Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.597
Filtrar
1.
Int J Equity Health ; 19(1): 63, 2020 05 07.
Artículo en Inglés | MEDLINE | ID: mdl-32381022

RESUMEN

The coronavirus disease 2019 (COVID-2019) pandemic struck Latin America in late February and is now beginning to spread across the rural indigenous communities in the region, home to 42 million people. Eighty percent of this highly marginalized population is concentrated in Bolivia, Guatemala, Mexico and Peru. Health care services for these ethnic groups face distinct challenges in view of their high levels of marginalization and cultural differences from the majority. Drawing on 30 years of work on the responses of health systems in the indigenous communities of Latin America, our group of researchers believes that countries in the region must be prepared to combat the epidemic in indigenous settings marked by deprivation and social disparity. We discuss four main challenges that need to be addressed by governments to guarantee the health and lives of those at the bottom of the social structure: the indigenous peoples in the region. More than an analysis, our work provides a practical guide for designing and implementing a response to COVID-19 in indigenous communities.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Coronavirus , Servicios de Salud del Indígena/organización & administración , Pandemias , Neumonía Viral/epidemiología , Grupos de Población , Población Rural , Betacoronavirus , Grupos Étnicos , Humanos , América Latina
2.
Salud Publica Mex ; 62(2): 228-230, 2020.
Artículo en Español | MEDLINE | ID: mdl-32237567

RESUMEN

The Health of Indigenous Peoples Program is a transversal axis of institutional policy. Its objective is to contribute to the well-being of indigenous peoples by doing research about their health needs, training human resources for their care, and innovating in policy development. This document presents the program's theoretical framework, which focuses on the structural determination of inequalities. It also describes its main lines of action, which contribute to the development of policies and programs aimed at the well-being of this population.


Asunto(s)
Pueblos Indígenas , Educación en Salud , Servicios de Salud del Indígena , Humanos
4.
Artículo en Inglés | PAHO-IRIS | ID: phr-51901

RESUMEN

To the editor: In the United States (US), an estimated 2.4 million persons have chronic infection with hepatitis C virus (HCV). The number of deaths from HCV-related mortality is greater than that of HIV and tuberculosis combined. Treatment with direct-acting antivirals (DAAs), usually 1-3 pills a day for 8 or 12 weeks, can cure over 95% of patients. Successful treatment of HCV has been shown to greatly reduce liver-related as well as all-cause mortality. American Indian and Alaska Native (AI/AN) people have over twice the national rate of HCV-related mortality. The largest health care provider for AI/AN communities is the Indian Health System, a national network of federal (Indian Health Service), tribal, and urban health facilities, comprised mostly of rural primary care clinics. As part of the Indian Health System response to HCV, health facilities have access to tele-mentoring support such as the ECHO (Extension for Community Healthcare Outcomes) model, which has demonstrated excellent outcomes in treating HCV. The program connects rural clinicians (‘spokes’) to a specialist team (‘hub’). These participants meet regularly via low-bandwidth video conference technology. The format of case-based learning, supported by short didactic presentations, aims to scale up clinical capacity across a health network. Patient presentations entail a brief de-identified standardized form with a patient’s clinical history to assess liver disease severity and determine optimal HCV treatment. [...]


Asunto(s)
Hepatitis C , Mortalidad , Enfermedades Transmisibles , Nativos de Alaska , Indios Norteamericanos , Salud Urbana , Servicios Urbanos de Salud , Hepatitis , Telemedicina , Telemedicina para Zonas Rurales y Remotas , Servicios de Salud del Indígena , Salud de Poblaciones Indígenas , Organizaciones Indígenas
5.
Health Qual Life Outcomes ; 18(1): 43, 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32093749

