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2.
Public Health Rep ; 134(4): 395-403, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31158319

RESUMO

OBJECTIVES: The objectives of our study were to (1) illustrate a public health workforce assessment process in a medium-sized city or county health department and (2) demonstrate the insights gained by moving from the use of aggregate department-level and competency domain-level training needs results to more granular division-level and skills-level results when creating a workforce development plan. METHODS: We used a 130-question needs assessment to guide the creation of a workforce development plan for the Lincoln Lancaster County Health Department (LLCHD) in Nebraska and its 7 divisions. Using SurveyMonkey, we administered the survey to 128 (of the 129) LLCHD public health staff members in June 2015. Using a Likert scale, respondents indicated (1) the importance of the skill to their work and (2) their capacity to carry out 57 skills in 8 domains of the core competencies for public health professionals. We identified training needs as those for which the percentage of respondents who perceived moderate-to-high importance was at least 15 percentage points higher than the percentage of respondents who perceived moderate-to-high capacity. RESULTS: LLCHD as a department had training needs in only 2 competency domains: financial planning and management (importance-capacity difference, 15 percentage points) and policy development and program planning (importance-capacity difference, 19 percentage points). The Health Promotion and Outreach division had training needs in all 8 domains (importance-capacity difference range, 15-45 percentage points). Of the 57 skills, 41 were identified by at least 1 of the LLCHD divisions as having training needs. In 24 instances, a division did not qualify as having training needs in the overall domain yet did have training needs for specific skills within a domain. CONCLUSIONS: When performing public health workforce assessments, medium-to-large public health departments can obtain detailed workforce training needs results that pertain to individual skills and that are tailored to each of their divisions. These results may help customize and improve workforce development plans, ensuring that the workforce has the necessary skills to do its job.


Assuntos
Diretrizes para o Planejamento em Saúde , Política de Saúde , Mão de Obra em Saúde/normas , Modelos Organizacionais , Administração em Saúde Pública/normas , Serviços Urbanos de Saúde/normas , Humanos , Nebraska , Planejamento Social , Estados Unidos
3.
J Pediatr Endocrinol Metab ; 32(6): 623-629, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31141484

RESUMO

Background Phenylketonuria (PKU) management practices differ between and within countries. In 2007, the Portuguese Society for Metabolic Disorders (SPDM) approved the Portuguese Consensus (PC) for the nutritional treatment of PKU. The recently published European PKU Guidelines (EPG, 2017) systematically reviewed recent evidence and aimed to harmonise treatment protocols in Europe. The objective of this study was to appraise the EPG acceptance and implementation in Portuguese treatment centres. Methods An electronic questionnaire was prepared and the link was sent to 135 SPDM members. It outlined the 10 EPG key recommendations and compared each statement with the consensus recommendations published by SPDM. Responses were recorded and descriptive analyses were performed. Results Twenty-five professionals completed the questionnaire, and over half (56%) were nutritionists/dieticians. At least one questionnaire from each of the 10 national treatment centres was returned. In general, responders accepted most of the recommendations. However, only the recommendation about target phenylalanine (Phe) concentrations between 120 and 360 µmol/L for patients <12 years received 100% consensus with a further seven recommendations gaining over 70% consensus. Almost half of the professionals (48%, n = 12) required further discussion about the EPG-safe upper target blood Phe concentration (600 µmol/L) suggested for patients aged ≥12 years. Almost one third (32%, n = 8) failed to agree with the recommendation in the EPG-proposed classification of Phe hydroxylase (PAH) deficiency. Conclusions The EPG received overall good acceptance, but there was divided opinion about some recommendations which require further discussion before implementation by the Portuguese treatment centres.


Assuntos
Pessoal de Saúde/normas , Diretrizes para o Planejamento em Saúde , Fenilcetonúrias/terapia , Guias de Prática Clínica como Assunto/normas , Criança , Consenso , Gerenciamento Clínico , Europa (Continente) , Humanos , Fenilcetonúrias/diagnóstico , Portugal , Prognóstico , Inquéritos e Questionários
4.
Lipids Health Dis ; 18(1): 114, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092270

