The Influence of Dentists' Profile and Health Work Management in the Performance of Brazilian Dental Teams.

To evaluate the association between dentists' profile and health work management with the performance of primary care dental teams in the Brazilian National Health System, both nationally and regionally. Secondary data analysis from a Brazilian National Programme that evaluated 18,114 Brazilian dental teams, working in the public sector, between 2013 and 2014. Twenty-four independent variables taken from dentists' profile and dental team management characteristics were analysed to assess their influence on reported "dental team performance." An estimated score was generated from their performance on 20 dental procedures by an item response theory model. Multiple linear regression models were performed for each Brazilian geographical region, separately and for the whole of Brazil. p values ≤ 0.05 were considered significant. Two variables related to dentists' profile, "having graduate studies" (ß = 0.151) and "undertaking continuing professional development training" (ß = 0.101), were associated with enhanced dental team performance in all five Brazilian geographical regions and nationally. The dental team management variables of "having a flexible dental appointment list" (ß = 0.218) and "monitoring oral health indicators" (ß = 0.132) also contributed to improve team performance in each of the regions and nationally. Dentists' profile influenced the performance of dental teams from south region more than the other regions. The findings suggest that continuing professional development, including postgraduate education, and strategic management characteristics are important for primary dental care performance and should be reflected in health policy initiatives in support of quality care. Regional factors could be considered for health care management.

Adequate emergency department resource usage: Applying simulation-based workshop to improve teaching competence among elementary and junior high school teachers in Taiwan.

INTRODUCTION: More than 80% of patients who visited Emergency Department (ED) was not urgent in Taiwan in 2019. It causes insufficient medical services and a latent fiscal threat to the Nation Health Insurance (NHI). This study adopted simulation-based educating modules to explore the effect in teaching competence among primary and middle school teachers for efficient AEDRU (adequate emergency department resource usage) education in the future. METHOD: The subjects were 414 elementary and junior high school teachers in Taiwan. 214 participants attended the simulation-based workshop as the simulation-based group, whereas 200 participants took an online self-learning module as the self-learning group. The workshop was created by an expert panel for decreasing the unnecessary usage amount of ED medial resources. The materials are lecture, board games, miniature ED modules, and simulation-based scenarios. A teaching competence questionnaire including ED knowledge, teaching attitude, teaching skills, and teaching self-efficacy was conducted among participants before and after the intervention. Data were analyzed via McNemar, paired t test and the generalized estimating equations (GEE). RESULTS: The study showed that teachers who participated in the simulation-based workshop had improved more in teaching competence than those who received the online self-learning module. In addition, there were significant differences between the pre-test and post-test among the two groups in teaching competence. CONCLUSION: The simulation-based workshop is effective and it should be spread out. When students know how to use ED medical resources properly, they could affect their families. It can help the ED service to be used properly and benefits the finance of the NHI. The health care cost will be managed while also improving health.

Avaliação das competências andragógicas dos docentes do nível técnico de enfermagem / Evaluación de las competencias andragógicas de los professores del nível técnico de enfermeira / Assessment of the andragogical skills of teachers at the level nursing technician

Resumo Objetivos Identificar como o enfermeiro docente do nível técnico de enfermagem avalia suas competências andragógicas como facilitador de aprendizagem, para o exercício da docência. Método Estudo transversal com abordagem quantitativa, desenvolvido com 73 enfermeiros docentes, em 30 unidades de uma instituição de nível técnico de enfermagem do Estado de São Paulo. Os dados foram coletados no período de setembro a dezembro de 2019. Foi aplicada a Escala de Classificação Autodiagnóstica de Competências para o Papel do Educador/Instrutor de Adultos. Foi utilizado teste Wilcoxon. Resultados Amostra predominantemente feminina (72,6%), com média de idade de 40,3 anos (DP=7,4) e tempo de atuação docente de 9,7 anos (DP=6,3). Os docentes consideraram que seu nível atual de competência encontra-se em moderado conhecimento para o desenvolvimento de cada competência, enquanto o nível que desejava atuar com adultos em processos de ensino e aprendizagem deveria estar em alto conhecimento. Conclusão e implicações para a prática Os docentes consideraram-se abaixo do nível desejado, em todos os itens avaliados nas competências andragógicas, como facilitadores de aprendizagem para o exercício da docência. O estudo apresenta grande relevância de inovação, pois não há disponível na literatura qualquer estudo que avalie as competências andragógicas dos docentes do nível técnico de enfermagem.

