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1.
Comunidad (Barc., Internet) ; 22(2): 0-0, jul.-oct. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-193597

RESUMO

En 2006 nace una ONG en Boulembou (A 500 km de Dakar), fundada por cooperantes e inmigrantes del pueblo en nuestro país, donde se hicieron estudios para definir el entorno y asambleas y comités para priorizar intervenciones. OBJETIVOS: conocer el funcionamiento de un proyecto comunitario y formar parte de una ONG de codesarrollo, así como obtener y valorar los resultados de sus acciones a medio y largo plazo sobre la población. MÉTODOS: codesarrollo (las personas inmigrantes ayudan en realizar intervenciones en sus países de origen) y salud comunitaria (acciones para mejorar la salud de una comunidad más allá de la individual). RESULTADOS: el pueblo tiene agua potable, huertos, centro de salud (enfermero, comadrona y agentes de salud) y mejoras en la escuela. DISCUSIÓN: el enfoque y las líneas de trabajo realizadas desde un punto de vista comunitario y de codesarrollo han permitido que los proyectos se autogestionen y autofinancien para poder seguir evolucionando y progresando


An NGO was founded in 2006 in Boulembou (located 500 km from Dakar). It was founded by aid workers and immigrants from this town to our country. Studies were performed there to define the setting and to start meetings and committees to prioritize interventions. OBJECTIVES: To ascertain the operation of a community project and be part of a co-development NGO in addition to obtaining and evaluating the impact of its actions on the population in the medium and long term. METHODS: Co-development (immigrants assist with development in countries of origin) and community health (actions targeted at improving community health). RESULTS: The town now has drinking water from fountains, orchards and a healthcare centre (with a nurse, midwife and healthcare agents) in addition to school improvements. DISCUSSION: Projects were implemented from a community and co-development point of view and have facilitated self-management and self-financing to continue evolving and progressing by themselves


Assuntos
Humanos , Masculino , Feminino , Criança , Participação da Comunidade , Organizações , Atenção Primária à Saúde/métodos , Emigrantes e Imigrantes , Cooperação Internacional , Senegal , Saúde Pública , Avaliação de Programas e Projetos de Saúde
2.
BMC Public Health ; 20(1): 1520, 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032564

RESUMO

BACKGROUND: New approaches on paediatric cancer treatment aim to maintain long-term health. As a result of radiotherapy, chemotherapy or surgery, paediatric cancer survivors tend to suffer from any chronic health condition. Endocrine dysfunction represents one of the most common issues and affects bone health. Exercise is key for bone mass accrual during growth, specifically plyometric jump training. The iBoneFIT study will investigate the effect of a 9-month online exercise programme on bone health in paediatric cancer survivors. This study will also examine the effect of the intervention on body composition, physical fitness, physical activity, calcium intake, vitamin D, blood samples quality of life and mental health. METHODS: A minimum of 116 participants aged 6 to 18 years will be randomized into an intervention (n = 58) or control group (n = 58). The intervention group will receive an online exercise programme and diet counselling on calcium and vitamin D. In addition, five behaviour change techniques and a gamification design will be implemented in order to increase the interest of this non-game programme. The control group will only receive diet counselling. Participants will be assessed on 3 occasions: 1) at baseline; 2) after the 9 months of the intervention; 3) 4 months following the intervention. The primary outcome will be determined by dual energy X-ray absorptiometry (DXA) and the hip structural analysis, trabecular bone score and 3D-DXA softwares. Secondary outcomes will include anthropometry, body composition, physical fitness, physical activity, calcium and vitamin D intake, blood samples, quality of life and mental health. DISCUSSION: Whether a simple, feasible and short in duration exercise programme can improve bone health has not been examined in paediatric cancer survivors. This article describes the design, rationale and methods of a study intended to test the effect of a rigorous online exercise programme on bone health in paediatric cancer survivors. If successful, the iBoneFIT study will contribute to decrease chronic health conditions in this population and will have a positive impact in the society. TRIAL REGISTRATION: Prospectively registered in isrctn.com: isrctn61195625 . Registered 2 April 2020.