RESUMEN

BACKGROUND: The oral health of Indigenous children in remote communities is much worse than other population groups in Australia. Providing and maintaining an oral health service is challenging due to the remoteness of communities, the associated high cost, and the low retention of clinical staff. An annual preventive intervention delivered by fly-in clinicians may be a more cost-effective way to manage this problem. In this analysis we estimate the cost-effectiveness of an annual professional intervention for the prevention of dental caries in children of a remote Indigenous community in Far North Queensland. METHODS: A cost-effectiveness analysis was conducted based on an annual preventive intervention protocol. This included treating all dental decay in those with disease, applying fissure sealants, a disinfectant swab, fluoride varnish and providing oral hygiene instructions and dietary advice to all participating school children. This study included an intervention group and a natural comparison group and both groups were followed-up for 2 years after the initial preventive intervention. A Markov model was built to assess the cost-effectiveness of the intervention compared with the usual care. Costs of treatment from the Queensland Department of Health were used and effectiveness was measured as quality-adjusted life years (QALYs) with the CHU-9D. One-way and probabilistic sensitivity analyses were conducted to identify key drivers and quantify uncertainty. RESULTS: The preventive intervention was found to be highly cost-effective. The incremental cost per QALY gained was AU$3747. Probability of new caries and seeking treatment were identified as the main drivers of the model. In probabilistic sensitivity analysis intervention was cost effective in 100% of simulations. CONCLUSION: An annual preventive intervention for remote Indigenous communities in Australia is a highly cost-effective strategy to prevent dental caries and improve the quality of life of children.


Asunto(s)
Caries Dental/terapia , Servicios de Salud del Indígena/economía , Salud Bucal/economía , Años de Vida Ajustados por Calidad de Vida , Estudios de Casos y Controles , Niño , Análisis Costo-Beneficio , Caries Dental/epidemiología , Femenino , Humanos , Masculino , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Queensland
6.
Int J Equity Health ; 19(1): 8, 2020 01 13.
Artículo en Inglés | MEDLINE | ID: mdl-31931810

RESUMEN

BACKGROUND: Aboriginal women are frequently called upon to support their families and other community members. At times, such supporting roles can be burdensome for these women. Many Aboriginal women live with chronic conditions. We explored the ways in which the women's caring roles impacted on how they maintained their own health. METHODS: The aim of this manuscript is to explore the psychosocial factors associated with the management of health and chronic disease in Aboriginal women. An interpretive phenomenological approach was used for the analysis of 72 in-depth semi-structured interviews. These interviews were conducted in four community controlled Aboriginal health services, in urban, rural and remote settings, across two states and a territory in Australia. RESULTS: Women living with chronic disease experience multiple challenges while caring for family, such as intergenerational trauma, mental health issues relating to addiction, domestic and family violence and incarceration. When these women become ill, they also have to take care of themselves. These women provided informal and unfunded care in response to a range of complex family and community problems. This continuous caring for family affected the women's ability to maintain their health and manage their own chronic conditions. CONCLUSION: The caring roles and responsibilities Aboriginal women have in their community impact on their health. Aboriginal women provide much needed refuge and support to family and the wider community. Underfunded and over-burdened formal support services are not meeting the needs of many Aboriginal women. Improved culturally secure resources and social services are required within communities to support Aboriginal women to successfully manage their own health.


Asunto(s)
Enfermedad Crónica/etnología , Enfermedad Crónica/terapia , Grupo de Ascendencia Oceánica/psicología , Autocuidado/psicología , Adulto , Anciano , Anciano de 80 o más Años , Australia , Femenino , Servicios de Salud del Indígena , Humanos , Persona de Mediana Edad , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Investigación Cualitativa
8.
J Cross Cult Gerontol ; 35(1): 69-83, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31853783

RESUMEN

This project aims to improve health literacy in Indigenous communities through the development of evidence-based culturally relevant health promotion materials on dementia that bridge the gap between Indigenous and Western perspectives of the illness. The research team worked in partnership with Health Canada's First Nations and Inuit Home and Community Care Program (FNIHCC) and consulted with Indigenous elders to utilize a two-eyed seeing framework that draws upon Indigenous knowledge and Western biomedicine. A consolidated review of materials and research involving Indigenous perspectives of Alzheimer's and age-related dementias led to the development of two culturally appropriate fact sheets. Two Indigenous-specific fact sheets were developed "What is Dementia? Indigenous Perspectives and Cultural Understandings" and "Signs and Symptoms of Dementia: An Indigenous Guide." The fact sheets prioritize Indigenous knowledge and pay particular attention to Indigenous languages, diverse Indigenous cultures, and literacy levels. The content uses phrasing and words from Indigenous people involved in the research to share information. Biomedical concepts and words were included when necessary but language or presentation of these aspects were often modified to reflect Indigenous conceptualizations. This project provides a foundation for evidence-based knowledge translation in relation to cultural safety in dementia care. Specifically, the researchers outline how health care providers can develop culturally appropriate health promotion material, thus increasing Indigenous cultural understandings of dementia and health literacy.


