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1.
BMC Health Serv Res ; 21(1): 567, 2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34107941

RESUMO

BACKGROUND: Healthcare practitioners (HCPs) play a crucial role in recognising, responding to, and supporting female patients experiencing intimate partner abuse (IPA). However, research consistently identifies barriers they perceive prevent them from doing this work effectively. These barriers can be system-based (e.g. lack of time or training) or personal/individual. This review of qualitative evidence aims to synthesise the personal barriers that impact HCPs' responses to IPA. METHODS: Five databases were searched in March 2020. Studies needed to utilise qualitative methods for both data collection and analysis and be published between 2010 and 2020 in order to qualify for inclusion; however, we considered any type of healthcare setting in any country. Article screening, data extraction and methodological appraisal using a modified version of the Critical Appraisal Skills Program checklist for qualitative studies were undertaken by at least two independent reviewers. Data analysis drew on Thomas and Harden's thematic synthesis approach. RESULTS: Twenty-nine studies conducted in 20 countries informed the final review. A variety of HCPs and settings were represented. Three themes were developed that describe the personal barriers experienced by HCPs: I can't interfere (which describes the belief that IPA is a "private matter" and HCPs' fears of causing harm by intervening); I don't have control (highlighting HCPs' frustration when women do not follow their advice); and I won't take responsibility (which illuminates beliefs that addressing IPA should be someone else's job). CONCLUSION: This review highlights the need for training to address personal issues in addition to structural or organisational barriers. Education and training for HCPs needs to: encourage reflection on their own values to reinforce their commitment to addressing IPA; teach HCPs to relinquish the need to control outcomes so that they can adopt an advocacy approach; and support HCPs' trust in the critical role they can play in responding. Future research should explore effective ways to do this within the context of complex healthcare organisations.


Assuntos
Pessoal de Saúde , Violência por Parceiro Íntimo , Atenção à Saúde , Feminino , Instalações de Saúde , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Pesquisa Qualitativa
2.
Artigo em Inglês | MEDLINE | ID: mdl-34070423

RESUMO

The availability of water, sanitation and hygiene (WASH) services is a key prerequisite for quality care and infection prevention and control in health care facilities (HCFs). In 2020, the COVID-19 pandemic highlighted the importance and urgency of enhancing WASH coverage to reduce the risk of COVID-19 transmission and other healthcare-associated infections. As a part of COVID-19 preparedness and response interventions, the Government of Zimbabwe, the United Nations Children's Fund (UNICEF), and civil society organizations conducted WASH assessments in 50 HCFs designated as COVID-19 isolation facilities. Assessments were based on the Water and Sanitation for Health Facility Improvement Tool (WASH FIT), a multi-step framework to inform the continuous monitoring and improvement of WASH services. The WASH FIT assessments revealed that one in four HCFs did not have adequate services across the domains of water, sanitation, health care waste, hand hygiene, facility environment, cleanliness and disinfection, and management. The sanitation domain had the largest proportion of health care facilities with poor service coverage (42%). Some of the recommendations from this assessment include the provision of sufficient water for all users, Menstrual Hygiene Management (MHM)- and disability-friendly sanitation facilities, handwashing facilities, waste collection services, energy for incineration or waste treatment facilities, cleaning supplies, and financial resources for HCFs. WASH FIT may be a useful tool to inform WASH interventions during the COVID-19 pandemic and beyond.