Assuntos
Densidade Óssea , Sobreviventes de Câncer/estatística & dados numéricos , Terapia por Exercício/métodos , Telemedicina , Adolescente , Criança , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa
3.
J Dent Educ ; 84(10): 1091-1098, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33063364

RESUMO

INTRODUCTION: A grant-funded faculty development program, From Practice to Preceptor (FP2P), sought to recruit and train diverse general and pediatric dentists to become dental faculty from 2012-2018. This study is an evaluation of this completed initiative and offers an initial review of long-term outcomes of the program. METHODS: Over 5 entering cohorts, 133 practitioners applied to the program and 45 were accepted. A 2-year training program used classroom and hands-on training to prepare practitioners for the occupational demands of academia. Program participants were offered pre- and post-surveys to evaluate their perceived preparedness in faculty competencies identified by the program. Participants were also sent an alumni survey, and employment was tracked by the host institution. RESULTS: Most (43 of 45) participants completed the program. Pre- and post-survey results were received from 24 of 30 (80%) participants in Cohorts 2, 3, and 5, and used for this analysis. The results suggest the program participants' perception of their ability to work effectively as faculty members in administrative, teaching, and clinical arenas increased. Over half of the program completers obtained employment as dental faculty. A majority of (19/26, 73%) program completers who responded to the alumni survey indicated the skills and knowledge gained in the program were useful to their current employment. CONCLUSION: The FP2P program evaluation results indicate a long-term faculty training program may be a useful methodology for recruiting and training current dentists to work in academic dentistry.


Assuntos
Docentes de Odontologia , Desenvolvimento de Pessoal , Criança , Estudos de Coortes , Currículo , Humanos , Avaliação de Programas e Projetos de Saúde
4.
Glob Health Sci Pract ; 8(3): 396-412, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33008854

RESUMO

This article assesses the CORE Group Polio Project (CGPP) experience over a 20-year period in 5 countries. It examines how a program designed to provide social mobilization to eradicate one disease, and which did so effectively, functioned within the general framework of community health workers (CHWs). Vertical health programs often have limited impact on broader community health. CGPP has a 20-year history of social mobilization and effective program interventions. This history provided an opportunity to assess how CGPP community mobilizers (CMs) functioned in polio and maternal and child health. The Updated Program Functionality Matrix for Optimizing Community Health Programs tool of the CHW Assessment and Improvement Matrix (AIM) was used to examine CGPP CM roles across different contexts. The analysis determined that CGPP CMs met the basic level of functioning (level 3) for 6 of the 10 components of the AIM tool. This cross-country descriptive analysis of the CGPP demonstrates the importance of embracing the full range of CHW AIM components, even in a vertical program. Use of data, community involvement, local adaptation, and linkage with the health system are especially critical for success. This general lesson could be applied to other community mobilization and disease/epidemic control initiatives, especially as we face the issues of the COVID-19 pandemic.


Assuntos
Agentes Comunitários de Saúde , Erradicação de Doenças/métodos , Poliomielite/prevenção & controle , Avaliação de Programas e Projetos de Saúde/métodos , Serviços de Saúde Rural , África , Ásia , Humanos , População Rural
5.
Matern Child Health J ; 24(Suppl 2): 171-177, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32889683

RESUMO

INTRODUCTION: Expectant and parenting young people (young parents) require diverse services to support their health, educational success, and family functioning. Rarely can the needs of young parents be met by a single school or service provider. This case study examines how one large school district funded through the pathways to success initiative was able to facilitate systems change to increase young parents' access to and use of supportive services. METHODS: Data sources include a needs and resources assessment, quarterly reports documenting grantee effort, sustainability plans, social network analysis, and capstone interviews. All data sources were systematically reviewed to identify the existing context prior to the start of the initiative, the changes that resulted from the initiative, and efforts that could potentially be maintained beyond the grant period. RESULTS: The community context prior to Pathways implementation was one of disconnected services and missed opportunities. The full-time program coordinator hired by the district focused on systems-level change and facilitated connections between organizations. This greater connectivity contributed to increased collaboration with the goal of producing lasting benefits for young parents. DISCUSSION: Promoting sustainable connections and collaboration at the systems level can help dismantle barriers to service access and benefit young parents.


