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1.
Texto & contexto enferm ; 29: e20180426, Jan.-Dec. 2020. tab, graf
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1101974

RESUMO

ABSTRACT Objective: to know the issues in evidence in rural nursing. Method: a six-stage integrative review. Data was collected from May to July 2017, in the SciELO, CUIDEN, PubMed, and ScienceDirect databases, with "Rural nursing" as descriptor. The analysis used was qualitative with the construction of subsets and topics. Results: of the 30 articles analyzed, 32% addressed professional training; 25% collective health-related practices; 12% hospital care; 10% job satisfaction; 7% were dedicated to telehealth and 3% of the studies addressed the following topics: nurses' recruitment and permanence in rural areas, continuing education, and professional practice in urgency and emergency regulation centers. Conclusion: working in rural areas demands that nurses face particularities such as isolation, difficulty of access, diverse socioeconomic conditions and specific epidemiological profiles, which influence the professional practice, making it a challenge.


RESUMEN Objetivo: conocer los temas en evidencia en la enfermería en el territorio rural. Método: revisión integradora compuesta por seis etapas. Los datos se recolectaron de mayo a junio de2017 en las bases de datos SciELO, CUIDEN, PubMed y ScienceDirect, con el siguiente descriptor: "Rural nursing". El análisis empleado fue el cualitativo con la elaboración de subconjuntos y temas. Resultados: de los 30 artículos analizados, el 32% abordaron la formación profesional; el 25%, acciones relacionadas con la salud colectiva; el 12%, la atención hospitalaria; el 10%, la satisfacción en el trabajo; el 7% estaban dedicados a la telesalud y el 3% de los estudios trataron dos temas: reclutamiento y permanencia de las enfermeras en el Espacio rural, educación permanente y desempeño profesional en la central de regulación de urgencias y emergencias. Conclusión: para desempeñarse profesionalmente en el territorio rural, una enfermera debe hacer frente a diversas particularidades como el aislamiento, la dificultad de acceso, condiciones socioeconómicas diversas y perfiles epidemiológicos específicos, que influyen sobre la práctica profesional, factores que la convierten en un desafío.


RESUMO Objetivo: conhecer os temas em evidência na enfermagem no território rural. Método: revisão integrativa composta por seis etapas. Os dados foram coletados no período de maio a julho de 2017, nas bases SciELO, CUIDEN, PubMed, ScienceDirect, com o descritor "Rural nursing". A análise utilizada foi qualitativa com a construção de subconjuntos e tópicos. Resultados: dos 30 artigos analisados 32% abordavam a formação profissional; 25% ações relacionadas a saúde coletiva; 12% assistência hospitalar; 10% a satisfação no trabalho; 7% dedicaram a telessaúde e 3% dos estudos trataram dos temas: recrutamento e permanência das Enfermeiras no Espaço rural, educação permanente e a atuação profissional em central de regulação de urgência e emergência. Conclusão: a atuação no território rural demanda à enfermeira enfrentar particularidades como isolamento, dificuldade de acesso, condições socioeconômicas diversas e perfis epidemiológicos específicos, que influenciam a prática profissional, o que a torna um desafio.


Assuntos
Saúde Pública , Enfermagem Rural , Cuidados de Enfermagem , Prática Profissional , Zona Rural , Saúde da População Rural , Enfermagem em Saúde Comunitária
2.
BMC Infect Dis ; 20(1): 836, 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33176715

RESUMO

BACKGROUND: The KwaZulu-Natal (KZN) province of South Africa has the highest prevalence of HIV infection in the world. Viral load (VL) testing is a crucial tool for clinical and programmatic monitoring. Within uMkhanyakude district, VL suppression rates were 91% among patients with VL data; however, VL performance rates averaged only 38·7%. The objective of this study was to determine if enhanced clinic processes and community outreach could improve VL monitoring within this district. METHODS: A packaged intervention was implemented at three rural clinics in the setting of the KZN HIV AIDS Drug Resistance Surveillance Study. This included file hygiene, outreach, a VL register and documentation revisions. Chart audits were used to assess fidelity. Outcome measures included percentage VL performed and suppressed. Each rural clinic was matched with a peri-urban clinic for comparison before and after the start of each phase of the intervention. Monthly sample proportions were modelled using quasi-likelihood regression methods for over-dispersed binomial data. RESULTS: Mkuze and Jozini clinics increased VL performance overall from 33·9% and 35·3% to 75·8% and 72·4%, respectively which was significantly greater than the increases in the comparison clinics (RR 1·86 and 1·68, p < 0·01). VL suppression rates similarly increased overall by 39·3% and 36·2% (RR 1·84 and 1·70, p < 0·01). The Chart Intervention phase showed significant increases in fidelity 16 months after implementation. CONCLUSIONS: The packaged intervention improved VL performance and suppression rates overall but was significant in Mkuze and Jozini. Larger sustained efforts will be needed to have a similar impact throughout the province.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Monitoramento Epidemiológico , HIV-1/genética , Saúde da População Rural , Carga Viral/métodos , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/virologia , Adulto , Antirretrovirais/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , População Rural , África do Sul/epidemiologia , Resposta Viral Sustentada , Carga Viral/efeitos dos fármacos
3.
PLoS One ; 15(10): e0238782, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33021973

