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1.
St. Augustine; The University of the West Indies, Faculty of Medical Sciences; 2004.
Monografia em Inglês | MedCarib | ID: med-17013
2.
Rev. panam. salud publica ; 13(6): 352-354, Jun. 2003.
Artigo em Inglês | MedCarib | ID: med-16991

RESUMO

Research on the health of older adults in Latin America and the Caribbean has been neglected in epidemiology and public health. This is of grave concern since dramatic changes in fertility and mortality rates in recent decades ensure a rapid aging of the population in the Western Hemisphere. Persons 60 and older in Latin America and the Caribbean now make up 8 percent of the total population; by the middle of this century that figure will grow to 22 percent. In absolute numbers, the population of older persons will total over 180 million by 2050. In the coming decades we expect to find poorer health status and grater disability in the cohorts of persons who survived childhood and adult diseases. That higher survival rate is due to more public health interventions and less to an improvement in their socioeconomic status. Therefore, policy-makers in Latin America and the Caribbean need to understand the correlation among different gradients of poverty, access to health care, social networks, and health in old age (AU)


Assuntos
Humanos , Idoso , Administração em Saúde Pública , América , Idoso , Idoso Fragilizado , Região do Caribe , Saúde do Idoso , Pesquisa sobre Serviços de Saúde , América Latina
3.
Curacao; The Foundation for Promotion of International Cooperation & Research in Health Care; 2001. 144 p. ilus.
Monografia em Inglês | MedCarib | ID: med-16388

RESUMO

'The Saba Health Study' is the first large scale health interview survey of the island. This book presents the main results of the study. It discusses the population's health status, use of health services, and satisfaction with health care. Known health risks, such as smoking, alcohol consumption, and overweight are evaluated and compared with situations on the sister island of Curacao and in western countries. Attention is focused on the identification of risk groups in need of specific policy interventions and health promotion programs (AU)


Assuntos
Adulto , Humanos , Estudo Comparativo , Pesquisas sobre Atenção à Saúde , Nível de Saúde , Pesquisa sobre Serviços de Saúde , Qualidade, Acesso e Avaliação da Assistência à Saúde , Antilhas Holandesas , Estilo de Vida , Região do Caribe , Promoção da Saúde , Ética
6.
Curacao; The Foundation for Promotion of International Cooperation & Research in Health Care; 2001. 136 p. ilus.
Monografia em Inglês | MedCarib | ID: med-16391
8.
Caribbean Health ; 3(2): 19-20, July 2000. ilus
Artigo em Inglês | MedCarib | ID: med-17346

RESUMO

Nearly 200 people attended the 45th scientific meeting of the Caribbean Health Research Council in Port-of-Spain's Hilton Hotel in April. Opening the event, Trinidad and Tobago's health minister Dr Hamza Rafeek emphasised the importance of essential national health research. He congratulated CHRC on the work it was doing. The minister for Tobago, Dr Morgan Job, gave an address discussing the financing of healthcare. Even wealthy nations were unable to meet the entire cost of providing care, he said. Individuals must be encouraged to take more responsibility for their own health, particularly with regard to behavioral change required to prevent ill-health. Presentations at the conference began with a consideration of the course content, and the delivery of that content, at the three campuses of the medical faculty of the University of the West Indies. Speakers from Barbados, Jamaica, and Trinidad described recent developments and the continuing efforts being made to ensure that doctors were well and appropriately trained (AU)


Assuntos
Humanos , Congresso , Saúde , Pesquisa sobre Serviços de Saúde , Sociedades , Região do Caribe
9.
Rev. panam. salud publica ; 7(5): 345-349, May 2000.
Artigo em Inglês | MedCarib | ID: med-16929

RESUMO

During the 1990s the countries of Latin America and the Caribbean went through profound transformations in their economic, political, and social structures-including in the way that those nations produced, disseminated, and used scientific knowledge that could enhance their citizen's health. Nevertheless, still more changes are needed to fully develop the potential of scientific activity to promote health in Latin America and the Caribbean (LAC). In this task the LAC countries face two major challenges: building their capacity to develop, interpret, and adapt new knowledge and technologies, and creating opportunities for democratic consensus-building so that this capacity serves to improve the health of the peoples of the LAC countries. And while those nations confront many weaknesses in generating and mastering the needed scientific and technological knowledge, the situation in the 1990s was greatly improved over that in the 1980s (AU)


