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1.
Home Health Care Manag Pract ; 36(3): 230-242, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39149713

RESUMO

Home care rehabilitation professionals (hcRPs) provide health services for clients with a broad range of medical conditions. During the COVID-19 pandemic, home care rehabilitation professionals experienced exacerbations of pre-existing work-related stressors, increased risk of transmission of the COVID-19 virus, reduced resource availability, greater workloads, and staffing shortages. The primary aim of this study was to examine the experience and impact of occupational and mental stress on hcRPs working during the COVID-19 pandemic. Semi-structured interviews were conducted with 24 hcRPs working in Ontario, Canada during the COVID-19 pandemic. Inductive thematic analysis was used to interpret and organize the data into conceptualized themes. Interview data was organized into three themes: (a) unique challenges of a home care rehabilitation professional, (b) COVID-19 exacerbations of home care occupational and mental stress, and (c) personal and workplace coping strategies. Many participants reported reducing their hours or taking on adjunctive roles in different clinical settings outside of home care due to work-related stress exacerbated by the COVID-19 pandemic. With a focus on the effects of COVID-19 on the practice of home care, this study provides a unique perspective on the challenges experienced by hcRPs during an emergent and evolving global public health concern. The exploratory nature of this research works towards providing a framework of factors to be addressed when creating sustainable healthcare interventions, as well as recommendations to support hcRPs to benefit both the community and health-care providers.

2.
J Asian Afr Stud ; 58(5): 747-765, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37461426

RESUMO

The second wave of the COVID-19 pandemic had left heart-wrenching impacts on all facets of life in general and the availability, accessibility, and affordability of medicines and vaccines in particular. Rather, the world has been divided into two groups regarding access to medicine and vaccines as haves and have-nots. The rich countries had pre-ordered the vaccines of COVID-19 along with the holding of the same. The pandemic situation was further worsened, given the Trade-Related Intellectual Property Rights (TRIPS) in practice and restrictions on sharing technology of vaccines, medicines, and life-saving equipment. In this context, India and South Africa have proposed the joint proposal and garnered support for waiving off TRIPS to ensure equity, accessibility, and affordability of vaccines and the same as public goods. In this review, we emphasize that global justice is one of the important elements of normative international theories, which focus on all the moral obligations from the world's rich to the world's poor. The paper also questions and argues that if the rich countries fail to go by the principles of global justice, can the Indian and South African (SA) patent diplomacy play a catalyst role in global justice? The review concludes with an emphasis on global solidarity, and the acceptance of joint India-South Africa's "patent diplomacy" for TRIPS waiver would result in mass production and fair distribution, making the COVID-19 medicines and technologies available to everyone regardless of their poor-rich status.

3.
BMC Psychiatry ; 22(1): 71, 2022 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-35090417

RESUMO

BACKGROUND: Early Marriage (EM) and associated Stressful Life Events (SLEs) and consequences such as psychological and physical well-being issues can lead to suicide and suicide attempts (SA). The study aimed to investigate the risk of suicide and SA among early married people who experienced SLEs. METHODS: A case-control study was conducted based on the registry for suicide in Malekan county in Iran during 2016-18. Cases included 154 SAs and 32 suicides. Simultaneously, 201 outpatients from the emergency department were chosen as controls. Holms and Rahe life event questionnaire was used to assess SLEs. Sub-group analysis (Mantel-Haenszel) by sex and age groups and multiple logistic regression were used to calculate adjusted Odds Ratios (ORs) with 95% Confidence Intervals (CIs) for the association between EM and suicide risk after adjusting for the potential confounders. RESULTS: The proportion (female vs male) of EM among suicides, controls, and SAs was 31.25% (18.7 vs 12.5%), 15.92% (11.9 vs 4.0%), and 13.0% (11.7 vs 1.3%), respectively. In subgroup analyses by sex, EM was associated with an increased risk of suicide in both females and males 2.64 and 2.36 times, respectively. Likewise, subgroup analysis by age groups revealed that EM increased suicide risk in subjects aged 10-15 years, while no association was found for age groups of 26-40 and > 40. After adjusting for the potential confounders, EM (OR: 3.01; 95% CI: 1.15 -7.29), financial problems (OR = 4.50; 95% CI: 1.83 -9.07), and family problems (OR = 2.60; 95% CI: 1.19-9.59), were associated with an increased risk of suicide. However, no association was found between EM, various types of SLEs, and the risk of SA. CONCLUSIONS: We found EM and SLEs were correlated with suicide risk, while no evidence found that EM increased the risk of SA. Progress in reducing EM and addressing its serious consequences can occur by a stronger political commitment and by sharing the experiences and voices of the early married. Our study provided preliminary findings to guide future studies; however, methodological and longitudinal studies are needed to understand and address the effect of EM on suicidal behaviors.


