Investigaciones

Cervical cancer screening at a tertiary care center in Rwanda

Publication date: Available online 26 May 2017
Source:Gynecologic Oncology Reports

Author(s): George Ruzigana, Lisa Bazzet-Matabele, Stephen Rulisa, Allison N. Martin, Rahel Ghebre

In limited resource settings such as Rwanda, visual inspection with acetic acid (VIA) is the primary model for cervical cancer screening. The objective of this study was to describe clinical characteristics and outcomes for women presenting for cervical cancer screening. A prospective, observational study was conducted between September 2015 and February 2016 at Kigali University Teaching Hospital (CHUK). Women referred to the VIA clinic were enrolled and completed a semi-structured questionnaire. During the six-month study period, 150 women were enrolled and evaluated with VIA followed by colposcopy directed biopsy for VIA positive. The median age was 42years (IQR 36–49). Only 20 (13.3%) asymptomatic women presented for screening exam, whereas 126 (84%) were symptomatic. Among symptomatic patients, more than one-third had never had a speculum exam prior to referral (n=43). Twenty-two (14.7%) women were VIA positive, and 8 (5.3%) had lesions suspicious for cancer, while 120 (80%) were found to be VIA negative. Among women undergoing biopsy (n=30), 11 were normal (36.7%), 5 cases showed CIN 1 (16.6%), 4 cases showed CIN 2 (13.3%), 2 cases showed CIN 3 (6.7%) and 8 were confirmed cervical cancers (26.7%). In Rwanda, VIA is the current method for cervical cancer screening. In this study, few asymptomatic patients presented for cervical cancer screening. Increasing knowledge about cervical cancer screening and expanding access are key elements to improving cervical cancer control in Rwanda.





Categorías: Investigaciones

Explaining regional variation in home care use by demand and supply variables

Publication date: Available online 26 May 2017
Source:Health Policy

Author(s): Olivier van Noort, Fredo Schotanus, Joris van der Klundert, Jan Telgen

In the Netherlands, home care services like district nursing and personal assistance are provided by private service provider organizations and covered by private health insurance companies which bear legal responsibility for purchasing these services. To improve value for money, their procurement increasingly replaces fee-for-service payments with population based budgets. Setting appropriate population budgets requires adaptation to the legitimate needs of the population, whereas historical costs are likely to be influenced by supply factors as well, not all of which are necessarily legitimate. Our purpose is to explain home care costs in terms of demand and supply factors. This allows for adjusting historical cost patterns when setting population based budgets. Using expenses claims of 60 Dutch municipalities, we analyze eight demand variables and five supply variables with a multiple regression model to explain variance in the number of clients per inhabitant, costs per client and costs per inhabitant. Our models explain 69% of variation in the number of clients per inhabitant, 28% of costs per client and 56% of costs per inhabitant using demand factors. Moreover, we find that supply factors explain an additional 17 to 23% of variation. Predictors of higher utilization are home care organizations that are integrated with intramural nursing homes, higher competition levels among home care organizations and the availability of complementary services.





Categorías: Investigaciones

SY-10 Status of SRHR in Africa - Examining Commitments, Policy and Actions (Africa Symposium by AFSHR & ACCPD)

Publication date: May 2017
Source:The Journal of Sexual Medicine, Volume 14, Issue 5, Supplement 4









Categorías: Investigaciones

Education, Practice, and Competency Gaps of Anesthetists in Ethiopia: Task Analysis

Publication date: Available online 25 May 2017
Source:Journal of PeriAnesthesia Nursing

Author(s): Sharon Kibwana, Mihereteab Teshome, Yohannes Molla, Catherine Carr, Leulayehu Akalu, Jos van Roosmalen, Jelle Stekelenburg

Purpose This study assessed the needs and gaps in the education, practice and competencies of anesthetists in Ethiopia. Design A cross-sectional study design was used. Methods A questionnaire consisting of 74 tasks was completed by 137 anesthetists who had been practicing for 6 months to 5 years. Findings Over half of the respondents rated 72.9% of the tasks as being highly critical to patient outcomes, and reported that they performed 70.2% of all tasks at a high frequency. More than a quarter of respondents reported that they performed 15 of the tasks at a low frequency. Nine of the tasks rated as being highly critical were not learned during pre-service education by more than one-quarter of study participants, and over 10% of respondents reported that they were unable to perform five of the highly critical tasks. Conclusions Anesthetists rated themselves as being adequately prepared to perform a majority of the tasks in their scope of practice.





Categorías: Investigaciones

The potential of task-shifting in scaling up services for prevention of mother-to-child transmission of HIV: a time and motion study in Dar es Salaam, Tanzania

Abstract Background

In many African countries, prevention of mother-to-child transmission of HIV (PMTCT) services are predominantly delivered by nurses. Although task-shifting is not yet well established, community health workers (CHWs) are often informally used as part of PMTCT delivery. According to the 2008 World Health Organization (WHO) Task-shifting Guidelines, many PMTCT tasks can be shifted from nurses to CHWs.