Assuntos
COVID-19 , Saneamento , Criança , Estudos Transversais , Desinfecção das Mãos , Instalações de Saúde , Humanos , Higiene , Menstruação , Pandemias , SARS-CoV-2 , Água , Abastecimento de Água , Zimbábue
3.
BMJ Open ; 11(6): e049116, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34083349

RESUMO

INTRODUCTION: Resilience in healthcare (RiH) is understood as the capacity of the healthcare system to adapt to challenges and changes at different system levels, to maintain high-quality care. Adaptive capacity is founded in the knowledge, skills and experiences of the people in the system, including patients, family or next of kin, healthcare providers, managers and regulators. In order to learn from and support useful adaptations, research is needed to better understand adaptive capacity and the nature and context of adaptations. This includes research on the actors involved in creating resilient healthcare, and how and in what circumstances different groups of patients and other key healthcare stakeholders enact adaptations that contribute to resilience across all levels of the healthcare system. METHODS AND ANALYSIS: This 5-year study applies an interactive design in a two-phased approach to explore and conceptualise patient and stakeholder involvement in resilient healthcare. Study phase 1 is exploratory and will use such data collection methods as literature review, document analysis, interviews and focus groups. Study phase 2 will use a participatory design approach to develop, test and evaluate a conceptual model for patient and stakeholder involvement in RiH. The study will involve patients and other key stakeholders as active participants throughout the research process. ETHICS AND DISSEMINATION: The RiH research programme of which this study is a part is approved by the Norwegian Centre for Research Data (No. 864334). Findings will be disseminated through scientific articles, presentations at national and international conferences, through social media and popular press, and by direct engagement with the public, including patient and stakeholder representatives.


Assuntos
Atenção à Saúde , Qualidade da Assistência à Saúde , Instalações de Saúde , Pessoal de Saúde , Humanos , Noruega
4.
BMC Public Health ; 21(1): 1092, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098914

RESUMO

BACKGROUND: More than 75% of neonatal deaths occurred in the first weeks of life as a result of adverse birth outcomes. Low birth weight, preterm births are associated with a variety of acute and long-term complications. In Sub-Saharan Africa, there is insufficient evidence of adverse birth outcomes. Hence, this study aimed to determine the pooled prevalence and determinants of adverse birth outcomes in Sub-Saharan Africa. METHOD: Data of this study were obtained from a cross-sectional survey of the most recent Demographic and Health Surveys (DHS) of ten Sub-African (SSA) countries. A total of 76,853 children born five years preceding the survey were included in the final analysis. A Generalized Linear Mixed Models (GLMM) were fitted and an adjusted odds ratio (AOR) with a 95% Confidence Interval (CI) was computed to declare statistically significant determinants of adverse birth outcomes. RESULT: The pooled prevalence of adverse birth outcomes were 29.7% (95% CI: 29.4 to 30.03). Female child (AOR = 0.94, 95%CI: 0.91 0.97), women attended secondary level of education (AOR = 0.87, 95%CI: 0.82 0.92), middle (AOR = 0.94,95%CI: 0.90 0.98) and rich socioeconomic status (AOR = 0.94, 95%CI: 0.90 0.99), intimate-partner physical violence (beating) (AOR = 1.18, 95%CI: 1.14 1.22), big problems of long-distance travel (AOR = 1.08, 95%CI: 1.04 1.11), antenatal care follow-ups (AOR = 0.86, 95%CI: 0.83 0.86), multiparty (AOR = 0.88, 95%CI: 0.84 0.91), twin births (AOR = 2.89, 95%CI: 2.67 3.14), and lack of women involvement in healthcare decision-making process (AOR = 1.10, 95%CI: 1.06 1.13) were determinants of adverse birth outcomes. CONCLUSION: This study showed that the magnitude of adverse birth outcomes was high, abnormal baby size and preterm births were the most common adverse birth outcomes. This finding suggests that encouraging antenatal care follow-ups and socio-economic conditions of women are essential. Moreover, special attention should be given to multiple pregnancies, improving healthcare accessibilities to rural areas, and women's involvement in healthcare decision-making.