RESUMO

Vision disorders are one of the most serious complications of diabetes mellitus (DM) affecting the quality of life of patients and eventually cause blindness. The ocular lesions in diabetes mellitus are located mainly in the blood vessels and retina layers. Different retina lesions could be grouped under the umbrella term of diabetic retinopathies (DMRP).We propose that one of the main causes in the etiopathogenesis of the DMRP consists of a progressive loss of the selective permeability of blood retinal barriers (BRB). The loss of selective permeability of blood retinal barriers will cause a progressive autoimmune process. Prolonged autoimmune injures in the retinal territory will triggers and maintains a low-grade chronic inflammation process, microvascular alterations, glial proliferation and subsequent fibrosis and worse, progressive apoptosis of the photoreceptor neurons.Patients with long-standing DM disturbances in retinal BRBs suffer of alterations in the enzymatic pathways of polyunsaturated fatty acids (PUFAs), increase release of free radicals and pro-inflammatory molecules and subsequently incremented levels of vascular endothelial growth factor. These facts can produce retinal edema and photoreceptor apoptosis.Experimental, clinical and epidemiological evidences showing that adequate metabolic and alimentary controls and constant practices of healthy life may avoid, retard or make less severe the appearance of DMRP. Considering the high demand for PUFAs ω3 by photoreceptor complexes of the retina, it seems advisable to take fish oil supplements (2 g per day). The cellular, subcellular and molecular basis of the propositions exposed above is developed in this article.Synthesizer drawings the most relevant findings of the ultrastructural pathology, as well as the main metabolic pathways of the PUFAs involved in balance and disbalanced conditions are provided.


Assuntos
Autoimunidade , Barreira Hematorretiniana/metabolismo , Barreira Hematorretiniana/patologia , Retinopatia Diabética/imunologia , Retinopatia Diabética/metabolismo , Ácidos Graxos Ômega-3/metabolismo , Inflamação/patologia , Animais , Retinopatia Diabética/patologia , Diretrizes para o Planejamento em Saúde , Humanos
5.
Biosci Trends ; 13(2): 110-116, 2019 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-31006715

RESUMO

As the reform of Chinese medical and health undertakings has advanced (since 2015), the admission, pricing and payment policies regarding the new health technologies of China have undergone significant changes, and health technology assessment (HTA) has gradually become one of the current reform and research hotspots in China. Based on the perspective of HTA driving factors and the development mode, this paper proposes a two-stage mode of HTA development in China, namely, the mode driven by the management of new heath technology admission and another one driven by new health technology pricing and medical insurance payment. In addition, the paper also proposes the challenges that HTA faces in China under the current mode, including the development system, process standard, data mechanism, and policy application. Besides, recommendations are provided for the further development of HTA construction in China, including strengthening the development system of regional HTA centers, formulating HTA process guidance, building a database, improving evaluation quality and intensifying policy integration.


Assuntos
Diretrizes para o Planejamento em Saúde , Avaliação da Tecnologia Biomédica , China , Tomada de Decisão Clínica , Política de Saúde , Humanos
6.
PLoS One ; 14(4): e0214675, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30933997

RESUMO

BACKGROUND: Outreach and promotion programs are essential to ensuring uptake of new public health interventions and guidelines. We assessed the costs and operation dynamics of outreach and promotion efforts for up front Xpert MTB/RIF (Xpert) testing for pediatric presumptive tuberculosis (TB) patients in four major Indian cities. METHODS: Xpert test costs were assessed as weighted average per-test costs based on the daily workload dynamics matched by test volume specific Xpert unit cost at each study site. Costs of outreach programs to recruit health providers to refer pediatric patients for Xpert testing were assessed as cost per referral for each quarter based on total program costs and referral data. All costs were assessed in the health service provider's perspective and expressed in 2015 USD. RESULTS: Weighted average per-test costs ranged from $14.71 to $17.81 at the four laboratories assessed. Differences between laboratories were associated with unused testing capacity and/or frequencies of overtime work to cope with increasing demand and same-day testing requirements. Outreach activities generated between 825 and 2,065 Xpert testing referrals on average each quarter across the four study sites, translating into $0.63 to $2.55 per patient referred. Overall outreach costs per referral decreased with time, stabilizing at an average cost of $1.10, and demonstrated a clear association with increased referrals. CONCLUSIONS: Xpert test and outreach program costs within and across study sites were mainly driven by the dynamics of Xpert testing demand resulting from the combined outreach activities. However, these increases in demand required considerable overtime work resulting in additional costs and operational challenges at the study laboratories. Therefore, careful laboratory operational adjustment should be evaluated at target areas in parallel to the anticipated demand from the Xpert referral outreach program scale-up in other Indian regions.


