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1.
West Afr J Med ; 39(4): 415-424, 2022 Apr 29.
Artículo en Inglés | MEDLINE | ID: mdl-35490416

RESUMEN

INTRODUCTION: The burden of HIV infection in households of people living with HIV (PLHIV) is usually high. The existence of HIV discordance and reasons for that is largely unknown. Moreover, how people in a discordant relationship can live happily together with negative partner not getting infected and/or safely have children are not well understood. This study is to determine the prevalence and factors associated with HIV sero-discordance among in-union HIV patients receiving care in a private health facility in Jos, north central Nigeria. METHODS: A descriptive cross sectional design was used for the study involving HIV clients. Their records were reviewed and a proforma used to extract needed information. Questionnaire was equally used. A total of 1505 patients were studied out of which 75 were sero-discordant. They were recruited consecutively. Data was analyzed using SPSS version 20 and presented using frequencies, percentages, and tables. RESULTS: Findings revealed that 75 (5.0%) were discordant giving a prevalence of 5%. Majority of the clients were females: [non-discordant 805(56.3%), discordant 45(60.0%)], attained secondary education [non-discordant 590(41.3%), discordant 60(80.0%)], have been in partnership for 1-10 years [non-discordant 525(36.7%). discordant 45(60.0%)], have sex with partner weekly [non-discordant 1385(96.9%), discordant 60(80.0%)], have no other sexual partner [non-discordant 1070(74.8%), discordant 75(100.0%)]. have viral load of <100 [non-discordant 1315(92.0%), discordant 75(100.0%)], have CD4 count of 200-499 [non-discordant 585(40.9%), discordant 30(40.0%)]. Most of participants knew that ART, consistent use of condom, abstinence and post exposure prophylaxis prevent HIV. There were statistical significant associations of characteristics of clients and their knowledge on HIV prevention with HIV status of partner. CONCLUSION: Prevalence of discordance is high. There was no identified predictor of HIV status of partner. For HIV prevalence and sero-discordant status to reduce, women should have a say or be at an equal platform as men in terms of control over their sexuality.


INTRODUCTION: Le fardeau de l'infection par le VIH dans les ménages de personnes vivant avec le VIH (PVVIH) est habituellement élevé. L'existence de la discordance du VIH et les raisons de cette discordance sont largement inconnues. En outré la façon dont les personnes dans une relation discordante peuvent vivre heureuses avec un partenaire négatif qui n'est pas infecté et / ou avoir des enfants en toute sécurité n'est pas bien comprise. Cette étude vise à déterminer la prévalence et les facteurs associés à la sérodiscination du VIH chez les patients syndiqués du VIH recevant des soins dans un établissement de santé privé à Jos, dans le centre-nord du Nigéria. MÉTHODES: Un plan transversal descriptif a été utilisé pour l'étude portant sur des clients séropositifs. Leurs dossiers ont été examinés et un formulaire a été utilisé pour extraire les informations nécessaires. Le questionnaire était également utilisé. Au total, 1505 patients ont été étudiés, dont 75 étaient séro-discordants. Ils ont été recrutés consécutivement. Les données ont été analysées à l'aide de la version 20 du SPSS et présentées à l'aide de fréquences,et tableaux. RÉSULTATS: Les résultats ont révélé que 75 (5.0%) étaient discordants, ce qui donne une prévalence de 5%. La majorité des clients étaient des femmes : [805 (56.3 %), 45 (60.0 %) discordants], ont fait des études secondaires [590 non discordants (41.3 %), discordants 60 (80.0 %)], sont en partenariat depuis 1 à 10 ans [non discordants 525 (36.7 %). discordants 45 (60.0 %)], ont des relations sexuelles avec un partenaire hebdomadaire [non discordant 1385 (96.9 %), discordant 60 (80.0 %)], n'ont pas d'autre partenaire sexuel [non discordant 1070 (74.8 %), discordant 75 (100.0 %)]. ont une charge virale de <100 [non discordant 1315 (92.0%), discordant 75 (100.0%)], ont un compte de CD4 de 200- 499 [non discordant 585 (40.9%), discordant30(40.0%)]. La plupart des participants savaient que le TAR, l'utilisation régulière du condom, l'abstinence et la prophylaxie post-exposition préviennent le VIH. Il y avait des associations statistiquement significatives de caractéristiques deles clients et leurs connaissances sur la prévention du VIH avec le statut VIH de partenaire. CONCLUSION: La prévalence de la discordance est élevée. Il n'y avait pas de prédicteur identifié du statut VIH du partenaire. Pour que la prévalence du VIH et le statut de sérodispondant diminuent, les femmes devraient avoir leur mot à dire ou être sur un pied d'égalité avec les hommes en termes de contrôle sur leur sexualité. Mot-clé: Séro-discordance, Immunodéficience humaine, Cohabitation Couple.


