and Health Sciences, 64732Atma Jaya Catholic University of Indonesia, Indonesia
| | | | | | | | | | - Yuda Turana
- Alzheimer Indonesia; Department of Neurology, School of Medicine and Health Sciences, 64732Atma Jaya Catholic University of Indonesia, Indonesia
| | | | - Marguerite Schneider
- Alan J. Flisher Centre for Public Mental Health, 37716University of Cape Town, South Africa
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Leach MJ, Gillam M, Gonzalez-Chica DA, Walsh S, Muyambi K, Jones M. Health care need and health disparities: Findings from the Regional South Australia Health (RESONATE) survey. Health Soc Care Community 2021; 29:905-917. [PMID: 32767700 DOI: 10.1111/hsc.13124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 05/05/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
Regional South Australia has some of the highest rates of psychological distress, chronic disease and multimorbidity of any Australian State or Territory. Yet, the healthcare needs of this population are still not completely understood. To better understand the healthcare needs of regional South Australians, we invited adults living in the region to complete the 44-item consumer utilisation, expectations and experiences of healthcare instrument (CONVERSATIONS), online or in hard-copy. The survey was conducted between April 2017 and March 2018. A multi-modal recruitment campaign was utilised to promote the survey. We examined associations between study outcomes and remoteness area, and drew comparisons between our findings and other surveys reporting pertinent outcomes in the urban SA population. The questionnaire was completed by 3,926 adults (52.5% females; 37.6% aged 60 + years). Among the 264 distinct health conditions reported by participants, the most prevalent were hypertension (31.6%), depression (25.7%), anxiety (23.5%) and hypercholesterolaemia (22.9%). The lifetime prevalence of these conditions among participants exceeded rates reported in urban SA. The largest regional-urban health disparities were observed for eczema/dermatitis, skin cancer, other cancer types and cataracts, where prevalence rates were 2075%, 400%, 373% and 324% higher, respectively, than that reported in urban SA. Participants also reported higher levels of multimorbidity (37.7% higher) relative to urban South Australians. By contrast, participants appeared to be exposed to fewer lifestyle risk behaviours (e.g. smoking, alcohol, inadequate fruit or vegetable intake) than their urban counterparts. In summary, there was a high level of healthcare need, and considerable health disparity among participants when compared with urban settings (particularly for skin and eye conditions). These findings highlight the need for a more targeted approach to delivering health services and health promotion activities in regional areas.
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Affiliation(s)
- Matthew J Leach
- National Centre for Naturopathic Medicine, Southern Cross University, East Lismore, NSW, Australia
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | | | - Sandra Walsh
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | - Kuda Muyambi
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
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Stockton DA, Fowler C, Debono D, Travaglia J. World Health Organization building blocks in rural community health services: An integrative review. Health Sci Rep 2021; 4:e254. [PMID: 33732894 PMCID: PMC7942400 DOI: 10.1002/hsr2.254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/15/2021] [Accepted: 02/04/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Developing and adapting health service models to effectively meet the needs of rural and remote communities is an international priority given inequities in health outcomes compared with metropolitan counterparts. This integrative review aims to inform rural and remote health service delivery systems by drawing on the WHO Framework building blocks to identify lessons learned from the literature describing experiences of rural and remote community health service planning and implementation; and inform recommendations to strengthen often disadvantaged rural and remote health systems for policy makers, health service managers, and those implementing international healthcare initiatives within these contexts. METHODS The integrative review examined the literature reporting rural and remote community health service delivery published from 2007 to 2017 (the decade following the release of the WHO Framework). Using an analytic frame, a structured template was developed to extract data and categorized against the WHO building blocks, followed by a synthesis of the key findings. RESULTS This integrative review identified that WHO Framework building blocks such as "Service Delivery" and "Health Workforce" are commonly reflected in rural and remote community health service delivery literature in the decade since the Framework's release. However, others such as "Sustainable Funding and Social Protection" are less commonly reported in the literature despite these elements being identified by the WHO as being integral to successful, sustainable health service delivery systems. CONCLUSIONS We found that collaboration across the health system governance continuum from local to policy level is an essential enabler for rural and remote health service delivery. Community-based participatory action research provides an opportunity to learn from one another, build capacity, optimize service model suitability, and promotes cultural safety by demonstrating respect and inclusivity in decision-making. Policy makers and funders need to acknowledge the time and resources required to build trust and community coalitions to inform effective planning and implementation.