Assuntos
Casamento , Tentativa de Suicídio , Estudos de Casos e Controles , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Fatores de Risco , Tentativa de Suicídio/psicologia
4.
BMC Pregnancy Childbirth ; 22(1): 709, 2022 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-36115842

RESUMO

INTRODUCTION: Globally, the rate of caesarean deliveries increased from approximately 16.0 million in 2000 to 29.7 million in 2015. In this study, we decomposed the rural-urban disparities in caesarean deliveries in sub-Saharan Africa. METHODS: Data for the study were extracted from the most recent Demographic and Health Surveys of twenty-eight countries in sub-Saharan Africa. We included 160,502 women who had delivered in health facilities within the five years preceding the survey. A multivariate non-linear decomposition model was employed to decompose the rural-urban disparities in caesarean deliveries. The results were presented using coefficients and percentages. RESULTS: The pooled prevalence of caesarean deliveries in the 28 countries considered in the study was 6.04% (95% CI = 5.21-6.88). Caesarean deliveries' prevalence was highest in Namibia (16.05%; 95% CI = 14.06-18.04) and lowest in Chad (1.32%; 95% CI = 0.91-1.73). For rural-urban disparities in caesarean delivery, the pooled prevalence of caesarean delivery was higher in urban areas (10.37%; 95% CI = 8.99-11.75) than rural areas (3.78%; 95% CI = 3.17-4.39) across the 28 countries. Approximately 81% of the rural-urban disparities in caesarean deliveries were attributable to the differences in child and maternal characteristics. Hence, if the child and maternal characteristics were levelled, more than half of the rural-urban inequality in caesarean deliveries would be reduced. Wealth index (39.2%), antenatal care attendance (13.4%), parity (12.8%), mother's educational level (3.5%), and health insurance subscription (3.1%) explained approximately 72% of the rural-urban disparities in caesarean deliveries. CONCLUSION: This study shows significant rural-urban disparities in caesarean deliveries, with the disparities being attributable to the differences in child and maternal characteristics: wealth index, parity, antenatal care attendance, mother's educational level, and health insurance subscription. Policymakers in the included countries could focus and work on improving the socioeconomic status of rural-dwelling women as well as encouraging antenatal care attendance, women's education, health insurance subscription, and family planning, particularly in rural areas.


Assuntos
Cesárea , População Rural , África Subsaariana/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Gravidez , Prevalência
5.
Health Res Policy Syst ; 20(1): 23, 2022 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-35183217

RESUMO

BACKGROUND: The leading emerging markets of Brazil, Russia, India, China and South Africa (BRICS) are increasingly shaping the landscape of the global health sector demand and supply for medical goods and services. BRICS' share of global health spending and future projections will play a prominent role during the 2020s. The purpose of the current research was to examine the decades-long underlying historical trends in BRICS countries' health spending and explore these data as the grounds for reliable forecasting of their health expenditures up to 2030. METHODS: BRICS' health spending data spanning 1995-2017 were extracted from the Institute for Health Metrics and Evaluation (IHME) Financing Global Health 2019 database. Total health expenditure, government, prepaid private and out-of-pocket spending per capita and gross domestic product (GDP) share of total health spending were forecasted for 2018-2030. Autoregressive integrated moving average (ARIMA) models were used to obtain future projections based on time series analysis. RESULTS: Per capita health spending in 2030 is projected to be as follows: Brazil, $1767 (95% prediction interval [PI] 1615, 1977); Russia, $1933 (95% PI 1549, 2317); India, $468 (95% PI 400.4, 535); China, $1707 (95% PI 1079, 2334); South Africa, $1379 (95% PI 755, 2004). Health spending as a percentage of GDP in 2030 is projected as follows: Brazil, 8.4% (95% PI 7.5, 9.4); Russia, 5.2% (95% PI 4.5, 5.9); India, 3.5% (95% PI 2.9%, 4.1%); China, 5.9% (95% PI 4.9, 7.0); South Africa, 10.4% (95% PI 5.5, 15.3). CONCLUSIONS: All BRICS countries show a long-term trend towards increasing their per capita spending in terms of purchasing power parity (PPP). India and Russia are highly likely to maintain stable total health spending as a percentage of GDP until 2030. China, as a major driver of global economic growth, will be able to significantly expand its investment in the health sector across an array of indicators. Brazil is the only large nation whose health expenditure as a percentage of GDP is about to contract substantially during the third decade of the twenty-first century. The steepest curve of increased per capita spending until 2030 seems to be attributable to India, while Russia should achieve the highest values in absolute terms. Health policy implications of long-term trends in health spending indicate the need for health technology assessment dissemination among the BRICS ministries of health and national health insurance funds. Matters of cost-effective allocation of limited resources will remain a core challenge in 2030 as well.