Asunto(s)
Infecciones por VIH , Niño , Estudios Transversales , Femenino , Infecciones por VIH/tratamiento farmacológico , Instituciones de Salud , Humanos , Masculino , Nigeria/epidemiología , Prevalencia
2.
Front Public Health ; 10: 797272, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35493387

RESUMEN

This study aims to compare determinants of health facility delivery for women under a health insurance scheme and those not under a health insurance scheme. Secondary data drawn from the National Demographic and Health Survey was used for the analysis. The characteristics of the women were presented with simple proportions. Binary multilevel logistic regression was used to examine the determinants of health facilities for women who enrolled in health insurance and those who did not. All statistical analyses were set at 5% level of significant level (p = 0.24). The result showed that 2.1% of the women were under a health insurance scheme. Disparity exists in health insurance ownership as a higher proportion of those enrolled in health insurance were those with higher education attainment, in urban parts of the country, and those situated on higher wealth quintiles. There is a significant difference between those with and those without health insurance. It implies that a higher proportion of women who enrolled in health insurance delivered in health facility delivery compared to those who do not. The unique determinants of health facility delivery for women under health insurance were parity and birth order, while unique determinants of health facility delivery for women not enrolled in health schemes were employment status, marriage type, and geopolitical zones. Uniform predictors of health facility delivery for both groups of women were maternal education, household wealth quintiles, autonomy on healthcare, number of antenatal contacts, residential status, community-level poverty, community-level media use, and community-level literacy. Intervention programs designed to improve health facility delivery should expand educational opportunities for women, improve household socioeconomic conditions, target rural women, and encourage women to undertake a minimum of four antenatal contacts.


Asunto(s)
Parto Obstétrico , Instituciones de Salud , Femenino , Humanos , Seguro de Salud , Nigeria , Embarazo , Factores Socioeconómicos
4.
BMJ Open ; 12(5): e059210, 2022 May 04.
Artículo en Inglés | MEDLINE | ID: mdl-35508340

RESUMEN

INTRODUCTION: There is scarce information about the allocation of health resources in Syria. Pre-existing inequalities were further intensified after the 2011 conflict which displaced over 50% of the population. This study provides an analysis of health inequalities in Syria focusing on spatial access to public hospitals and employs data from 2010, just prior to the outbreak of conflict. Establishing a preconflict snapshot of the health system could serve as a helpful baseline assessment for future studies to measure the impact of the conflict on the health system. Such information could also offer systematic data to guide postconflict reconstruction efforts. METHODS: We compared two methods to quantify the inpatient bed access: provider to population ratio (PPR) and two-step floating catchment area (2SFCA) method. We compared PPR calculated at the governorate level with population weighted 2SFCA score calculated at a resolution of 2 km by 2 km. We then aggregated at the governorate level, tested multiple catchment sizes and calculated Gini coefficient for each governorate. RESULTS: We found high inequality in access to public hospitals across and within governorates, especially in the north and eastern regions, where all governorates ranked in the lowest two quintiles using both PPR and 2SFCA. Relatively small governorates in the west and the south had higher spatial access and less inequality. Testing variability in catchment size showed that even at 125 km catchment, 65% of the country had accessibility below national average. CONCLUSION: Methodologically, the use of 2SFCA provided more nuanced insights about hospital bed allocation than PPR. 2SFCA was able to account for the cross-boundary effect and road network quality. Realistic representation of health accessibility is possible in data-scarce settings such as Syria and could be adapted to assess health access inequalities in conflict and postconflict settings.