Assuntos
Serviços de Saúde do Adolescente/organização & administração , Poder Familiar/psicologia , Serviços de Saúde Escolar/organização & administração , Apoio Social , Adolescente , Feminino , Humanos , Avaliação de Programas e Projetos de Saúde , Instituições Acadêmicas , Rede Social
6.
Sante Publique ; 32(2): 149-159, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32985831

RESUMO

OBJECTIVE: “Health service”, a French national service-learning program for health profession students, was launched in 2018. It aimed at developing knowledge and skills in health promotion and prevention. The purpose of this study was to assess the local implementation of this program, among medical, pharmacy, midwifery and physical therapy students at the Grenoble Alps University. METHODS: Relevant data were extracted from the placement reports, the directors’ feedback forms and an on-line questionnaire for students. We described the teams, the actions, the targeted publics, the students’ satisfaction and directors’ satisfaction. RESULTS: 400 students participated in this service-learning program (207 medical students, 93 pharmacy students, 39 midwifery students and 61 physical therapy students). 92 teams took actions in 91 institutions, including 90 secondary schools. 96.0% of the students were in interprofessional teams. Of 7,926 people reached, 7,872 (99.3%) were secondary school pupils. The main issues addressed were the substance-use prevention program based on life skills development, Unplugged (55 schools) and screen time and cyberstalking (17 schools). CONCLUSIONS: This program achieved interprofessional education and practice, with health-student-delivered activities. Interdisciplinarity was a core strength of the “Health service”. Areas for improvement were the communication and the reimbursement of transportation expenses.


Assuntos
Ocupações em Saúde/educação , Relações Interprofissionais , Estudantes de Ciências da Saúde/psicologia , França , Humanos , Avaliação de Programas e Projetos de Saúde , Estudantes de Ciências da Saúde/estatística & dados numéricos , Inquéritos e Questionários , Universidades
7.
J Med Internet Res ; 22(10): e21211, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-32997642

RESUMO

The physical and social distancing measures that have been adopted worldwide because of COVID-19 will probably remain in place for a long time, especially for senior adults, people with chronic conditions, and other at-risk populations. Teleconsultations can be useful in ensuring that patients continue to receive clinical care while reducing physical crowding and avoiding unnecessary exposure of health care staff. Implementation processes that typically take months of planning, budgeting, pilot testing, and education were compressed into days. However, in the urgency to deal with the present crisis, we may be forgetting that the introduction of digital health is not exclusively a technological issue, but part of a complex organizational change problem. This viewpoint offers insight regarding issues that rapidly adopted teleconsultation systems may face in a post-COVID-19 world.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Consulta Remota/tendências , Telemedicina/tendências , Centros Médicos Acadêmicos , Betacoronavirus , Humanos , Países Baixos/epidemiologia , Pandemias , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Consulta Remota/organização & administração , Software , Telemedicina/organização & administração , Interface Usuário-Computador
8.
Lancet Public Health ; 5(9): e493-e500, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32888442

RESUMO

BACKGROUND: Many children are exposed to second-hand smoke in the home and are at increased risk of asthma and other respiratory conditions. In Scotland, a public health mass-media campaign was launched on March 24, 2014, called Take it Right Outside (TiRO), with a focus on reducing the exposure of children to domestic second-hand smoke. In this study, our aim was to establish whether the TiRO campaign was followed by a decrease in hospital admissions for childhood asthma and other respiratory conditions related to second-hand smoke exposure across Scotland. METHODS: For an interrupted time-series analysis, data were obtained on all hospital admissions in Scotland between 2000 and 2018 for children aged younger than 16 years. We studied changes in the monthly incidence of admissions for conditions potentially related to second-hand smoke exposure (asthma, lower respiratory tract infection, bronchiolitis, croup, and acute otitis media) per 1000 children following the 2014 TiRO campaign, while considering national legislation banning smoking in public spaces from 2006. We considered asthma to be the primary condition related to second-hand smoke exposure, with monthly asthma admissions as the primary outcome. Gastroenteritis was included as a control condition. The analysis of asthma admissions considered subgroups stratified by age and area quintile of the Scottish Index of Multiple Deprivations (SIMD). FINDINGS: 740 055 hospital admissions were recorded for children. 138 931 (18·8%) admissions were for respiratory conditions potentially related to second-hand smoke exposure, of which 32 342 (23·3%) were for asthma. After TiRO in 2014, we identified a decrease relative to the underlying trend in the slope of admissions for asthma (-0·48% [-0·85 to -0·12], p=0·0096) in younger children (age <5 years), but not in older children (age 5-15 years). Asthma admissions did not change after TiRO among children 0-15 years of age when data were analysed according to area deprivation quintile. Following the 2006 legislation, independent of TiRO, asthma admissions decreased in both younger children (-0·36% [-0·67 to -0·05], p=0·021) and older children (-0·68% [-1·00 to -0·36], p<0·0001), and in children from the most deprived (SIMD 1; -0·49% [-0·87 to -0·11], p=0·011) and intermediate deprived (SIMD 3; -0·70% [-1·17 to -0·23], p=0·0043) area quintiles, but not in those from the least deprived (SIMD 5) area quintile. INTERPRETATION: Our findings suggest that smoke-free home interventions could be an important tool to reduce asthma admissions in young children, and that smoke-free public space legislation might improve child health for many years, especially in the most deprived communities. FUNDING: University of Aberdeen Research Excellence Framework 2021 Impact Support Award Scheme.