Asunto(s)
Demencia/etnología , Alfabetización en Salud/métodos , Pueblos Indígenas , Canadá/etnología , Competencia Cultural , Conocimientos, Actitudes y Práctica en Salud , Servicios de Salud del Indígena , Humanos , Indios Norteamericanos/etnología , Lenguaje
9.
Support Care Cancer ; 28(1): 317-327, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31049670

RESUMEN

PURPOSE: The role of general practitioners in cancer care has expanded in recent years. However, little is known about utilization of primary health care (PHC) services by patients with cancer, particularly among socio-economically disadvantaged groups. We describe utilization of PHC services by patients with cancer, and the nature of the care provided. The study focuses on a disadvantaged group in Australia, namely Indigenous Australians. METHODS: A retrospective audit of clinical records in ten PHC services in Queensland, Australia. Demographic and clinical data of Indigenous Australians diagnosed with cancer during 2010-2016 were abstracted from patient's medical records at the PHC services. The rates of cancer-related visits were calculated using person years at risk as a denominator. RESULTS: A total of 138 patients' records were audited. During 12 months following the cancer diagnosis, patients visited the PHC service on average 5.95 times per year. Frequency of visits were relatively high in remote areas and among socioeconomic disadvantaged patients (IRR = 1.87, 95%CI 1.61-2.17; IRR = 1.79, 95%CI 1.45-2.21, respectively). Over 80% of visits were for seeking attention for symptoms, wound care, and emotional or social support. Patients who did not undergo surgery, had greater comorbidity, received chemotherapy and/or radiotherapy, and male gender had significantly greater rate of visits than their counterparts. CONCLUSION: The frequency of utilization of PHC services, especially by patients with comorbidities, and the range of reasons for attendance highlights the important role of PHC services in providing cancer care. The reliance on PHC services, particularly by patients in remote and disadvantaged communities, has important implications for appropriate resourcing and support for services in these locations.


Asunto(s)
Servicios de Salud del Indígena/estadística & datos numéricos , Neoplasias/terapia , Grupo de Ascendencia Oceánica , Médicos de Atención Primaria/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Auditoría Clínica , Femenino , Médicos Generales/normas , Médicos Generales/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/normas , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud del Indígena/normas , Humanos , Pueblos Indígenas/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Neoplasias/etnología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Pautas de la Práctica en Medicina/normas , Atención Primaria de Salud/normas , Queensland/epidemiología , Derivación y Consulta/normas , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Adulto Joven
10.
Interface (Botucatu, Online) ; 24: e190166, 2020.
Artículo en Portugués | LILACS | ID: biblio-1056557

RESUMEN

Este relato de experiência visa qualificar a realização de atividades de Educação Permanente em saúde indígena no Sistema Único de Saúde (SUS) em prol da consolidação de direitos. Atividades de Educação Permanente foram realizadas em serviços do SUS. Os principais resultados deste artigo demonstram o desconhecimento a respeito dos povos indígenas na região e das especificidades da saúde indígena. Aspectos burocráticos e organizativos dos serviços são colocados como dificultadores, ainda que a equidade seja um princípio constitutivo do mesmo sistema. A presença de indígenas nas capacitações abriu espaço para uma construção conjunta com o público atendido. A atenção diferenciada é vista por muitos trabalhadores da saúde como um privilégio, sendo necessário que desigualdades étnico-raciais e diferenças culturais sejam compreendidas pelos profissionais em busca da efetivação da universalidade e equidade previstas no SUS e do fortalecimento da Política Nacional de Atenção à Saúde dos Povos Indígenas (PNASPI).(AU)