Resumen Objetivo Identificar cómo el enfermero docente del nivel técnico de enfermería evalúa sus habilidades andragógicas como facilitador del aprendizaje para el ejercicio de la enseñanza. Método Estudio descriptivo transversal con enfoque cuantitativo, desarrollado con 73 enfermeras docentes en 30 unidades de una institución de nivel técnico de enfermería en el Estado de São Paulo. Los datos se recogieron de septiembre a diciembre de 2019. Se aplicó la Escala de calificación de aptitudes de autodiagnóstico para la función de educador/instructor de adultos. Se utilizó la prueba de Wilcoxon. Resultados Muestra predominantemente femenina (72,6%), con una edad media de 40,3 años (DE = 7,4) y experiencia docente de 9,7 años (DE = 6,3). Los docentes consideraron que su nivel actual de competencia es de conocimiento moderado para el desarrollo de cada competencia, mientras que el nivel que deseaba trabajar con adultos en los procesos de enseñanza y aprendizaje debía ser de conocimiento alto. Conclusiones e implicaciones para la práctica Los profesores se consideraron por debajo del nivel deseado, en todos los ítems evaluados en las competencias andragógicas, como facilitadores de aprendizaje para el ejercicio de la docencia. El estudio presenta gran relevancia teniendo como característica la innovación, ya que no existe ningún estudio disponible en la literatura que evalúe las competencias andragógicas de los profesores de enfermería a nivel técnico.

Abstract Objective To identify how the teaching nurse of the technical level of nursing evaluates his/her andragogical skills as a facilitator of learning, for the exercise of teaching. Method A cross-sectional study with a quantitative approach, developed with 73 teaching nurses, in 30 units of a technical nursing level institution in the State of São Paulo. The data was collected from September to December 2019. The Self-diagnostic Classification Scale of Competencies for the Educator of Adults Role was applied. Wilcoxon's test was used. Results A predominantly female sample (72.6%), with a mean age of 40.3 years (SD=7.4) and teaching time of 9.7 years (SD=6.3). The teachers considered that their current level of competence is in moderate knowledge for the development of each skill, while the level that they wanted to work with adults in teaching and learning processes should be in high knowledge. Conclusions and implications for practice The teachers considered themselves below the desired level, in all the items evaluated in the andragogical skills, as learning facilitators for the teaching exercise. The study presents great innovation relevance, because there is not available in the literature any study that evaluates the andragogical competences of the teachers of the technical nursing level.

Managerial competencies-A survey of healthcare managers in a tertiary hospital in Calabar, South-South Nigeria.

BACKGROUND: Tertiary hospitals are specialized institutions that provide managed care for patients. It has been shown that the productivity of any organization/institution is as good as the performance of its managers. AIM: This study assessed the management knowledge of Healthcare Managers in a tertiary hospital in Calabar, Nigeria. METHODOLOGY: This was a descriptive cross-sectional study that employed a structured questionnaire (adapted from the Health Leadership Alliance competency directory). Data were analyzed using SPSS version 20. RESULTS: A total of 266 managers were included in this studywith a M: F ratio of 1.3:1. The knowledge rating of role of non-clinical professionals, regulatory agency standards, preparation of business communication, change process management and policy formulation and analysis varied significantly among the three levels of management (p < 0.05). Less than 50% of operational and middle managers rated themselves as experts in all the competency domains while majority (80%) of strategic managers rated themselves as more than proficient in most of the competency items. CONCLUSION: There is inadequate managerial knowledge at all levels of management in a typical tertiary hospital in Nigeria with the potential to impact negatively on quality healthcare delivery.