Assuntos
Poluição do Ar em Ambientes Fechados/prevenção & controle , Promoção da Saúde , Hospitalização/estatística & dados numéricos , Habitação , Poluição por Fumaça de Tabaco/prevenção & controle , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Análise de Séries Temporais Interrompida , Masculino , Avaliação de Programas e Projetos de Saúde , Escócia
9.
PLoS One ; 15(9): e0238365, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881986

RESUMO

INTRODUCTION: Health care decision makers require capacity to demand and use research evidence for effective decision making. Capacity to undertake health policy and systems research (HPSR) and teaching is low in developing countries. Strengthening the capacity of producers and users of research is a more sustainable strategy for developing the field of HPSR in Africa, than relying on training in high-income countries. METHODS: Data were collected from 118 participants who had received the capacity building, using a pre-tested questionnaire. Respondents included health research scientists from institutions (producers) and decision makers (users) in the public health sector, in Anambra and Enugu states, southeast Nigeria. Data were collected on participants' progress with proposed group activities in their short- term goals; effects of these activities on evidence-informed decision making and constraints to implementing activities. Univariate analysis was done using SPSS version 16. FINDINGS: All prioritised activities were carried out. However, responses were low. Highest response for an activity amongst producers was 39.1%, and 44.4% for users. Some of the activities implemented positively influenced changes in practice; like modification of existing policies and programme plans. There was a wide range of responses between producers of evidence (0.0-39.1%) and users (2.7-44.4%) across both study states. Lack of authority to implement activities was the major constraint (42-9-100.0% across activities), followed by financial constraints (70.6%). CONCLUSION: Capacity building intervention improved skills of a critical mass of research scientists, policymakers and practitioners, towards evidence-based decision making. Participants committed to undertake proposed activities but faced a number of constraints. These need to be addressed, especially the decision space and authority, improving funding to implement activities that influence Getting Research into Policy & Practice (GRIPP). Being at different stages of planning and implementing proposed activities; participants require continuous technical and financial support to successfully implement activities and engage meaningfully within and across professional boundaries and roles, in order to achieve short-, medium- and long- term goals.


Assuntos
Pessoal Administrativo/psicologia , Tomada de Decisões , Política de Saúde , Avaliação de Programas e Projetos de Saúde , Adulto , Fortalecimento Institucional , Conferências de Consenso como Assunto , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Inquéritos e Questionários
10.
Epidemiol Psychiatr Sci ; 29: e169, 2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-32996442

RESUMO

AIMS: Many people who are homeless with severe mental illnesses are high users of healthcare services and social services, without reducing widen health inequalities in this vulnerable population. This study aimed to determine whether independent housing with mental health support teams with a recovery-oriented approach (Housing First (HF) program) for people who are homeless with severe mental disorders improves hospital and emergency department use. METHODS: We did a randomised controlled trial in four French cities: Lille, Marseille, Paris and Toulouse. Participants were eligible if they were 18 years or older, being absolutely homeless or precariously housed, with a diagnosis of schizophrenia (SCZ) or bipolar disorder (BD) and were required to have a high level of needs (moderate-to-severe disability and past hospitalisations over the last 5 years or comorbid alcohol or substance use disorder). Participants were randomly assigned (1:1) to immediate access to independent housing and support from the Assertive Community Treatment team (social worker, nurse, doctor, psychiatrist and peer worker) (HF group) or treatment as usual (TAU group) namely pre-existing dedicated homeless-targeted programs and services. Participants and interviewers were unmasked to assignment. The primary outcomes were the number of emergency department (ED) visits, hospitalisation admissions and inpatient days at 24 months. Secondary outcomes were recovery (Recovery Assessment Scale), quality of life (SQOL and SF36), mental health symptoms, addiction issues, stably housed days and cost savings from a societal perspective. Intention-to-treat analysis was performed. RESULTS: Eligible patients were randomly assigned to the HF group (n = 353) or TAU group (n = 350). No differences were found in the number of hospital admissions (relative risk (95% CI), 0.96 (0.76-1.21)) or ED visits (0.89 (0.66-1.21)). Significantly less inpatient days were found for HF v. TAU (0.62 (0.48-0.80)). The HF group exhibited higher housing stability (difference in slope, 116 (103-128)) and higher scores for sub-dimensions of S-QOL scale (psychological well-being and autonomy). No differences were found for physical composite score SF36, mental health symptoms and rates of alcohol or substance dependence. Mean difference in costs was €-217 per patient over 24 months in favour of the HF group. HF was associated with cost savings in healthcare costs (RR 0.62(0.48-0.78)) and residential costs (0.07 (0.05-0.11)). CONCLUSION: An immediate access to independent housing and support from a mental health team resulted in decreased inpatient days, higher housing stability and cost savings in homeless persons with SCZ or BP disorders.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pessoas em Situação de Rua/psicologia , Habitação/estatística & dados numéricos , Adulto , Alcoolismo/complicações , Alcoolismo/epidemiologia , Transtorno Bipolar/complicações , Transtorno Bipolar/epidemiologia , Comorbidade , Feminino , França/epidemiologia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde/métodos , Qualidade de Vida , Esquizofrenia/complicações , Esquizofrenia/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
11.
BMC Public Health ; 20(1): 1463, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993607