Assuntos
Testes Genéticos , Custos de Cuidados de Saúde , Técnicas de Diagnóstico Molecular , Tuberculose/diagnóstico , Tuberculose/economia , Carga de Trabalho , Adolescente , Técnicas de Tipagem Bacteriana/economia , Técnicas de Tipagem Bacteriana/normas , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Testes Genéticos/economia , Testes Genéticos/métodos , Testes Genéticos/normas , Custos de Cuidados de Saúde/estatística & dados numéricos , Diretrizes para o Planejamento em Saúde , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Técnicas de Diagnóstico Molecular/economia , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Diagnóstico Molecular/normas , Equipe de Assistência ao Paciente/economia , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/normas , Tuberculose/epidemiologia , Carga de Trabalho/economia , Carga de Trabalho/estatística & dados numéricos
7.
Environ Health Prev Med ; 24(1): 14, 2019 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-30836940

RESUMO

In 1952, the Japanese Society for Hygiene had once passed a resolution at its 22nd symposium on population control, recommending the suppression of population growth based on the idea of cultivating a healthier population in the area of eugenics. Over half a century has now passed since this recommendation; Japan is witnessing an aging of the population (it is estimated that over 65-year-olds made up 27.7% of the population in 2017) and a decline in the birth rate (total fertility rate 1.43 births per woman in 2017) at a rate that is unparalleled in the world; Japan is faced with a "super-aging" society with low birth rate. In 2017, the Society passed a resolution to encourage all scientists to engage in academic researches to address the issue of the declining birth rate that Japan is currently facing. In this commentary, the Society hereby declares that the entire text of the 1952 proposal is revoked and the ideas relating to eugenics is rejected. Since the Society has set up a working group on the issue in 2016, there have been three symposiums, and working group committee members began publishing a series of articles in the Society's Japanese language journal. This commentary primarily provides an overview of the findings from the published articles, which will form the scientific basis for the Society's declaration. The areas we covered here included the following: (1) improving the social and work environment to balance between the personal and professional life; (2) proactive education on reproductive health; (3) children's health begins with nutritional management in women of reproductive age; (4) workplace environment and occupational health; (5) workplace measures to counter the declining birth rate; (6) research into the effect of environmental chemicals on sexual maturity, reproductive function, and the children of next generation; and (7) comprehensive research into the relationship among contemporary society, parental stress, and healthy child-rearing. Based on the seven topics, we will set out a declaration to address Japan's aging society with low birth rate.


Assuntos
Envelhecimento , Coeficiente de Natalidade/tendências , Projetos de Pesquisa/normas , Sociedades Científicas/organização & administração , Criança , Saúde da Criança , Exposição Ambiental/efeitos adversos , Exposição Ambiental/prevenção & controle , Feminino , Diretrizes para o Planejamento em Saúde , Humanos , Japão/epidemiologia , Masculino , Saúde do Trabalhador , Saúde Reprodutiva/educação , Estresse Psicológico/prevenção & controle , Saúde da Mulher
9.
Nervenarzt ; 90(3): 285-292, 2019 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-30643955

RESUMO

BACKGROUND AND GOAL: According to § 136a (2) SGB V (volume V of the German Social Security Code) the German legislator instructed the Federal Joint Committee (G-BA) to specify binding minimum standards for the staff needed for the treatment in inpatient psychiatric and psychosomatic facilities. This induced the expert associations/organizations to develop their own conceptional approach as to the future organization of staffing. METHOD: Organization of regular expert workshops, the results of which were systematically documented and validated by the experts. RESULTS: The essential elements of the concept are: the starting points for the calculation are the needs of all patients treated in the institution. The need for treatment has three dimensions: (a) psychiatric psychotherapeutic/psychosomatic psychotherapeutic/pediatric and adolescent psychiatric-psychotherapeutic, (b) somatic and (c) psychosocial needs. The model developed by the platform distinguishes between staff requirements being directly related to the treatment of the individual patient, staff requirements caused by the treatment setting and such staff requirements arising at an institutional level. Minimum staff requirement is understood as the staff structure which is, among others, needed to guarantee the multiprofessional, physician-led treatment and the required medical care services for all patients specified by the existing guidelines or an expert consensus as well as to ensure the protection of the patient, fellow patients and the employees working in the facility against hazards. CONCLUSION: This model considers the medical progress within the meaning of the evidence-based guidelines and the modified healthcare practice including sociopolitical standards aimed at the patients' self-determination.