Asunto(s)
Instituciones de Salud , Accesibilidad a los Servicios de Salud , Áreas de Influencia de Salud , Humanos , Análisis Espacial , Siria
7.
PLoS One ; 17(5): e0268014, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35511932

RESUMEN

BACKGROUND: Providing compassionate and respectful maternity care to mothers is a vital intervention to improve health outcomes of women and newborns. However, there is less data of compassionate and respectful maternity care in Gondar city. Therefore, this study aimed to assess the magnitude of mistreatment and associated factors among mothers who gave birth at the public health facilities in Gondar city, northwest Ethiopia. METHODS: Institutional based cross-sectional study was conducted from March to April 2019 in Gondar city public nine health facilities. A total of 584 randomly selected women in the postpartum period were recruited in this study. A binary logistic regression analysis was done to see whether there was an association between mistreatment and independent variables. Finally, the logistic regression analysis was done by stratifying type of parity and mode of delivery. RESULTS: Overall, 73.2% (95% CI: 69.7-76.7%) of the women were mistreated during their childbirth care. Non-consented care was the most commonly experienced form of mistreatment (63.6%, 95% CI: 59.6-67.6%). Having less than four antenatal care follow-up visits (AOR = 3.58, 95% CI: 2.04-6.29), giving birth in the hospital (AOR = 2.83, 95% CI: 1.52-5.27), and facing complications during delivery (AOR = 2.06, 95% CI: 1.52-3.98) were significantly associated with mistreatment among postpartum mothers. CONCLUSIONS: This study showed a lower proportion of mistreatment than other studies in Ethiopia. Having less than four ANC follow up, place of current delivery, and facing complication during delivery were identified as the determinants of mistreatment. Therefore, this calls for strengthening actions, like providing maternity education during antenatal care and appropriate management of complications to improve the quality of maternity care at health facilities, and enhancing hospital working health workers capacity on compassionate and respectful maternity care.


Asunto(s)
Servicios de Salud Materna , Estudios Transversales , Parto Obstétrico , Etiopía/epidemiología , Femenino , Instituciones de Salud , Humanos , Recién Nacido , Parto , Embarazo , Prevalencia , Factores de Riesgo
8.
BMC Pregnancy Childbirth ; 22(1): 386, 2022 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-35505295

RESUMEN

BACKGROUND: The present study aimed to assess the magnitude and factors associated with neglected and non-consented care during childbirth in public health facilities in Central Tigray, Ethiopia. METHODS: A health facility-based cross-sectional survey supplemented by a qualitative study was conducted from April to May 2020 among women giving birth. We included 415 participants and recruited via a systematic random sampling technique. To collect the data, a pre-tested, face-to-face exit interview using an interviewer-administered structured questionnaire was used. Neglected and non-consented care and its outcomes (yes and no) were the dependent variables, and Socio-demographic data such as (age, educational level, region, and income), and other variables associated with compassionate and respective maternity care were the independent variables. We applied bivariate and multivariate logistic regression to determine predictors for non-consented and non-confidential care components of disrespect or abuse. The in-depth interviews were analyzed using content analysis. RESULTS: Among the participants, 82.4% and 78.6% had neglected care and non-consented care among women giving birth respectively. No formal education level (AOR: 0.37, 95%, CI (0.18-0.78)) and primary education level (AOR: 0.18, 95%, CI (0.05-0.57))., mode of delivery (AOR 3.79, 95% CI 1.42-10.09), sex of skilled healthcare providers (AOR: 0.56, 95%, CI (0.34-0.93)), number of deliveries in a health Centre (AOR: 1.89, 95% CI (1.03-3.47)) predicted non-consented care, and history ANC (AOR: 8.10, 95% CI (1.33-49.51)), and federal government employee (AOR: 0.24, 95% CI (0.07-0.78)) predicted neglected care during childbirth. In-depth interview result shows the mode of delivery and sex of healthcare providers were factor associated with non-consented care and women's stay at health facilities were factor associated with neglected care. CONCLUSION: The level of neglected and non-consented care during delivery was high reflecting substantial mistreatment. Educational level, mode of delivery, sex of skilled healthcare providers, and the number of deliveries in a health Centre were associated with non-consented care, and history ANC and Federal Government employees were associated with neglected care during childbirth. These findings imply the urgent needs or intervention including strengthening of awareness of both patients and healthcare providers on patients' rights and responsibilities and training service providers in patient-centered care and interpersonal communication and relationships to minimize mistreatment.


