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1.
Artigo em Inglês | MEDLINE | ID: mdl-31909791

RESUMO

Quality issue: Improving quality of care has become a global health priority to improve health outcomes and strengthen health systems, particularly in the context of achieving universal health coverage. Initial assessment: The delivery of quality essential health services in settings of extreme adversity, such as fragile, conflict-affected, vulnerable or disaster contexts, has been identified as a high priority globally to address the massive level of need. Choice of solution: This paper provides an action framework to systematically address the quality of health services for state and non-state actors working in such settings. The framework is designed to be practical, comprehensible and simple in adoption and implementation. It describes challenges, a set of medical needs and population priorities, a menu of quality-related interventions, and a hierarchy of health system levels defining the roles and responsibilities of key actors. Conclusion: Optimizing the use of limited resources in delivering the best quality possible in 'the hardest of the hard settings' is imperative.

2.
Sci Total Environ ; 714: 136553, 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-31982735

RESUMO

There are 70.8 million forcibly displaced people worldwide, including internally displaced persons, refugees, and asylum seekers. Since mortality rates are highest in the first six months of displacement, the provision of adequate services and infrastructure by relief organizations is critical in this "emergency phase." Environmental health provisions such as adequate water supply, excreta management, solid waste management, and vector control measures are among those essential services. We conducted a systematic scoping review of environmental health in the emergency phase of displacement (the six months following first displacement). A total of 122 publications, comprising 104 peer-reviewed and 18 grey literature publications, met the inclusion criteria. We extracted data relating to environmental health conditions and services, associated outcomes, and information concerning obstacles and recommendations for improving these conditions and services. Despite the fact that most displaced people live outside of camps, publications largely report findings for camps (n = 73, 60%). Water supply (n = 57, 47%) and excreta management (n = 47, 39%) dominate the literature. Energy access (n = 7, 6%), exposure to harsh weather from inadequate shelter (n = 5, 4%), food hygiene and safety (n = 4, 3%), indoor air quality (n = 3, 3%), menstrual hygiene management (n = 2, 2%), dental hygiene (n = 2, 2%), and ambient air quality (n = 1, 1%) are relatively understudied. The most common health outcome attributed to inadequate environmental conditions in the included publications is diarrhea (n = 43, 35%). We found that organizations and governments often embrace their own standards, however we call for policymakers to adopt standards no less rigorous than Sphere for the emergency phase of displacement. Although other reviews examine water, sanitation, and hygiene interventions in emergencies, this is the first systematic review of environmental health more broadly in the first six months of displacement.

3.
Lancet ; 394(10216): 2237-2238, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-31868622
4.
Hum Resour Health ; 17(1): 91, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791358

RESUMO

Recent studies reveal public-sector healthcare providers in low- and middle-income countries (LMICs) are frequently absent from work, solicit informal payments for service delivery, and engage in disrespectful or abusive treatment of patients. While extrinsic factors may foster and facilitate these negative practices, it is not often feasible to alter the external environment in low-resource settings. In contrast, healthcare professionals with strong intrinsic motivation and a desire to serve the needs of their community are less likely to engage in these negative behaviors and may draw upon internal incentives to deliver a high quality of care. Reforming medical education admission and training practices in LMICs is one promising strategy for increasing the prevalence of medical professionals with strong intrinsic motivation.

6.
Sleep Med ; 63: 75-81, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31606652

RESUMO

BACKGROUND: The Pittsburgh Sleep Quality Index (PSQI) is a standardized questionnaire that used for subjective assessment of sleep quality. It has been translated into several languages and is widely used in clinical research settings. Since there is no sleep-related scale standardized in the Kurdish language, the present study aimed to translate and validate the PSQI into Kurdish. METHODS: First, the PSQI was successfully translated into Kurdish then back-translated into English by independent professional bilingual translators. The translated version of PSQI was tested with 230 participants, 150 healthy subjects, 40 subjects with insomnia, and 40 subjects with physical symptoms. Internal consistency was calculated by the Cronbach Alpha method using SPSS-20 software. Spearman correlation via a test-retest process was used for reliability. The General Health Questionnaire (GHQ28) was used to analyze criterion validity. The construct validity of the scale was tested by exploratory factor analysis (EFA). Factor weight was checked by confirmatory factor analysis (CFA) using LISREL software version 8.8. RESULTS: The internal consistency and reliability for PSQI global score was acceptable (Cronbach's alpha = 0.70). The result showed a strong correlation between test and retest after six weeks (r = 0.83). Correlations between the global score and components of the PSQI with the GHQ28 were all statistically significant (r = 0.23-0.72, p < 0.05). Exploratory factor analysis revealed three factors with a significant correlation between the PSQI global score and these factors. All factor weights were above 0.40. CONCLUSION: The results of this study support the PSQI's validity and reliability. This study offers a foundation for further studies in Kurdish populations.