Assuntos
Diretrizes para o Planejamento em Saúde , Hospitais Psiquiátricos , Corpo Clínico Hospitalar , Recursos Humanos , Técnicas de Apoio para a Decisão , Alemanha , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Corpo Clínico Hospitalar/legislação & jurisprudência , Corpo Clínico Hospitalar/provisão & distribução , Psicoterapia , Recursos Humanos/normas , Recursos Humanos/estatística & dados numéricos
11.
Clin Neuropsychol ; 33(1): 57-74, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29600743

RESUMO

OBJECTIVE: To identify types of recommendations that neuropsychologists most frequently give to patients, and determine which specific recommendations are most and least consistently given to patients across and within different diagnostic populations. METHOD: A total of 309 clinical neuropsychologists completed a survey evaluating the frequency with which they made particular types of recommendations (e.g. driving, employment and education, health and rehabilitation referrals) to patients with various disorders (e.g. traumatic brain injury, dementia). RESULTS: Recommendations in some categories were common across diagnoses (e.g. recommendations related to health). Neuropsychologists reported being more likely to give patients with dementia (relative to other clinical populations) recommendations related to educational resources, supervision and independence, and driving. Patients with a TBI diagnosis were more likely to be given recommendations related to employment and education, health and rehabilitation referrals, and mental health and substance use. Patients with a psychiatric diagnosis were more likely to be given recommendations related to mental health and substance use. Irrespective of diagnosis, neuropsychologists reported being most likely to give recommendations that could be implemented by the patient or caregiver without assistance from outside sources. Neuropsychologists varied in their use of recommendations to seek evaluations and treatment from health and rehabilitation referrals and in providing recommendations related to driving. CONCLUSIONS: Recommendations provided within diagnostic groups are consistent with the etiology and prognosis of those conditions. Recommendations for the use of compensatory strategies to address cognitive deficits and recommendations to improve health were endorsed by the vast majority of neuropsychologists across diagnoses.


Assuntos
Diretrizes para o Planejamento em Saúde , Neuropsicologia/educação , Humanos , Inquéritos e Questionários
12.
Int J Colorectal Dis ; 34(3): 431-440, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30523398

RESUMO

PURPOSE: There is a growing evidence for over-, under-, or misuse of health care in patients with inflammatory bowel disease. Most studies looked at treatment variability or used quality measures, which mostly capture supportive interventions rather than treatment of IBD in itself. We aimed to evaluate if current recommendations in clinical practice guidelines regarding the medical treatment of patients with inflammatory bowel diseases are being followed in Germany. METHODS: A questionnaire was sent to 1901 patients insured with two large German statutory sickness funds and an ICD 10 diagnosis of Crohn's disease (CD) or ulcerative colitis (UC). The questionnaire asked about drug treatment, indications for drug treatment, provision of surveillance endoscopies in ulcerative colitis patients, and smoking status in Crohn's disease patients. RESULTS: Out of 460 evaluable patients, 62.4% of UC patients and 53.9% of CD patients were treated with mesalamine according to guidelines, 91.3% of all patients were treated with glucocorticoids according to guideline recommendations, while only 75.6% received recommended immunosuppressive treatment. Of UC patients, 94.5% had surveillance colonoscopies at the recommended interval and 58.8% of CD patients were non-smokers. No predictor for overall treatment according to guidelines could be found while being of age older than 60 or being treated outside of a dedicated IBD clinic was associated with less immunosuppressive treatment. CONCLUSIONS: A large proportion of patients with IBD do not receive drug treatment in accordance with clinical practice guidelines. Quality improvement measures are much needed.


Assuntos
Diretrizes para o Planejamento em Saúde , Guias de Prática Clínica como Assunto , Inquéritos e Questionários , Adulto , Idoso , Feminino , Humanos , Doenças Inflamatórias Intestinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco
13.
Biol Blood Marrow Transplant ; 25(3): 562-569, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30315940