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Affiliation(s)
- Deborah A. Stockton
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Cathrine Fowler
- School of Nursing and MidwiferyUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Deborah Debono
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Joanne Travaglia
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
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Goswami P, Chakraborty A, Das DK, Ray S. Gap Analysis in Workforce and Infrastructure in the Subcenters for Upgradation to Health and Wellness Center in a Community Development Block of Purba Bardhaman District, West Bengal. Indian J Community Med 2021; 46:300-303. [PMID: 34321747 PMCID: PMC8281851 DOI: 10.4103/ijcm.ijcm_552_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 02/09/2021] [Indexed: 11/23/2022] Open
Abstract
Context: The government of India has recently decided to upgrade subcenters (SCs) to health and wellness centers (HWCs) for providing comprehensive quality services. Aims: The present study was undertaken to determine workforce- and infrastructure-wise gaps in the SCs for upgradation to HWCs and assess knowledge of the auxiliary nurse midwives (ANMs) regarding services to be delivered through HWCs. Settings and Design: This cross-sectional study was conducted in Bhatar block of Purba Bardhaman district between August and October 2019. Subjects and Methods: Workforce and infrastructure availability was assessed using a checklist in 38 SCs and knowledge was assessed using a questionnaire among ANMs. Statistical Analysis Used: Data entry and analysis was done in Microsoft™ Excel™. Results: No Subcentre had Community Health Officer and 23.7% of Subcentre were without second ANM. 28.9% of the ANMs had adequate knowledge about services to be delivered through HWCs. Infrastructurally, lack of staff residential facility (76.3%), water supply (34.2%), and inadequate civil construction (34.2%) were major barriers. Conclusions: Adequate recruitment of HCWs, infrastructure upliftment, and proper training of HCWs in the SCs are the need of the hour.
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Affiliation(s)
- Prosun Goswami
- Department of Community Medicine, Burdwan Medical College, Bardhaman, West Bengal, India
| | - Amitava Chakraborty
- Department of Community Medicine, Burdwan Medical College, Bardhaman, West Bengal, India
| | - Dilip Kumar Das
- Department of Community Medicine, Burdwan Medical College, Bardhaman, West Bengal, India
| | - Soumalya Ray
- Department of Community Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
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Nichol AA, Mwaka ES, Luyckx VA. Ethics in Research: Relevance for Nephrology. Semin Nephrol 2021; 41:272-281. [PMID: 34330367 DOI: 10.1016/j.semnephrol.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Research is crucial to progress in nephrology. It is important that studies are conducted rigorously from the scientific perspective, as well as in adherence to ethical standards. Traditional clinical research places a high value on individual research subject autonomy. Research questions often include the clinical effectiveness of new interventions studied under highly controlled conditions. Such research has brought the promise of new game-changers in nephrology, such as the sodium-glucose cotransporter 2 inhibitors. Implementation research takes such knowledge further and investigates how to translate it into broader-scale policy and practice, to achieve swift and global uptake, with a focus on justice and equity. Newer challenges arising globally in research ethics include those relating to oversight of innovation, biobanking and big data, human-challenge studies, and research during emergencies. This article details the history of clinical research ethics and the role of research ethics committees, describes the evolving spectrum of biomedical research in human medicine, and presents emerging clinical research ethics issues using illustrative examples and a hypothetical case study. It is imperative that researchers and research ethics committees are well versed in the ethical principles of all forms of human research such that research is conducted to the highest standards and that effective interventions can be implemented at scale as rapidly as possible.