Assuntos
Gastos em Saúde , Financiamento da Assistência à Saúde , Brasil , China , Política de Saúde , Humanos , Índia , África do Sul
6.
Curr Psychol ; : 1-8, 2022 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-35194356

RESUMO

The present study's aim is to find the prevalence of two of the common indicators of mental health - depression and anxiety - and any correlation with socio-demographic indicators in the Pakistani population during the lockdown from 5 May to 25 July 2020. A cross-sectional survey was conducted using an online questionnaire sent to volunteer participants. A total of 1047 participants over 18 were recruited through convenience sampling. The survey targeted depression and anxiety levels, which were measured using a 14 item self-reporting Hospital Anxiety and Depression Scale (HADS). Out of the total sample population (N=354), 39.9% suffered from depression and 57.7% from anxiety. Binary logistical regressions indicated significant predictive associations of gender (OR=1.410), education (OR=9.311), residence (OR=0.370), household income (OR=0.579), previous psychiatric problems (OR=1.671), and previous psychiatric medication (OR=2.641). These were the key factors e associated with a significant increase in depression. Increases in anxiety levels were significantly linked to gender (OR=2.427), residence (OR=0.619), previous psychiatric problems (OR=1.166), and previous psychiatric medication (OR=7.330). These results suggest depression and anxiety were prevalent among the Pakistani population during the lockdown. Along with other measures to contain the spread of COVID-19, citizens' mental health needs the Pakistani government's urgent attention as well as that of mental health experts. Further large-scale, such as healthcare practitioners, should be undertaken to identify other mental health indicators that need to be monitored.

7.
BMC Pregnancy Childbirth ; 21(1): 426, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34126936

RESUMO

BACKGROUND: Neural tube defects (NTDs) are a group of disorders that arise from the failure of the neural tube close between 21 and 28 days after conception. About 90% of neural tube defects and 95% of death due to these defects occurs in low-income countries. Since these NTDs cause considerable morbidity and mortality, this study aimed to determine the prevalence and associated factors of NTDs in Africa. METHODS: The protocol of this study was registered in the International Prospective Register of Systematic Reviews (PROSPERO number: CRD42020149356). All major databases such as PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, African Journals Online (AJOL), and Google Scholar search engine were systematically searched. A random-effect model was used to estimate the pooled prevalence of NTDs in Africa, and Cochran's Q-statistics and I2 tests were used to assess heterogeneity between included studies. Publication bias was assessed using Begg 's tests, and the association between determinant factors and NTDs was estimated using a random-effect model. RESULTS: Of the total 2679 articles, 37 articles fulfilled the inclusion criteria and were included in this systematic review and meta-analysis. The pooled prevalence of NTDs in Africa was 50.71 per 10,000 births (95% CI: 48.03, 53.44). Folic acid supplementation (AOR: 0.40; 95% CI: 0.19-0.85), maternal exposure to pesticide (AOR: 3.29; 95% CI: 1.04-10.39), mothers with a previous history of stillbirth (AOR: 3.35, 95% CI: 1.99-5.65) and maternal exposure to x-ray radiation (AOR 2.34; 95% CI: 1.27-4.31) were found to be determinants of NTDs. CONCLUSIONS: The pooled prevalence of NTDs in Africa was found to be high. Maternal exposure to pesticides and x-ray radiation were significantly associated with NTDs. Folic acid supplementation before and within the first month of pregnancy was found to be a protective factor for NTDs.