This article is an experience report that aims to discuss the performance of Continuing Education activities about indigenous health in the Brazilian National Health System (SUS) in favor of the consolidation of rights. Continuing Education activities were carried out in SUS services. The main results show lack of knowledge about indigenous peoples in the region and about the specificities of indigenous health. Bureaucratic and organizational aspects of the services are viewed as hindrances, although equity is a constitutive principle of SUS. The presence of indigenous individuals in the activities opened space for a joint construction with the assisted population. Care provided according to different needs is seen by many health workers as a privilege; therefore, it is necessary that ethnic-racial inequalities and cultural differences are understood by professionals so that the SUS principles of universality and equity are brought into effect and the National Healthcare Policy for Indigenous Peoples (PNASPI) is strengthened.(AU)


Este artículo es un relato de experiencia cuyo objetivo es calificar la realización de actividades de Educación Permanente sobre Salud Indígena en el Sistema Brasileño de Salud (SUS) en pro de la consolidación de derechos. Se realizaron actividades de Educación Permanente en servicios del SUS. Los principales resultados de este artículo demuestran el desconocimiento con relación a los pueblos indígenas en la región y los aspectos específicos de la salud indígena. Aspectos burocráticos y organizativos de los servicios se plantean como dificultadores, aunque la equidad sea un principio constitutivo del mismo sistema. La presencia de indígenas en las capacitaciones abrió espacio para una construcción conjunta con el público atendido. La atención diferenciada es vista por muchos trabajadores de la salud como un privilegio, siendo necesario que los profesionales comprendan las desigualdades étnico-raciales y las diferencias culturales para que busquen hacer efectiva la universalidad y la equidad previstas en el SUS y el fortalecimiento de la PNASPI.(AU)


Asunto(s)
Humanos , Sistema Único de Salud/ética , Educación Continua/tendencias , Salud de Poblaciones Indígenas/legislación & jurisprudencia , Brasil , Educación Continua/métodos , Servicios de Salud del Indígena/legislación & jurisprudencia
13.
Aust J Rural Health ; 27(6): 542-549, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31880049

RESUMEN

OBJECTIVE: The aim of this study is to examine the challenges faced by the Aboriginal Health Practitioners in the community assisting their clients to manage medicines. DESIGN: Qualitative, in depth interviews with eight Aboriginal Health Practitioners employed at various Aboriginal Community Controlled Health services in Victoria were undertaken. SETTING: Rural Aboriginal Community Controlled Health Service. PARTICIPANTS: Aboriginal Health Practitioners who are registered with the Aboriginal and Torres Strait Islander Health Practice Board of Australia as an Aboriginal Health Practitioner and who have experience in the planning, provision, management and evaluation of health services within their scope of practice. RESULTS: This study revealed multiples challenges faced by Aboriginal Health Practitioners assisting clients with medication management. These were mainly divided into the attitudes and the culture of the workplace and barriers with medications use faced by the clients. The following subthemes were identified within the attitudes and workplace culture theme. These were reporting of errors, pamphlets not culturally appropriate, lack of education of Aboriginal Health Practitioner role and doctors' understanding of Aboriginal culture. The subthemes identified by the Aboriginal Health Practitioners that were specific to the clients included language barriers, immediacy, sharing medications by family members, medications disposal, self-diagnosis, traditional medicine, not feeling comfortable with doctors, literacy and alcohol use. CONCLUSION: This study has identified many barriers to medication safety in the Aboriginal community, and strategies to improve some of the challenges identified.


Asunto(s)
Servicios de Salud del Indígena , Administración del Tratamiento Farmacológico , Grupo de Ascendencia Oceánica , Adulto , Femenino , Humanos , Entrevistas como Asunto , Masculino , Errores de Medicación/prevención & control , Persona de Mediana Edad , Investigación Cualitativa , Victoria
14.
Int J Equity Health ; 18(1): 194, 2019 12 16.
Artículo en Inglés | MEDLINE | ID: mdl-31842869

