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2.
Lancet Psychiatry ; 9(1): 59-71, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34921796

RESUMO

BACKGROUND: There have been no trials of task-shared care (TSC) using WHO's mental health Gap Action Programme for people with severe mental disorders (psychosis or affective disorder) in low-income or middle-income countries. We aimed to evaluate the efficacy and cost-effectiveness of TSC compared with enhanced specialist mental health care in rural Ethiopia. METHODS: In this single-blind, phase 3, randomised, controlled, non-inferiority trial, participants had a confirmed diagnosis of a severe mental disorder, recruited from either the community or a local outpatient psychiatric clinic. The intervention was TSC, delivered by supervised, non-physician primary health care workers trained in the mental health Gap Action Programme and working with community health workers. The active comparison group was outpatient psychiatric nurse care augmented with community lay workers (PSY). Our primary endpoint was whether TSC would be non-inferior to PSY at 12 months for the primary outcome of clinical symptom severity using the Brief Psychiatric Rating Scale, Expanded version (BPRS-E; non-inferiority margin of 6 points). Randomisation was stratified by health facility using random permuted blocks. Independent clinicians allocated groups using sealed envelopes with concealment and outcome assessors and investigators were masked. We analysed the primary outcome in the modified intention-to-treat group and safety in the per-protocol group. This trial is registered with ClinicalTrials.gov, number NCT02308956. FINDINGS: We recruited participants between March 13, 2015 and May 21, 2016. We randomly assigned 329 participants (111 female and 218 male) who were aged 25-72 years and were predominantly of Gurage (198 [60%]), Silte (58 [18%]), and Mareko (53 [16%]) ethnicity. Five participants were found to be ineligible after randomisation, giving a modified intention-to-treat sample of 324. Of these, 12-month assessments were completed in 155 (98%) of 158 in the TSC group and in 158 (95%) of 166 in the PSY group. For the primary outcome, there was no evidence of inferiority of TSC compared with PSY. The mean BPRS-E score was 27·7 (SD 4·7) for TSC and 27·8 (SD 4·6) for PSY, with an adjusted mean difference of 0·06 (90% CI -0·80 to 0·89). Per-protocol analyses (n=291) were similar. There were 47 serious adverse events (18 in the TSC group, 29 in the PSY group), affecting 28 participants. These included 17 episodes of perpetrated violence and seven episodes of violent victimisation leading to injury, ten suicide attempts, six hospital admissions for physical health conditions, four psychiatric admissions, and three deaths (one in the TSC group, two in the PSY group). The incremental cost-effectiveness ratio for TSC indicated lower cost of -US$299·82 (95% CI -454·95 to -144·69) per unit increase in BPRS-E scores from a health care sector perspective at 12 months. INTERPRETATION: WHO's mental health Gap Action Programme for people with severe mental disorders is as cost-effective as existing specialist models of care and can be implemented effectively and safely by supervised non-specialists in resource-poor settings. FUNDING: US National Institute of Mental Health.


Assuntos
Transtornos Mentais/economia , Transtornos Mentais/terapia , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Adulto , Idoso , Análise Custo-Benefício , Etiópia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Programas , População Rural , Método Simples-Cego , Organização Mundial da Saúde
4.
PLoS One ; 16(12): e0261470, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34928996

RESUMO

BACKGROUND: Hepatitis B infection is a major health concern in Myanmar. Hepatitis B birth dose vaccination to prevent mother-to-child transmission is not universal, especially in births outside of health care facilities. Little is documented about delivery of immunization programs in rural Myanmar or in conflict-affected regions. To address this gap, this study describes the implementation of a novel community delivered neonatal hepatitis B immunization program in rural Karenni State, Myanmar. METHODS: A mixed-methods study assessed the effectiveness and feasibility of hepatitis B birth dose immunization program. 1000 pregnant women were screened for hepatitis B virus (HBV) infection using point of care testing. Neonates of HBV positive mothers were immunized with a three dose HBV vaccine schedule at birth, 1, and 6 months of age. HBV testing was completed for children at 9 months to assess for infection. Descriptive statistics were collected including demographic data of mothers, neonatal vaccination schedule completion, and child HBV positivity at 9 months. Qualitative data examining barriers to implementation were collected through semi-structured interviews, participant-observation, and analysis of program documents. Themes were codified and mapped onto the Consolidated Framework for Implementation Research. RESULTS: 46 pregnant women tested HBV positive leading to 40 live births. 39 women-child dyads were followed until the 9-month age mark. With the exception of two neonates who received their birth dose past 24 hours, all children received their vaccines on time. None of the 39 children tested positive for HBV at nine months. Themes regarding barriers included adaptability of the program to the rural setting, friction with other stakeholders and not meeting all needs of the community. Identified strengths included good communication and leadership within the implementing ethnic health organization. CONCLUSION: A community delivered neonatal HBV vaccination program by ethnic health organizations is feasible and effective in rural Myanmar.