Asunto(s)
Servicios de Salud Materna , Estudios Transversales , Parto Obstétrico , Etiopía , Femenino , Instituciones de Salud , Humanos , Masculino , Parto , Embarazo
9.
Rev Lat Am Enfermagem ; 30: e3557, 2022.
Artículo en Portugués, Inglés, Español | MEDLINE | ID: mdl-35507956

RESUMEN

OBJECTIVE: to evaluate the adherence of Brazilian long-term care facilities to the World Health Organization Infection Prevention and Control guidance, and assess the association of their size with the adherence to these recommendations. METHOD: cross-sectional study conducted with facilities' managers. Authors developed a 20-item questionnaire based on this guidance, and a global score of adherence, based on the adoption of these recommendations. Adherence was classified as (1) excellent for those who attended ≥14 out of 20 recommendations; (2) good for 10 to 13 items; and (3) low for those with less than ten items. Facilities' sizes were established as small, intermediate, and large according to a two-step cluster analysis. Descriptive statistics and chi-square tests were used at a 5% significance level. RESULTS: among 362 included facilities, 308 (85.1%) adhered to 14 or more recommendations. Regarding its size, adherence to screening COVID-19 symptoms of visitors (p=0.037) and isolating patients until they have had two negative laboratory tests (p=0.032) were lower on larger ones compared to medium and small facilities. CONCLUSION: adherence to COVID-19 mitigation measures in Brazilian facilities was considered excellent for most of the recommendations, regardless of the size of the units.


Asunto(s)
COVID-19 , COVID-19/prevención & control , Estudios Transversales , Instituciones de Salud , Humanos , Cuidados a Largo Plazo , Encuestas y Cuestionarios
10.
BMC Pregnancy Childbirth ; 22(1): 389, 2022 May 04.
Artículo en Inglés | MEDLINE | ID: mdl-35509044

RESUMEN

BACKGROUND: In a woman's life, labor pain is the most severe pain that they have ever faced. In Ethiopia, the provision of pain relief in labor is often neglected. Furthermore, evidence strongly urged that further research is needed on non-pharmacological labor pain management. Therefore, obstetrics care providers' attitudes and utilization of non-pharmacological labor pain management need to be assessed. METHOD: A facility-based cross-sectional study was conducted from May 20 to June 10, 2021, in Harari regional state health facilities, Ethiopia. All obstetric caregivers in Harari regional state health facilities were included in the study. A structured questionnaire adapted from the previous studies was used to collect data. The data was entered into Epi-data version 3.1 statistical software. Statistical analysis was carried out by using SPSS for windows version 22. Multivariate linear regression analysis was employed to determine the association between independent variables and the outcome variable. RESULT: The overall utilization of non-pharmacological labor pain relief methods was 59.3% [(95% CI (53.9,63.4)]. Three hundred five (65.5%) of the study participants had unfavorable attitudes. Females compared to males (ß = - 0.420; 95% CI: - 0.667, - 0.173), clinical experience (ß = - 0.201; 95% CI: - 0.268, - 0.134), knowledge sum score (ß =0.227: 95%; CI: 0.18,0.247), and attitude sum score (ß = 0.376; 95% CI: 0.283, 0.47) were showed significantly association with utilization of non-pharmacological labor pain management. CONCLUSION: The overall utilization of non-pharmacological labor pain relief methods was relatively good compared to other studies done in Ethiopia but all women's need for labor relief methods should not be ignored. In this study sex of the respondents, clinical experience, individual preference, attitude and knowledge were factors associated with the utilization of non-pharmacological labor pain management. All stake holds need to work together to improve the attitude of health providers and to increase the utilization of non-pharmacologic labor pain management.


Asunto(s)
Dolor de Parto , Obstetricia , Estudios Transversales , Etiopía , Femenino , Instituciones de Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Dolor de Parto/terapia , Masculino , Manejo del Dolor , Embarazo , Encuestas y Cuestionarios
12.
BMJ Open ; 12(5): e054757, 2022 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-35534071