RESUMO

In 2015, UN member states committed to eliminate female genital mutilation (FGM) by 2030 as part of the Sustainable Development Agenda. To reach this goal, interventions need to be targeted and guided by the best available evidence. To date, however, estimates of the number of girls and women affected by FGM and their trends over time and geographic space have been limited by the availability, specificity and quality of population-level data. We present new estimates based on all publicly available nationally representative surveys collected since the 1990s that contain both information on FGM status and on the age at which FGM occurred. Using survival analysis, we generate estimates of FGM risk by single year of age for all countries with available data, and for rural and urban areas separately. The likelihood of experiencing FGM has decreased at the global level, but progress has been starkly uneven between countries. The available data indicate no progress in reducing FGM risk in Gambia, Guinea-Bissau, Mali and Guinea. In addition, rural and urban areas have diverged over the last two decades, with FGM declining more rapidly in urban areas. We describe limitations in the availability and quality of data on FGM occurrence and age-at-FGM. Based on current trends, the SDG goal of eliminating FGM by 2030 is out of reach, and the pace at which the practice is being abandoned would need to accelerate to eliminate FGM by 2030. The heterogeneity in trends between countries and rural vs urban areas offers an opportunity to contrast countries where FGM is in rapid decline and explore potential policy lessons and programmatic implications for countries where the practice of FGM appears to remain entrenched.


Assuntos
Circuncisão Feminina , Adolescente , Adulto , Criança , Pré-Escolar , Circuncisão Feminina/legislação & jurisprudência , Circuncisão Feminina/estatística & dados numéricos , Circuncisão Feminina/tendências , Estudos de Coortes , Estudos Transversais , Feminino , Saúde Global/legislação & jurisprudência , Saúde Global/estatística & dados numéricos , Saúde Global/tendências , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Estudos Retrospectivos , Saúde da População Rural , Inquéritos e Questionários , Nações Unidas , Saúde da População Urbana , Saúde da Mulher/legislação & jurisprudência , Saúde da Mulher/estatística & dados numéricos , Saúde da Mulher/tendências , Adulto Jovem
4.
IEEE Pulse ; 11(5): 17-20, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33064639

RESUMO

Before the novel coronavirus (COVID-19) started sweeping across the United States, it began on the coasts. The first known case was reported in a county just outside of Seattle, WA, with other cases quickly cropping up in California and in the greater New York City region. As the virus lingered on the periphery of the country, doctors and physicians working in inland, rural communities worried about what might happen if the virus hit their homes.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Pandemias , Pneumonia Viral/terapia , Serviços de Saúde Rural , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Criatividade , Humanos , Colaboração Intersetorial , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Saúde da População Rural , Serviços de Saúde Rural/organização & administração , População Rural , Estados Unidos/epidemiologia , Universidades , Voluntários
5.
BMC Infect Dis ; 20(1): 722, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008314