Assuntos
Humanos , Administração em Saúde Pública , América Latina , Organização e Administração/métodos , Pesquisa sobre Serviços de Saúde
10.
West Indian med. j ; 49(Suppl. 2): 47-8, Apr. 2000.
Artigo em Inglês | MedCarib | ID: med-929

RESUMO

OBJECTIVE: To evaluate the Essential National Research (ENHR) process since its introduction in nine developing countries. DESIGN AND METHODS: A survey of ENHR was conducted between December 1997 and November 1998 in nine developing countries. A total of 27 respondents from 7 South East Asian and 2 Caribbean countries completed questionaires. Respondents included 14 men and 13 women with a median age of 48 years (ranged 25-69 years); 15 were researchers, 6 were health providers, 3 policy makers and 1 a community representative (1 no response). RESULTS: ENHR was formally adopted in 5 countries mainly through public policy statements. Seven countries has a mechanism in place of promotion of ENHR and national meetings were held in 5 countries in the year prior to the survey. A special activity was conducted in order to define health research priorities in 8 countries and a list of these priorities was available in 7 countries. The level of ENHR activity was ranked as low or moderate in most countries except India and Malaysia which were rated as moderate to high. Three countries reported that the process resulted in new or additional funds being made available for research while India reported available funds being reallocated to meet the priorities defined. The respondents of 6 countries said that ENHR networking had led to tangible results including improved collaboration among researchers and research institutions and the sharing of resources among different organisation (5 countries). The ENHR process had resulted in research findings being used to formulate or change health policy in 5 countries. Most countries had not produced any new research protocols through the ENHR process. However, there were 250 new research protocols in India and 68 in Pakistan, of which 20 and between 25 and 35, respectively, were funded, and 15 peer reviewed articles published from India. CONCLUSION: This survey does suggest that the ENHR process may be promoting health research on priority health problems and the use of results to formulate policy in selected countries. However, it is too early to assess the contribution of ENHR to health and development and a variety of different studies would be needed to conduct this assessment.(AU)


Assuntos
Feminino , Humanos , Masculino , Idoso , Pessoa de Meia-Idade , Adulto , Política de Saúde , Pesquisa sobre Serviços de Saúde , Coleta de Dados , Índia , Paquistão , Malásia , Sudeste Asiático , Região do Caribe
11.
West Indian med. j ; 49(Suppl 2): 21, Apr. 2000.
Artigo em Inglês | MedCarib | ID: med-999

RESUMO

OBJECTIVE: We evaluated variations in care among government health centres in Trinidad and Tobago. DESIGN AND METHODS: We studied processes of care and drug prescribing for diabetes in 23 government health centres in Trinidad and Tobago. Data were abstracted from the records of 1579 subjects with clinical diabetes, related to 12 processes of care and the prescription of five hypoglycaemic drugs and six cases of anti-hypertensive drug. Health centre level variances were estimated using multilevel statistical models. RESULTS: At different health centres, the proportion of patients receiving dietary advice ranged from 6 percent ot 95 percent; blood glucose estimations ranged from 14 percent to 88 percent; and foot inspection from 3 percent to 43 percent. Using a process of care summary score ranging from zero to 12, the lowest scoring health centre achieved a mean score of 1.55 and the highest 7.45. Regression analyses showed that health centres with only one nurse or doctor at each session provided fewer processes of care. More processes of care were provided when there were more patients attending each session, or when the health centre had more items of equipment. The proportion of patients prescribed insulin ranged from 3 percent to 29 percent. Prescription of insulin was associated with younger age and male gender but not with health centre characteristics. CONCLUSIONS: Larger health centres with more staff and equipment, or with higher patient attendance rates, appeared to provide better quality care. Variations in drug utilisation were less and tended to be explained by individual patient characteristics.(Au)


Assuntos
Humanos , Níveis de Atenção à Saúde , Variações Dependentes do Observador , Trinidad e Tobago , Pesquisa sobre Serviços de Saúde , Revisão de Uso de Medicamentos
12.
West Indian med. j ; 49(Suppl 2): 20-1, Apr. 2000.
Artigo em Inglês | MedCarib | ID: med-1000