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Affiliation(s)
- Ariadne A Nichol
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA
| | - Erisa S Mwaka
- Department of Anatomy, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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Ahmed R, Dayani K, Amir HA, Mian A. Zero cost approach to fostering multidisciplinary engagement and innovation in an academic medical centre during COVID-19: experience from the Jugaar Innovation Challenge. BMJ Innov 2021; 7:302-307. [PMID: 37556241 PMCID: PMC7754668 DOI: 10.1136/bmjinnov-2020-000542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/11/2020] [Accepted: 11/29/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Rafeh Ahmed
- CCIT and
TISC, Aga Khan University, Karachi, Sind,
Pakistan
| | - Komal Dayani
- CCIT,
Aga Khan University, Karachi, Sind,
Pakistan
| | | | - Asad Mian
- CCIT,
Aga Khan University, Karachi, Sind,
Pakistan
- Emergency
Medicine, The Aga Khan University Hospital,
Karachi, Pakistan
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Dehnavieh R, Nia RG, Nazeri Z. The Challenges and Achievements in the Implementation of the Natural Childbirth Instruction Program: A Qualitative Study. Iran J Nurs Midwifery Res 2021; 25:502-513. [PMID: 33747840 PMCID: PMC7968595 DOI: 10.4103/ijnmr.ijnmr_295_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/23/2020] [Accepted: 08/09/2020] [Indexed: 11/04/2022]
Abstract
Background The natural childbirth instruction program, which aims to reduce the cesarean section (C-section) rates in the country and pay attention to demographic policies, has achieved significant accomplishments in the short time span since it was implemented throughout the country. In the present study, the advantages and challenges of the implementation of this program have been analyzed. Materials and Methods This qualitative study carried out with the participation of 32 knowledgeable individuals who were selected using purposeful sampling and snowball sampling methods among the personnel of Kerman University of Medical Sciences, and it's affiliated educational (university) hospital. The data were collected through semi-structured interviews based on the research objectives, review of texts, and experts' experiences. Data analysis was performed using content analysis method in MaxQDA software. Results Data analysis provided the 5 main categories of implementation instructions' strengths, implementation instructions' defects, implementation instructions' achievements, implementation instructions' challenges and threats, and suggestions. Conclusions Accountability in the system that provides health care services for pregnant mothers in public hospitals has been created through the implementation of the natural childbirth promotion package. If managerial barriers and executive and legal inefficiencies are followed up and suitable measures are taken for solving the intra-system conflicts, we can hope that the package, which has been one of the most serious efforts made by the Ministry of Health over the past decades to reduce cesarean delivery, will achieve significant accomplishments.
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Affiliation(s)
- Reza Dehnavieh
- Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Rahil Ghorbani Nia
- Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Nazeri
- Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Makinde OA, Odimegwu CO, Udoh MO, Adedini SA, Akinyemi JO, Atobatele A, Fadeyibi O, Sule FA, Babalola S, Orobaton N. Death registration in Nigeria: a systematic literature review of its performance and challenges. Glob Health Action 2021; 13:1811476. [PMID: 32892738 PMCID: PMC7783065 DOI: 10.1080/16549716.2020.1811476] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Death registration provides an opportunity for the legal documentation of death of persons. Documentation of deaths has several implications including its use in the recovery of inheritance and insurance benefits. It is also an important input for construction of life tables which are crucial for national planning. However, the registration of deaths is poor in several countries including Nigeria. Objective This paper describes the performance of death registration in Nigeria and factors that may affect its performance. Methods We conducted a systematic literature review of death registration completeness in Nigeria to identify, characterize issues as well as challenges associated with realizing completeness in death registration. Results Only 13.5% of deaths in Nigeria were registered in 2007 which regressed to 10% in 2017. There was no data reported for Nigeria in the World Health Organization database between 2008 and 2017. The country scored less than 0.1 (out of a maximum of 1) on the Vital Statistics Performance Index. There are multiple institutions with parallel constitutional and legal responsibilities for death registration in Nigeria including the National Population Commission, National Identity Management Commission and Local Government Authorities, which may be contributing to its overall poor performance. Conclusions We offer proposals to substantially improve death registration completeness in Nigeria including the streamlining and merger of the National Population Commission and the National Identity Management Commission into one commission, the revision of the legal mandate of the new agency to mainly coordination and establishment of standards. We recommend that Local Government authorities maintain the local registries given their proximity to households. This arrangement will be enhanced by increased utilization of information and communications technology in Civil Registration and Vital Statistics processes that ensure records are properly archived.