Assuntos
Instalações de Saúde , Cuidado Pré-Natal , África ao Sul do Saara/epidemiologia , Criança , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Recém-Nascido , Gravidez , Prevalência
5.
Reprod Health ; 18(1): 127, 2021 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-34120650

RESUMO

BACKGROUND: Quality of essential newborn care is defined as the extent of health care services to improve the health of newborns. However, studies are scarce regarding the quality of newborn care implementation. Therefore, this study aimed to measure the magnitude and factors associated with essential newborn care implementation perceived quality among health facility deliveries in Northwest Ethiopia. METHODS: A facility-based cross-sectional study design was employed to collect data from 370 randomly selected deliveries in 11 health facilities from November 2018 to March 2019. Essential newborn care implementation perceived quality was assessed in two domains (delivery and process) from clients' perspectives. A pre-tested interviewer-administered structured questionnaire was adopted from different kinds of literature and guidelines. The research data were collected by trained midwives and nurses. A binary logistic regression model was used to identify associated factors with newborn care implementation perceived quality. Odds ratio with 95% CI was computed to assess the strength and significant level of the association at p-value < 0.05. RESULTS: About 338 mothers completed the interview with a response rate of 97.1%. The mean age of the study participants was 26.4 (SD = 5.7) with a range of 12 and 45 years. Most mothers, 84.3%, have attended antenatal care. The overall implementation perceived quality of essential newborn care was found to be 66.3%. The implementation perceived quality of cord care, breast-feeding and thermal care was 75.4, 72.2 and 66.3% respectively. Newborn immunization and vitamin K administration had the lowest implementation perceived quality i.e. 22.4 and 24.3% respectively. Friendly care during delivery (AOR = 5.1, 95% CI: 2.4, 11.0), partograph use (AOR = 3.0, 95% CI: 1.1, 8.6), child immunization service readiness (AOR = 2.9, 95% CI: 1.5, 5.7), BEmEONC service readiness (AOR = 2.1, 95% CI: 1.2, 3.9) and facing no neonatal illness at all (AOR = 4.2, 95% CI: 1.6, 10.9) were significantly associated with good essential newborn care implementation qualities. CONCLUSIONS: The perceived quality of essential newborn care implementation was low in the study area. This is associated with poor readiness on BEmEONC and child immunization services, unfriendly care and not using partograph during delivery. Hence, availing the BEmEONC and the child immunization service inputs, continuous training and motivation of healthcare workers for friendly care are vital for improving essential newborn care implementation perceived quality.


Assuntos
Aleitamento Materno , Atenção à Saúde , Cuidado do Lactente/normas , Recém-Nascido , Mães/psicologia , Cuidado Pré-Natal , Adolescente , Adulto , Aleitamento Materno/estatística & dados numéricos , Criança , Estudos Transversais , Etiópia , Feminino , Instalações de Saúde , Humanos , Pessoa de Meia-Idade , Gravidez , Qualidade da Assistência à Saúde , Adulto Jovem
6.
Cien Saude Colet ; 26(suppl 1): 2471-2482, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34133627

RESUMO

To describe a general overview of health services delivery in Mexico and geospatially analyze the current distribution and accessibility of Primary Health Care (PHC) facilities to contribute to new approaches to improve healthcare planning in Mexico. We performed a spatial analysis of official data to analyze current distances from health facilities to population, to determine the underserved areas of health services delivery in three selected states using a ranking of indicators. We estimated service area coverage of PHC facilities with road networks of three Mexican states (Chiapas, Guerrero, and Oaxaca). Our estimations provide an overview of spatial access to healthcare of the Mexican population in Mexico's three most impoverished states. We did not consider social security nor private providers. Geospatial access to health facilities is critical to achieving PHC and adequate coverage. Countries like Mexico must measure this to identify underserved areas with a lack of geospatial access to healthcare to solve it. This type of analysis provides critical information to help decision-makers decide where to build new health facilities to increase effective geospatial access to care and to achieve Universal Health Coverage.