Methods

The aim of this time and motion study in Dar es Salaam, Tanzania, was to estimate the potential of task-shifting in PMTCT service delivery to reduce nurses’ workload and health system costs. The time used by nurses to accomplish PMTCT activities during antenatal care (ANC) and postnatal care (PNC) visits was measured. These data were then used to estimate the costs that could be saved by shifting tasks from nurses to CHWs in the Tanzanian public-sector health system.

Results

A total of 1121 PMTCT-related tasks carried out by nurses involving 179 patients at ANC and PNC visits were observed at 26 health facilities. The average time of the first ANC visit was the longest, 54 (95% confidence interval (CI) 42–65) min, followed by the first PNC visit which took 29 (95% CI 26–32) minutes on average. ANC and PNC follow-up visits were substantially shorter, 15 (95% CI 14–17) and 13 (95% CI 11–16) minutes, respectively. During both the first and the follow-up ANC visits, 94% of nurses’ time could be shifted to CHWs, while 84% spent on the first PNC visit and 100% of the time spent on the follow-up PNC visit could be task-shifted. Depending on CHW salary estimates, the cost savings due to task-shifting in PMTCT ranged from US$ 1.3 to 2.0 (first ANC visit), US$ 0.4 to 0.6 (ANC follow-up visit), US$ 0.7 to 1.0 (first PNC visit), and US$ 0.4 to 0.5 (PNC follow-up visit).

Conclusions

Nurses working in PMTCT spend large proportions of their time on tasks that could be shifted to CHWs. Such task-shifting could allow nurses to spend more time on specialized PMTCT tasks and can substantially reduce the average cost per PMTCT patient.

Categorías: Investigaciones

Nurses who work in rural and remote communities in Canada: a national survey

Abstract Background

In Canada, as in other parts of the world, there is geographic maldistribution of the nursing workforce, and insufficient attention is paid to the strengths and needs of those providing care in rural and remote settings. In order to inform workforce planning, a national study, Nursing Practice in Rural and Remote Canada II, was conducted with the rural and remote regulated nursing workforce (registered nurses, nurse practitioners, licensed or registered practical nurses, and registered psychiatric nurses) with the intent of informing policy and planning about improving nursing services and access to care. In this article, the study methods are described along with an examination of the characteristics of the rural and remote nursing workforce with a focus on important variations among nurse types and regions.

Methods

A cross-sectional survey used a mailed questionnaire with persistent follow-up to achieve a stratified systematic sample of 3822 regulated nurses from all provinces and territories, living outside of the commuting zones of large urban centers and in the north of Canada.

Results

Rural workforce characteristics reported here suggest the persistence of key characteristics noted in a previous Canada-wide survey of rural registered nurses (2001-2002), namely the aging of the rural nursing workforce, the growth in baccalaureate education for registered nurses, and increasing casualization. Two thirds of the nurses grew up in a community of under 10 000 people. While nurses’ levels of satisfaction with their nursing practice and community are generally high, significant variations were noted by nurse type. Nurses reported coming to rural communities to work for reasons of location, interest in the practice setting, and income, and staying for similar reasons. Important variations were noted by nurse type and region.

Conclusions

The proportion of the rural nursing workforce in Canada is continuing to decline in relation to the proportion of the Canadian population in rural and remote settings. Survey results about the characteristics and practice of the various types of nurses can support workforce planning to improve nursing services and access to care.

Categorías: Investigaciones

Extending access to essential services against constraints: the three-tier health service delivery system in rural China (1949–1980)

Abstract Background

China has made remarkable progress in scaling up essential services during the last six decades, making health care increasingly available in rural areas. This was partly achieved through the building of a three-tier health system in the 1950s, established as a linked network with health service facilities at county, township and village level, to extend services to the whole population.

Methods

We developed a Theory of Change to chart the policy context, contents and mechanisms that may have facilitated the establishment of the three-tier health service delivery system in rural China. We systematically synthesized the best available evidence on how China achieved universal access to essential services in resource-scarce rural settings, with a particular emphasis on the experiences learned before the 1980s, when the country suffered a particularly acute lack of resources.

Results

The search identified only three peered-reviewed articles that fit our criteria for scientific rigor. We therefore drew extensively on government policy documents, and triangulated them with other publications and key informant interviews. We found that China’s three-tier health service delivery system was established in response to acute health challenges, including high fertility and mortality rates. Health system resources were extremely low in view of the needs and insufficient to extend access to even basic care. With strong political commitment to rural health and a “health-for-all” policy vision underlying implementation, a three-tier health service delivery model connecting villages, townships and counties was quickly established. We identified several factors that contributed to the success of the three-tier system in China: a realistic health human resource development strategy, use of mass campaigns as a vehicle to increase demand, an innovative financing mechanisms, public-private partnership models in the early stages of scale up, and an integrated approach to service delivery. An implementation process involving gradual adaptation and incorporation of the lessons learnt was also essential.