7.
Artigo em Inglês | MEDLINE | ID: mdl-31294796

RESUMO

QUALITY PROBLEM OR ISSUE: There are record-setting numbers of people living in settings of extreme adversity and they continue to increase each year. INITIAL ASSESSMENT: There is a paucity of validated data on quality and safety across settings of extreme adversity. CHOICE OF SOLUTION: This paper argues for an action framework to address the unique challenges of providing quality in extreme adversity. IMPLEMENTATION: We describe a preliminary Quality in Extreme Adversity framework which has been informed by-and will continue to be validated through-literature, data collection, WHO expert consultations and through working in settings of extreme adversity with national authorities and NGOs. LESSONS LEARNED: Poor quality care costs lives, livelihoods and trust in health services. The recommended framework, based on evidence and experiential lessons, intends to address the WHO goal for 2019-2023 of 'one billion people better protected from health emergencies' (9).

8.
Med Confl Surviv ; 35(1): 80-102, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30522353

RESUMO

The relatively poor health outcomes in Iraq have been attributed to the inability to address the shortfalls in the public health model. Calls for health system reform in Iraqi Kurdistan Region started in 2004; however, few, if any, significant changes have been achieved since then. This research examines the factors impeding public health system reform in the Iraqi Kurdistan Region, as perceived by the health policy makers, through 11 in-depth, unstructured interviews. Participants attributed the delay in reform to 16 impeding factors that can be categorized into 5 major themes: historical, ethical, cultural, political and institutional. The intricate network of these inter-dependent factors provides a possible explanation for the failure or unsustainability of reform efforts. Reform initiatives might have a better chance of success if they take into consideration the well-established and unique background and social construct in Iraq, as well as the impact of decades of conflict and insecurity, both of which influence the individual and institutional reasoning and behaviour across the entire health system.


Assuntos
Assistência à Saúde/organização & administração , Órgãos Governamentais/organização & administração , Reforma dos Serviços de Saúde , Política de Saúde , Saúde Pública , Pessoal Administrativo/psicologia , Cultura , Reforma dos Serviços de Saúde/ética , Reforma dos Serviços de Saúde/organização & administração , Humanos , Entrevistas como Assunto , Iraque , Percepção , Política , Confiança
9.
Int J Qual Health Care ; 31(10): G187-G190, 2019 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-32159781

RESUMO

QUALITY PROBLEM OR ISSUE: Armed conflicts pose significant challenges to ensuring timely access to quality health care services for millions around the world. INITIAL ASSESSMENT: Ensuring access and basic infrastructure for conflict-affected populations are overlooked in the global movement to provide quality of care. CHOICE OF SOLUTION: This paper identifies strategies and interventions to improve access to good quality care in settings and communities afflicted by conflict. LESSONS LEARNED: t is crucial to focus more attention on, and develop an evidence base for, ensuring access and basic infrastructure to improve quality of care in conflict-affected regions.

10.
Confl Health ; 12: 47, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30559835
11.
Med Confl Surviv ; 34(3): 152-157, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30264596

RESUMO

Obsessive-compulsive disorder (OCD) is a chronic but very treatable medical condition. Adhering to the therapy plan is considered one of the biggest challenges for OCD patients, especially when communities are insecure due to armed conflicts and political upheavals. This paper documents the results of using social media platforms (especially Facebook Messenger, which provides free internet access) to manage the symptoms of a young female with chronic OCD. The results suggest that social media can be a potentially effective therapeutic tool, mainly in situations where armed conflicts, displacement and insecurity are present and where more traditional customs and conservative norms are sometimes reinforced as a protective mechanism, particularly for women who may be prevented from following the classic person-to-person consultation protocol. Social media, when used skilfully and properly protected, may help overcome the multiple cultural and social barriers that prevent the application of the more traditional treatment protocol. .


Assuntos
Transtorno Obsessivo-Compulsivo/terapia , Mídias Sociais , Terapia Cognitivo-Comportamental , Feminino , Humanos , Iraque , Adulto Jovem
14.
Med Confl Surviv ; : 1-20, 2018 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-29482355

RESUMO

Refugees are often afflicted with health conditions that require long-term, specialized and continuous care services that are costly and difficult to secure in host countries and camp settings. This study interviewed 21 Syrian refugees in Jordan with life-limiting conditions such as cancer, diabetes, chronic disability and renal failure, and 4 caregivers caring for refugee children with similar conditions. This study found that patients in refugee camps and communities would benefit from receiving palliative care services that are often either unavailable or inaccessible. Training humanitarian teams and primary care providers to implement pain management, offer psychosocial support services and address emotional, spiritual, and psychological conditions could ameliorate many of the problems faced by this vulnerable group.

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