RESUMEN

OBJECTIVE: The aim of this study was to evaluate the benefit-cost of E-claims. A benefit-cost analysis was used to evaluate the efficiency of E-claims from the perspective of the providers and the purchaser. DESIGN: A benefit-cost analysis approach was taken for this economic evaluation. Furthermore, we estimated the incremental benefit-cost ratio (IBCR) of the intervention under assessment. PARTICIPANTS: Purchasers and healthcare providers of the National Health Insurance Scheme (NHIS) of Ghana were the study population. RESULTS: The analysis was stratified according to providers and purchaser. Cost incurred in processing claims electronically and manually were estimated by assessing the resource use and their corresponding costs. Sensitivity analysis was conducted to assess the robustness of the results to variations in discount rate and proportions of claims processed under E-claims compared with paper claims. The combined sample of providers and purchaser made incremental gains from processing claims electronically. The IBCR was -19.75, 25.56 and 5.10 for all (sample) providers, purchaser and both providers and purchaser, respectively. When projected for the 330 facilities submitting claims to the NHIS claims processing centre (CPC) as at December 2014, the IBCR were -35.20, 25.56 and 90.06 for all providers, purchaser and both providers and purchaser. The results were sensitive to the discount rate used and proportions of E-claims compared with paper claims. CONCLUSION: Electronic processing of claims is more efficient compared with manual processing, hence provide an economic case for scaling it up to cover many more healthcare facilities and NHIS CPCs in the Ghana.


Asunto(s)
Instituciones de Salud , Programas Nacionales de Salud , Análisis Costo-Beneficio , Electrónica , Ghana , Humanos , Seguro de Salud
13.
BMJ Open ; 12(5): e060158, 2022 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-35534075

RESUMEN

OBJECTIVES: Explore what 'good' patient and family involvement in healthcare adverse event reviews may involve. DESIGN: Data was collected using semi-structured telephone interviews. Interview transcripts were analysed using an inductive thematic approach. SETTING: NHS Scotland. PARTICIPANTS: 19 interviews were conducted with patients who had experienced an adverse event during the provision of their healthcare or their family member. RESULTS: Four key themes were derived from these interviews: trauma, communication, learning and litigation. CONCLUSIONS: There are many advantages of actively involving patients and their families in adverse event reviews. An open, collaborative, person-centred approach which listens to, and involves, patients and their families is perceived to lead to improved outcomes. For the patient and their family, it can help with reconciliation following a traumatic event and help restore their faith in the healthcare system. For the health service, listening and involving people will likely enhance learning with subsequent improvements in healthcare provision with reduction in risk of similar events occurring for other patients. This study suggests eight recommendations for involving patients and families in adverse event reviews using the APICCTHS model (table 3) which includes an apology, person-centred inclusive communication, closing the loop, timeliness, putting patients and families at the heart of the review with appropriate support for staff involved. Communicating in a compassionate manner could also decrease litigation claims following an adverse event.


Asunto(s)
Comunicación , Familia , Atención a la Salud , Instituciones de Salud , Humanos , Investigación Cualitativa
14.
BMC Health Serv Res ; 22(1): 621, 2022 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-35534850

RESUMEN

BACKGROUND: The balanced scorecard (BSC) has been implemented to evaluate the performance of health care organizations (HCOs). BSC proved to be effective in improving financial performance and patient satisfaction. AIM: This systematic review aims to identify all the perspectives, dimensions, and KPIs that are vital and most frequently used by health care managers in BSC implementations. METHODS: This systematic review adheres to PRISMA guidelines. The PubMed, Embase, Cochrane, and Google Scholar databases and Google search engine were inspected to find all implementations of BSC at HCO. The risk of bias was assessed using the nonrandomized intervention studies (ROBINS-I) tool to evaluate the quality of observational and quasi-experimental studies and the Cochrane (RoB 2) tool for randomized controlled trials (RCTs). RESULTS: There were 33 eligible studies, of which we identified 36 BSC implementations. The categorization and regrouping of the 797 KPIs resulted in 45 subdimensions. The reassembly of these subdimensions resulted in 13 major dimensions: financial, efficiency and effectiveness, availability and quality of supplies and services, managerial tasks, health care workers' (HCWs) scientific development error-free and safety, time, HCW-centeredness, patient-centeredness, technology, and information systems, community care and reputation, HCO building, and communication. On the other hand, this review detected that BSC design modification to include external and managerial perspectives was necessary for many BSC implementations. CONCLUSION: This review solves the KPI categorization dilemma. It also guides researchers and health care managers in choosing dimensions for future BSC implementations and performance evaluations in general. Consequently, dimension uniformity will improve the data sharing and comparability among studies. Additionally, despite the pandemic negatively influencing many dimensions, the researchers observed a lack of comprehensive HCO performance evaluations. In the same vein, although some resulting dimensions were assessed separately during the pandemic, other dimensions still lack investigation. Last, BSC dimensions may play an essential role in tackling the COVID-19 pandemic. However, further research is required to investigate the BSC implementation effect in mitigating the pandemic consequences on HCO.