Assuntos
Sistemas de Informação Geográfica , Acesso aos Serviços de Saúde , Instalações de Saúde , Humanos , México , Cobertura Universal do Seguro de Saúde
7.
Cien Saude Colet ; 26(suppl 1): 2497-2506, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34133629

RESUMO

This study diagnosed the situation regarding the physical accessibility of the resident population to primary health care, based on the characteristics of the population served, their spatial distribution in the territory, based on space-time analysis. Thus, bearing the different means of transport available and the specific features of a low-density territory, we considered several mobility profiles under analysis, and selected the Baixo Alentejo as the study area. In methodological terms, besides using the location of primary health facilities and their areas of influence, the use of the road network and its restrictions, we selected the use the new 1x1 km grid, recently implemented throughout the EU (European Union), instead of using the statistical units or administrative boundaries. Its advantages allow overcoming some of the issues of the usual base cartography. The final results can be divided into two groups: conclusions related to the methodologies used and conclusions related to the accessibility of primary health care equipment in the study area.


Assuntos
Acesso aos Serviços de Saúde , Atenção Primária à Saúde , Instalações de Saúde , Humanos , Portugal
8.
BMC Infect Dis ; 21(1): 511, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074268

RESUMO

INTRODUCTION: Discontinuation of tuberculosis treatment (DTT) among children in sub-Saharan Africa is a major obstacle to effective tuberculosis (TB) control and has the potential to worsen the emergence of multi-drug resistant TB and death. DTT in children is understudied in Uganda. We examined the level and factors associated with DTT among children at four large health facilities in Kampala Capital City Authority and documented the reasons for DTT from treatment supporters and healthcare provider perspectives. METHODS: We conducted a retrospective analysis of records for children < 15 years diagnosed and treated for TB between January 2018 and December 2019. We held focus group discussions with treatment supporters and key informant interviews with healthcare providers. We defined DTT as the stoppage of TB treatment for 30 or more consecutive days. We used a stepwise generalized linear model to assess factors independently associated with DTT and content analysis for the qualitative data reported using sub-themes. RESULTS: Of 312 participants enrolled, 35 (11.2%) had discontinued TB treatment. The reasons for DTT included lack of privacy at healthcare facilities for children with TB and their treatment supporters, the disappearance of TB symptoms following treatment initiation, poor implementation of the community-based directly observed therapy short-course (CB-DOTS) strategy, insufficient funding to the TB program, and frequent stock-outs of TB drugs. DTT was more likely during the continuation phase of TB treatment compared to the intensive phase (Adjusted odds ratio (aOR), 5.22; 95% Confidence Interval (CI), 1.76-17.52) and when the treatment supporter was employed compared to when the treatment supporter was unemployed (aOR, 3.60; 95% CI, 1.34-11.38). CONCLUSION: Many children with TB discontinue TB treatment and this might exacerbate TB morbidity and mortality. To mitigate DTT, healthcare providers should ensure children with TB and their treatment supporters are accorded privacy during service provision and provide more information about TB symptom resolution and treatment duration versus the need to complete treatment. The district and national TB control programs should address gaps in funding to TB care, the supply of TB drugs, and the implementation of the CB-DOTS strategy.


Assuntos
Tuberculose/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Terapia Diretamente Observada , Feminino , Grupos Focais , Instalações de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Razão de Chances , Estudos Retrospectivos , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Uganda/epidemiologia
9.
Soins ; 66(855): 60-63, 2021 May.
Artigo em Francês | MEDLINE | ID: mdl-34103145

RESUMO

The progress made in the medical field thanks to artificial intelligence and its applications has developed doctors' knowledge and patients' knowledge of how to act. By giving a voice to all stakeholders in care, a commons of digital healthcare practices can be formed. Certain therapeutic support and monitoring tools, based on dialogue between health professionals, already exist. By guiding them by means of an approach of collective ethics, they, and likewise artificial intelligence, can help to foster inclusion.


Assuntos
Inteligência Artificial , Atenção à Saúde , Instalações de Saúde , Pessoal de Saúde , Humanos
10.
Lima; Perú. Ministerio de Salud; 20210600. 48 p. tab.
Monografia em Espanhol | MINSAPERÚ | ID: biblio-1252704

RESUMO

El documento contiene orientaciones para el personal de la salud que brinda cuidados integrales de salud mental a la población adolescente que se atiende en los establecimientos de salud a nivel nacional.