RESUMEN

BACKGROUND: In recent decades, financial investment has been made in health-related programs and services to overcome inequities and improve Indigenous people's wellbeing in Australia and New Zealand. Despite policies aiming to 'close the gap', limited evaluation evidence has informed evidence-based policy and practice. Indigenous leaders have called for evaluation stakeholders to align their practices with Indigenous approaches. METHODS: This study aimed to strengthen culturally safe evaluation practice in Indigenous settings by engaging evaluation stakeholders, in both countries, in a participatory concept mapping study. Concept maps for each country were generated from multi-dimensional scaling and hierarchical cluster analysis. RESULTS: The 12-cluster Australia map identifies four cluster regions: An Evaluation Approach that Honours Community; Respect and Reciprocity; Core Heart of the Evaluation; and Cultural Integrity of the Evaluation. The 11-cluster New Zealand map identifies four cluster regions: Authentic Evaluation Practice; Building Maori Evaluation Expertise; Integrity in Maori Evaluation; and Putting Community First. Both maps highlight the importance of cultural integrity in evaluation. Differences include the distinctiveness of the 'Respecting Language Protocols' concept in the Australia map in contrast to language being embedded within the cluster of 'Knowing Yourself as an Evaluator in a Maori Evaluation Context' in the New Zealand map. Participant ratings highlight the importance of all clusters with some relatively more difficult to achieve, in practice. Notably, the 'Funding Responsive to Community Needs and Priorities' and 'Translating Evaluation Findings to Benefit Community' clusters were rated the least achievable, in Australia. The 'Conduct of the Evaluation' and the 'Prioritising Maori Interests' clusters were rated as least achievable in New Zealand. In both countries, clusters of strategies related to commissioning were deemed least achievable. CONCLUSIONS: The results suggest that the commissioning of evaluation is crucial as it sets the stage for whether evaluations: reflect Indigenous interests, are planned in ways that align with Indigenous ways of working and are translated to benefit Indigenous communities Identified strategies align with health promotion principles and relational accountability values of Indigenous approaches to research. These findings may be relevant to the commissioning and conduct of Indigenous health program evaluations in developed nations.


Asunto(s)
Asistencia Sanitaria Culturalmente Competente/organización & administración , Promoción de la Salud/métodos , Servicios de Salud del Indígena/organización & administración , Grupo de Ascendencia Oceánica , Australia , Análisis por Conglomerados , Disparidades en el Estado de Salud , Humanos , Nueva Zelanda , Evaluación de Programas y Proyectos de Salud
15.
Aust N Z J Public Health ; 43(6): 538-543, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31667912

RESUMEN

OBJECTIVE: Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) have been identified as having an important role in improving the health and wellbeing of individuals in prison; however, a lack of information exists on how to strengthen this role. This paper explores the experiences of ACCHO staff in primary health care to individuals inside or leaving prison. METHODS: Nineteen staff from four ACCHOs were interviewed. ACCHO selection was informed by proximity to prisons, town size and/or Local Government Area offending rates. Thematic analysis of the interviews was undertaken. RESULTS: While most ACCHOs had delivered post-release programs, primary health care delivery to prisoners was limited. Three themes emerged: i) a lack of access to prisoners; ii) limited funding to provide services to prisoners; and iii) the need for a team approach to primary health care delivery. CONCLUSION: A holistic model of care underpinned by a reliable funding model (including access to certain Medicare items) and consistent access to prisoners could strengthen ACCHOs' role in primary health care delivery to people inside or leaving prison. Implications for public health: ACCHOs have an important role to play in the delivery of primary health care to prisoners. Existing models of care for prisoners should be examined to explore how this can occur.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud del Indígena/organización & administración , Grupo de Ascendencia Oceánica/psicología , Atención Primaria de Salud/organización & administración , Prisioneros , Prestación de Atención de Salud/métodos , Femenino , Humanos , Masculino , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Atención Primaria de Salud/métodos , Prisioneros/psicología , Prisioneros/estadística & datos numéricos , Investigación Cualitativa , Apoyo Social
16.
Aust N Z J Public Health ; 43(6): 544-550, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31667969