Knowledge, attitude, and practice of pharmacy professionals on generic medicines in Eastern Ethiopia: A cross-sectional study.

BACKGROUND: Generic medicines are similar to innovator medicine in terms of safety, quality, efficacy, dosage form, strength, and route of administration. They have the same therapeutic use to innovator medicines and available at a far lower price. However, health professionals' poor knowledge and attitude may limit its utilization. The present study aimed at assessing the knowledge, attitude, and practice of pharmacy professionals towards generic medicines in Harar city, Eastern Ethiopia. METHODS: A cross-sectional survey was conducted among community pharmacists in Harar city. A self-administered thirty-three item questionnaire on Knowledge, attitude, and practice of community pharmacists was utilized. Logistic regression analysis was performed to predict the determinants of knowledge and attitude of pharmacists. An odds ratio at 95% confidence interval along with a p-value < 0.05 was considered significant. RESULTS: Among 80 community pharmacists' approached, 74 completed the survey, providing a response rate of 92.5%. Sixty-seven percent of the respondents knew that generic drugs are bioequivalent to brand drugs and claimed generic medicines are cheaper (86.5%). Nearly half (48.6%) of participants believe that generic medicines are less effective and slower in the onset of action (58.1%). More than half (54.1%) of study participants revealed their lack of belief in generic medicine as a factor hindering the selection and dispensing of generic medicines. In multivariate logistic regression, experience in community pharmacy practice (Adjusted odds ratio (AOR = 2.18, 95%CI: 1.21-63.1) and Sex (AOR = 3.88, 95%CI: 2.12-39.62) were significantly associated with knowledge and attitude toward generic medicines, respectively. CONCLUSION: The current study revealed that there is a gap in the knowledge and attitude of community pharmacists towards generic and brand drugs. More than averages of the respondents have known the concept of generic medicine including their right to perform generic substitution and had a positive attitude toward generics. Female pharmacists were more likely to have a positive attitude and the overall knowledge was higher in those who have more than 5 years of work experience.

The magnitude and precision of estimates of change in formative teacher assessment.

Despite growing interest in formative assessment of teacher practices, research on rates of change in teachers' practices is sparse. This is the first study to examine the characteristics of observed change in classroom practices using the Classroom Strategies Assessment System (CSAS) across alternative schedules of data collection during instructional coaching. Our primary objectives included examining (a) the magnitude, variability, and precision of estimates of average rates of change in teacher practices and (b) the impact of data collection duration (i.e., number of weeks of data collection) and density (i.e., the number of classroom observations per week) on the precision of estimates of rates of change over time. A sample of teachers (N = 63) participating in instructional coaching was observed 14 times during coaching using the CSAS. Findings revealed a significant gradual improvement in strategy use, with significant between-teacher variation in rates of change. The frequency of observations was associated with the precision of estimates for average rates of change across teachers and for individual teachers, providing initial guidance on minimum number of observations required to monitor change in practice over time. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Knowledge of managers on the National Mental Health Policy.

OBJECTIVE: Identify the knowledge of mental health service managers about the national mental health policy. METHOD: This is a qualitative study conducted with 20 coordinators, who were submitted to a structured interview. Data were categorized in a thematic analysis using ALCESTE software. RESULTS: The results produced the following categories: Back to society: protagonism and autonomy of patients; Interprofessional team: assignments and activities; Structuring of a psychosocial care network; Challenges affecting the service; Distance between policy and practice. FINAL CONSIDERATIONS: Public managers demonstrated they are aware of the key concepts for effective structuring of a psychosocial care network based on patient protagonism and autonomy, the assignments and activities performed by interprofessional teams, and the challenges found while structuring a psychosocial care network.

What Predicts a Mayoral Official's Opinion about the Role of Stress in Health Disparities?