Assuntos
Saúde Mental , Adolescente , Empatia , Instalações de Saúde
11.
PLoS One ; 16(5): e0251434, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34015017

RESUMO

A nationwide questionnaire survey about community-acquired infection of coronavirus disease 2019 (COVID-19) was conducted in July 2020 to identify the characteristics of and measures taken by Japanese medical facilities providing maternity services. A case-control study was conducted by including medical facilities with (Cases) and without (Control) community-acquired infection of COVID-19. Responses from 711 hospitals and 707 private clinics were assessed (72% of all hospital and 59% all private clinics provided maternity service in Japan). Seventy-five COVID-19-positive pregnant women were treated in 52 facilities. Community-acquired infection was reported in 4.1% of the facilities. Of these, 95% occurred in the hospital. Nine patients developed a community-acquired infection in the maternity ward or obstetric department. Variables that associated with community-acquired infection of COVID-19 (adjusted odds ratio [95% confidence interval]) were found to be state of emergency prefecture (4.93 [2.17-11.16]), PCR test for SARS-CoV-2 on admission (2.88 [1.59-5.24]), and facility that cannot treat COVID-19 positive patients (0.34 [0.14-0.82]). In conclusion, community-acquired infection is likely to occur in large hospitals that treat a higher number of patients than private clinics do, regardless of the preventive measures used.


Assuntos
COVID-19/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Instalações de Saúde/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Feminino , Humanos , Incidência , Japão , Gravidez
13.
Inquiry ; 58: 469580211020884, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34056947

RESUMO

Global spread of a disease causes fear that can lead to discrimination against the people infected with the disease. On December 2019, COVID-19 emerged in Wuhan, China, and has spread throughout the world. In this descriptive and analytic study Perceived discrimination of the patients admitted to COVID-19 wards was measured in medical settings. Data was collected of 176 patients discharged in March and April 2020. Discrimination scale was used to collect data in medical settings. Overall mean score of the scale was 11.51 ± 3.883 indicating low level of perceived discrimination. The highest level of discrimination belonged to refusal of physicians and nurses to physically examine the patients (0.992 ± 3.49). Low level of perceived discrimination was reported in this study, which necessitated taking useful measures to identify discrimination, determines causes and prevent discriminatory behaviors in medical settings to improve the hospitalization experience and disease outcomes.


Assuntos
COVID-19 , Instalações de Saúde , Discriminação Social , Adolescente , Adulto , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , SARS-CoV-2 , Inquéritos e Questionários , Adulto Jovem
14.
Health Aff (Millwood) ; 40(5): 719-726, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33939504

RESUMO

Private equity firms have increased their participation in the US health care system, raising questions about incentive alignment and downstream effects on patients. However, there is a lack of systematic characterization of private equity acquisition of short-term acute care hospitals. We present an overview of the scope of private equity-backed hospital acquisitions over the course of 2003-17, comparing the financial and operational differences between those hospitals and hospitals that remained unacquired through 2017. A total of 42 private equity deals occurred, involving 282 unique hospitals across 36 states. In unadjusted analyses, hospitals that were acquired had larger bed sizes, more discharges, and more full-time-equivalent staff positions in 2003 relative to nonacquired hospitals; private equity-acquired hospitals also had higher charge-to-cost ratios and higher operating margins, and this gap widened during our study period. These findings motivate evaluations by policy makers and researchers on the impact, if any, of private equity acquisition on health care access, spending, and risk-adjusted outcomes.