RESUMO

BACKGROUND: Healthcare facilities are notorious for occupational health and safety problems. Multi-level interventions are needed to address interacting exposures and their overlapping origins in work organization features. Worker participation in problem identification and resolution is essential. This study evaluates the CPH-NEW Healthy Workplace Participatory Program (HWPP), a Total Worker Health® protocol to develop effective employee teams for worker safety, health, and wellbeing. METHODS: Six public sector, unionized healthcare facilities are enrolled, in three pairs, matched by agency. The unit of intervention is a workplace health and safety committee, adapted here to a joint labor-management "Design Team" (DT). The DT conducts root cause analyses, prioritizes problems, identifies feasible interventions in light of the constraints and needs of the specific setting, makes business-case presentations to facility leadership, and assists in evaluation. Following a stepped-wedge (cross-over) design, one site in each pair is randomly assigned to "immediate intervention" status, receiving the full coached intervention at baseline; in the "lagged intervention" site, coaching begins about half-way through the study. Program effectiveness and cost-effectiveness outcomes are assessed at both organizational (e.g., workers' compensation claim and absenteeism rates, perceived management support of safety) and individual levels (e.g., self-rated health, sleep quality, leisure-time exercise). Targeted pre-post analyses will also examine specific outcomes appropriate to the topics selected for intervention. Process evaluation outcomes include fidelity of the HWPP intervention, extent of individual DT member activity, expansion of committee scope to include employee well-being, program obstacles and opportunities in each setting, and sustainability (within the available time frame). DISCUSSION: This study aims for a quantitative evaluation of the HWPP over a time period long enough to accomplish multiple intervention cycles in each facility. The design seeks to achieve comparable study engagement and data quality between groups. We will also assess whether the HWPP might be further improved to meet the needs of U.S. public sector healthcare institutions. Potential challenges include difficulty in pooling data across study sites if Design Teams select different intervention topics, and follow-up periods too short for change to be observed. TRIAL REGISTRATION: ClinicalTrials.gov NCT04251429 (retrospectively registered January 29, 2020), protocol version 1.


Assuntos
Promoção da Saúde/métodos , Saúde do Trabalhador/estatística & dados numéricos , Engajamento no Trabalho , Local de Trabalho/organização & administração , Análise Custo-Benefício , Exercício Físico , Humanos , Grupos Populacionais , Avaliação de Programas e Projetos de Saúde/métodos , Estudos Prospectivos , Indenização aos Trabalhadores
12.
PLoS One ; 15(9): e0236812, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877443