Asunto(s)
COVID-19 , Pandemias , COVID-19/epidemiología , Instituciones de Salud , Personal de Salud , Humanos , Satisfacción del Paciente
15.
BMJ Open ; 12(5): e059400, 2022 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-35501096

RESUMEN

OBJECTIVES: We aimed to identify the core elements of centredness in healthcare literature. Our overall research question is: How has centredness been represented within the health literature published between 1990 and 2019? METHODS: A scoping review across five databases (Medline (Ovid), PsycINFO, CINAHL, Embase (Ovid) and Scopus; August 2019) to identify all peer-reviewed literature published since 1990 that focused on the concept of centredness in any healthcare discipline or setting. Screening occurred in duplicate by a multidisciplinary, multinational team. The team met regularly to iteratively develop and refine a coding template that was used in analysis and discuss the interpretations of centredness reported in the literature. RESULTS: A total of 23 006 title and abstracts, and 499 full-text articles were screened. A total of 159 articles were included in the review. Most articles were from the USA, and nursing was the disciplinary perspective most represented. We identified nine elements of centredness: Sharing power; Sharing responsibility; Therapeutic relationship/bond/alliance; Patient as a person; Biopsychosocial; Provider as a person; Co-ordinated care; Access; Continuity of care. There was little variation in the concept of centredness no matter the preceding word (eg, patient-/person-/client-), healthcare setting or disciplinary lens. Improving health outcomes was the most common justification for pursuing centredness as a concept, and respect was the predominant driving value of the research efforts. The patient perspective was rarely included in the papers (15% of papers). CONCLUSIONS: Centredness is consistently conceptualised, regardless of the preceding word, disciplinary lens or nation of origin. Further research should focus on centring the patient perspective and prioritise research that considers more diverse cultural perspectives.


Asunto(s)
Formación de Concepto , Atención Dirigida al Paciente , Atención a la Salud , Instituciones de Salud , Humanos , Atención Dirigida al Paciente/métodos
16.
Aten Primaria ; 54(4): 102219, 2022 Apr.
Artículo en Español | MEDLINE | ID: mdl-35504664

RESUMEN

BACKGROUND: To describe the capacity of the primary health care's nurse in the resolution of the self-limiting mild processes after the implementation of the healthcare demand's process in Basque Country. SETTING: 25 primary health care centers of the OSI Bilbao-Basurto. TYPE OF STUDY: An observational, descriptive, transversal study. Using as a guide protocols previously agreed and within hers scope of competence, the nurse values and resolves five self-limiting mild processes: upper airway infection, sore throat, fever, nausea and/or vomiting and diarrhea. Furthermore, the nurse can refer patients to other specialist in the cases concomitant disease is detected or their state of heath is aggravated. PARTICIPANTS: 6985 patient's records, who consulted 1 of 5 self-limiting mild processes from 1st November 2019 to 29th February 2020, were analyzed. MAIN MEASUREMENTS: The main variable was the nurse's resolution. The three possible resolutions ways were health education, health education, medical administrative consultation and health education, and medical consultation. RESULTS: The nurse solved the 47% of the self-limiting mild processes. According to the type of process, differences in the resolution were appreciated, solving as far as 57% of the processes of consultations for diarrhea. 10.5% (CI 95%; 9.8-11.2%) of the assisted people were followed-up for reasons related to the self-limiting mild processes of the origin. The follow-up consultations were not related to the way the process was resolved. CONCLUSIONS: The nurse solves nearly half of the processes that values in spite of not having some of the tools such as, the competence of indicate and dispense medications.


Asunto(s)
Instituciones de Salud , Faringitis , Atención a la Salud , Diarrea/terapia , Femenino , Humanos , Derivación y Consulta
17.
JAMA ; 327(18): 1782-1794, 2022 05 10.
Artículo en Inglés | MEDLINE | ID: mdl-35510397