Assuntos
Defeitos do Tubo Neural/epidemiologia , Cuidado Pré-Natal , África/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Defeitos do Tubo Neural/prevenção & controle , Gravidez , Prevalência , Fatores de Risco
8.
BMC Pregnancy Childbirth ; 21(1): 834, 2021 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-34906105

RESUMO

BACKGROUND: Despite the numerous policy interventions targeted at preventing early age at first childbirth globally, the prevalence of adolescent childbirth remains high. Meanwhile, skilled birth attendance is considered essential in preventing childbirth-related complications and deaths among adolescent mothers. Therefore, we estimated the prevalence of early age at first childbirth and skilled birth attendance among young women in sub-Saharan Africa and investigated the association between them. METHODS: Demographic and Health Survey data of 29 sub-Saharan African countries was utilized. Skilled birth attendance and age at first birth were the outcome and the key explanatory variables in this study respectively. Overall, a total of 52,875 young women aged 20-24 years were included in our study. A multilevel binary logistic regression analysis was performed and the results presented as crude and adjusted odds ratios at 95% confidence interval. RESULTS: Approximately 73% of young women had their first birth when they were less than 20 years with Chad having the highest proportion (85.7%) and Rwanda recording the lowest (43.3%). The average proportion of those who had skilled assistance during delivery in the 29 sub-Saharan African countries was 75.3% and this ranged from 38.4% in Chad to 93.7% in Rwanda. Young women who had their first birth at the age of 20-24 were more likely to have skilled birth attendance during delivery (aOR = 2.4, CI = 2.24-2.53) than those who had their first birth before 20 years. CONCLUSION: Early age at first childbirth has been found to be associated with low skilled assistance during delivery. These findings re-emphasize the need for sub-Saharan African countries to implement programs that will sensitize and encourage the patronage of skilled birth attendance among young women in order to reduce complications and maternal mortalities. The lower likelihood of skilled birth attendance among young women who had their first birth when they were adolescents could mean that this cohort of young women face some barriers in accessing maternal healthcare services.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Idade Materna , Parto , Gravidez na Adolescência/etnologia , Gravidez na Adolescência/estatística & dados numéricos , Adolescente , África Subsaariana , Demografia , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Humanos , Gravidez , Adulto Jovem
9.
AIDS Res Ther ; 18(1): 40, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-34266455

RESUMO

BACKGROUND: HIV/AIDS is still one of the major public health concerns globally. It is one of the major contributory causes of deaths among women in the reproductive age (15-49 years) and has resulted in about 14 million orphaned children globally. Knowledge of Mother-to Child transmission is one of the strategies to fight against HIV. This study, therefore, sought to assess the knowledge and determinants of women's knowledge on vertical transmission of HIV and AIDS in their reproductive age in South Africa. METHODS: Data were obtained from the South Africa Demographic and Health Survey (SADHS) 2016. Both descriptive (frequencies and percentages) and inferential analysis (multilevel mixed-effects complementary log-log regression model) were conducted and the statistical significance was set at p < 0.05. RESULTS: The prevalence of knowledge of mother to child transmission of HIV and AIDS during pregnancy, delivery, breastfeeding and at least knowledge of one source are 87.0%, 81.1%, 80.3% and 91.4% respectively. At the individual level, those with secondary [AOR = 1.28, CI = 1.04,1.57] and higher [AOR = 1.55, CI = 1.21,1.99], those who read newspaper less than once a week [AOR = 1.16, CI = [1.05,1.28], at least once a week [AOR = 1.14, CI = 1.04,1.25], and those who listen to the radio less than once a week [AOR = 1.22, CI = 1.03,1.43] had higher odds of knowledge on MTCT of HIV and AIDS. However, those with parity 0 [AOR = 0.73, CI = [0.63,0.85] had lower odds of knowledge of MTCT of HIV and AIDS compared with those with parity 4 or more. At the contextual level, those in the poorest wealth quintile [AOR = 0.82,CI = 0.69,0.97] had lower odds of having knowledge of MTCT of HIV and AIDS. Those in the urban areas [AOR = 1.17, CI = [1.04,1.31], those in Limpopo [AOR = 1.35, CI = [1.12,1.64], Gauteng [AOR = 1.35, CI = [1.12,1.62] and North west[AOR = 1.49, CI = [1.22,1.81] had higher odds of knowledge of mother to child transmission of HIV and AIDS. CONCLUSION: The study has demonstrated that there is relatively high knowledge of mother to child transmission of HIV and AIDS in South Africa. The factors associated with the knowledge are educational level, exposure to mass media, parity, wealth status, place of residence and the region of residence. To further increase the knowledge, it is imperative to adopt various messages and target respondents in different part of SSA through the mass media channels. This should be done taking cognizant of the rural-urban variations and socio-economic status.