Conclusions

China’s 60 year experience in establishing a de-professionalized, community-based, health service delivery model that is economically feasible, institutionally and culturally appropriate mechanism can be useful to other low- and middle-income countries (LMICs) seeking to extend essential services. Lessons can be drawn from both reform content and from its implementation pathway, identifying the political, institutional and contextual factors shaping the three-tier delivery model over time.

Categorías: Investigaciones

Measuring health workers’ motivation composition: validation of a scale based on Self-Determination Theory in Burkina Faso

Abstract Background

Although motivation of health workers in low- and middle-income countries (LMICs) has become a topic of increasing interest by policy makers and researchers in recent years, many aspects are not well understood to date. This is partly due to a lack of appropriate measurement instruments. This article presents evidence on the construct validity of a psychometric scale developed to measure motivation composition, i.e., the extent to which motivation of different origin within and outside of a person contributes to their overall work motivation. It is theoretically grounded in Self-Determination Theory (SDT).

Methods

We conducted a cross-sectional survey of 1142 nurses in 522 government health facilities in 24 districts of Burkina Faso. We assessed the scale’s validity in a confirmatory factor analysis framework, investigating whether the scale measures what it was intended to measure (content, structural, and convergent/discriminant validity) and whether it does so equally well across health worker subgroups (measurement invariance).

Results

Our results show that the scale measures a slightly modified version of the SDT continuum of motivation well. Measurements were overall comparable between subgroups, but results indicate that caution is warranted if a comparison of motivation scores between groups is the focus of analysis.

Conclusions

The scale is a valuable addition to the repository of measurement tools for health worker motivation in LMICs. We expect it to prove useful in the quest for a more comprehensive understanding of motivation as well as of the effects and potential side effects of interventions intended to enhance motivation.

Categorías: Investigaciones

Performance of the Antiretroviral Treatment Program in Ethiopia, 2005-2015: strengths and weaknesses toward ending AIDS

Publication date: Available online 19 May 2017
Source:International Journal of Infectious Diseases

Author(s): Yibeltal Assefa, Charles F. Gilks, Lutgarde Lynen, Owain Williams, Peter S. Hill, Taye Tolera, Alankar Malvia, Wim Van Damme

Background Ethiopia is one of the countries which has scaled up antiretroviral treatment (ART) over the past decade. This study reviews the performance of the ART program in Ethiopia during the past decade, and identifies successes and weaknesses toward ending AIDS in the country. Methods A review and synthesis of data was conducted using multiple data sources: reports from all health facilities in Ethiopia to the Federal Ministry of Health, HIV/AIDS estimates and projections, and retrospective cohort and cross-sectional studies conducted between 2005/6 and 2014/15. Findings The ART program has been successful over several critical areas: (1) ART coverage improved from 4% to 54%; (2) the median CD4 count/mm3 at the time of ART initiation increased from 125 in 2005/6 to 231 in 2012/13; (3) retention in care after 12 months on ART has increased from 82% to 92%. In spite of these successes, important challenges also remain: (1) ART coverage is not equitable: among regions (5.6%-93%), between children (25%) and adults (60%), and between female (54%) and male patients (69%); (2) retention in care is variable among regions (83%-94%); and, (3) the shift to second-line ART is slow and low (0·58%). Interpretation The findings suggest that the ART program should sustain the successes and reflect on the shortcomings toward the goal of ending AIDS. It is important to capitalize on and calibrate the interventions and approaches utilized to scale up ART in the past. Analysis of the treatment cascade, in order to pinpoint the gaps and identify appropriate solutions, is commendable in this regard.