RESUMEN

Importance: In nonurban areas with limited access to thrombectomy-capable centers, optimal prehospital transport strategies in patients with suspected large-vessel occlusion stroke are unknown. Objective: To determine whether, in nonurban areas, direct transport to a thrombectomy-capable center is beneficial compared with transport to the closest local stroke center. Design, Setting, and Participants: Multicenter, population-based, cluster-randomized trial including 1401 patients with suspected acute large-vessel occlusion stroke attended by emergency medical services in areas where the closest local stroke center was not capable of performing thrombectomy in Catalonia, Spain, between March 2017 and June 2020. The date of final follow-up was September 2020. Interventions: Transportation to a thrombectomy-capable center (n = 688) or the closest local stroke center (n = 713). Main Outcomes and Measures: The primary outcome was disability at 90 days based on the modified Rankin Scale (mRS; scores range from 0 [no symptoms] to 6 [death]) in the target population of patients with ischemic stroke. There were 11 secondary outcomes, including rate of intravenous tissue plasminogen activator administration and thrombectomy in the target population and 90-day mortality in the safety population of all randomized patients. Results: Enrollment was halted for futility following a second interim analysis. The 1401 enrolled patients were included in the safety analysis, of whom 1369 (98%) consented to participate and were included in the as-randomized analysis (56% men; median age, 75 [IQR, 65-83] years; median National Institutes of Health Stroke Scale score, 17 [IQR, 11-21]); 949 (69%) comprised the target ischemic stroke population included in the primary analysis. For the primary outcome in the target population, median mRS score was 3 (IQR, 2-5) vs 3 (IQR, 2-5) (adjusted common odds ratio [OR], 1.03; 95% CI, 0.82-1.29). Of 11 reported secondary outcomes, 8 showed no significant difference. Compared with patients first transported to local stroke centers, patients directly transported to thrombectomy-capable centers had significantly lower odds of receiving intravenous tissue plasminogen activator (in the target population, 229/482 [47.5%] vs 282/467 [60.4%]; OR, 0.59; 95% CI, 0.45-0.76) and significantly higher odds of receiving thrombectomy (in the target population, 235/482 [48.8%] vs 184/467 [39.4%]; OR, 1.46; 95% CI, 1.13-1.89). Mortality at 90 days in the safety population was not significantly different between groups (188/688 [27.3%] vs 194/713 [27.2%]; adjusted hazard ratio, 0.97; 95% CI, 0.79-1.18). Conclusions and Relevance: In nonurban areas in Catalonia, Spain, there was no significant difference in 90-day neurological outcomes between transportation to a local stroke center vs a thrombectomy-capable referral center in patients with suspected large-vessel occlusion stroke. These findings require replication in other settings. Trial Registration: ClinicalTrials.gov Identifier: NCT02795962.


Asunto(s)
Arteriopatías Oclusivas , Procedimientos Endovasculares , Accidente Cerebrovascular Isquémico , Trombectomía , Activador de Tejido Plasminógeno , Anciano , Anciano de 80 o más Años , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/tratamiento farmacológico , Arteriopatías Oclusivas/cirugía , Isquemia Encefálica/tratamiento farmacológico , Isquemia Encefálica/etiología , Isquemia Encefálica/cirugía , Femenino , Instituciones de Salud , Humanos , Accidente Cerebrovascular Isquémico/tratamiento farmacológico , Accidente Cerebrovascular Isquémico/etiología , Accidente Cerebrovascular Isquémico/cirugía , Masculino , España , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/cirugía , Trombectomía/efectos adversos , Activador de Tejido Plasminógeno/administración & dosificación , Activador de Tejido Plasminógeno/efectos adversos , Resultado del Tratamiento , Población Urbana
18.
BMJ Lead ; 6(1): 53-56, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35537022

RESUMEN

BACKGROUND: Women comprise over three-quarters of the National Health Service workforce, yet remain underrepresented in senior medical grades, on managerial boards and in senior leadership roles. This is attributed to a wide range of internalised, interpersonal and structural factors. OBJECTIVE: To explore the experiences of aspiring clinical leaders working with senior female leader colleagues and the perceived impact of these interactions on professional development and future aspirations. METHODS: Healthcare professionals, self-identifying as female aspiring clinical leaders, were recruited via email and social media to participate in a focus group or semistructured interview. Interviews were recorded and reviewed and the key enablers, barriers and actions to facilitate opportunities for female clinical leaders in the workplace identified. RESULTS: Participants (n=11) had varied experiences of working with senior female colleagues. Reported barriers from existing leaders included 'Queen Bee' phenomenon and reticence to talk about barriers faced. Enablers included 'nudging' towards opportunities and women leaders sharing challenges they had faced and overcome. CONCLUSION: Supporting women to achieve their leadership potential requires individualised support, role modelling and mentorship, and organisational change to tackle workplace biases and microaggressions. These are crucial to ensuring gender balance across leadership in health and social care.