RESUMO

Unequal access to health promotion resources and early prevention services is a major determinant of health inequity among youth. Initiatives that improve the access to and adoption of health promotion messages are important undertakings, e.g., sport. Sport-for-development (SFD) programs are seen as valuable delivery tools, in which coaches are used as change agents to increase health awareness and behavior among at-risk youth. The delivery of such messages requires specific knowledge and skills that can be attained through training; however, the effectiveness of such training requires assessment. In this study, we evaluated the feasibility of such a training program for SFD coaches using process evaluation from a realist perspective, and views from multiple stakeholders, among other sources. We also clarified the inner workings of the training and investigated how context shaped the training outcomes. Increased health awareness and a sense of responsibility from acting as a role model for at-risk youth were among the perceived training outcomes. Building a safe environment for learning, engagement, and bonds of trust increased the confidence to learn, and resulted in a sense of critical self-reflection and self-development of SFD coaches towards health and prevention messages. Importantly, the unique situations (or context) of SFD coaches and SFD in general presented challenging variables, e.g., a precarious life history or living conditions, mental health issues, or low educational skills, that hampered the impact of the mechanisms put in place by the training. Here, we present a process in which the development of the 'right mind-set,' engagement and bonds of trust, in combination with the right settings are key elements for SFD coaches to learn how to convey health-promoting messages and take responsibility as role models for at-risk youth.


Assuntos
Promoção da Saúde , Avaliação de Programas e Projetos de Saúde , Esportes Juvenis , Estudos de Viabilidade , Humanos
13.
N C Med J ; 81(5): 293-299, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32900887

RESUMO

BACKGROUND Mailed at-home stool testing offers a promising strategy for overcoming barriers to colorectal cancer (CRC) screening in vulnerable populations. This paper evaluates the facilitators and barriers of successful implementation of a mailed fecal testing program among Medicaid populations within a health department setting.METHOD Interviews were conducted with key informants involved in intervention start-up and implementation tasks. The Consolidated Framework for Implementation Research (CFIR) was used to design the interview guide and structure the analysis. Axial coding was used to connect the themes to each other under the major categories of facilitators and barriers.RESULTS Overall, the process evaluation suggests that with strong partnerships, effective champions, and existing infrastructure, a large county health department can successfully implement a mailed fecal testing program targeted at Medicaid beneficiaries. The identified facilitators and challenges to implementation provide important information for similar emerging programs.LIMITATIONS The sample size of this evaluation is small. Additionally, we are unable to discern whether participating stakeholders' responses represent the feelings of non-interviewed staff, program implementers, or participants. We were not able to collect data on patient perspectives of the intervention. The nursing staff and interns were not able to be included in the process evaluation. Lastly, the information taken from this process evaluation may not be applicable to organizations and systems with different attributes.CONCLUSION The process evaluation suggests strong partnerships, effective champions, and elegant program designs were key contributors to successful implementation of a CRC screening program targeted at Medicaid beneficiaries in a large county health department.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Acesso aos Serviços de Saúde , Fezes , Humanos , Medicaid , Serviços Postais , Avaliação de Programas e Projetos de Saúde , Estados Unidos
14.
PLoS One ; 15(9): e0236712, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915798

RESUMO

INTRODUCTION: The Reproductive Life Plan (RLP) is a clinical tool to help clients find strategies to achieve their reproductive goals. Despite much research on the RLP from high-income countries, it has never been studied in low- or middle income countries. Together with health workers called Mentor Mothers (MMs), we used a context-adapted RLP in disadvantaged areas in Eswatini. Our aim was to evaluate the implementation of the RLP in this setting. METHODOLOGY: MMs participated in focus group discussions (FGDs, n = 3 MMs n = 29) in January 2018 and at follow-up in May 2018 (n = 4, MMs n = 24). FGDs covered challenges in using the RLP, how to adapt it, and later experiences from using it. We used a deductive qualitative thematic analysis with the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, creating themes guided by its four constructs: facilitation, innovation, recipients and context. The MMs also answered a questionnaire to assess the implementation process inspired by normalization process theory. RESULTS: The RLP intervention was feasible and acceptable among MMs and fit well with existing practices. The RLP questions were perceived as advantageous since they opened up discussions with clients and enabled reflection. All except one MM (n = 23) agreed or strongly agreed that they valued the effect the RLP has had on their work. Using the RLP, the MMs observed progress in pregnancy planning among their clients and thought it improved the quality of contraceptive counselling. The clients' ability to form and achieve their reproductive goals was hampered by contextual factors such as intimate partner violence and women's limited reproductive health and rights. DISCUSSION: The RLP was easily implemented in these disadvantaged communities and the MMs were key persons in this intervention. The RLP should be further evaluated among clients and suitable approaches to include partners are required.