High stress is a public health issue in the United States (US), that disproportionately affects socially-marginalized group members, including racial and ethnic minorities and those of low socioeconomic status. While city governments have the potential to reduce stress exposure and health disparities through municipal policies, very little is known about factors that are associated with mayor officials' beliefs about stress as a determinant of disparities. This information is important because it can inform the design of interventions to educate city policymakers about evidence related to stress and health disparities. Using data from a 2016 survey of 230 mayor officials (101 mayors, 129 senior staff), multivariable logistic regression was used to determine the extent to which respondents' individual characteristics (e.g., ideology, highest level of education) and the characteristics of their city's population (e.g., percentage of residents non-white) were associated with their identification of stress as a factor that has a "very strong effect" on health disparities. Forty-four percent of respondents identified stress as having a very strong effect on health disparities. In the fully adjusted model, every percentage point increase in the proportion of a respondent's city population that was non-White increased the odds of identifying stress as having a very strong effect on health disparities by 2% [adjusted odds ratio (aOR) = 1.02; 95% CI = 1.00,1.04]. Interventions are needed to increase city policymakers' knowledge about the role of stress in the production of health disparities, which could, in turn, help cultivate political will for city policies that reduce disparities.

Assessment of Gender-based Qualitative Differences within Trainee Evaluations of Faculty.

Rationale: Recent studies of trainee evaluations of medical faculty have demonstrated subtle gender-based word choice differences. However, it is not known if this manifests in major contextual differences in written comments.Objectives: To characterize qualitative differences in narrative evaluations of female and male pulmonary and critical care medicine faculty.Methods: We performed a single-center, retrospective cohort analysis of trainee narrative evaluations of pulmonary and critical care medicine faculty at the Hospital of the University of Pennsylvania, written from 2015 to 2016. Directive and summative content analysis was performed by four raters. Major contextual themes were identified using constant comparative techniques. Thematic differences based on faculty gender were identified, with statistical significance determined using χ2 analysis (P < 0.05). Effect sizes were calculated using Cramér's V.Results: A total of 1,216 total narrative evaluations were analyzed, representing 62 faculty members (17 women and 45 men), with analysis continued for the full cohort beyond achieving saturation of themes. Five overarching themes emerged: teaching skills, clinical skills, supervision, interpersonal and communication skills, and leadership skills. Within subthemes, we found no significant gender differences in reference to general teaching skills, learning environment, enthusiasm for teaching, or interpersonal concern. We identified subtheme differences between male and female faculty evaluations in regard to mentions of learner autonomy, clinical learning environment, humor, and motivating the trainee for patient care. Although the mention of constructive criticisms did not differ between genders, constructive criticisms of female faculty were more likely to mention demeanor (P = 0.06).Conclusions: Our data suggest minimal thematic differences in trainee narrative evaluations of male and female pulmonary and critical care medicine faculty. However, we noted several subtheme contextual differences between male and female faculty, which warrants further investigation.

Knowledge, attitude and perception on antimicrobial use and antimicrobial resistance among final year medical students in the College of Medicine, Malawi.

Background: Medical curricula need to provide adequate knowledge on antimicrobial medicine use and antimicrobial resistance (AMR). Such knowledge is critical in shaping correct attitudes and perceptions among future prescribers. However, the extent of preparation provided by medical curricula remains unknown. Aim: The current study sought to determine knowledge, attitude and perception on antimicrobial use and AMR among final year medical students in Malawi. Methods: A descriptive cross-sectional study was undertaken among all final year medical students at the College of Medicine, University of Malawi in 2016. Total population sampling and self-administered questionnaires were used. Data were entered using Microsoft Excel and analysed with Epi info. Descriptive analysis for categorical data was done using frequencies and proportions, and for continuous data using measures of central tendency. Results: The response rate in this study was 95%. The mean and median aggregated scores were 7.2 and 7, respectively, for the 11 knowledge questions. Over 88% of the respondents answered more than half of the knowledge questions correctly. Respondents agreed that antimicrobials are overused both at national (50; 69%) and at hospital (52; 72%) levels. Conclusion: This study reports high aggregated knowledge scores on antimicrobial use and resistance with wide variations on correct knowledge scores per question. The study further shows varying level in attitudes and perceptions among medical students. Overall, there were gaps on antimicrobial use and knowledge of AMR which the medical curriculum should addresses.

