Concept analysis of health system resilience.

BACKGROUND: There are several definitions of resilience in health systems, many of which share some characteristics, but no agreed-upon framework is universally accepted. Here, we review the concept of resilience, identifying its definitions, attributes, antecedents and consequences, and present the findings of a concept analysis of health system resilience. METHODS: We follow Schwarz-Barcott and Kim's hybrid model, which consists of three phases: theoretical, fieldwork and final analysis. We identified the concept definitions, attributes, antecedents and consequences of health system resilience and constructed an evidence-informed framework on the basis of the findings of this review. We searched PubMed, PsycINFO, CINAHL Complete, EBSCOhost-Academic Search and Premier databases and downloaded identified titles and abstracts on Covidence. We screened 3357 titles and removed duplicate and ineligible records; two reviewers then screened each title, and disagreements were resolved by discussion with the third reviewer. From the 130 eligible manuscripts, we identified the definitions, attributes, antecedents and consequences using a pre-defined data extraction form. RESULTS: Resilience antecedents are decentralization, available funds, investments and resources, staff environment and motivation, integration and networking and finally, diversification of staff. The attributes are the availability of resources and funds, adaptive capacity, transformative capacity, learning and advocacy and progressive leadership. The consequences of health system resilience are improved health system performance, a balanced governance structure, improved expenditure and financial management of health and maintenance of health services that support universal health coverage (UHC) throughout crises. CONCLUSION: A resilient health system maintains quality healthcare through times of crisis. During the coronavirus disease 2019 (COVID-19) epidemic, several seemingly robust health systems were strained under the increased demand, and services were disrupted. As such, elements of resilience should be integrated into the functions of a health system to ensure standardized and consistent service quality and delivery. We offer a systematic, evidence-informed method for identifying the attributes of health system resilience, intending to eventually be used to develop a measuring tool to evaluate a country's health system resilience performance.

Palliative Care Nursing Development in the Middle East and Northeast Africa: Lessons From Oman.

Nurses are on the frontline of palliative care, and in some countries, are the only contact for patients and families facing life-threatening illness. The Oman Cancer Association in the Sultanate of Oman, in collaboration with the Middle Eastern Cancer Consortium and the Oncology Nursing Society, led a palliative care initiative over the past decade to better integrate palliative care into the health care system. Components of this initiative include integrating palliative care into the health care curricula and providing palliative care education to over 400 nurses and other health care professionals within Oman. The four-part education series includes the following courses: (1) Foundations of Palliative Care, (2) Advanced Concepts in Palliative Care, (3) Palliative Care Leadership, and (4) Palliative Care Research. Additional participants from 17 different countries in the Middle East and northern Africa also attended the training. Twenty of the trainees who were considered palliative care leaders in their countries then participated in a Train the Trainer course. This group trained the last cohort of health care professionals in Oman and then took learned concepts and strategies back to their respective countries in order to provide country-wide education and build palliative care capacity in the region. Outcomes include the development of palliative care units, quality improvement projects that improved care, and advocacy projects to increase opioid availability within some countries. The collaborative continues its work and connections through social medial, email, and virtual collaboration. Other countries can use this model to permeate palliative care within their regions.

GCC women: causes and processes of midlife weight gain.

Perimenopausal obesity is a particular problem in Gulf Cooperation Council (GCC) countries. This study examined the culturally specific views of perimenopausal GCC women, and the causes and processes of midlife weight gain using a qualitative descriptive design with semistructured interviewing and content analysis. Constructs derived from the health belief model and Kleiman's explanatory model were used to identify and sort themes into conceptual categories. The findings of this study suggest that weight-management program plans targeting perimenopausal GCC women should take into consideration the multiple levels of factors and cultural influences on their behavior.

Evaluation of intervention research in weight reduction in post menopausal women.

To describe the evidence that has accrued for interventions targeting weight loss in postmenopausal women, and to assess the strengths and limitations of weight loss interventions in postmenopausal women using the framework of evaluation theory, including definition of the problem and the use of theoretical framework and mediators. Electronic databases were used, including CINAHL, EBSCO Host, Google scholar, Medline, and the Science Citation Index, Expanded, in the Web of Science from 1995 to December 2009. Keyword searches included the terms obesity, obese, overweight, menopause, and weight management interventions. Searches were combined to find reports addressing 1 or more keywords. Experimental design studies that examined physical activity or dietary intervention effects on weight loss or body composition changes in postmenopausal women were selected for review. Reports of 15 intervention studies met inclusion criteria from the list of 120 generated through the database searches. Each article was evaluated for 1) effects produced as a result of the intervention, 2) the characteristics of the problem of postmenopausal obesity, 3) specification of theoretical constructs and critical inputs that guide the design of an intervention, and 4) link of the theoretical predictors and the outcome measures selected. Four types of interventions were tested in the 15 research reports. Only 5 of the 15 used theories or models to guide the interventions. All of the interventions resulted in some positive weight management outcome, such as lowered body mass index, fat mass, waist circumference, systolic blood pressure, glucose, and cholesterol. Overall, the reviewed research showed efficacy of varying intensities of exercise when combined with hypocaloric diet or meal replacement therapy in producing low body weight, low fat, improved insulin sensitivity, glycemic control, and cardio-respiratory fitness. The external validity of the 15 studies was limited in reporting of a clear delineation of the problem, theoretical frameworks, and application of the findings.

Perimenopausal obesity.

Obesity is recognized as one of the most important underlying risk factors for a wide variety of diseases, including heart disease and diabetes. Women are particularly prone to obesity, and approaches that address life transitions across the life span suggest that a number of factors may converge at passage points, such as menopause, that contribute to weight accumulation in the aging woman. The menopausal phase of a woman's life brings a number of changes that may trigger and maintain weight gain. Although the prevalence of overweight and obesity is attributable to each of these factors, it is most likely the interaction among multiple factors that determines an individual's propensity for excess energy intake, sedentary behavior, patterns of fat distribution, and risk of developing obesity. The problem of weight change and obesity in perimenopausal women is best understood from an ecological perspective that can integrate the analysis of factors across levels, from the culture and built environment of the community to family-related factors to individual factors, such as subjective norms, values, attitudes, and beliefs, and biological/genetic predispositions. This review describes the literature relevant to weight change during perimenopause using a multilevel perspective and recommends future directions for the development of translational weight management research to meet the unique needs of women.