RESUMEN

OBJECTIVE: To investigate the association between hearing impairment (HI) and Year 1 school attendance in Aboriginal children in the Northern Territory (NT) of Australia. METHODS: Observational cohort study (n=3,744) by analysing linked individual-level information for Aboriginal children from the NT Government school attendance records, NT Perinatal Register and Remote Hearing Assessment dataset, and community level data for relative remoteness, socioeconomic disadvantage and housing crowdedness. RESULTS: Children with unilateral hearing loss, mild HI and moderate or worse HI had significantly lower Year 1 attendance than those with normal hearing, attending 5.6 (95%CI, -9.10 ∼-2.10), 4.0 (95%CI, -7.17 ∼-0.90) and 6.1 (95%CI, -10.71 ∼-1.49) days fewer, respectively. Other variables that yielded significant association were: male gender, having attended preschool less than 20% of available days, speaking English as second language, twin birth and average household size >5. CONCLUSIONS: Aboriginal children with any level of HI are likely to have lower school attendance rates in Year 1 than their peers with normal hearing. Implications for public health: In this population, where the prevalence of otitis media and accompanying HI remains extremely high, the early detection and management of hearing loss on entry into primary school should be included in the measures to improve school attendance.


Asunto(s)
Pérdida Auditiva/etiología , Vivienda , Grupo de Ascendencia Oceánica/psicología , Otitis Media/complicaciones , Instituciones Académicas , Niño , Preescolar , Estudios de Cohortes , Femenino , Servicios de Salud del Indígena , Pérdida Auditiva/epidemiología , Pérdida Auditiva/etnología , Humanos , Masculino , Northern Territory , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Otitis Media/epidemiología , Otitis Media/etnología , Prevalencia , Factores Socioeconómicos
17.
Artículo en Inglés | MEDLINE | ID: mdl-31738865

RESUMEN

This eleventh national annual immunisation coverage report focuses on data for the calendar year 2017 derived from the Australian Immunisation Register (AIR) and the National Human Papillomavirus (HPV) Vaccination Program Register. This is the first report to include data on HPV vaccine course completion in Aboriginal and Torres Strait Islander (Indigenous) adolescents. 'Fully immunised' vaccination coverage in 2017 increased at the 12-month assessment age reaching 93.8% in December 2017, and at the 60-month assessment age reaching 94.5%. 'Fully immunised' coverage at the 24-month assessment age decreased slightly to 89.8% in December 2017, following amendment in December 2016 to require the fourth DTPa vaccine dose at 18 months. 'Fully immunised' coverage at 12 and 60 months of age in Indigenous children reached the highest ever recorded levels of 93.2% and 96.9% in December 2017. Catch-up vaccination activity for the second dose of measles-mumps-rubella-containing vaccine was considerably higher in 2017 for Indigenous compared to non-Indigenous adolescents aged 10-19 years (20.3% vs. 6.4%, respectively, of those who had not previously received that dose). In 2017, 80.2% of females and 75.9% of males aged 15 years had received a full course of three doses of human papillomavirus (HPV) vaccine. Of those who received dose one, 79% and 77% respectively of Indigenous girls and boys aged 15 years in 2017 completed three doses, compared to 91% and 90% of non-Indigenous girls and boys, respectively. A separate future report is planned to present adult AIR data and to assess completeness of reporting.


Asunto(s)
Programas de Inmunización , Inmunización , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Papillomaviridae/inmunología , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Cobertura de Vacunación , Adolescente , Algoritmos , Informes Anuales como Asunto , Australia/epidemiología , Preescolar , Estudios de Cohortes , Femenino , Servicios de Salud del Indígena , Humanos , Lactante , Masculino , Infecciones por Papillomavirus/virología , Sistema de Registros
18.
Health Care Women Int ; 40(12): 1302-1335, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31600118

RESUMEN

First Nations women who live on rural and remote reserves in Canada leave their communities between 36 and 38 weeks gestational age to receive labor and birthing services in large urban centers. The process and administrative details of this process are undocumented despite decades of relocation as a routine component of maternity care. Using data from 32 semistructured interviews and information from peer-reviewed literature, grey literature, and public documents, I constructed a descriptive map and a visual representation of the policy. I present new and detailed information about Canada's health policy as well as recommendations to address the health care gaps identified.