RESUMO

OBJECTIVE: To evaluate associations of health status and social inequalities with consultation at a private doctor among public primary care clinic attendees. DESIGN AND METHODS: The sample included 2,117 randomly selected subjects with clinical diabetes attending 35 government health centres in Trinidad and Tobago. Measures included attendance at a private doctor, the type 2 Diabetes Symptom Checklist, the SF36 questionnaire and indicators of social and economic status. RESULTS: Of the sample, 1,256 (59 percent) reported attending a private doctor, 577 (27 percent) attended a private doctor for diabetes, and 378 (18 percent) attended a private doctor regularly. Attendance at a private doctor was associated with lower SF36 score. The odds ratio for a 10 unit increase in SF36 physical component score was 0.81 (95 percent confidence interval 0.72 to 0.91). After adjusting for demographic and social factors, the relative odds were 0.89 (0.80 to 1.00). After allowing for differences in health status, those without pipe-borne water supply in the home were less likely to attend a private doctor than those with (odds ratio 0.77, 0.63 to 0.94). Those living alone were less likely to attend a private doctor than those living with their children and partner (odds ratio 0.60, 0.43 to 0.83). CONCLUSIONS: Persons consulting doctors in the private sector had worse health status than those relying only on public care. Household rather than individual measures of lower social or economic status were associated with less access to private care in relation to need, even among those who use public sector care.(Au)


Assuntos
Humanos , Monitoramento Epidemiológico , Fatores Socioeconômicos , Trinidad e Tobago , Pesquisa sobre Serviços de Saúde
13.
West Indian med. j ; 49(Suppl 2): 20, Apr. 2000.
Artigo em Inglês | MedCarib | ID: med-1001

RESUMO

OBJECTIVE: The purpose of this study was to assess the health service cost of haemodialysis delivered by the Queen Elizabeth Hospital, Barbados. DESIGN AND METHODS: A cost analysis was performed from the viewpoint of the study hospital using the treatment protocols based on current practice. These incorporated procedures to establish dialysis access sites (surgical set up) and dialysis maintenance. Cost and patient data were collected for the period April 1, 1998 to March 31, 1999. Sixty-four patients were studied. Analyzed costs included personnel, drug expenditure, supplies (dialysis and non-dialysis related), inpatient costs, laboratory and other ancillary services, and indirect or overhead costs such as plant, housekeeping, laundry and administration. RESULTS: The final cost per patient year was $37,930.04 in the first year of dialysis and included surgical set-up, and $34,059.08 in the subsequent years (excluding inpatient admissions and treatments for complications). The total cost of dialysis provision for the year excluding surgical set up was $2,178,561.09. The cost per visit was estimated to be $286.95. Direct costs (determined by patient utilization and physician and nurse directives) amounted to 81.8 percent of total cost. The main expenditure sections were dialysis-related supplies, labour and overheads. Cost savings incurred as a result of strict modification of treatment guidelines were estimated. By altering the number of dialysis visits per week and introducing other cost saving measures, such as dialyzer re-use, a savings of $852,176.32 was observed with a full potential savings of $902,218.63. An incremental cost analysis of a service expansion (scenario 1) indicated that the cost savings would be sufficient to provide an additional 3,328 dialysis treatments or visits per year, incorporating 4 additional dialysis machines. CONCLUSIONS: These findings are important in the light of constrained economic resources. However, the outcomes associated with the observed costs must be explored in order to assess the "true value" or cost effectiveness of the current dialysis practice. Therefore, this analysis is but one component of an overall study to review the renal dialysis services in Barbados for the purpose of informing plans for expansion and optimization of services.(Au)


Assuntos
Humanos , Unidades Hospitalares de Hemodiálise/economia , Custos e Análise de Custo , Barbados , Estudo de Avaliação , Pesquisa sobre Serviços de Saúde
14.
West Indian med. j ; 49(Suppl 2): 20, Apr. 2000.
Artigo em Inglês | MedCarib | ID: med-1002

RESUMO

OBJECTIVES: To determine the cost of treating acute asthma at the Queen Elizabeth Hospital (QEH) and to identify ways of reducing these costs. DESIGN AND METHODS: Case notes of all patients presenting to the Asthma Bay of the QEH during a two-week period in March 1999, were reviewed. Data, extracted included gender, arrival time, number of nebulizations, dosage of oral prednisolone and inhalers prescribed. A questionnaire was completed by a sample of these patients regarding use of inhalers, follow-up care and time lost from work and school. RESULTS: A total of 303 cases were reviewed and 75 patients completed questionnaires. The majority of asthmatics received oral prednisolone (74 percent) and/or three nebulizations (42 percent). The cost of treating each patient was determined to be approximately US $22.00, including medical and nursing salary costs. The annual cost to the QEH was estimated to be US $214,000 including the costs of admitting patients. Indirect costs included the time lost from work or school in 86 percent of patients and in 56 percent of parents taking time off to look after their sick children. The questionnaire survey revealed that 63 percent of patients with "preventer" medications were not using them and only 38 percent received follow-up care. Seventy-four percent of these patients had repeated asthmatic attacks during the preceding 3 months with 11 percent having more than six attacks. CONCLUSIONS: A significant amount of money is spent on asthma care at the QEH. However, improper understanding and use of medication coupled with lack of continuity of care lead to poor control and frequent attacks. These findings justify the need for an asthma clinic for these patients.(Au)