Categorías: Investigaciones

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015

Publication date: Available online 18 May 2017
Source:The Lancet

Author(s): GBD 2015 Healthcare Access and Quality CollaboratorsRyan MBarberNancyFullmanReed J DSorensenThomasBollykyMartinMcKeeEllenNolteAmanuel AlemuAbajobirKalkidan HassenAbateCristianaAbbafatiKaja MAbbasFoadAbd-AllahAbdishakur MAbdulleAhmed AbdulahiAbdurahmanSemaw FeredeAberaBijuAbrahamGirmatsion FissehaAbrehaKelemeworkAdaneAdemola LukmanAdelekanIfedayo Morayo OAdetifaAshkanAfshinArnavAgarwalSanjay KumarAgarwalSunilkumarAgarwalAnuragAgrawalAliasghar AhmadKiadaliriAlirezaAhmadiKedir YimamAhmedMuktar BeshirAhmedRufus OlusolaAkinyemiTomi FAkinyemijuNadiaAkseerZiyadAl-AlyKhurshidAlamNooreAlamSayed SaidulAlamZewdie AderawAlemuKefyalew AddisAleneLilyAlexanderRaghibAliSyed DanishAliRezaAlizadeh-NavaeiAla'aAlkerwiFrançoisAllaPeterAllebeckChristineAllenRajaaAl-RaddadiUbaiAlsharifKhalid AAltirkawiElena AlvarezMartinNelsonAlvis-GuzmanAzmeraw TAmareErfanAminiWalidAmmarJoshuAmo-AdjeiYaw AmpemAmoakoBenjamin OAndersonSofiaAndroudiHosseinAnsariMustafa GeletoAnshaCarl Abelardo TAntonioJohanÄrnlövAlArtamanHamidAsayeshRezaAssadiAyalewAstatkieTesfay MehariAteySulemanAtiqueNiguse TadeleAtnafuSachin RAtreLeticiaAvila-BurgosEuripide Frinel G ArthurAvokpahoBeatriz Paulina AyalaQuintanillaAshishAwasthiNebiyu NegussuAyelePeterAzzopardiHuda Omer BaSaleemTillBärnighausenUmarBachaAlaaBadawiAmitavaBanerjeeAleksandraBaracMiguel ABarbozaSuzanne LBarker-ColloLope HBarreroSanjayBasuBernhard TBauneKaleabBayeYibeltal TebekawBayouShahrzadBazargan-HejaziNeerajBediEttoreBeghiYannickBéjotAminu KBelloDerrick ABennettIsabela MBensenorAdugnawBerhaneEduardoBernabéOscar AlbertoBernalAddisu ShunuBeyeneTariku JibatBeyeneZulfiqar ABhuttaSibhatuBiadgilignBorisBikbovSait MentesBirlikCharlesBirungiStanBiryukovDonalBisanzioHabtamu MellieBizuayehuDipanBoseMichaelBraininMichaelBrauerAlexandraBrazinovaNicholas J KBreitbordeHermannBrennerZahid AButtRosarioCárdenasLuceroCahuana-HurtadoIsmael RicardoCampos-NonatoJosipCarJuan JesusCarreroDanielCaseyValeriaCasoCarlos ACastañeda-OrjuelaJacqueline CastilloRivasFerránCatalá-LópezPedroCecilioKellyCercyFiona JCharlsonAlan ZChenAdrienneChewMirriamChibalabalaChioma EzinneChibuezeVesper HichilombweChisumpaAbdulaal AChitheerRajivChowdhuryHanneChristensenDevasahayam JesudasChristopherLiliana GCiobanuMassimoCirilloMegan SCoggeshallLeslie TrumbullCooperMonicaCortinovisJohn ACrumpKoustuvDalalHadiDanawiLalitDandonaRakhiDandonaPaul IDarganJosedas NevesGailDaveyDragos VDavitoiuKairatDavletovDiegoDe LeoLiana CDel GobboBorjadel Pozo-CruzRobert PDellavalleKebedeDeribeAmareDeribewDon CDes JarlaisSubhojitDeySamath DDharmaratneDanielDickerEric LDingKlaraDokovaE RayDorseyKerrie EDoyleManishaDubeyRebeccaEhrenkranzChristian LyckeEllingsenIqbalElyazarAhmadaliEnayatiSergey PetrovichErmakovBabakEshratiAlirezaEsteghamatiKaraEstepThomasFürstImad D AFaghmousFanuel Belayneh BekeleFanuelEmerito Jose AquinoFaraonTalha AFaridCarla Sofia e SaFarinhaAndreFaroMaryam SFarvidFarshadFarzadfarValery LFeiginAndrea BFeiglSeyed-MohammadFereshtehnejadJefferson GFernandesJoão CFernandesTesfaye RegassaFeyissaFlorianFischerChristinaFitzmauriceThomas DFlemingNataliyaFoigtKyle JForemanMohammad HForouzanfarRichard CFranklinJosephFrostadTsegaye TeweldeG/hiwotEmmanuelaGakidouKetevanGambashidzeAmiranGamkrelidzeWayneGaoAlberto LGarcia-BasteiroTeshomeGebreAmanuel TesfayGebremedhinMengistu WeldayGebremichaelAlemseged AregayGebruAmha AdmasieGelayeJohanna MGeleijnseRicardGenova-MalerasKatherine BGibneyAbabi ZergawGirefMelkamu DedefoGishuGiorgiaGiussaniWilliam WGodwinAudraGoldEllen MGoldbergPhilimon NGonaAmadorGoodridgeSameer ValiGopalaniAtsushiGotoNicholasGraetzFelixGreavesMaxGriswoldPeter ImreGubanHarish ChanderGugnaniPrakash CGuptaRahulGuptaRajeevGuptaTanushGuptaVipinGuptaTesfa DejenieHabtewoldNimaHafezi-NejadDemewozHaileAlemayehu DesalegneHailuGessessew BugssaHailuAlexHakuzimanaRandah RibhiHamadehMitiku TeshomeHambisaSamerHamidiMouhanadHammamiGraeme JHankeyYuantaoHaoHilda LHarbHabtamu AberaHareriJosep MariaHaroMohammad SadeghHassanvandRasmusHavmoellerRoderick JHaySimon IHayDeliaHendrieIleana BeatrizHeredia-PiHans WHoekMasakoHorinoNobuyukiHoritaH DeanHosgoodAung SoeHtetGuoqingHuHsiangHuangJohn JHuangBethany MHuntleyChantalHuynhKim MoesgaardIburgBogdan VasileIleanuKaireInnosAsnake ArarsaIrensoNaderJahanmehrMihajlo BJakovljevicPeterJamesSpencer LewisJamesMehdiJavanbakhtSudha PJayaramanAchala UpendraJayatillekePanniyammakalJeemonVivekanandJhaDennyJohnCatherineJohnsonSarah CJohnsonJost BJonasKnudJuelZubairKabirYogeshwarKalkondeRitulKamalHaidongKanAndreKarchCorine KakiziKaremaSeyed MKarimiAmirKasaeianNicholas JKassebaumAnshulKastorSrinivasa VittalKatikireddiKonstantinKazanjanPeter NjengaKeiyoroLauraKemmerAndrew HaddonKempAndre PascalKengneAmene AbebeKerboMaiaKereselidzeChandrasekharan NairKesavachandranYousef SalehKhaderIbrahimKhalilAbdur RahmanKhanEjaz AhmadKhanGulfarazKhanYoung-HoKhangAbdullah Tawfih AbdullahKhojaIrmaKhonelidzeJagdishKhubchandaniGetiye DejenuKibretDanielKimPaulineKimYun JinKimRuth WKimokotiYohannesKinfuNiranjanKissoonMiiaKivipeltoYoshihiroKokuboAnneliKolkDhavalKolteJacek AKopecSoewartaKosenParvaiz AKoulAiKoyanagiMichaelKravchenkoSanjayKrishnaswamiKristopher JKrohnBarthelemy KuateDefoBurcu KucukBicerErnst JKuipersVeena SKulkarniG AnilKumarFekede AsefaKumsaMichaelKutzHmwe HKyuAnton Carl JonasLagerAparnaLalDharmesh KumarLalRatilalLallooTeaLallukkaQingLanSinead MLanganVan CLansinghHeidi JLarsonAndersLarssonDennis OdaiLaryeaAsma AbdulLatifAlicia Elena BeatrizLawrynowiczJanet LLeasherJamesLeighMallLeinsaluCheru TesemaLeshargieJanniLeungRickyLeungMiriamLeviXiaofengLiangStephen SLimMargaretLindShaiLinnSteven ELipshultzPatrickLiuYangLiuLoon-TzianLoGiancarloLogroscinoAlan DLopezScott ALorchPaulo ALotufoRafaelLozanoRaimundasLuneviciusRonan ALyonsErlyn Rachelle KingMacarayanMark TMackayHassan Magdy AbdEl RazekMohammed Magdy AbdEl RazekMahdiMahdaviAzeemMajeedRezaMalekzadehDeborah CarvalhoMaltaLorenzo GMantovaniTsegahunManyazewalChabila CMapomaWagnerMarcenesGuy BMarksNealMarquezJoseMartinez-RagaMelvin BarrientosMarzanJoãoMassanoManu RajMathurPallab KMaulikMohsenMazidiColmMcAlindenJohn JMcGrathClaireMcNellanPeter AMeaneyAlemMehariMan MohanMehndirattaToniMeierAlemayehu BMekonnenKidanu GebremariamMelesZiad AMemishMelkamu MeridMengeshaDesalegn TadeseMengisteMubarek AberaMengistieBereket GebremichaelMenotaGeorge AMensahSeid TikuMeretaAtteMeretojaTuomo JMeretojaHaftay BerhaneMezgebeRenataMichaAnoushkaMillearEdward JMillsShawnMinnigMojdeMirarefinErkin MMirrakhimovCharles NMockKarzan AbdulmuhsinMohammadShafiuMohammedSanjay KMohantyAli HMokdadGlen Liddell DMolaMariamMolokhiaLorenzoMonastaMarcellaMonticoMaziarMoradi-LakehPaulaMoragaLidiaMorawskaRintaroMoriMarkMosesUlrich OMuellerSrinivasMurthyKamarul ImranMusaJean BNachegaChieNagataGabrieleNagelMohsenNaghaviAliyaNaheedLuigiNaldiVinayNangiaBruno RamosNascimentoIonutNegoiSudan PrasadNeupaneCharles RNewtonMarieNgFrida NamnyakNgalesoniJosephine WanjikuNgunjiriGrantNguyenDina Nur AnggrainiNingrumSandraNolteMarikaNomuraOle FNorheimBoNorrvingJean Jacques NNoubiapCarla MakhloufObermeyerFelix AkpojeneOgboIn-HwanOhAnselmOkoroOlanrewajuOladimejiAndrew ToyinOlagunjuPedro ROlivaresHelen EOlsenBolajoko OlubukunolaOlusanyaJacob OlusegunOlusanyaJohn NelsonOpioEyalOrenAlbertoOrtizRichard HOsborneMajdiOsmanMayowa OOwolabiMaheshPAAmanda WPainSmitaPakhaleElizabeth PalomaresCastilloAdrianPanaChristinaPapachristouMahboubehParsaeianTejasPatelGeorge CPattonDeepakPaudelVinod KPaulNeilPearceDavid MPereiraRogelioPerez-PadillaFernandoPerez-RuizNorbertoPericoKonradPesudovsMaxPetzoldMichael RobertPhillipsDavid MPigottJulian DavidPillayChristinePinhoSuzannePolinderConstance DPondVPrakashManoramaPurwarMostafaQorbaniD AlexQuistbergAmirRadfarAnwarRafayKazemRahimiVafaRahimi-MovagharMahfuzarRahmanMohammad Hifz UrRahmanRajesh KumarRaiUshaRamSaleem MRanaZaneRankinPaturi VishnupriyaRaoPuja CRaoSalmanRawafMaria Albertina SantiagoRegoMarissaReitsmaGiuseppeRemuzziAndre M N NRenzahoSergeResnikoffSatarRezaeiMohammad SadeghRezaiAntonio LRibeiroHirbo ShoreRobaMohammad BagherRokniLucaRonfaniGholamrezaRoshandelGregory ARothDietrichRothenbacherNawal KRoyPerminder SSachdevBen BenascoSackeyMohammad YahyaSaeediSaeidSafiriRajeshSagarMohammad AliSahraianMuhammad MuhammadSalehJoshua ASalomonAbdallah MSamyJuan RamonSanabriaMaria DoloresSanchez-NiñoLoganSandarItamar SSantosJoão VascoSantosMilena M SantricMilicevicRodrigoSarmiento-SuarezBennSartoriusMaheswarSatpathyMilojeSavicMonikaSawhneyMete ISaylanBenSchöttkerAletta ESchutteDavid CSchwebelSorayaSeedatAbdulbasit MusaSeidCanaan NegashSeifuSadaf GSepanlouBerrinSerdarEdson EServan-MoriTesfayeSetegnKatya AnneShackelfordAmiraShaheenSaeidShahrazMasood AliShaikhMarinaShakh-NazarovaMansourShamsipourSheikh Mohammed SharifulIslamJayendraSharmaRajeshSharmaJunSheSaraSheikhbahaeiJiabinShenPeilinShiMikaShigematsuMin-JeongShinRahmanShiriHaithamShomanMark GShrimeEphrem Lejore SibamoSibamoInga DoraSigfusdottirDiego Augusto SantosSilvaDayane Gabriele AlvesSilveiraShireenSindiAbhishekSinghJasvinder ASinghOm PrakashSinghPrashant KumarSinghVirendraSinghAbiy HiruyeSinkeAklilu EndalamawSinshawVegardSkirbekkKarenSliwaAlisonSmithEugeneSobngwiSamirSonejiJoan BSorianoTatiane Cristina MoraesSousaLuciano ASposatoChandrashekhar TSreeramareddyVasilikiStathopoulouNicholasSteelCaitlynSteinerSabineSteinkeMark AndrewStokesSaverioStrangesMarkStrongKonstantinosStroumpoulisLelaSturuaMuawiyyah BabaleSufiyanRizwan AbdulkaderSuliankatchiJiandongSunPatrickSurSoumyaSwaminathanBryan LSykesRafaelTabarés-SeisdedosKaren MTabbGetachew RedaeTaffereRoberto TchioTalongwaMusharafTarajiaMohammadTavakkoliNunoTaveiraStephanieTeepleTeketo KassawTegegneArashTehrani-BanihashemiTesfalidetTekelabDejen YemaneTekleGirma TemamShifaAbdullah SuliemanTerkawiAzeb GebresilassieTesemaJSThakurAlan JThomsonTaaviTillmannTenaw YimerTiruyeRuoyanTobe-GaiMarcelloTonelliRomanTopor-MadryMiguelTortajadaChristopherTroegerThomasTruelsenAbera KenayTuraUche SUchenduKingsley NUkwajaEduardo AUndurragaChigozie JesseUnekeOlalekan AUthmanJob F Mvan BovenRitaVan DingenenSantoshVarugheseTommiVasankariNarayanaswamyVenketasubramanianFrancesco SViolanteSergey KVladimirovVasiliy VictorovichVlassovStein EmilVollsetTheoVosJoseph AWagnerTolassaWakayoStephen GWallerJudd LWalsonHaidongWangYuan-PangWangDavid AWatkinsElisabeteWeiderpassRobert GWeintraubChi-PangWenAndreaWerdeckerJoshuaWesanaRonnyWestermanHarvey AWhitefordJames DWilkinsonCharles SheyWiysongeBelete GetahunWoldeyesCharles D AWolfeSunghoWonAbdulhalikWorkichoShimelash BitewWorkieMamoWubshetDenisXavierGelinXuAjit KumarYadavMohsenYaghoubiBereketYakobLijing LYanYuichiroYanoMehdiYaseriHassen HamidYimamPaulYipNaohiroYonemotoSeok-JunYoonMustafa ZYounisChuanhuaYuZoubidaZaidiMaysaaEl Sayed ZakiCarlosZambrana-TorrelioTomasZapataZerihun MenlkalewZenebeSanjayZodpeyLeoZoecklerLiesl JoannaZuhlkeChristopher J LMurray