RESUMO

BACKGROUND: Ross River virus (RRV) is responsible for the most common vector-borne disease of humans reported in Australia. The virus circulates in enzootic cycles between multiple species of mosquitoes, wildlife reservoir hosts and humans. Public health concern about RRV is increasing due to rising incidence rates in Australian urban centres, along with increased circulation in Pacific Island countries. Australia experienced its largest recorded outbreak of 9544 cases in 2015, with the majority reported from south east Queensland (SEQ). This study examined potential links between disease patterns and transmission pathways of RRV. METHODS: The spatial and temporal distribution of notified RRV cases, and associated epidemiological features in SEQ, were analysed for the period 2001-2016. This included fine-scale analysis of disease patterns across the suburbs of the capital city of Brisbane, and those of 8 adjacent Local Government Areas, and host spot analyses to identify locations with significantly high incidence. RESULTS: The mean annual incidence rate for the region was 41/100,000 with a consistent seasonal peak in cases between February and May. The highest RRV incidence was in adults aged from 30 to 64 years (mean incidence rate: 59/100,000), and females had higher incidence rates than males (mean incidence rates: 44/100,000 and 34/100,000, respectively). Spatial patterns of disease were heterogeneous between years, and there was a wide distribution of disease across both urban and rural areas of SEQ. Overall, the highest incidence rates were reported from predominantly rural suburbs to the north of Brisbane City, with significant hot spots located in peri-urban suburbs where residential, agricultural and conserved natural land use types intersect. CONCLUSIONS: Although RRV is endemic across all of SEQ, transmission is most concentrated in areas where urban and peri-urban environments intersect. The drivers of RRV transmission across rural-urban landscapes should be prioritised for further investigation, including identification of specific vectors and hosts that mediate human spillover.


Assuntos
Infecções por Alphavirus/epidemiologia , Vírus do Rio Ross , Adulto , Infecções por Alphavirus/transmissão , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Queensland/epidemiologia , Saúde da População Rural , Saúde da População Urbana
6.
J Stroke Cerebrovasc Dis ; 29(10): 105135, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912521

RESUMO

BACKGROUND: Knowledge on the prevalence and correlates of intracranial atherosclerotic disease (ICAD) is limited. We aimed to assess prevalence, clinical and neuroimaging correlates of ICAD in a cohort of older adults of Amerindian ancestry. METHODS: The study included 581 community-dwellers aged ≥60 years (mean age 71 ± 8.4 years; 57% women) living in rural Ecuadorian villages. ICAD was identified by means of CT determinations of carotid siphon calcifications (CSC) or MRA findings of significant stenosis of intracranial arteries. Fully-adjusted logistic regression models were fitted with biomarkers of ICAD as the dependent variables. RESULTS: A total of 205 (35%) of 581 participants had ICAD, including 185 with high calcium content in the carotid siphons and 40 with significant stenosis of at least one intracranial artery (20 subjects had both biomarkers). Increasing age, high fasting blood glucose, >10 enlarged basal ganglia-perivascular spaces and non-lacunar strokes were associated with high calcium content in the carotid siphons. In contrast, male gender, moderate-to-severe white matter hyperintensities, lacunar and non-lacunar strokes were associated with significant stenosis of intracranial arteries. Stroke was more common among subjects with any biomarker of ICAD than in those with no biomarkers (29% versus 9%, p < 0.001). Significant stenosis of intracranial arteries was more often associated with stroke than high calcium content in the carotid siphons, suggesting that CSC are more likely an ICAD biomarker than causally related to stroke. CONCLUSIONS: ICAD prevalence in Amerindians is high, and is significantly associated with stroke. CSC and significant stenosis of intracranial arteries may represent different phenotypes of ICAD.


Assuntos
Vida Independente , Índios Sul-Americanos , Arteriosclerose Intracraniana/etnologia , Saúde da População Rural/etnologia , Acidente Vascular Cerebral/etnologia , Calcificação Vascular/etnologia , Fatores Etários , Idoso , Envelhecimento/etnologia , Comorbidade , Equador/epidemiologia , Feminino , Nível de Saúde , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem
8.
Surg Clin North Am ; 100(5): 823-833, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882165

RESUMO

This article reviews key population trends affecting rural American health. The article explains the role of demography in defining and studying rural health using example data from the 2014 to 2018 American Community Survey. Specific trends, including depopulation, aging, racial/ethnic diversification, socioeconomic status, and health characteristics found in rural areas, are highlighted. Insights are offered into how population trends, changing age and sex structures, and socioeconomic distributions have implications for rural health care practitioners and surgeons. Several areas and opportunities to address current and future rural health needs are identified.


Assuntos
Demografia/estatística & dados numéricos , Saúde da População Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , Humanos , Estados Unidos
9.
Surg Clin North Am ; 100(5): 921-936, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882174

RESUMO

Care for rural and urban surgical patients is increasingly more complex due to advancing knowledge and technology. Interhospital transfers occur in approximately 10% of index encounters at rural hospitals secondary to mismatch of patient needs and local resources. Due to the recent expansion of air transport to rural areas, distance and geography are less of a barrier. The interhospital transfer process is understudied and far from standardized. Interhospital transfer status is associated with increase in mortality, complications, length of stay, and costs. The cost, price to patients, and safety of air ambulance transports cannot be ignored.