The Impact of Compulsory Schooling on Hourly Wage: Evidence From the 1999 Education Reform in Poland.

BACKGROUND: In 1999, an education reform was implemented in Poland, which added 1 year to the shortest available educational path-that of basic vocational education. Under the new system, students choosing this path receive one additional year of general education. According to the authors of the reform, this should improve the students' position in the labor market, as a shortage of general skills was identified as the main deficit of basic vocational school leavers prior to the reform. PURPOSE: The study assesses the impact of the 1999 reform on the hourly wage of individuals who completed formal education after obtaining a basic vocational school certificate. METHODS: The analysis is based on individual data from the Polish Labor Force Survey for the years 2001-2016. As the education reform was implemented simultaneously across the country, a regression discontinuity design is used to assess its impact. RESULTS AND CONCLUSIONS: The study finds that one additional year of general education has led to a 13% increase in the hourly wages of individuals who completed basic vocational schools. This effect is higher than those reported in studies for other countries where the wage premium is typically found to be under 10%. This may be because the extension of compulsory schooling in Poland affected individuals with relatively low general skills and abilities.

Knowledge of managers on the National Mental Health Policy / Conocimiento de los gestores respecto de la Política Nacional de Salud Mental / Conhecimento de gestores sobre a Política Nacional de Saúde Mental

ABSTRACT Objective: Identify the knowledge of mental health service managers about the national mental health policy. Method: This is a qualitative study conducted with 20 coordinators, who were submitted to a structured interview. Data were categorized in a thematic analysis using ALCESTE software. Results: The results produced the following categories: Back to society: protagonism and autonomy of patients; Interprofessional team: assignments and activities; Structuring of a psychosocial care network; Challenges affecting the service; Distance between policy and practice. Final Considerations: Public managers demonstrated they are aware of the key concepts for effective structuring of a psychosocial care network based on patient protagonism and autonomy, the assignments and activities performed by interprofessional teams, and the challenges found while structuring a psychosocial care network.

RESUMEN Objetivo: Verificar el conocimiento de los gestores de servicios de salud mental acerca de la política nacional de salud mental. Método: Investigación cualitativa, realizada con 20 coordinadores, sometidos a entrevista estructurada. Datos categorizados de acuerdo a análisis temático, con ayuda del software ALCESTE. Resultados: Los resultados determinaron las siguientes categorías: De vuelta a la sociedad: protagonismo y autonomía de los pacientes; Equipo multiprofesional: atribuciones y actividades; Estructuración de la Red de Atención Psicosocial: Trabas que afectan el servicio; Distancia entre la política y la práctica. Consideraciones Finales: Los gestores demostraron conocimientos sobre los conceptos clave para la efectiva construcción de la red de atención psicosocial a partir del protagonismo y la autonomía de los pacientes, de las atribuciones y actividades desempeñadas por el equipo multiprofesional, y de las dificultades para estructurar la red de atención psicosocial.

RESUMO Objetivo: Identificar o conhecimento dos gestores de serviços de saúde mental sobre a política nacional de saúde mental. Método: Trata-se de uma pesquisa qualitativa realizada com 20 coordenadores, submetidos à entrevista estruturada. Os dados foram categorizados sob a análise temática, auxiliada pelo software ALCESTE. Resultados: Os resultados apontaram as seguintes categorias: De volta à sociedade: protagonismo e autonomia dos usuários; Equipe multiprofissional: atribuições e atividades; Estruturação da Rede de Atenção Psicossocial; Entraves que afetam o serviço; Distanciamento entre a política e a prática. Considerações Finais: Os gestores demonstraram conhecimento sobre os conceitos-chave para a efetiva construção da rede de atenção psicossocial a partir do protagonismo e autonomia dos usuários, das atribuições e atividades desempenhadas pela equipe multiprofissional, e das dificuldades em estruturar a rede de atenção psicossocial.

Assessing Executive Nurse Leaders' Financial Literacy Level: A Mixed-Methods Study.