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Funding Bill & Melinda Gates Foundation.





Categorías: Investigaciones

Processes and experiences of Portugal’s international recruitment scheme of Colombian physicians: did it work?

Publication date: Available online 17 May 2017
Source:Health Policy

Author(s): Erika Masanet

The Portuguese Ministry of Health performed five international recruitment rounds of Latin American physicians due to the need for physicians in certain geographic areas of the country and in some specialties, as a temporary solution to shortages. Among these recruitments is that of Colombian physicians in 2011 that was the largest of the five groups. This paper presents an evaluation of the international recruitment procedure of Colombian physicians based on the criteria of procedural outcomes and health system outcomes. The methodology used is qualitative, based on semi-structured interviews with key informants and Colombian physicians recruited in Portugal and also on documentary analysis of secondary sources. International recruitment of Colombian physicians coincided with a period of political change and severe economic crisis in Portugal that caused some problems in the course of this recruitment, mainly family reunification in the later group of Colombian physicians and non-compliance of the salary originally agreed upon. Furthermore, due to the continuous resignations of Colombian physicians throughout the 3-year contract, procedural outcomes and health system outcomes of this international recruitment were not fulfilled and therefore the expected results to meet the temporary needs for medical personnel in some areas of the country were not accomplished.





Categorías: Investigaciones

Towards Reinforcing Telemedicine Adoption amongst Clinicians in Nigeria

Publication date: Available online 17 May 2017
Source:International Journal of Medical Informatics

Author(s): Kayode I. Adenuga, Noorminshah A. Iahad, Suraya Miskon

Telemedicine systems have been considered as a necessary measure to alleviate the shortfall in skilled medical specialists in developing countries. However, the obvious challenge is whether clinicians are willing to use this technological innovation, which has aided medical practice globally. One factor which has received little academic attention is the provision of suitable encouragement for clinicians to adopt telemedicine, in the form of rewards, motivation or incentives. A further consideration for telemedicine usage in developing countries, especially sub-Saharan Africa and Nigeria in particular, are to the severe shortage of available practising clinicians. The researchers therefore explore the need to positively reinforce the adoption of telemedicine amongst clinicians in Nigeria, and also offer a rationale for this using the UTAUT model. Data were collected using a structured paper-based questionnaire, with 252 physicians and nurses from six government hospitals in Ondo state, Nigeria. The study applied SmartPLS 2.0 for analysis to determine the relationship between six variables. Demographic moderating variables, age, gender and profession, were included. The results indicate that performance expectancy (p <0.05), effort expectancy (p <0.05), facilitating condition (p <0.01) and reinforcement factor (p <0.001) have significant effects on clinicians’ behavioural intention to use telemedicine systems, as predicted using the extended UTAUT model. Our results showed that the use of telemedicine by clinicians in the Nigerian context is perceived as a dual responsibility which requires suitable reinforcement. In addition, performance expectancy, effort expectancy, facilitating condition and reinforcement determinants are influential factors in the use of telemedicine services for remote-patient clinical diagnosis and management by the Nigerian clinicians.





Categorías: Investigaciones

Quality improvement in emergency service delivery: Assessment of knowledge and skills amongst emergency nurses at Connaught Hospital, Sierra Leone

Publication date: Available online 16 May 2017
Source:African Journal of Emergency Medicine