Assuntos
Atenção à Saúde , Investimentos em Saúde , Programas Governamentais , Instalações de Saúde , Hospitais Privados , Humanos
16.
BMJ Open ; 11(5): e041530, 2021 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947723

RESUMO

INTRODUCTION: Despite recognition of the importance of patient engagement in research and knowledge translation, systematic approaches to engagement and co-ideation remain limited. Living labs are collaborative knowledge sharing systems that use multimethod, user-centred approaches that hold potential to catalyse these aims. However, their use in healthcare is limited, and no living lab has been developed in paediatric rehabilitation. In response to this gap and to propel innovative knowledge exchange, we propose a mixed methods study to co-develop a living lab prototype (ie, preliminary infrastructure with opportunity for scale up) in paediatric rehabilitation, with relevance to other healthcare contexts. METHODS: An exploratory sequential mixed methods study will be undertaken to determine research and knowledge exchange priorities and to inform the development of the living lab prototype. Stage 1: we will use a multipronged approach to sample 18-21 youth with developmental differences or rehabilitation needs, their youth siblings and parents/guardians from a provincial paediatric rehabilitation centre, to participate in qualitative and arts-based data collection. Data will provide insight into desirable features of the living lab. Stage 2: E-surveys to youth, siblings, parents/guardians and clinicians who receive or provide services at this same centre will expand on priorities and living lab features. Stage 3: integrated analysis will inform the living lab prototype development. ANALYSIS: Inductive thematic analysis using interpretive description, integrated analysis of visual data and descriptive and content analysis of e-survey data will be undertaken. Joint displays will facilitate data integration. Priorities will be identified using a modified rank-order method for each key living lab domain. ETHICS AND DISSEMINATION: Institutional ethics and site approval have been granted. A parent advisory group and rehabilitation engineering partners will confer on data and inform the development of the living lab prototype. User engagement with the prototype will occur during an online or in-person event, and findings shared through non-technical research summaries, journal articles and academic presentations.


Assuntos
Instalações de Saúde , Participação do Paciente , Adolescente , Criança , Humanos , Organizações , Inquéritos e Questionários , Pesquisa Médica Translacional
17.
BMJ Open ; 11(5): e042058, 2021 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947724

RESUMO

OBJECTIVE: To measure the length of stay at a health facility after childbirth, identify factors associated with the length of stay and measure the gap between the timings of the last check-up and discharge. DESIGN: A cross-sectional study. SETTING: Five public health facilities in Dhading, Nepal. PARTICIPANTS: 351 randomly selected mothers who gave birth at selected health facilities within 1 year of data collection between 10 and 31 August 2018. OUTCOME MEASURE: Length of stay (hours) at a health facility after childbirth. Adequate length was defined as 24 hours or longer based on the WHO guidelines. RESULTS: Among 350 mothers (99.7%) out of 351 recruited, 61.7% were discharged within 24 hours after childbirth. Factors associated with shorter length of stay were as follows: travel time less than 30 min to a health facility (incidence rate ratio (IRR)=0.69, 95% CI 0.61 to 0.78); delivery attended by auxiliary staff (IRR=0.86, 95% CI 0.75 to 0.98); and delivery in a primary healthcare centre (IRR=0.67, 95% CI 0.58 to 0.79). Factors associated with longer length of stay were as follows: aged 22 years or above at the first pregnancy (IRR=1.25, 95% CI 1.13 to 1.40); having maternal complications (IRR=2.41, 95% CI 2.16 to 2.70); accompanied by her own family (IRR=1.17, 95% CI 1.03 to 1.34), accompanied by her husband (IRR=1.16, 95% CI 1.04 to 1.29); and delivered at a facility with a physical space where mother and newborn could stay overnight (IRR=1.20, 95% CI 1.07 to 1.34). Among mothers without complications, 32% received the last check-up 3 hours or less before discharge. CONCLUSIONS: Multiple factors, such as mothers' conditions, health facility characteristics and external support, were associated with the length of stay after childbirth. However, even if mothers stayed long, they might have not necessarily received timely and proper assessment before discharge.