RESUMO

This study aimed to develop a survivorship care plan (SCP) that can be individualized to facilitate long-term follow-up care of hematopoietic cell transplantation (HCT) survivors. A sample SCP was developed that included 2 documents: a treatment summary and preventive care recommendations that combined data on treatment exposures routinely submitted by HCT centers to the Center for International Blood and Marrow Transplant Research (CIBMTR) with long-term follow-up guidelines. Focus groups were conducted by phone to characterize the critical patient-centered elements of the SCP. Focus group eligibility criteria included (1) adult patients >1 year post-HCT and their caregivers (3 groups; n = 22), (2) HCT physicians and advanced practice providers (APPs) (2 groups; n = 14), (3) HCT nurses and social workers (4 groups; n = 17), and (4) community health care professionals (3 groups; n = 24). Transcripts were analyzed for saturation of key themes using NVivo 10 software. Patients and caregivers suggested combining the treatment summary and care guidelines into a single document. They also requested sections on sexual and emotional health and the immune system. Providers wanted the treatment summary to focus only on what they absolutely must know. Themes were similar across healthcare professionals, although screening for psychosocial issues was emphasized more by the nurses and social workers. All preferred to receive the SCP electronically; however, hardcopy was considered necessary for some patients. All felt that the SCP would facilitate appropriate post-HCT care. This study highlights the need for an SCP instrument to facilitate HCT survivorship care. Furthermore, it demonstrates the feasibility and value of engaging HCT recipients, caregivers, and providers in developing an SCP. Their feedback was incorporated into a final SCP that was subsequently tested in a randomized trial.


Assuntos
Diretrizes para o Planejamento em Saúde , Transplante de Células-Tronco Hematopoéticas , Sobreviventes , Sobrevivência , Cuidadores , Assistência à Saúde/organização & administração , Feminino , Pessoal de Saúde , Humanos , Masculino , Pacientes
14.
J Am Acad Orthop Surg ; 27(8): 287-294, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30278016

RESUMO

INTRODUCTION: The purpose of this study was to survey trauma and arthroplasty surgeons to investigate associations between subspecialty training and management of geriatric femoral neck fractures and to compare treatments with the American Academy of Orthopaedic Surgeons clinical practice guidelines. METHODS: Five hundred fifty-six surgeons completed the online survey consisting of two sections: (1) surgeon demographics and (2) two geriatric hip fracture cases with questions regarding treatment decisions. RESULTS: In both clinical scenarios, arthroplasty surgeons were more likely than trauma surgeons to recommend total hip arthroplasty (THA) (case 1: 96% versus 84%; case 2: 29% versus 10%; P ≤ 0.02) and spinal anesthesia (case 1: 70% versus 40%; case 2: 62% versus 38%; P < 0.01). Surgeons who have made changes based on clinical practice guidelines (n = 96; 21% of surveyed) cited more use of THA (n = 56; 58% of respondents) and cemented stems (n = 28; 29% of respondents). CONCLUSION: Arthroplasty surgeons are more likely to recommend THA over hemiarthroplasty and have a higher expectation for spinal anesthesia for the management of geriatric femoral neck fractures.


Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Tomada de Decisão Clínica , Fraturas do Colo Femoral/cirurgia , Cirurgiões Ortopédicos , Ortopedia/organização & administração , Guias de Prática Clínica como Assunto , Sociedades Médicas/organização & administração , Idoso , Idoso de 80 Anos ou mais , Raquianestesia/estatística & dados numéricos , Artroplastia de Quadril/métodos , Feminino , Diretrizes para o Planejamento em Saúde , Hemiartroplastia/estatística & dados numéricos , Humanos , Masculino , Inquéritos e Questionários
15.
Neurol Sci ; 40(3): 457-468, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30554356

RESUMO

Congenital myasthenic syndromes (CMS) are genetic disorders due to mutations in genes encoding proteins involved in the neuromuscular junction structure and function. CMS usually present in young children, but perinatal and adult onset has been reported. Clinical presentation is highly heterogeneous, ranging from mild symptoms to severe manifestations, sometimes with life-threatening respiratory episodes, especially in the first decade of life. Although considered rare, CMS are probably underestimated due to diagnostic difficulties. Because of the several therapeutic opportunities, CMS should be always considered in the differential diagnosis of neuromuscular disorders. The Italian Network on CMS proposes here recommendations for proper CMS diagnosis and management, aiming to guide clinicians in their practical approach to CMS patients.


Assuntos
Gerenciamento Clínico , Diretrizes para o Planejamento em Saúde , Síndromes Miastênicas Congênitas , Humanos , Itália , Síndromes Miastênicas Congênitas/diagnóstico , Síndromes Miastênicas Congênitas/epidemiologia , Síndromes Miastênicas Congênitas/terapia
16.
Int J Colorectal Dis ; 34(2): 217-227, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30564910

RESUMO

INTRODUCTION: Visceral pain is a symptom reported by over 70% of inflammatory bowel disease (IBD) sufferers. So far, a single, specific cause of this debilitating state has not been established. Chronic pain is one of the most important factors decreasing the quality of life in IBD course. Concurrently, management of pain is the most challenging issue encountered by clinicians in IBD treatment. AREAS COVERED: This review focuses on pathophysiology of inflammatory bowel disease-caused visceral pain and explores currently available approaches to its management. We also covered recent pharmacological developments in the field. CONCLUSIONS: Pain-related disability has major effects on quality of life and on functional and social outcomes in IBD patients. Currently, there is no one standardized method of managing chronic visceral pain in IBD. Therefore, future development, focusing primarily on alleviating the pain, but also on reducing inflammation, is essential.