Assuntos
Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Síndrome da Imunodeficiência Adquirida/epidemiologia , Criança , Feminino , Infecções por HIV/epidemiologia , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , População Rural , África do Sul/epidemiologia
10.
Psychogeriatrics ; 21(3): 296-303, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33576129

RESUMO

BACKGROUND: Older adults may be more prone to death anxiety than their younger counterparts. This study explores factors affecting death anxiety based on gender differences. METHODS: In this correlational study, 450 older adults referred to the health centres in the city of Bukan, Iran were recruited by using a randomised sampling method. Next, data were collected about the demographic questionnaire, anxiety about ageing, death anxiety, mental well-being, perceived social support, and quality of life questionnaire. The Spearman correlation coefficient was used to determine the correlation between variables, and the predictors of death anxiety were evaluated using quintile regression. Relationship between death anxiety and other variables was evaluated by the Structural Equation Model (SEM). The study was approved by the Tabriz University of Medical Sciences Ethics Committee (Ethics Code: IR.TBZMED.REC.1397.304). RESULTS: The results showed that death anxiety in men had a significant relationship with the level of literacy (P = 0.047), body self-imaging (P = 0.031), and perceived social activity (P = 0.033). Among women, death anxiety had a significant relationship with physical activity (P = 0.007) and perceived social activity (P = 0.002). Additionally, quintile regression analysis was calculated: among men, anxiety about ageing was related to death anxiety (ß = 0.182, P = 0.05), while in women, only perceived social support was associated to death anxiety (ß = -0.376, P = 0.05). Finally, according to SEM, a significantly different level of predictability of mental well-being was found for death anxiety among older men and women. CONCLUSION: Understanding the gender differences about death anxiety by the healthcare system might be useful in controlling and reducing a variety of concerns among elders who experience high levels of anxiety of death.


Assuntos
Qualidade de Vida , Caracteres Sexuais , Idoso , Ansiedade , Estudos Transversais , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino
11.
Reprod Health ; 17(1): 43, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32238177

RESUMO

This century is witnessing dramatic changes in the health needs of the world's populations. The double burden of infectious and chronic diseases constitutes major causes of morbidity and mortality. Over the last two decades, there has been a rise in infectious diseases, including the severe acute respiratory syndrome virus (SARS), the H1N1 pandemic influenza, the Ebolavirus and the Covid-19 virus. These diseases have rapidly spread across the world and have reminded us of the unprecedented connectivity that defines our modern civilization. Though some countries have made substantial progress toward improving global surveillance for emerging infectious diseases (EIDs), the vast majority of Low-and Middle-income Countries (LMICs) with fragile health systems and various system-related bottlenecks remain vulnerable to outbreaks and, as such, experience dramatic social and economic consequences when they are reported. Lessons learned from past outbreaks suggest that gender inequalities are common across a range of health issues relating to Sexual and Reproductive Health and Rights (SRHR), with women being particularly disadvantaged, partially due to the burden placed on them. Though these countries are striving to improve their health systems and be more inclusive to this vulnerable group, the national/ global outbreaks have burdened the overall system and thus paralyzed normal services dedicated to the delivery of Sexual and Reproductive Health (SRH) services. In this paper, we discuss the global commitments to SRH, the impact of the EIDs on the LMICs, the failure in the delivery of SRH services, and the strategies for successful implementation of recovery plans that must address the specific and differentiated needs of women and girls in resource-poor settings.