Asunto(s)
Política de Salud , Accesibilidad a los Servicios de Salud , Servicios de Salud del Indígena/organización & administración , Indios Norteamericanos , Partería/métodos , Parto/etnología , Mujeres Embarazadas/psicología , Canadá , Femenino , Humanos , Entrevistas como Asunto , Manitoba , Servicios de Salud Materna/organización & administración , Área sin Atención Médica , Embarazo , Mujeres Embarazadas/etnología , Investigación Cualitativa , Población Rural
19.
Artículo en Inglés | MEDLINE | ID: mdl-31569670

RESUMEN

Aboriginal and Torres Strait Islander women have significantly higher cervical cancer incidence and mortality than other Australian women. In this study, we assessed the documented delivery of cervical screening for women attending Indigenous Primary Health Care (PHC) centres across Australia and identified service-level factors associated with between-centre variation in screening coverage. We analysed 3801 clinical audit records for PHC clients aged 20-64 years from 135 Indigenous PHC centres participating in the Audit for Best Practice in Chronic Disease (ABCD) continuous quality improvement (CQI) program across five Australian states/territories during 2005 to 2014. Multilevel logistic regression models were used to identify service-level factors associated with screening, while accounting for differences in client-level factors. There was substantial variation in the proportion of clients who had a documented cervical screen in the previous two years across the participating PHC centres (median 50%, interquartile range (IQR): 29-67%), persisting over years and audit cycle. Centre-level factors explained 40% of the variation; client-level factors did not reduce the between-centre variation. Screening coverage was associated with longer time enrolled in the CQI program and very remote location. Indigenous PHC centres play an important role in providing cervical screening to Aboriginal and Torres Strait Islander women. Thus, their leadership is essential to ensure that Australia's public health commitment to the elimination of cervical cancer includes Aboriginal and Torres Strait Islander women. A sustained commitment to CQI may improve PHC centres delivery of cervical screening; however, factors that may impact on service delivery, such as organisational, geographical and environmental factors, warrant further investigation.


Asunto(s)
Detección Precoz del Cáncer/normas , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud del Indígena/normas , Disparidades en Atención de Salud/estadística & datos numéricos , Grupo de Ascendencia Oceánica , Atención Primaria de Salud/normas , Adulto , Australia/epidemiología , Auditoría Clínica , Detección Precoz del Cáncer/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Servicios de Salud del Indígena/estadística & datos numéricos , Humanos , Modelos Logísticos , Persona de Mediana Edad , Atención Primaria de Salud/estadística & datos numéricos , Mejoramiento de la Calidad , Neoplasias del Cuello Uterino/etnología , Adulto Joven
20.
Aust N Z J Public Health ; 43(6): 532-537, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31577862

RESUMEN

OBJECTIVE: This paper provides a case study of the responses to alcohol of an Aboriginal Community Controlled Health Service (The Service), and investigates the implementation of comprehensive primary health care and how it challenges the logic of colonial approaches. METHODS: Data were drawn from a larger comprehensive primary health care study. Data on actions on alcohol were collected from: a) six-monthly service reports of activities; b) 29 interviews with staff and board members; c) six interviews with advocacy partners; and d) community assessment workshops with 13 service users. RESULTS: The Service engaged in rehabilitative, curative, preventive and promotive work targeting alcohol, including advocacy and collaborative action on social determinants of health. It challenged other government approaches by increasing Aboriginal people's control, providing culturally safe services, addressing racism, and advocating to government and industry. CONCLUSIONS: This case study provides an example of implementation of the full continuum of comprehensive primary health care activities. It shows how community control can challenge colonialism and ongoing power imbalances to promote evidence-based policy and practice that support self-determination as a positive determinant for health. Implications for public health: Aboriginal Community Controlled Health Services are a good model for comprehensive primary health care approaches to alcohol control.


Asunto(s)
Trastornos Relacionados con Alcohol/terapia , Servicios de Salud Comunitaria/organización & administración , Servicios de Salud del Indígena/organización & administración , Atención Primaria de Salud/métodos , Trastornos Relacionados con Alcohol/etnología , Colonialismo , Humanos , Grupo de Ascendencia Oceánica , Racismo , Determinantes Sociales de la Salud
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA