Theoretical frameworks for project goal-setting: A qualitative case study of an organisational practice in Nigeria.

INTRODUCTION: Goal-setting in any practice context is vague unless the process is based on a framework that produces good goals. Popular goal-setting frameworks construct Specific, Measurable, Attainable, Realistic, and Time-bound (SMART) goal statements. Yet, research of how healthcare goals that are foundational to health plans are formulated is scanty. This case study explored the goal-setting practice of an organisation in Nigeria to discover the theoretical frameworks for setting the goals of their leprosy projects. METHODS: The study triangulated individual semi-structured interviews of 10 leprosy managers with a review of their project plans and a participant observation of the organisation's annual planning event. A five-stage thematic analysis was used to serially identify, code, and integrate goal-setting themes from the data collected. FINDINGS: This produced three final emergent themes: stakeholders, strategy, and goal statements, with 11 associated conceptual frameworks. All were further theoretically integrated into one general framework that illustrates the organisational goal-setting practice at the time of study. This revealed a practice with a four-staged linear centre-driven process that led to a top-down, problem-based goal formulation, and produced assigned project plans based on hierarchical non-SMART goal statements. CONCLUSION: Collaborative goal-setting process is proposed for Specific, Measurable, Attainable, Realistic, Timed, and Agreeable statements of project objectives and aims written with Change, Beneficiaries, Indicator, Target, Timeframe and Change, Beneficiaries, Location, and Timeframe models respectively.

Hanseniasis in the municipality of Western Amazon (Acre, Brazil): are we far from the goal of the World Health Organization?

ABSTRACT Background: Hanseniasis is a public health concern in developing countries. Although a decrease in the number of new cases in Brazil has been reported, there is a prevalence above that recommended in some regions. Aims: Considering the goal of the World Health Organization (WHO) to accelerate towards a leprosy-free world from 2020, the aim of this study was to analyze the epidemiological profile and leprosy trends in the city of Cruzeiro do Sul, Acre, Brazil. Methods: This retrospective cohort study analyzed the epidemiology and trends of hanseniasis between 2005 and 2018, monitoring socioeconomic and clinical epidemiological variables obtained from the Information System of Notifiable Diseases of Hanseniasis (SINAN) database. Results: A total of 422 cases of hanseniasis (284 male, 138 female) were included. The questionnaire of six patients was incomplete. The highest number of cases (89) was recorded in 2006 (11.7/10,000 inhabitants). The borderline clinical form was most common, with 45.4% of cases. Throughout the historical series, the rate of annual percentage change in the detection of new cases and cases with grade 2 disability showed a decreasing profile, at −13.9 [95% CI: −19.1, −8.2] and −13.1 [95% CI: −21.8, −5.5], respectively. The same rates were observed in patients below 15 years of age. Limitations: This study reflects the scenario in one reference center and data were obtained retrospectively. Conclusions: The incidence of hanseniasis in this reference center is declining gradually; however, the indicators show active disease transmission and late diagnosis.

Hanseniasis in the municipality of Western Amazon (Acre, Brazil): are we far from the goal of the World Health Organization?: Hansen and Western Amazon.

BACKGROUND: Hanseniasis is a public health concern in developing countries. Although a decrease in the number of new cases in Brazil has been reported, there is a prevalence above that recommended in some regions. AIMS: Considering the goal of the World Health Organization (WHO) to accelerate towards a leprosy-free world from 2020, the aim of this study was to analyze the epidemiological profile and leprosy trends in the city of Cruzeiro do Sul, Acre, Brazil. METHODS: This retrospective cohort study analyzed the epidemiology and trends of hanseniasis between 2005 and 2018, monitoring socioeconomic and clinical epidemiological variables obtained from the Information System of Notifiable Diseases of Hanseniasis (SINAN) database. RESULTS: A total of 422 cases of hanseniasis (284 male, 138 female) were included. The questionnaire of six patients was incomplete. The highest number of cases (89) was recorded in 2006 (11.7/10,000 inhabitants). The borderline clinical form was most common, with 45.4% of cases. Throughout the historical series, the rate of annual percentage change in the detection of new cases and cases with grade 2 disability showed a decreasing profile, at -13.9 [95% CI: -19.1, -8.2] and -13.1 [95% CI: -21.8, -5.5], respectively. The same rates were observed in patients below 15 years of age. LIMITATIONS: This study reflects the scenario in one reference center and data were obtained retrospectively. CONCLUSIONS: The incidence of hanseniasis in this reference center is declining gradually; however, the indicators show active disease transmission and late diagnosis.

Measuring medical students' empathy using direct verbal expressions.

PURPOSE: Empathy is an important trait in physicians and a key element in the physician-patient relationship. Accordingly, one of the goals in medical education is developing empathy in students. We attempted to practically assess medical students' empathy through their direct verbal expressions. METHODS: The medical students' empathy was measured using the modified Pencil-and-Paper Empathy Rating Test by Winefield and Chur-Hansen (2001). The students took 15 minutes or so to complete the scale, and it was then scored by one of two trained evaluators (0 to 4 points for each item, for a total score of 40). The subjects were 605 medical students, and the data were analyzed using descriptive analysis, independent t-test, and one-way analysis of variance in SPSS version 21.0. RESULTS: The students' empathy scores were low (mean, 12.13; standard deviation, 2.55); their most common responses (78.6%) registered as non-empathetic. Differences in empathy were observed by gender (female students>male students; t=-5.068, p<0.001), school system (medical school>medical college; t=-1.935, p=0.053), and academic level (pre-medical 1 year < other years; t=-4.050, p<0.001). CONCLUSION: Our findings lead us to the significant conclusion that there is the need for empathy enhancement training programs with practical content.

Are we there yet? Assessing achievement of vaccine-preventable disease goals in WHO's Western Pacific Region.

Accelerated disease control goals have long been appreciated for their role in galvanizing commitment and bringing a sense of urgency for disease prevention. WHO's Western Pacific Region has 14 on-going communicable disease reduction goals including 1 targeting eradication, 10 targeting elimination, and 3 control initiatives. These goals cover mother-to-child transmission of HIV, congenital syphilis, tuberculosis, leprosy, five parasitic diseases and four vaccine-preventable diseases (VPD). The initiatives have distinct objectives, approaches, and means in which to measure achievement of the goals. Given the long history and experience with VPD initiatives in the Western Pacific Region, this manuscript focuses on the Region's following initiatives: (1) smallpox eradication, (2) polio eradication, (3) measles elimination, (4) maternal and neonatal tetanus elimination (MNTE), and (5) hepatitis B control. There is good consistency across the Region's VPD initiatives yet a pattern of more robust and representative data requirements, stricter evaluation criteria, and more formal evaluation bodies are linked to the intensity of the goal - with eradication being the peak. On the other end of this spectrum, the Regional hepatitis B control initiative has established efficient and low-cost approaches for measuring impact and evaluating if the goals have been met. Even within the confines of VPD initiatives there are some deviations in use of terminology and comparisons across other disease control initiatives in the Region are provided.

Elimination of neglected tropical diseases in the South-East Asia Region of the World Health Organization.

The neglected tropical diseases (NTDs), which affect the very poor, pose a major public health problem in the South-East Asia Region of the World Health Organization (WHO). Although more than a dozen NTDs affect the region, over the past five years four of them in particular - leprosy, lymphatic filariasis, visceral leishmaniasis (kala-azar) and yaws - have been targeted for elimination. These four were selected for a number of reasons. First, they affect the WHO South-East Asia Region disproportionately. For example, every year around 67% of all new leprosy cases and 60% of all new cases of visceral leishmaniasis worldwide occur in countries of the region, where as many as 850 million inhabitants are at risk of contracting lymphatic filariasis. In addition, several epidemiological, technological and historical factors that are unique to the region make each of these four diseases amenable to elimination. Safe and effective tools and interventions to achieve these targets are available and concerted efforts to scale them up, singly or in an integrated manner, are likely to lead to success. The World Health Assembly and the WHO Regional Committee, through a series of resolutions, have already expressed regional and global commitments for the elimination of these diseases as public health problems. Such action is expected to have a quick and dramatic impact on poverty reduction and to contribute to the achievement of the Millennium Development Goals. This paper reviews the policy rationale for disease control in the WHO South-East Asia Region, the progress made so far, the lessons learnt along the way, and the remaining challenges and opportunities.

Four TDR diseases can be "eliminated". 2. Leprosy: from elimination to eradication?

PIP: The number of registered leprosy cases fell from 5.4 million in 1985 to 1.3 million in 1995, due to the increasingly widespread distribution of effective multidrug therapy (MDT). Much, however, remains to be done in order to achieve the 1994 Hanoi Declaration target of reducing the number of registered cases to 1/10,000 people in each endemic country by the year 2000. Countries numerically farthest away from achieving this goal were Brazil, Chad, India, Mozambique, and Nepal. In 1995, only 75% of registered cases were receiving therapy, with Africa having the worst treatment ratios. The largest total numbers of untreated registered cases were in India, approximately 200,000, and 60,000 in Brazil. The number of undetected cases is highest in India (150,000) and Bangladesh (120,000). Worldwide, an estimated 600,000 to 1 million cases are undetected. Special Action Projects for the Elimination of Leprosy (SAPEL) have been launched to increase MDT coverage in hard-to-reach areas. SAPEL, together with other campaigns being conducted to identify undetected highly infectious cases, will likely lead to the realization of the Hanoi Declaration.^ieng