Assuntos
Feminino , Humanos , Masculino , Asma/economia , Asma/terapia , Custos e Análise de Custo , Barbados , Prednisolona/uso terapêutico , Coleta de Dados , Inquéritos e Questionários , Pesquisa sobre Serviços de Saúde
15.
West Indian med. j ; 49(Suppl 2): 19, Apr. 2000.
Artigo em Inglês | MedCarib | ID: med-1003

RESUMO

OBJECTIVE: To determine the annual cost of treating asthma in Barbados over a ten-year period. METHODS: The Barbados Drug Service is the central procurement agent for drugs on the Barbados National Formulary. Information on the costs of the various asthma medications, and the number of prescriptions written for these drugs, were obtained from the Barbados Drug Service records. The prescriptions written for asthma medications between 1986 and 1997 were analysed and the annual cost of the various categories of asthma calculated. RESULTS: The annual drug cost of treating asthma in Barbados increased from $293,111 in 1987 to $1,268,348 in 1996, a four-fold increase over ten years. There was a rapid rise in the cost of anti-inflammatory drugs during the study period, from $48,628 or 16.5 percent of total drug cost in 1986 to $503,092 or 39.6 percent of total drug cost in 1997. The cost of inhaled beta-2-agonists over the same period increased from $131,154 or 44.7 percent of the total drug cost in 1997. However, the cost of oral beta-2-agonists decreased over the ten-year period, reflecting the increased use of the inhaled form of the medication. With the increasing number of acute asthmatics seen in the Accident and Emergency Department at the Queen Elizabeth Hospital, the cost of nebulization solutions increased eight-fold, from $8,361 in 1986 to $69,172 in 1997. CONCLUSIONS: Asthma has been an increasing burden on the medical resources of Barbados over the past decade. The drug costs of treating asthma have increased significantly over the 10-year period 1986 to 1997 and accounted for 5.8 percent of the annual budget of the Barbados Drug Service in 1997.(Au)


Assuntos
Humanos , Asma/economia , Asma/terapia , Custos e Análise de Custo , Coleta de Dados/economia , Pesquisa sobre Serviços de Saúde
16.
West Indian med. j ; 49(Suppl 2): 19, Apr. 2000.
Artigo em Inglês | MedCarib | ID: med-1004

RESUMO

OBJECTIVES: To determine if signed consent for a research project constitutes informed consent in sexually transmitted diseases (STD) clinic attendees who understood the voluntary nature of confidentiality outlined in the consent form. DESIGN AND METHODS: A sexual behaviour research project was conducted by researchers from local institutions in association with investigators from a university in Alabama. This present study was a cross-sectional survey using a 34-item questionnaire administered to a consecutive sample of STD clinic attendees in Port-of-Spain, Trinidad, who had been invited to participate in the sexual behaviour research project. RESULTS: Of the 102 participants, 48 (47.1 percent) persons had read the entire consent form in the sexual behaviour survey. Thirty-eight (37.3 percent) persons reported that they thought the health care they received would be worse if they declined to participate in that study. Subjects with less education were significantly more likely to believe their health care would be negatively affected if they refused to participate (p<0.001). Thirty-nine (38.2 percent) persons believed that they had to complete the sexual behaviour questionnaire in order to be treated at the clinic. Almost two-thirds of respondents thought that their answers to the sexual behaviour questionnaire could be traced back to them by persons other than the interviewers and researchers. CONCLUSIONS: The findings clearly indicate that amongst this population a signed consent form does not constitute informed consent. The process of obtaining truly informed consent for research conducted in this setting requires review.(Au)