Asunto(s)
Liderazgo , Medicina Estatal , Atención a la Salud , Femenino , Instituciones de Salud , Humanos
19.
BMJ Open ; 12(5): e057484, 2022 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-35523490

RESUMEN

OBJECTIVE: To explore the barriers to and options for improving access to quality healthcare for the urban poor in Nairobi, Kenya. DESIGN AND PARTICIPANTS: This was a qualitative approach. In-depth interviews (n=12), focus group discussions with community members (n=12) and key informant interviews with health providers and policymakers (n=25) were conducted between August 2019 and September 2020. Four feedback and validation workshops were held in December 2019 and April-June 2021. SETTING: Korogocho and Viwandani urban slums in Nairobi, Kenya. RESULTS: The socioe-conomic status of individuals and their families, such as poverty and lack of health insurance, interact with community-level factors like poor infrastructure, limited availability of health facilities and insecurity; and health system factors such as limited facility opening hours, health providers' attitudes and skills and limited public health resources to limit healthcare access and perpetuate health inequities. Limited involvement in decision-making processes by service providers and other key stakeholders was identified as a major challenge with significant implications on how limited health system resources are managed. CONCLUSION: Despite many targeted interventions to improve the health and well-being of the urban poor, slum residents are still unable to obtain quality healthcare because of persistent and new barriers due to the COVID-19 pandemic. In a devolved health system, paying attention to health services managers' abilities to assess and respond to population health needs is vital. The limited use of existing accountability mechanisms requires attention to ensure that the mechanisms enhance, rather than limit, access to health services for the urban slum residents. The uniqueness of poor urban settings also requires in-depth and focused attention to social determinants of health within these contexts. To address individual, community and system-level barriers to quality healthcare in this and related settings and expand access to health services for all, multisectoral strategies tailored to each population group are needed.


Asunto(s)
COVID-19 , Grupos de Población , Instituciones de Salud , Accesibilidad a los Servicios de Salud , Humanos , Kenia , Pandemias , Investigación Cualitativa
20.
BMC Health Serv Res ; 22(1): 614, 2022 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-35525954

RESUMEN

BACKGROUND: Female genital mutilation (FGM) curtails women's health, human rights and development. Health system as a critical pillar for social justice is key in addressing FGM while executing the core mandate of disease prevention and management. By leveraging opportune moments, events and experiences involving client-provider interactions, relevant FGM-related communications, behavior change and management interventions can be implemented through health facilities or in communities. It is unclear whether Kenyan health system has maximized this strategic advantage and positioning to address FGM. OBJECTIVE: Determine the quality of services offered to women with FGM across health facilities in West Pokot county, Kenya. METHODS: A mixed quantitative data collection strategies were used. These included: client-provider interactions observations with (61) health care workers (HCWs) and women with FGM seeking services; client-exit interviews with (360) women with FGM seeking services. These approaches sought to determine the content and quality of FGM-related care services; and service data abstractions involving records on services sought/offered from (10) facilities in West Pokot. RESULTS: A large (76%) proportion of women had experienced FGM aged 11-15 years, were married between 15 and 19 years (39%), had primary (47.5%) or no education (33%) with income <30 USD/month (43%). Only 14.8% HCWs identified FGM and related complications (11.5%) during consultations. Few FGM-related prevention interventions were implemented with IEC materials (4.9%) for reinforcing preventive messages lacking. Infrastructure (88.5%) for reproductive health services existed albeit limited human resources (14.8%) and capacity (42.6%) for FGM prevention and management; few (16%) health facilities and workers explained the negative consequences of FGM and need for stopping it (15.3%); and while data on women who sought antenatal (ANC), postnatal (PNC) and family planning (FP) care services were available no information of those with FGM or related complications. CONCLUSION: Health systems in high prevalent settings actively interface with women with FGM, despite the primary reason for seeking services not being FGM. Despite high number of women having undergone the cut, diagnosis, prevention, care services, and documentation of FGM and related complications are suboptimal. This underscores the need for health system strengthening in response to the practice with consideration for training kits for HCWs, empowering HCWs, anchoring of FGM indicators in the HMIS, documentation and IEC material to support FGM prevention at service delivery points, and overall integration of FGM into health programs.


Asunto(s)
Circuncisión Femenina , Atención a la Salud , Femenino , Instituciones de Salud , Personal de Salud , Humanos , Kenia , Embarazo
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