Assuntos
Serviços de Saúde Rural , Saúde da População Rural , Procedimentos Cirúrgicos Operatórios , Estado Terminal , Humanos , Transferência da Responsabilidade pelo Paciente , Transferência de Pacientes , Transporte de Pacientes , Estados Unidos
10.
PLoS One ; 15(9): e0237139, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925943

RESUMO

BACKGROUND: Despite remarkable progress in reducing under five mortalities in Malawi, a relative proportion of under nutrition among children still exist. OBJECTIVES: The study examines dietary consumption factors and their effect on under nutrition outcomes among children under five years' children in rural Malawi. METHODS: Using the 2015-16 Malawi Demographic and Health Survey, in which 4,150 children were reported of under nutrition statuses, the study used nested logistic regression models to estimate factors influencing the prevalence of under nutrition among children. RESULTS: Based on the results, exclusive breast feeding among children under five years, after controlling for parental socioeconomic factors, was found to reduce the levels of wasting (ODDS RATIO [OR] = 0.763; p < 0.05), underweight (OR = 0.548; p < 0.001) and stunting (OR = 0.709; p < 0.005). Furthermore, it was found that despite the perceived adequacy among women in accessing fruits and vegetables, carbohydrates and micro-nutrient supplements, their children under five years, still experiences public health challenges and suffers from wasting, underweight and stunting. CONCLUSION: There is need to implement extensive pro-rural under five nutritional and health educational advocacy using community-based approaches, targeting parents, emphasizing the significance of exclusive breast feeding and consistencies in giving dietary foods, if and only if the persistent public health challenges due to under nutrition among children under five years, is to be sustainably dealt with, in Malawi.


Assuntos
Dieta , Estado Nutricional , Saúde da População Rural , Fatores Socioeconômicos , Aleitamento Materno , Pré-Escolar , Transtornos do Crescimento , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Malaui , Mães/educação , População Rural , Magreza , Síndrome de Emaciação
11.
J Med Internet Res ; 22(9): e21561, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32936773

RESUMO

BACKGROUND: The COVID-19 pandemic has accelerated the need for telehealth at home. Although the Department of Veterans Affairs is a leading provider of telehealth, disparities may exist in reaching older veterans living in rural areas. VA Video Connect (VVC) is a video conferencing app that enables veterans to connect with their health care provider via a secure and private session. OBJECTIVE: The aim of this study was to examine the capability and willingness of older veterans to participate in a VVC visit during the COVID-19 pandemic. METHODS: A cross-sectional study was conducted on older veterans (N=118) at the Central Arkansas Veterans Healthcare System. Participants were interviewed over the phone and responses to the following items were recorded: availability of internet, email, and an electronic device with a camera; veterans' willingness to complete an appointment via a VVC visit; and availability of assistance from a caregiver for those who were unable to participate in a VVC visit alone. RESULTS: Participants' mean age was 72.6 (SD 8.3) years, 92% (n=108) were male, 69% (n=81) were Caucasian, 30% (n=35) were African Americans, and 36% (n=42) lived in a rural location. The majority reported having access to the internet (n=93, 77%) and email service (n=83, 70%), but only 56% (n=67) had a camera-equipped device. Overall, 53% (n=63) were willing and capable of participating in a VVC visit. The availability of internet access was significantly lower in rural compared to nonrural participants (P=.045) and in those with or less than a high school education compared to those who pursued higher education (P=.02). Willingness to participate in the VVC visit was significantly lower in rural compared to nonrural participants (P=.03). Of the participants who reported they were able and willing to partake in a VVC visit (n=54), 65% (n=35) opted for VVC and 35% (n=19) preferred a phone visit. In total, 77% (n=27) of the scheduled VVC visits were successful. CONCLUSIONS: Despite advances in technology, and willingness on the part of health care systems, there are some lingering issues with capability and willingness to participate in video telehealth visits, particularly among older adults residing in rural areas.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Saúde da População Rural/estatística & dados numéricos , Telemedicina , Veteranos/psicologia , Veteranos/estatística & dados numéricos , Comunicação por Videoconferência , Idoso , Agendamento de Consultas , Arkansas/epidemiologia , Cuidadores , Estudos Transversais , Assistência à Saúde , Correio Eletrônico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias
12.
BMC Infect Dis ; 20(1): 659, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894092