Assuntos
Implementação de Plano de Saúde/normas , Avaliação de Programas e Projetos de Saúde , Educação Sexual/métodos , Adulto , Essuatíni , Feminino , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Reprodutivo/psicologia , Comportamento Reprodutivo/estatística & dados numéricos , Educação Sexual/normas , Inquéritos e Questionários , Populações Vulneráveis
16.
Afr J Prim Health Care Fam Med ; 12(1): e1-e4, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32896147

RESUMO

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused an unprecedented burden on our healthcare systems and workers. Healthcare workers are at risk of contracting and spreading SARS-CoV-2 given their proximity to positive cases, often with a lack of personal protective equipment. The South African Department of Health requires that all employees be screened daily for symptoms and potential persons under investigation identified timeously. This report aims to assesses the efficacy of daily self-screening tools in detecting and managing potential staff cases of SARS-CoV-2. Our hospital, situated in KwaZulu-Natal, South Africa, developed a daily self-screening tool for all healthcare workers to complete, consisting of questions on symptoms and epidemiological risk factors. The screening tools were collected and assessed after four weeks of use. Fifty-four forms were assessed. Twenty-eight (51.9%) forms were not completed, whilst 12 (22.2%) indicated positive symptoms with no documentation that any further medical assessment, testing or isolation was done. We identified that the poor completion of forms was likely because of the lack of education of staff on the importance of the forms, poor oversight by management, staff forgetfulness or lack of awareness of the forms. Screening of staff is vital during this pandemic but requires constant oversight by line managers, staff motivation and adequate education. Ongoing development of efficient screening programmes is required.


Assuntos
Infecções por Coronavirus/prevenção & controle , Programas de Rastreamento/métodos , Pandemias/prevenção & controle , Recursos Humanos em Hospital , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , África do Sul/epidemiologia
17.
J Am Board Fam Med ; 33(5): 774-778, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32989072

RESUMO

BACKGROUND: Primary care practice-based research networks (PBRNs) are critical laboratories for generating evidence from real-world settings, including studying natural experiments. Primary care's response to the novel coronavirus-19 (COVID-19) pandemic is arguably the most impactful natural experiment in our lifetime. EVALUATING THE IMPACT OF COVID-19: We briefly describe the OCHIN PBRN of community health centers (CHCs), its partnership with implementation scientists, and how we are leveraging this infrastructure and expertise to create a rapid research response evaluating how CHCs across the country responded to the COVID-19 pandemic. COVID-19 RESEARCH ROADMAP: Our research agenda focuses on asking: How has care delivery in CHCs changed due to COVID-19? What impact has COVID-19 had on the delivery of preventive services in CHCs? Which PBRN services (e.g., data surveillance, training, evidence synthesis) are most impactful to real-world practices? What decision-making strategies were used in the PBRN and its practices to make real-time changes in response to the pandemic? What critical factors in successfully and sustainably transforming primary care are illuminated by pandemic-driven changes? DISCUSSION AND CONCLUSIONS: PBRNs enable real-world evaluation of practice change and natural experiments, and thus are ideal laboratories for implementation science research. We present a real-time example of how a PBRN Implementation Laboratory activated a response to study a historic natural experiment, to help other PBRNs charting a course through this pandemic.


Assuntos
Betacoronavirus , Centros Comunitários de Saúde/tendências , Redes Comunitárias/tendências , Infecções por Coronavirus , Assistência à Saúde/tendências , Pesquisa sobre Serviços de Saúde/tendências , Pandemias , Pneumonia Viral , Atenção Primária à Saúde/tendências , Centros Comunitários de Saúde/organização & administração , Redes Comunitárias/organização & administração , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Prática Clínica Baseada em Evidências , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Humanos , Ciência da Implementação , Disseminação de Informação , Inovação Organizacional , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , Participação dos Interessados , Estados Unidos
18.
PLoS One ; 15(8): e0237772, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853246