Assuntos
Doenças Transmissíveis Emergentes , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Saúde Reprodutiva , Direitos Sexuais e Reprodutivos , Direitos da Mulher , Betacoronavirus , COVID-19 , Países em Desenvolvimento , Surtos de Doenças , Saúde Global , Recursos em Saúde , Humanos , Serviços de Saúde Reprodutiva , SARS-CoV-2 , Desenvolvimento Sustentável , Saúde da Mulher
12.
BMC Psychiatry ; 18(1): 343, 2018 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-30340476

RESUMO

BACKGROUND: Current evidence suggests that the addiction on one substance may underpin or affect addiction on another in polysubstance users. However, there is no tool that has been shown to have psychometric validation for assessment of the severity of khat addiction in polysubstance users. METHODS: Polysubstance users with khat chewing habit (n = 178, age = 25.8 ± 3.6, BMI = 23.3 ± 2.8 kg/m2) were recruited from randomly selected houses for a cross-sectional study in Mizan, Ethiopia. The survey including severity of dependence scale for khat (SDS-khat), a brief metacognition questionnaire, and a semi-structured socio-demographics tool were administered by trained interviewers. RESULTS: There was no ceiling effect or floor effect in the SDS-Khat scores. Internal consistency was moderate (Cronbach's alpha = 0.58). Internal homogeneity was adequate (Item-total correlations of the SDS-Khat; r ≥ 0.55). Significant negative correlations between the SDS-Khat and the metacognition (r = -.19 to -.34, p < 0.05 or p < 0.01) indicated convergent validity. The findings of exploratory factor analysis were non-unanimous with a suggestion of two models, i.e., a 2-factor and a 1-factor model, while the confirmatory factor analysis favored 1-Factor model. CONCLUSION: The SDS-Khat has adequate psychometric validity for the assessment of psychological severity of khat addiction in the polysubstance users.


Assuntos
Comportamento Aditivo/diagnóstico , Comportamento Aditivo/psicologia , Catha , Índice de Gravidade de Doença , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Comportamento Aditivo/epidemiologia , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Metacognição , Psicometria , Distribuição Aleatória , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários
13.
Int J Qual Health Care ; 30(suppl_1): 10-14, 2018 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-29873794

RESUMO

Improving health care involves many actors, often working in complex adaptive systems. Interventions tend to be multi-factorial, implementation activities diverse, and contexts dynamic and complicated. This makes improvement initiatives challenging to describe and evaluate as matching evaluation and program designs can be difficult, requiring collaboration, trust and transparency. Collaboration is required to address important epidemiological principles of bias and confounding. If this does not take place, results may lack credibility because the association between interventions implemented and outcomes achieved is obscure and attribution uncertain. Moreover, lack of clarity about what was implemented, how it was implemented, and the context in which it was implemented often lead to disappointment or outright failure of spread and scale-up efforts. The input of skilled evaluators into the design and conduct of improvement initiatives can be helpful in mitigating these potential problems. While evaluation must be rigorous, if it is too rigid necessary adaptation and learning may be compromised. This article provides a framework and guidance on how improvers and evaluators can work together to design, implement and learn about improvement interventions more effectively.


Assuntos
Melhoria de Qualidade/organização & administração , Humanos , Aprendizagem , Modelos Organizacionais , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Melhoria de Qualidade/normas
14.
Int J Qual Health Care ; 30(suppl_1): 5-9, 2018 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-29873793

RESUMO

Quality improvement approaches can strengthen action on a range of global health priorities. Quality improvement efforts are uniquely placed to reorient care delivery systems towards integrated people-centred health services and strengthen health systems to achieve Universal Health Coverage (UHC). This article makes the case for addressing shortfalls of previous agendas by articulating the critical role of quality improvement in the Sustainable Development Goal era. Quality improvement can stimulate convergence between health security and health systems; address global health security priorities through participatory quality improvement approaches; and improve health outcomes at all levels of the health system. Entry points for action include the linkage with antimicrobial resistance and the contentious issue of the health of migrants. The work required includes focussed attention on the continuum of national quality policy formulation, implementation and learning; alongside strengthening the measurement-improvement linkage. Quality improvement plays a key role in strengthening health systems to achieve UHC.