RESUMO

BACKGROUND: Diarrheagenic Escherichia coli (DEC) are among the leading pathogens associated with endemic diarrhea in low income countries. Yet, few epidemiological studies have focused the contribution of enterohemorrhagic E. coli (EHEC), enteroinvasive E. coli (EIEC) and diffusely adherent E. coli (DAEC). METHODS: We assessed the contribution of EHEC, EIEC and DAEC isolated from stool samples from a case-control study conducted in children aged < 5 years in Southern Mozambique between December 2007 and November 2012. The isolates were screened by conventional PCR targeting stx1 and stx2 (EHEC), ial and ipaH (EIEC), and daaE (DAEC) genes. RESULTS: We analyzed 297 samples from cases with less-severe diarrhea (LSD) matched to 297 controls, and 89 samples from cases with moderate-to-severe diarrhea (MSD) matched to 222 controls, collected between November 3, 2011 and November 2, 2012. DEC were more common among LSD cases (2.7%, [8/297] of cases vs. 1.3% [4/297] of controls; p = 0.243]) than in MSD cases (0%, [0/89] of cases vs. 0.4%, [1/222] of controls; p = 1.000). Detailed analysis revealed low frequency of EHEC, DAEC or EIEC and no association with diarrhea in all age strata. Although the low frequency, EIEC was predominant in LSD cases aged 24-59 months (4.1% for cases vs. 0% for controls), followed by DAEC in similar frequency for cases and controls in infants (1.9%) and lastly EHEC from one control. Analysis of a subset of samples from previous period (December 10, 2007 and October 31, 2011) showed high frequency of DEC in controls compared to MSD cases (16.2%, [25/154] vs. 11.9%, [14/118], p = 0.383, respectively). Among these, DAEC predominated, being detected in 7.7% of cases vs. 17.6% of controls aged 24-59 months, followed by EIEC in 7.7% of cases vs. 5.9% of controls for the same age category, although no association was observed. EHEC was detected in one sample from cases and two from controls. CONCLUSIONS: Our data suggests that although EHEC, DAEC and EIEC are less frequent in endemic diarrhea in rural Mozambique, attention should be given to their transmission dynamics (e.g. the role on sporadic or epidemic diarrhea) considering that the role of asymptomatic individuals as source of dissemination remains unknown.


Assuntos
Diarreia/epidemiologia , Escherichia coli Êntero-Hemorrágica/genética , Infecções por Escherichia coli/epidemiologia , Saúde da População Rural , Estudos de Casos e Controles , Pré-Escolar , Diarreia/microbiologia , Doenças Endêmicas , Escherichia coli Êntero-Hemorrágica/isolamento & purificação , Infecções por Escherichia coli/microbiologia , Fezes/microbiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Moçambique/epidemiologia , Reação em Cadeia da Polimerase , Prevalência , População Rural
13.
Medicine (Baltimore) ; 99(37): e22067, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925742

RESUMO

INTRODUCTION: Coastal areas in Malaysia can have important impacts on the livelihoods and health of local communities. Efforts by Malaysian government to develop and improve the landscape and ecosystem have been planned; however, the progress has been relatively slow because some of the coastal areas are remote and relatively inaccessible. Thus, these coastal communities face various challenges in health, healthcare and quality of life. This paper presents a study protocol to examine the health status, healthcare utilisation, and quality of life among the coastal communities. In addition, the relationship between the community and their coastal environment is examined. METHODOLOGY AND ANALYSIS: The population of interest is the coastal communities residing within the Tun Mustapha Park in Sabah, Malaysia. The data collection is planned for a duration of 6 months and the findings are expected by December 2020. A random cluster sampling will be conducted at three districts of Sabah. This study will collect 600 adult respondents (300 households are estimated to be collected) at age of 18 and above. The project is a cross sectional study via face-to-face interview with administered questionnaires, anthropometrics measurements and observation of the living condition performed by trained interviewers.