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Affiliation(s)
- Olusesan Ayodeji Makinde
- Viable Helpers Development Organization , Abuja, Nigeria.,Viable Knowledge Masters , Abuja, Nigeria
| | - Clifford Obby Odimegwu
- Demography and Population Studies Program, Schools of Public Health and Social Sciences, University of the Witwatersrand , Johannesburg, South Africa
| | - Mojisola O Udoh
- Department of Pathology, University of Benin/University of Benin Teaching Hospital , Benin-City, Nigeria
| | - Sunday A Adedini
- Vaccine and Infectious Disease Analytics Research Unit, University of the Witwatersrand , Johannesburg, South Africa
| | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan , Ibadan, Nigeria
| | - Akinyemi Atobatele
- Monitoring and Evaluations Unit, United States Agency for International Development , Abuja, Nigeria
| | | | | | - Stella Babalola
- Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD, USA
| | - Nosakhare Orobaton
- MNCH Program Strategy Team, Bill and Melinda Gates Foundation , Seattle, WA, USA
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Caetano HBS, Israel-Caetano C, López-Gil JF, Sentone RG, Godoy KBS, Cavichiolli FR, Paulo AC. Physical fitness tests as a requirement for physical performance improvement in officers in the military police of the state of Paraná, Brazil. Rev Bras Med Trab 2021; 18:444-448. [PMID: 33688326 PMCID: PMC7934165 DOI: 10.47626/1679-4435-2020-581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/29/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Physical fitness is crucial for the work of military police officers. Over time, officers show a substantial decrease in physical fitness. State military officers must undergo a physical fitness test every year, but prior to 2015, failure on this test had no impact on career advancement. State Law No. 18.659/2015 included passage of the physical fitness test as a requirement for promotion for officers in the Paraná military police (Polícia Militar do Paraná). OBJECTIVES To verify whether the obligation to undergo the physical fitness test had any effects on the physical performance of military police officers. METHODS The physical fitness tests results from 2016-2019 (n = 1705) were entered into an electronic spreadsheet and stratified by year. The spreadsheet included scores on individual tests (shuttle run, upper body and 12-minute run) as well as the sum total across all tests. Then, descriptive statistics, normality test, Kruskal-Wallis H test, and post-hoc comparisons were performed using the Mann-Whitney U test. with a significance level of p < 0.05. RESULTS Significant differences (p < 0.05) were observed on all variables in the physical fitness test when compared between the years of 2016, 2017, 2018 and 2019. Mean scores on the shuttle run (96.91 ± 7.54) and upper body tests (82.60 ± 24.81) were highest in 2019, while the mean score on the 12-minute run test was highest in 2017 (60.33 ± 28.38). The effect size of these differences (r) was small. CONCLUSIONS The evidence suggests that the inclusion of the physical fitness test as a requirement for promotion can contribute to the improvement of physical performance in military police officers.