RESUMO

BACKGROUND: Substance use is common among people living with HIV and has been associated with suboptimal HIV treatment outcomes. Integrating substance use services into HIV care is a promising strategy to improve patient outcomes. METHODS: We report on substance use education, screening, and referral practices from two surveys of HIV care and treatment sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. HIV care and treatment sites participating in IeDEA are primarily public-sector health facilities and include both academic and community-based hospitals and health facilities. A total of 286 sites in 45 countries participated in the 2014-2015 survey and 237 sites in 44 countries participated in the 2017 survey. We compared changes over time for 147 sites that participated in both surveys. RESULTS: In 2014-2015, most sites (75%) reported providing substance use-related education on-site (i.e., at the HIV clinic or the same health facility). Approximately half reported on-site screening for substance use (52%) or referrals for substance use treatment (51%). In 2017, the proportion of sites providing on-site substance use-related education, screening, or referrals increased by 9%, 16%, and 8%, respectively. In 2017, on-site substance use screening and referral were most commonly reported at sites serving only adults (compared to only children/adolescents or adults and children/adolescents; screening: 86%, 37%, and 59%, respectively; referral: 76%, 47%, and 46%, respectively) and at sites in high-income countries (compared to upper middle income, lower middle income or low-income countries; screening: 89%, 76%, 68%, and 45%, respectively; referral: 82%, 71%, 57%, and 34%, respectively). CONCLUSION: Although there have been increases in the proportion of sites reporting substance use education, screening, and referral services across IeDEA sites, gaps persist in the integration of substance use services into HIV care, particularly in relation to screening and referral practices, with reduced availability for children/adolescents and those receiving care within resource-constrained settings.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Infecções por HIV/terapia , Acesso aos Serviços de Saúde/organização & administração , Centros de Tratamento de Abuso de Substâncias/organização & administração , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adolescente , Adulto , Fatores Etários , Criança , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Saúde Global , Infecções por HIV/complicações , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Programas de Rastreamento/organização & administração , Programas de Rastreamento/estatística & dados numéricos , Educação de Pacientes como Assunto , Lacunas da Prática Profissional/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
19.
Matern Child Health J ; 24(Suppl 2): 141-151, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32748287

RESUMO

OBJECTIVES: With funding from the Pregnancy Assistance Fund, the Maternal, Child, and Adolescent Health Division (MCAH) of California redesigned its existing Adolescent Family Life Program (AFLP) for expectant and parenting young women into a more intensive and structured intervention, AFLP with positive youth development (PYD). This paper presents key findings from a federally funded, rigorous implementation study of the two programs. METHODS: This implementation study collected data from 13 agencies from January 2016 through December 2017, including interviews with 69 case managers and 18 supervisors; focus groups with 130 program participants; surveys of 66 case managers and 1330 young women; and observations of 42 visits with program participants. The study combined qualitative and quantitative analysis methods. RESULTS: As designed, PYD was a much more structured and intensive program than AFLP. Case managers and supervisors saw value in the PYD model and new approach but needed more support and guidance than expected in order to deliver it with fidelity. MCAH provided additional trainings and technical assistance to address challenges. In practice, although staff noted differences in approach and content, the youth experience with the two programs was similar. CONCLUSIONS FOR PRACTICE: Integrating the PYD framework into case management systems may foster youth self-sufficiency and resiliency. However, the rigid structure of the program was often challenging to implement in practice. Organizations interested in implementing prescribed case management approaches should consider allowing opportunities for flexibility in implementation and providing more detailed preservice training to prepare staff for real-world implementation.


Assuntos
Mães/educação , Poder Familiar , Gravidez na Adolescência , Avaliação de Programas e Projetos de Saúde/métodos , Adolescente , California , Administração de Caso , Feminino , Humanos , Mães/psicologia , Gravidez
20.
Ann Hematol ; 99(10): 2295-2301, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32844323

RESUMO

Early detection of individuals with hereditary hemochromatosis (HH) is important to manage iron levels and prevent future organ damage. Although the HFE mutations that cause most cases of HH have been identified, their geographic distribution is highly variable, and their contribution to iron overload is not fully understood. All new registered blood donors at the Sahlgrenska University hospital between 1998 and 2015 were included in the study. Donors with signs of iron overload at baseline and subsequent follow-up testing were recommended genotyping of the HFE gene. Of the 50,493 donors that were included in the study, 950 (1.9%) had signs of iron overload on both test occasions. Of the 840 donors with iron overload that performed HFE genotyping, 117 were homozygous for C282Y, and 97 were compound heterozygotes. The prevalence of C282Y homozygosity was 0.23%. Iron overload screening effectively detects individuals at risk of carrying the C282Y mutation of the HFE gene and enables early treatment to prevent HH complications.


Assuntos
Doadores de Sangue , Seleção do Doador/métodos , Proteína da Hemocromatose/genética , Hemocromatose/diagnóstico , Mutação de Sentido Incorreto , Adulto , Diagnóstico Precoce , Feminino , Ferritinas/sangue , Frequência do Gene , Genótipo , Hemocromatose/sangue , Hemocromatose/genética , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Suécia/epidemiologia , Adulto Jovem
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