Assuntos
Utilização de Instalações e Serviços , Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Vigilância em Saúde Pública , Qualidade de Vida , Saúde da População Rural , Estudos Transversais , Ecossistema , Programas Governamentais , Acesso aos Serviços de Saúde , Humanos , Malásia/epidemiologia
14.
Rev Panam Salud Publica ; 44, sept. 2020
Artigo em Espanhol | PAHO-IRIS | ID: phr-52708

RESUMO

Se propone un modelo conceptual sobre condiciones y medio ambiente de trabajo en salud que integra la evidencia disponible para facilitar el diseño y la evaluación de intervenciones orientadas a mejorar la atracción, captación y retención del personal de salud en el primer nivel de atención de áreas rurales y remotas. Se consultó la evidencia teórica, empírica y testimonial para fundamentar la propuesta y se sintetizaron 15 modelos difundidos en los últimos 20 años. El artículo da cuenta de la diversidad de perspectivas y la complejidad que conlleva establecer las dimensiones que deben considerarse en una propuesta que sea útil para aplicar a las políticas de recursos humanos en salud. El modelo propuesto incluye cuatro categorías de componentes: factores del contexto externo, factores organizacionales, condiciones del empleo y del trabajo, y factores individuales. Los límites entre los componentes –así como el peso y la influencia de cada uno– varían en función de la relación entre ellos y de la interacción con el medio, por lo que su interpretación debe adecuarse al ámbito en que se pretenda aplicar. A partir de este modelo conceptual, el diseño y la evaluación de las intervenciones dirigidas a incrementar la disponibilidad de personal de salud –en particular en el primer nivel de atención de áreas rurales y remotas de la Región de las Américas– deberían surgir de una interacción entre las políticas de salud y empleo, y las realidades y expectativas de los trabajadores y las comunidades.


This report proposes a conceptual model on workplace environment and working conditions that integrates the available evidence to facilitate the design and evaluation of interventions aimed at improving the attraction, recruitment and retention of health personnel at the first level of care in rural and remote areas. Theoretical, empirical and testimonial evidence was consulted to support the model, and 15 frameworks disseminated in the last 20 years were synthesized. The article shows the diversity of perspectives and the complexity involved in establishing the dimensions to be considered in a proposal that is useful to apply to human resources for health policies. The proposed model includes four categories of components: factors of the external context, organizational factors, employment and work conditions, and individual factors. The boundaries between the components – as well as the weight and influence of each one– vary according to the interrelationship among them and the interaction with the environment, and thus its interpretation must be adapted to the context in which it is intended to be applied. Based on this conceptual model, the design and evaluation of interventions aimed at increasing the availability of health personnel –particularly at the primary care level in rural and remote areas of the Region of the Americas– should emerge from an interaction between health and employment policies, and the realities and expectations of workers and the communities.


Assuntos
Condições de Trabalho , Modelos Teóricos , Saúde da População Rural , Zonas Remotas , Mão de Obra em Saúde , Meio Ambiente e Saúde Pública , Condições de Trabalho , Modelos Teóricos , Saúde da População Rural , Instituições de Saúde, Recursos Humanos e Serviços , Zonas Remotas , América
15.
J Prev Med Hyg ; 61(2): E137-E142, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32802996

RESUMO

The 1918-1919 influenza pandemic had a significantly different impact on mortality rates in Spanish and Portuguese provinces and cities. In this study, several small villages have been identified which were not affected at all by the Spanish influenza pandemic. These all shared a number of features in common: their villages were very small, comprising only a few hundred inhabitants; they were located in mountainous regions, with very poor transport infrastructure; and they were self-sufficient and capable of fulfilling their basic alimentary needs. Their inhabitants were conscious of the problem and acted together, effectively isolating themselves from surrounding villages. Since these villagers managed to avoid direct contact with ill people from other municipalities, the flu was not transmitted and the pandemic did not arise in their villages. In this paper, it is proposed that the human habitability spaces that meet these characteristics, I call them "Safe Villages" or "Shelter Village". Knowledge of the circumstances in which the 1918-1919 flu pandemic developed and of the means employed to resist it can help us to take relevant measures when faced with future pandemics.