Assuntos
Humanos , Consentimento Livre e Esclarecido , Infecções Sexualmente Transmissíveis , Estudos Transversais , Inquéritos e Questionários , Trinidad e Tobago , Pesquisa sobre Serviços de Saúde
17.
Public Health ; 113(6): 307-9, Nov., 1999.
Artigo em Inglês | MedCarib | ID: med-740

RESUMO

This study seeks to identify background characteristics of the people who utilize health care services in Trinidad and Tobago and to investigate their perceptions of the services offered. Data were collected through a survey of health care users distributed throughout Trinidad and Tobago. Multi-stage sampling was used to select 1500 health care users and structured interviews were conducted on regular clinic days by trained personnel. Results indicate that there are fairly high levels of patient satisfaction with health care centres in Trinidad and Tobago and that the more disadvantaged groups (the elderly, women and the unemployed) utilize these services more frequently. Results also show variations with respect to pay, services that need improving and doctor's willingness to listen to problems. (AU)


Assuntos
Feminino , Humanos , Masculino , Satisfação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Eficiência Organizacional , Acesso aos Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Amostragem , Classe Social , Trinidad e Tobago
18.
Bull World Health Organ ; 77(4): 356-60, 1999.
Artigo em Inglês | MedCarib | ID: med-1330

RESUMO

This paper endeavours to identify the background characteristics of health centre users in Trinidad and Tobago and their perceptions of the efficiency of the services provided. Multistage sampling was employed to select 1451 users. Data were obtained during structured interviews on regular clinic days. Of the people using the health centres, 80.4 percent were unemployed and 75.9 percent were women. People aged over 60 accounted for 25.4 percent of the sample. Users included a disproportionately high number of persons from the lower socioeconomic categories. The proportions of persons of different ethnic and religious groups closely reflected those in the country's general population. Approximately 74 percent of the interviewees were satisfied with the performance of the doctors in the health centres. For nurses the satisfaction rating was about 10 percent higher. The greatest needs for improvement were perceived to be in pharmacists' and doctors' services, with particular reference to waiting times.(Au)


Assuntos
Adulto , Pessoa de Meia-Idade , Feminino , Humanos , Masculino , Pessoal de Saúde/normas , Satisfação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/normas , Eficiência Organizacional , Emprego/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Determinação de Necessidades de Cuidados de Saúde , Inquéritos e Questionários , Fatores Socioeconômicos , Trinidad e Tobago
19.
West Indian med. j ; 47(2): 41-6, Jun. 1998.
Artigo em Inglês | MedCarib | ID: med-1804

RESUMO

The Faculty of Medical Sciences has contributed to improvements in health status in the Caribbean through its research, training, and service and outreach programmes. Basic and applied research has yielded important scientific data and information that has guided health care, resulting in decrease in morbidity and mortality. Physicians graduating from its undergraduate programme and successfully completing its graduate programmes, and nurse and other professionals trained in the Faculty, are widely dispersed throughout the Caribbean and, together with Faculty staff members, have collaborated with others to formulate and implement health policies, and to provide the facilities for health education and promotion, and for the care of ill patients. Outreach programmes include organising and/or participating in projects, conferences, workshops or consultations for or with countries or organisations. Collaboration and partnership for all these activities have been important. The problems and challenges are discussed, with an outline of some of the plans being employed to resolve them.(AU)


Assuntos
Indicadores Básicos de Saúde , Docentes de Medicina , Papel (figurativo) , Atenção à Saúde , Índias Ocidentais , Pesquisa sobre Serviços de Saúde , Distribuição de Médicos
20.
West Indian med. j ; 46(suppl. 2): 26, Apr. 1997.
Artigo em Inglês | MedCarib | ID: med-2289

RESUMO

A Profile of health research in Jamaica 1991- 1995 was prepared. Of 43 organizations or research groups surveyed, 31 met the criteria of at least one peer review publication between 1991 and 1995. Most had fewer than 20 professionals staff, and less than 10 engaged in health research, with a total of 227 health researchers. Institutional objectives and funding opportunities largely determined research priorities. A total of 704 research papers were published over the period with one-third (10) of the organizations responsible for 459 or 65 percent of all publications. On the whole, local research groups appear to be small, vulnerable, under-funded and deficient in basic equipment as well as in trained and experience researchers and support staff. These are compelling reasons for health researchers to come together to tackle common problems, promote collaboration and forge a joint strategy to strengthen health research capability in Jamaica(AU)


Assuntos
Pesquisa sobre Serviços de Saúde , Apoio à Pesquisa como Assunto , Jamaica
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