Assuntos
Dor Crônica/complicações , Dor Crônica/terapia , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/terapia , Manejo da Dor , Dor Abdominal/complicações , Dor Abdominal/terapia , Diretrizes para o Planejamento em Saúde , Humanos
18.
Reprod Health ; 15(1): 211, 2018 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-30558675

RESUMO

BACKGROUND: Investing in adolescent's health, especially, the role of girls in community health and future generations is one of the most important strategies of the Millennium Development Goals. In this regard, supplying adolescents' special needs including access to educational, health and counseling services for promoting reproductive health have been emphasized. About 36% of registered marriages in Iran are under the age of 19 though, reproductive health services based on married adolescent girls` needs in social-cultural context were not predicted in national health system. Therefore, this study aim was designing a guideline for empowering married adolescents in reproductive health. METHODS: This is a sequential exploratory Mixed-method study conducted in three consecutive phases. The first phase, with a qualitative approach, explores needs, barriers and strategies for empowering married adolescent girls in reproductive health. In the second phase, a systematic review will be conducted to identify the recommendation and strategies for empowering married adolescent girls in reproductive health in other countries. Finally, in third phase, data from qualitative study and systematic review are emerged and the most important solutions and recommendations related to the issue are extracted and the final guideline is adapted by the experts. DISCUSSION: This study is attempting to provide a guideline containing comprehensive recommendations for health system` policy makers and providers in order to empowering adolescent girls in reproductive health.


Assuntos
Serviços de Planejamento Familiar/normas , Educação em Saúde , Diretrizes para o Planejamento em Saúde , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saúde Reprodutiva/educação , Direitos da Mulher/normas , Adolescente , Estudos Transversais , Feminino , Humanos , Casamento , Gravidez
19.
Washington, D.C.; OPS; 2018-12.
em Espanhol | PAHO-IRIS | ID: phr-49680

RESUMO

[Antecedentes]. La OMS estima que, en el 2015, había en el mundo 71 millones de personas con una infección crónica por el virus de la hepatitis C (VHC) y que 399.000 habían fallecido como consecuencia de una cirrosis o un carcinoma hepatocelular causados por la infección por el VHC. En mayo del 2016, la Asamblea Mundial de la Salud respaldó la Estrategia Mundial del Sector de la Salud (GHSS) para las hepatitis víricas, que propone la eliminación de esta como amenaza de salud pública para el año 2030 (reducción de un 90% de la incidencia y reducción de un 65% de la mortalidad). La eliminación de las hepatitis virales como amenaza de salud pública requiere que el 90% de las personas infectadas sean diagnosticadas y que el 80% de las diagnosticadas sean tratadas.


Assuntos
Hepatite C , Hepatite C Crônica , Diretrizes para o Planejamento em Saúde , Antivirais , Conflito de Interesses , Análise Custo-Eficiência
20.
Transfus Apher Sci ; 57(6): 721-723, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30401518

RESUMO

Acquired von Willebrand syndrome (AVWS) is a rare acquired bleeding disorder that resembles von Willebrand disease by its clinical symptoms and laboratory findings, but differs by its negative personal and family history of bleeding diathesis. AVWS is mostly seen in the elderly, but it has been described in children, often in those with congenital heart disease and Wilms tumor. It is most commonly associated with lymphoproliferative, myeloproliferative, cardio-vascular, or autoimmune diseases, solid tumors, and certain drugs. The diagnosis should be suspected in a patient who is known for one of these underlying conditions and who presents with new onset of bleeding or who will be undergoing an invasive procedure. Treatment of the underlying condition, when possible, usually results in correction of AVWS. When acute bleeding occurs or the underlying condition is not treated, emphasis should be put on control and prevention of bleeding. Many options are available. DDAVP is the first line of treatment for bleeding. vWF concentrates are used to treat bleeding that is unresponsive to DDAVP and as prophylaxis before procedures. This review summarises current knowledge and reviews the different management options for bleeding.


Assuntos
Doenças de von Willebrand/terapia , Criança , Diretrizes para o Planejamento em Saúde , Humanos , Doenças de von Willebrand/diagnóstico
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