Assuntos
Saúde Global , Prioridades em Saúde , Melhoria de Qualidade , Conservação dos Recursos Naturais , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Saúde Global/normas , Política de Saúde , Humanos , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade/organização & administração , Migrantes , Cobertura Universal do Seguro de Saúde/organização & administração
16.
J Natl Med Assoc ; 109(4): 279-286, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29173935

RESUMO

PURPOSE: It is known that racial disparities exist in terms of disease prevalence and access to health care. However, the link between race/ethnicity and sleep quality is often under-recognized. RESULTS: Current evidence shows that differences exist between Blacks and Whites in terms of sleep duration, sleep quality, and the likelihood of acquiring a sleep disorder. It has been argued that the adverse effects of ethnicity on sleep quality or duration interact with other social or personal factors (such as employment) and that the effects of these factors are interactive and need to be analyzed simultaneously. There is a growing body of evidence showing that disturbed sleep is a mediator of the effect of environmental stressors on personal health, which is more pronounced in ethnic minorities. CONCLUSIONS: These findings support the notion that perceived discrimination or unfair treatment has significant associations with complaints of sleep disturbance and disturbed objective measures of sleep quality and sleep architecture. Hence, greater efforts are needed to demonstrate how racial/ethnic factors influence different sleep processes.


Assuntos
Negro ou Afro-Americano , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Racismo , Transtornos do Sono-Vigília/etnologia , Sono , População Branca , Negro ou Afro-Americano/psicologia , Humanos , Grupos Minoritários , Racismo/etnologia , Racismo/psicologia , Fatores de Risco , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/psicologia , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Estresse Psicológico , Estados Unidos , População Branca/psicologia
17.
Indian J Public Health ; 61(2): 134-136, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28721965

RESUMO

Global health diplomacy (GHD) is relatively a very new field that has yet to be clearly defined and developed though there are various definitions given by different experts from foreign policy, global health, diplomacy, international relations, governance, and law. With the intensification of globalization and increasing gaps between countries, new and reemerging health threats such as HIV/AIDS, tuberculosis, influenza, severe acute respiratory syndrome, Ebola, and Zika and a gradual rethinking on security concepts framed a new political context. The health problems addressed diplomatically have also become diverse ranging from neglected tropical diseases, infectious diseases, sale of unsafe, counterfeit drugs to brain drain crisis. We see that global health has become more diverse as the actors widened and also the interests appealing not only to the traditional humanitarian ideals associated with health but also to the principles grounded in national and global security. Recently, we are witnessing the increased priority given to the GHD because the issue of health is discussed by various actors outside the WHO to shape the global policy for health determinants. In fact, the area of health has become the part of UN Summit Diplomacy involving the G8, G20, BRICS, and the EU. The recent WHO Pandemic Influenza Framework, UN High Level Framework on Prevention and Control of Noncommunicable Diseases, and the WHO Framework Convention on Tobacco Control are some of the examples of long-term negotiation processes for agreements that took place.


Assuntos
Diplomacia , Saúde Global , Internacionalidade , Humanos , Índia , Saúde da População , Política Pública
20.
JNMA J Nepal Med Assoc ; 62(275): 478-482, 2024 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-39369421

RESUMO

As a seismic hotspot, Nepal has endured many catastrophic earthquakes, including the 2023 Jajarkot quake. These quakes worsen the existing fragilities, resulting in difficulties in accessing healthcare, outbreaks of infectious diseases, mental health problems, and nutritional shortfalls. The article examines the complex web of health consequences, such as infectious and non-infectious diseases and malnutrition, highlighting the need for a global health lens in tackling these issues. It also reveals the long-term health effects, such as mental health disorders and increased disease susceptibility, that emerge after the quake and the importance of enhancing coordination and communication, enforcing building codes, and assisting affected communities in response to the seismic hazards. The article identifies mitigation strategies, community involvement, and international cooperation as key elements in building resilience against future quakes. It discusses the role of climate change in seismic risks and the need for research, innovation, and adaptability in global health interventions, suggesting measures such as strengthening primary healthcare, preventing avoidable health problems through education, and improving supply chains. The article calls for a holistic approach to building resilient health systems, emphasizing community engagement, prevention, and preparedness to protect the health of vulnerable groups in seismic regions.


Assuntos
Terremotos , Saúde Global , Nepal/epidemiologia , Humanos , Mudança Climática , Planejamento em Desastres/organização & administração , Cooperação Internacional , Desnutrição/epidemiologia , Desnutrição/prevenção & controle , Participação da Comunidade/métodos , Acessibilidade aos Serviços de Saúde
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