Author(s): Hedda Bøe Nyhus, Michael M. Kamara

Introduction The ability to deliver quality emergency care services is reliant on a well-trained workforce. Since Sierra Leone was declared Ebola free in December 2015, the country has now moved into the post-Ebola reconstructive phase focusing on specialty training of healthcare workers. This development aligns well to the growing momentum for improved emergency medicine as a speciality in other regions of Sub-Saharan Africa. The first stage in assessing how to develop an emergency nursing speciality in Sierra Leone is to conduct an assessment of what is needed in terms of educational interventions. Concurrently enhancing emergency nursing capacity requires a comprehensive understanding of the role, function and emergency nurse educational requirements. This study was conducted to fully understand the current context, elucidate current nursing functions and gain knowledge of the educational desires and needs of nurses in the emergency centre at Connaught Hospital, the largest referral hospital in Sierra Leone. Methods This mixed-methods study comprised self-assessment, one multiple-choice questionnaire, focus group interviews and observational methods. Results Emergency nurses scored relatively low on the multiple-choice questionnaire, indicating through the self-assessment that they aspired to learn more about several topics within emergency care, and identified several themes which were considered to be barriers to delivery of care through focus group discussions and observations in the emergency centre. Conclusion This study has identified key aspects of emergency nursing speciality training to be developed through theoretical and skill-based education provided by the nursing schools and hospital clinical facilities in Sierra Leone.





Categorías: Investigaciones

The Triple Impact of Nursing

Publication date: Available online 11 May 2017
Source:International Journal of Nursing Studies

Author(s): Lord Crisp, Mary Watkins







Categorías: Investigaciones

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

Publication date: Available online 11 May 2017
Source:International Journal of Nursing Studies

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

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





Categorías: Investigaciones

Health workforce and governance: the crisis in Nigeria

Abstract Background

In Nigeria, several challenges have been reported within the health sector, especially in training, funding, employment, and deployment of the health workforce. We aimed to review recent health workforce crises in the Nigerian health sector to identify key underlying causes and provide recommendations toward preventing and/or managing potential future crises in Nigeria.

Methods

We conducted a scoping literature search of PubMed to identify studies on health workforce and health governance in Nigeria. A critical analysis, with extended commentary, on recent health workforce crises (2010–2016) and the health system in Nigeria was conducted.

Results

The Nigerian health system is relatively weak, and there is yet a coordinated response across the country. A number of health workforce crises have been reported in recent times due to several months’ salaries owed, poor welfare, lack of appropriate health facilities and emerging factions among health workers. Poor administration and response across different levels of government have played contributory roles to further internal crises among health workers, with different factions engaged in protracted supremacy challenge. These crises have consequently prevented optimal healthcare delivery to the Nigerian population.

Conclusions

An encompassing stakeholders’ forum in the Nigerian health sector remain essential. The national health system needs a solid administrative policy foundation that allows coordination of priorities and partnerships in the health workforce and among various stakeholders. It is hoped that this paper may prompt relevant reforms in health workforce and governance in Nigeria toward better health service delivery in the country.

Categorías: Investigaciones

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

Publication date: Available online 11 May 2017
Source:Annals of Global Health

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

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





Categorías: Investigaciones

The challenges of physician retirement

Publication date: 16 January 2017
Source:Canadian Medical Association Journal, Volume 189, Issue 2

Author(s): Roger Collier







Categorías: Investigaciones

Task shifting of triage to peer expert informal care providers at a tertiary referral HIV clinic in Malawi: a cross-sectional operational evaluation

Abstract Background

HIV treatment models in Africa are labour intensive and require a high number of skilled staff. In this context, task-shifting is considered a feasible alternative for ART service delivery. In 2006, a lay health cadre of expert patients (EPs) at a tertiary referral HIV clinic in Zomba, Malawi was capacitated. There are few evaluations of EP program efficacy in this setting. Triage is the process of prioritizing patients in terms of the severity of their condition and ensures that no harmful delays occur to treatment and care. This study evaluates the safety of task-shifting triage, in an ambulatory low resource setting, to EPs.

Methods

As a quality improvement exercise in April 2010, formal triage training was conducted by adapting the World Health Organization Emergency Triage Assessment and Treatment Triage Module Guidelines. A cross sectional observation study was conducted 2 years after the intervention. Triage assessments performed by EPs were repeated by a clinical officer (gold standard) to assess sensitivities, specificities, positive and negative predictive values for EP triage scores. Proportions were calculated for categories of disposition by stratifying by EP and clinician triage scores.

Results

A total of 467 patients were triaged by 7 EPs and re-triaged by clinical officers. With combined triage scores for emergency and priority patients we report a sensitivity of 85% and specificity of 74% for the EP scoring, with a low positive predictive value (41%) and a high negative predictive value (96%). We calculate a serious miss rate of EP scoring (i.e. missed priority or emergency patients) as 2.2%. Admission rates to hospital were highest among those patients triaged as emergency cases either by the EP’s (21%) or the clinicians (83%). Fewer patients triaged as priority by either EPs (5%) or clinicians (15%) were admitted to hospital, however these patients had the highest prevalence of same day lab testing and/or specialty referral.

Conclusions

Our study provides reassurance that in the context of adequate training and ongoing supervision, task-shifting triage to lay health care workers does not necessarily lead to less accurate triaging. EPs have a tendency to be more conservative in over-triaging patients.

Categorías: Investigaciones

Páginas