Assuntos
Parto Obstétrico , Mães , Estudos Transversais , Feminino , Instalações de Saúde , Humanos , Recém-Nascido , Tempo de Internação , Nepal , Gravidez
18.
West Afr J Med ; 38(5): 465-471, 2021 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-34051719

RESUMO

OBJECTIVE: Determine factors associated with noninstitutional deliveries (NIDs) in urban and rural communities of Ebonyi state, Nigeria. METHODS: Community based cross-sectional comparative study design was used. Two stage sampling technique was used to select 660 women in 4 out of 13 local government areas. Information was obtained using a pre-tested, interviewer administered questionnaire. Respondents were womenwho have delivered in past one year irrespective of place of delivery. Outcome measure was proportion of women who did not deliver with a skilled birth attendant. RESULTS: Comparable proportion of respondents delivered outside health facilities, (urban, 14.5%; rural, 10%) (p=0.075). Decisions were made mainly during labour (urban, 43.8%; rural, 36.4%). Predictors of NID in urban areas included receiving no formal antenatal care, (AOR = 50.4; 95%CI: 14.4-177.2), being <30 years, (AOR = 2.9; 95%CI:1.1- 8.0) and previous history of Caesarean section, (AOR = 0.05, 95%CI: 0.01-0.5). Predictor of NID in rural areas was not receiving formal antenatal care, (AOR = 43.9; 95%CI:13.0-148.3). CONCLUSION: Minor proportion of respondents delivered outside heath facilities in urban and rural communities. Good utilization of primary health centers is essential in improving maternal health in Nigeria especially in rural communities. There is a need for all women to receive antenatal care from skilled providers as this increases the likelihood of delivering with skilled birth attendants. Ensuring deliveries with skilled birth attendants will improve the poor maternal health index in Nigeria.


Assuntos
Cesárea , População Rural , Estudos Transversais , Feminino , Instalações de Saúde , Acesso aos Serviços de Saúde , Humanos , Masculino , Nigéria , Políticas , Gravidez
19.
Stud Health Technol Inform ; 281: 502-503, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34042621

RESUMO

The decisions derived from AI-based clinical decision support systems should be explainable and transparent so that the healthcare professionals can understand the rationale behind the predictions. To improve the explanations, knowledge graphs are a well-suited choice to be integrated into eXplainable AI. In this paper, we introduce a knowledge graph-based explainable framework for AI-based clinical decision support systems to increase their level of explainability.


Assuntos
Inteligência Artificial , Sistemas de Apoio a Decisões Clínicas , Atenção à Saúde , Instalações de Saúde , Reconhecimento Automatizado de Padrão
20.
Stud Health Technol Inform ; 281: 625-629, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34042651

RESUMO

The aim of the Foundation Healthcare Group (FHG) Vanguard model was to develop a sustainable local hospital model between two National Health Service (NHS) Trusts (a London Teaching Hospital Trust and a District General Hospital Trust) that makes best use of scarce resources and can be replicated across the NHS, UK. The aim of this study was to evaluate the provision, use and implementation of the IT infrastructure; based on qualitative interviews and focused mainly on the perspectives of the IT staff and the clinicians' perspectives. In total 24 interview transcripts, along with 'Acute Care Collaboration' questionnaire responses, were analysed using a thematic framework for IT infrastructure, sharing themes across the vascular, paediatric and cardiovascular strands of the FHG programme. Findings indicated that Skype for Business had been an innovative and helpful development widely available to be used between the two Trusts. Clinicians initially reported lack of IT support and infrastructure expected at the outset for a national Vanguard project, but later appreciated that remote access to most clinical applications between the two Trusts became operational. The Local Care Record (LCR), an IT project was perceived to have been delivered successfully in South London. Shared technology reduced patient travelling time by providing locally based shared care. Spreading and scaling-up innovations from the Vanguard sites was the aspiration and challenge for system leaders.


Assuntos
Atenção à Saúde , Medicina Estatal , Criança , Instalações de Saúde , Humanos , Londres
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