OBJECTIVES: To evaluate the reliability and validity of the Financial Management Competency Self-assessment (FMCA) in executive nurse leaders (ENLs) and to determine how ENLs develop and apply financial knowledge. BACKGROUND: Financial literacy (FL) helps in planning, implementing, and evaluating fiscal decisions, but many ENLs report weaknesses in this core competency. METHODS: An explanatory-sequential mixed-methods study was conducted to psychometrically test the FMCA and explore how ENLs with different levels of FL develop and apply financial knowledge. Eligible participants (n = 178) were recruited from a population of ENLs across the United States. RESULTS: The test-retest reliability of the FMCA was good (mean difference, 6.80; 95% confidence interval). Correlations between domain scores (P < .01) and the overall score (Cronbach's α = .99) demonstrated the reliability and validity of the instrument. The cutoff scores were fair indicators of different levels of FL in ENLs (P < .001). Self-awareness, gaps in hospital and graduate nursing education, application of financial knowledge, and a micro versus macro view emerged as important themes in the qualitative analysis. CONCLUSION: FMCA reliability and validity were established. FMCA cutoff scores were established to determine FL level, and the ENL lived experience described in financial knowledge development and application.

Assessment of Gender-Based Linguistic Differences in Physician Trainee Evaluations of Medical Faculty Using Automated Text Mining.

Importance: Women are underrepresented at higher ranks in academic medicine. However, the factors contributing to this disparity have not been fully elucidated. Implicit bias and unconscious mental attitudes toward a person or group may be factors. Although academic medical centers use physician trainee evaluations of faculty to inform promotion decisions, little is known about gender bias in these evaluations. To date, no studies have examined narrative evaluations of medical faculty by physician trainees for differences based on gender. Objective: To characterize gender-associated linguistic differences in narrative evaluations of medical faculty written by physician trainees. Design, Setting, and Participants: This retrospective cohort study included all faculty teaching evaluations completed for the department of medicine faculty by medical students, residents, and fellows at a large academic center in Pennsylvania from July 1, 2015, through June 30, 2016. Data analysis was performed from June 1, 2018, through July 31, 2018. Main Outcomes and Measures: Word use in faculty evaluations was quantified using automated text mining by converting free-text comments into unique 1- and 2-word phrases. Mixed-effects logistic regression analysis was performed to assess associations of faculty gender with frequencies of specific words and phrases present in a physician trainee evaluation. Results: A total of 7326 unique evaluations were collected for 521 faculty (325 men [62.4%] and 196 women [37.6%]). The individual words art (odds ratio [OR], 7.78; 95% CI, 1.01-59.89), trials (OR, 4.43; 95% CI, 1.34-14.69), master (OR, 4.24; 95% CI, 1.69-10.63), and humor (OR, 2.32; 95% CI, 1.44-3.73) were significantly associated with evaluations of male faculty, whereas the words empathetic (OR, 4.34; 95% CI, 1.56-12.07), delight (OR, 4.26; 95% CI, 1.35-13.40), and warm (OR, 3.45; 95% CI, 1.83-6.49) were significantly associated with evaluations of female faculty. Two-word phrases associated with male faculty evaluations included run rounds (OR, 7.78; 95% CI, 1.01-59.84), big picture (OR, 7.15; 95% CI, 1.68-30.42), and master clinician (OR, 4.02; 95% CI, 1.21-13.36), whereas evaluations of female faculty were more likely to be associated with model physician (OR, 7.75; 95% CI, 1.70-35.39), just right (OR, 6.97; 95% CI, 1.51-32.30), and attention (to) detail (OR, 4.26; 95% CI, 1.36-13.40). Conclusions and Relevance: The data showed quantifiable linguistic differences between free-text comments about male and female faculty in physician trainee evaluations. Further evaluation of these differences, particularly in association with ongoing gender disparities in faculty promotion and retention, may be warranted.

Understanding perceptions of global healthcare experiences on provider values and practices in the USA: a qualitative study among global health physicians and program directors.