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Affiliation(s)
| | - Cristiano Israel-Caetano
- Departamento de Educação Física, Universidade Federal do Paraná, Curitiba, PR, Brazil
- Assessoria Técnica, Casa Militar, Polícia Militar do Paraná, Curitiba, PR, Brazil
| | | | - Rafael Gomes Sentone
- Departamento de Educação Física, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | | | - Anderson Caetano Paulo
- Departamento de Educação Física, Universidade Tecnológica Federal do Paraná, Curitiba, PR, Brazil
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Hemmat M, Ayatollahi H, Maleki M, Saghafi F. Health information technology foresight for Iran: A Delphi study of experts' views to inform future policymaking. HEALTH INF MANAG J 2021; 50:76-87. [PMID: 31416345 DOI: 10.1177/1833358319868445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Policymakers require a systematic approach when planning for information technology needs in healthcare. OBJECTIVE The aim of this study was to obtain experts' predictions of future health information technology (HIT) needs until 2025 for Iran in relation to the relative importance of key technologies, expected timeframe of realisation, areas that may be impacted upon and obstacles to achieving these goals. METHOD This article presents results from the third phase (a Delphi study) of a larger mixed-method study. Policymakers from the Iranian Ministry of Health and faculty members from different medical universities across the country who were expert in the field of HIT were invited to participate (n = 61). RESULTS Participants (39) completed the first-round questionnaire and 24 completed the second. The development of personal health records (n = 32, 82.0%), the development of clinical decision-making systems (n = 30, 76.9%) and the use of business intelligence for collecting and analysing clinical and financial data (n = 32, 82.0%) were predicted to occur after 2025. The healthcare areas predicted to experience the greatest impact from most HITs were facilitating patient-provider communication and improving healthcare quality. Key barriers to achieving HITs were related to weaknesses in planning and limited financial resources for most technologies. CONCLUSION By identifying the areas of impact and the barriers to achieving the HIT goals, more accurate planning is possible and resources can be allocated according to priorities.
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Affiliation(s)
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
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Werner SS, Afandiyeva G, Karimova G, Kiefer S, Abdujabborov N, Dzhamalova M, Bandaev I, Prytherch H. Scaling up Business Plans in Tajikistan: a qualitative study of the history, barriers, facilitators and lessons learnt. Glob Health Action 2021; 14:1947552. [PMID: 34342247 PMCID: PMC8344240 DOI: 10.1080/16549716.2021.1947552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/22/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND To improve health planning at primary health care (PHC) level, Business Plans were introduced in Tajikistan by the Enhancing Primary Health Care (EPHC) Services Project. OBJECTIVE To describe the history and process of implementation of Business Plans and to identify barriers, facilitators and lessons learnt from scaling up Business Plans. METHODS Set in a qualitative research design, we conducted a desk review of project and official documents and seventeen semi-structured interviews with key stakeholders at national and sub-national levels between May and July 2020. We used an interview guide informed by the ExpandNet/WHO framework and analyzed the data following a content analysis approach facilitated by MAXQDA. RESULTS With the participation of various user organizations and resource teams and through a variety of strategic scale-up choices, Business Plans have been scaled up from a vertical pilot project to institutionalized health management tools covering 45% of Tajikistan's PHC facilities. The most prominent facilitators for scaling up Business Plans were the institutionalization and integration of the tool into the Tajik health system, the close collaboration with Community Health Teams (CHTs), the high acceptance of the tool among the users, the advocacy through champions and policy-makers and the large dissemination network. The most outstanding barriers to scaling up Business Plans were insufficient financial or human resources, general weaknesses in health governance, the lack of a strategic scale-up plan and strategic decisions, the lack of motivation or overall vision to implement Business Plans at a large scale and difficulties in donor coordination. CONCLUSION To ensure the continuity of scaling up Business Plans, developing a scale-up strategy, strengthening cross-sectoral collaboration and participation during scaling up, and capacitating the user organizations of Business Plans are important next steps to ensure the sustainability and effectiveness of Business Plans in the future.
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Affiliation(s)
- Sarah S Werner
- University College Freiburg, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Gulara Afandiyeva
- “Enhancing Primary Health Care Services” Project, Representative Office of the Swiss Tropical and Public Health Institute, Dushanbe, Tajikistan
| | - Gulzira Karimova
- “Enhancing Primary Health Care Services” Project, Representative Office of the Swiss Tropical and Public Health Institute, Dushanbe, Tajikistan
| | - Sabine Kiefer
- Swiss Center for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nasrullo Abdujabborov
- “Enhancing Primary Health Care Services” Project, Representative Office of the Swiss Tropical and Public Health Institute, Dushanbe, Tajikistan
| | - Muazamma Dzhamalova
- Swiss Cooperation Office, Swiss Agency for Development and Cooperation, Dushanbe, Tajikistan
| | - Ilhom Bandaev
- Ministry of Health and Social Protection of Population, Dushanbe, Republic of Tajikistan
| | - Helen Prytherch
- Swiss Center for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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