Assuntos
Influenza Pandêmica, 1918-1919/história , Saúde da População Rural/história , População Rural/história , História do Século XX , Humanos , Influenza Humana , Portugal , Espanha
16.
BMC Infect Dis ; 20(1): 581, 2020 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-32762656

RESUMO

BACKGROUND: Human T-cell lymphotropic virus (HTLV) remains a major safety concern for blood supplies. Despite many HTLV positive cases being reported in southeastern China, the detection of HTLV has not been prioritized in routine blood screening. Additionally, data on the prevalence of HTLV infection among blood donors is also limited. The objective of this study was to investigate the prevalence of HTLV among blood donors in three Chinese provinces through their representative blood centers, to evaluate the feasibility of chemiluminescence immunoassay (CLIA) for blood screening. METHODS: From November 2018 to March 2019, blood plasma samples were collected from Hebei, Changsha, and Shenzhen blood centers and were screened for the HTLV-1/2 antibody using a CLIA and enzyme-linked immunosorbent assay (ELISA). This was followed by confirmatory tests using INNO-LIA HTLV I/II. RESULTS: A total of 59,929 blood donations were collected and screened for HTLV-1/2. The reactive rate of CLIA and ELISA among donations in the Shenzhen blood center (0.0943%, 27/28,621) was higher than Hebei (0.0248%, 4/16,144), and Changsha (0.0198%, 3/15,164) (p < 0.05). After confirmation, 3 samples were confirmed as indeterminate for HTLV antibodies, and only one sample from the Shenzhen blood center was confirmed as HTLV-1. The overall prevalence of HTLV-1/2 was 1.67 per 100,000 (1/59,929). The HTLV-infected blood came from a 32-year-old first-time female donor with a high school degree, who belonged to the SHE ethnic minority and was born in the Fujian province. CONCLUSIONS: In summary, the overall prevalence of HTLV-1/2 among blood donors in the three blood centers in China remains relatively low. However, blood donations with positive or indeterminate results for HTLV antibodies reminded us of the importance of HTLV screening among blood donors in China.


Assuntos
Doadores de Sangue , Infecções por HTLV-I/diagnóstico , Infecções por HTLV-I/epidemiologia , Infecções por HTLV-II/diagnóstico , Infecções por HTLV-II/epidemiologia , Vírus Linfotrópico T Tipo 1 Humano/imunologia , Vírus Linfotrópico T Tipo 2 Humano/imunologia , Saúde da População Rural , Adolescente , Adulto , China/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Infecções por HTLV-I/etnologia , Infecções por HTLV-I/virologia , Infecções por HTLV-II/etnologia , Infecções por HTLV-II/virologia , Humanos , Medições Luminescentes , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Grupos Minoritários , Prevalência , Serviços de Saúde Rural , Adulto Jovem
17.
BMC Public Health ; 20(1): 1241, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32799826

RESUMO

BACKGROUND: Providing universal access to safe water, sanitation and hygiene (WASH) in remote Nepal remains challenging. We investigated WASH conditions and their association with children's nutritional status, intestinal parasitic infections and diarrhoea. METHODS: Data was collected through a cross-sectional survey of 1427 households, including questionnaires, observations, stool analysis, anthropometry, water quality measurements, and assessment of clinical signs of nutritional deficiencies. RESULTS: We found 55.5% of children were undernourished, 63.9% had clinical signs of nutritional deficiencies, 51.1% had intestinal parasitic infections and 52.2% had diarrhoea. Multivariate mixed logistic regression analysis revealed a statistically significant negative association between undernutrition and socio-economic level, with adjusted odds ratios (AOR) of 0.70 (95%-CI = 0.43-1.11) and 0.43 (95%-CI = 0.25-0.75) for high and intermediate levels compared to the lowest level. Undernutrition was negatively associated with regular deworming of children (AOR = 0.44, 95% CI = 0.20-0.94), food supplements (AOR = 0.57, 95% CI = 0.38-0.84), household's own food production (AOR = 0.67, 95% CI = 0.46-0.97) and personal hygiene (AOR = 0.83, 95% CI = 0.51-1.35). Nutritional deficiency was negatively associated with handwashing after cleaning a baby's bottom (AOR = 0.60, 95% CI = 0.40-0.92) and cleanliness of caregiver's hands (AOR = 0.61, 95% CI = 0.41-0.89) and positively associated with keeping animals inside the house overnight (AOR = 1.71, 95% CI = 1.17-2.51) and the presence of total coliforms in the drinking water source (AOR = 10.44, 95% CI = 1.61-67.4). Diarrhoea was positively associated with intermittent water supply (AOR = 2.72, 95% CI = 1.18-6.31) and the presence of a mud floor (AOR = 2.29, 95% CI = 1.20-4.37) and negatively associated with cleanliness of the toilet (AOR = 0.68, 95% CI = 0.47-0.98), and the cleanliness of children's hands (AOR = 0.62, 95% CI = 0.40-0.96). CONCLUSIONS: Our study found, more than half of the survey children were in a critical health condition. Results suggest that child health improvements are dependent on multiple public health improvements, including providing better nutrition, promoting adequate hygiene behaviour, such as handwashing, keeping the latrines clean, keeping the household environment free from animal faeces and assuring a reliable supply of safe water.