OBJECTIVES: The study aimed to qualitatively examine the perspectives of US-based physicians and academic global health programme leaders on how global health work shapes their viewpoints, values and healthcare practices back in the USA. DESIGN: A prospective, qualitative exploratory study that employed online questionnaires and open-ended, semi-structured interviews with two participant groups: (1) global health physicians and (2) global health programme leaders affiliated with USA-based academic medical centres. Open coding procedures and thematic content analysis were used to analyse data and derive themes for discussion. PARTICIPANTS: 159 global health physicians and global health programme leaders at 25 academic medical institutions were invited via email to take a survey and participate in a follow-up interview. Twelve participants completed online questionnaires (7.5% response rate) and eight participants (four survey participants and four additionally recruited participants) participated in in-depth, in-person or phone semi-structured interviews. RESULTS: Five themes emerged that highlight how global health physicians and academic global health programme leaders perceive global health work abroad in shaping USA-based medical practices: (1) a sense of improved patient rapport, particularly with low-income, refugee and immigrant patients, and improved and more engaged patient care; (2) reduced spending on healthcare services; (3) greater awareness of the social determinants of health; (4) deeper understanding of the USA's healthcare system compared with systems in other countries; and (5) a reinforcement of values that initially motivated physicians to pursue work in global health. CONCLUSIONS: A majority of participating global health physicians and programme leaders believed that international engagements improved patient care back in the USA. Participant responses relating to the five themes were contextualised by highlighting factors that simultaneously impinge on their ability to provide improved patient care, such as the social determinants of health, and the challenges of changing USA healthcare policy.

Contested credibility economies of nuclear power in India.

STS scholars studying anti-nuclear activism in the context of nations in the Global North have observed the critical role of science to mediate relations of domination and resistance. Through a historical examination of anti-nuclear activism in India, this article investigates the instrumentalization of science as a liberal democratic rationality. In doing so, the article shows how elite Indian activists - many of whom are scientists, engineers, journalists and academic professionals - will never be seen as scientifically knowledgeable in nuclear matters, because of their non-state educational pedigrees. If activists cannot hold the state accountable through science, they have attempted to anticipate what other kinds of arguments and modes of contention may gain traction. As such, they have deployed more 'guerilla' tactics grounded in bureaucratic rationalities in the hopes of installing themselves as alternate sources of expertise in India's nuclear landscape.

Prescribing patterns and compliance with World Health Organization recommendations for the management of severe malaria: a modified cohort event monitoring study in public health facilities in Ghana and Uganda.

BACKGROUND: Injectable artesunate (AS) is the World Health Organization (WHO) recommended medication for the treatment of severe malaria followed with an oral artemisinin-based combination therapy (ACT). There are few studies indicating how physicians prescribe injectable AS, injectable quinine (Q) or injectable artemether (AR) and ACT for severe malaria. This study was undertaken to evaluate prescription compliance to the WHO recommendation in 8 public health facilities in Ghana and Uganda. This was a modified cohort event monitoring study involving patients who were administered with injectable anti-malarial for treatment of presumed or confirmed severe malaria. Patients prescribed at least one dose of injectable artesunate, artemether or quinine qualified to enrol in the study. Patients were recruited at inpatient facilities and followed up in the hospital, by phone or at home. Following WHO recommendations, patients are to be prescribed 3 doses of injectable AS, Q or AR for at least 24 h followed with oral ACT. Compliance rate was estimated as the number of patient prescriptions that met the WHO recommendation for treatment of severe malaria divided by the total number of patients who completed the study by end of follow up. Log-binomial regression model was used to identify predictors for compliance. Based on the literature and limitations of available data from the patients' record, the diagnosis results, age, gender, weight, and country were considered as potential predictors of prescriber adherence to the WHO recommendations. RESULTS: A total of 1191 patients completed the study, of which 93% were prescribed injectable AS, 3.1% (injectable AR or Q) with 32.5% prescribed follow-on oral ACT and 26% on concomitant antibiotics. 391 (32.8%) were in Ghana and 800 (67.2%) in Uganda. There were 582 (48.9%) women. The median age was 3.9 years (IQR = 2, 9) and median weight was 13 kg (IQR = 10, 20). Of the 1191 patients, 329 of the prescriptions complied with the WHO recommendation (compliance rate = 27.6%; 95% CI = [25.2, 30.2]). Diagnostic results (Adjusted prevalence ratio (aPR) = 4.56; 95% = [3.42, 6.08]; p < 0.0001) and weight (20 + kg vs < 10 kg: aPR = 0.65; 95% = [0.44, 0.96]; p = 0.015) were identified as factors independently associated with compliance. CONCLUSION: Injectable AS is the most commonly prescribed medicine in the management of severe malaria in Ghana and Uganda. However, adherence to the WHO recommendation of at least 3 doses of injectable anti-malarial in 24 h followed by a full course of ACT is low, at less than 30%.