Assuntos
Diarreia/epidemiologia , Higiene , Enteropatias Parasitárias/epidemiologia , Estado Nutricional , Saúde da População Rural/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Abastecimento de Água/estatística & dados numéricos , Adulto , Cuidadores/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Nepal/epidemiologia
18.
South Med J ; 113(8): 368-371, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747962

RESUMO

Coronavirus disease 2019 (COVID-19) rapidly led to global human devastation, including multiple deaths, sicknesses, and financial reverberations across many individuals and communities. As COVID-19 gained its foothold in the United States, medical school administrators, faculty, and students had to undergo rapid change to mitigate the disease spread, putting all parties in dubious situations. Medical school administrators had to make swift and judicious decisions that would best serve the student body and the diverse patient population at clinical sites. Medical schools with students practicing in rural, remote regions with a dearth of healthcare resources have even more complicated decisions to make in these unprecedented times. We provide an overview of rapid decision-making processes that can be used by curriculum leaders and medical school administrators to continue to meet accreditation requirements while attempting to keep medical students safe and prepared for graduation in response to the COVID-19 health crisis.


Assuntos
Infecções por Coronavirus , Currículo , Técnicas de Apoio para a Decisão , Educação Médica/organização & administração , Pandemias , Pneumonia Viral , Faculdades de Medicina/organização & administração , Acreditação , Betacoronavirus , Educação Médica/normas , Humanos , Saúde da População Rural , Estados Unidos/epidemiologia
19.
Am J Public Health ; 110(10): 1519-1522, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32816549

RESUMO

We introduce "rural legal deserts," or rural areas experiencing attorney shortages, as a meaningful health determinant. We demonstrate that the absence of rural attorneys has significant impacts on public health-impacts that are rapidly exacerbated by COVID-19.Our work builds on recent scholarship that underscores the public health relevance of attorneys in civil and criminal contexts. It recognizes attorneys as crucial to interprofessional health care teams and to establishing equitable health-related laws and policies. Attorney interventions transform institutional practices and help facilitate the stability necessary for health maintenance and recovery. Yet, critically, many rural residents cannot access legal supports.As more individuals experience unemployment, eviction, and insecure benefits amid the COVID-19 pandemic, there is a need for attorneys to address these social determinants of health as legal needs. Accordingly, the growing absence of attorneys in the rural United States proves particularly consequential-because of this pandemic context but also because of rural health disparities. We argue that unless a collaborative understanding of these interrelated phenomena is adopted, justice gaps will continue to compound rural health inequities.


Assuntos
Infecções por Coronavirus/epidemiologia , Advogados/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Saúde Pública , Saúde da População Rural , Determinantes Sociais da Saúde , Betacoronavirus , Disparidades em Assistência à Saúde , Humanos , Pandemias , Serviços de Saúde Rural , Estados Unidos/epidemiologia
20.
Can Bull Med Hist ; 37(2): 427-460, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822554

RESUMO

As new government health policy was created and implemented in the late 1910s and the late 1960s, women patients and health practitioners recognized gaps in the new health services and worked together to create better programs. This article brings the histories of the district nursing program (1919-43) and local birth control centres (1970-79) together to recognize women's health provision (as trained nurses or lay practitioners) as community-based and collaborative endeavours in the province of Alberta. The district nursing and birth control centre programs operated under different health policies, were influenced by different feminisms, and were situated in different Indigenous-settler relations. But the two programs, occurring half a century apart, provided space for health workers and their patients to implement change at a community level. Health practitioners in the early and late twentieth century took women's experiential knowledge seriously, and, therefore, these communities formed a new field of women's health expertise.


Assuntos
Instituições de Assistência Ambulatorial/história , Enfermagem em Saúde Comunitária/história , Anticoncepção/história , Pessoal de Saúde/história , Serviços de Saúde do Indígena/história , Saúde da Mulher/história , Alberta , Feminino , Feminismo/história , Política de Saúde/história , História do Século XX , Humanos , Saúde da População Rural/história
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