Effect of Supportive Supervision on Malaria Microscopy Competencies in Sub-Saharan Africa.

Although light microscopy is the reference standard for diagnosing malaria, maintaining skills over time can be challenging. Between 2015 and 2017, the U.S. President's Malaria Initiative-funded MalariaCare project supported outreach training and supportive supervision (OTSS) visits at 1,037 health facilities in seven African countries to improve performance in microscopy slide preparation, staining, and reading. During these visits, supervisors observed and provided feedback to health-care workers (HCWs) performing malaria microscopy using a 30-step checklist. Of the steps observed in facilities with at least three visits, the proportion of HCWs that performed each step correctly at baseline ranged from 63.2% to 94.2%. The change in the proportion of HCWs performing steps correctly by the third visit ranged from 16.7 to 23.6 percentage points (n = 916 observations). To assess the overall improvement, facility scores were calculated based on the steps performed correctly during each visit. The mean score at baseline was 85.7%, demonstrating a high level of performance before OTSS. Regression analysis predicted an improvement in facility scores of 3.6 percentage points (P < 0.001) after three visits across all countries. In reference-level facilities with consistently high performance on microscopy procedures and parasite detection, quality assurance (QA) mechanisms could prioritize more advanced skills, such as proficiency testing for parasite counting and species identification. However, in settings with high staff turnover and declining use of microscopy in favor of rapid diagnostic tests, additional supervision visits and/or additional QA measures may be required to improve and maintain performance.

Registered Nurses' Knowledge of and Experience with Health Literacy.

Background: Limited skill in health literacy is a global issue. Variation in health literacy skills within societies is a source of health inequality unless health care providers apply health literacy practices to effectively communicate with all clients. Objective: This study examined Iranian registered nurses' knowledge of and experience with health literacy practices. Methods: This cross-sectional study provides a quantitative description of knowledge of and experience with health literacy practices. Using a rigorous process, we adapted the Health Literacy Knowledge and Experience Survey to collect data from the participants, who were 190 registered nurses working in Tehran, Iran. Key Results: Findings identify gaps in participants' knowledge and experience with health literacy practices. Knowledge deficits are most noticeable in standards to create written materials, screening tools to identify limited health literacy, and the Teach-Back strategies to determine people's understanding. Limited experience is prominent in using health literacy screening tools, evaluating written health information, and applying technologies to provide health information. Our multivariate analysis suggests participants who reported more interaction with health care professionals for personal reasons scored higher in knowledge of health literacy practices. Conclusions: This study indicated that registered nurses in Iran do not have adequate knowledge and experience regarding health literacy practices. Addressing this issue is fundamental to promoting health equity. Future investigations should identify both barriers and facilitators for nurses to apply health literacy practices. [HLRP: Health Literacy Research and Practice. 2019;3(4):e268-e279.]. Plain Language Summary: Health literacy practices enable health care professionals to offer understandable health information to all people and contribute to health equity. We surveyed 190 registered nurses in Iran to assess their knowledge of and experience with health literacy practices. The findings will be a guide to create interventions to improve registered nurses' knowledge of these practices and to use them to communicate clearly with clients.