Assuntos
Vacinas contra Hepatite B/uso terapêutico , Hepatite B/prevenção & controle , Programas de Imunização/organização & administração , Doenças do Recém-Nascido/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Adolescente , Adulto , Feminino , Vacinas contra Hepatite B/administração & dosagem , Humanos , Programas de Imunização/métodos , Esquemas de Imunização , Recém-Nascido , Pessoa de Meia-Idade , Mianmar/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Desenvolvimento de Programas , Adulto Jovem
5.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 29(Special Issue): 1275-1280, 2021 Aug.
Artigo em Russo | MEDLINE | ID: mdl-34792877

RESUMO

Ensuring effective epidemiological surveillance of tuberculosis is essential and one of the paramount tasks for any national tuberculosis control program. The article analyzes the organization of the tuberculosis epidemiological monitoring system at the level of the subject, based on the experience of implementing such a system in the city of Moscow in 1996-2020, defines its tasks and principles of its construction. The systems of epidemiological monitoring of tuberculosis, implemented taking into account the developed principles, provide an analysis of the epidemiological situation in the territory, the results of which can be successfully used for making managerial decisions, program-target planning and evaluating the effectiveness of the measures taken.


Assuntos
Tuberculose , Monitoramento Epidemiológico , Humanos , Moscou/epidemiologia , Organizações , Desenvolvimento de Programas , Tuberculose/diagnóstico , Tuberculose/epidemiologia
6.
Rev Esp Salud Publica ; 952021 Oct 01.
Artigo em Espanhol | MEDLINE | ID: mdl-34593751

RESUMO

The objective of this work was to describe the implantation project presented by the Virgen de las Nieves University Hospital (Granada, Spain) to be selected as a candidate for "Best Practice Spotlight Organization"® (in Spain CCEC®) program in the cohort (2015-2017) to implement three guidelines for Nurses Association of Canada Ontario (RNAO) clinical practice of care. The methodology used was the model called "knowledge for action" and the actions developed for each of the phases of the action cycle for applying knowledge to practice were described: 1) identification of the problem, 2) adaptation to the local context, 3) evaluation of facilitators and barriers, 4) adaptation and implementation of interventions, 5) monitoring and evaluation of results and 6) sustainability. This work adds to the set of studies that address the improvement and maintenance of evidence-based practice programs in nursing, and in health services in general. It shows the application of a framework for the implementation of clinical practice guidelines for care in a specific health environment for its replication in other different health settings. It has been shown that it is essential to dedicate efforts to planning the implementation of this type of programs, taking into account the context in which they are developed, the specific characteristics of the population being served, identifying the different barriers and facilitators that may affect during the course of the program. process and defining actions to make the changes in practice sustainable.


Assuntos
Medicina Baseada em Evidências , Hospitais Universitários , Desenvolvimento de Programas , Medicina Baseada em Evidências/organização & administração , Hospitais Universitários/organização & administração , Humanos , Espanha
7.
New Dir Stud Leadersh ; 2021(171): 77-87, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34658184

RESUMO

This article explores how leadership education and program development is centered on the needs of students, local tribal communities, and institutional charter within the Tribal College and University (TCU) context. Two leadership-based academic programs at two respective TCUs are discussed through the lens of a culturally appropriate framework of Native-nation building to illustrate how leadership development at TCUs is focused on developing student leaders within and for tribal communities.


Assuntos
Liderança , Universidades , Humanos , Desenvolvimento de Programas , Estudantes
11.
J Korean Acad Nurs ; 51(4): 465-477, 2021 Aug.
Artigo em Coreano | MEDLINE | ID: mdl-34497255

RESUMO

PURPOSE: This study aimed to evaluate the effects of head monted display based home-visits virtual reality simulation (HVRS) program developed for undergraduate nursing students. METHODS: A nonequivalent control group with a non-synchronized design was utilized and 84 participants (experimental group, 44; control group, 40) were recruited from August 31, 2020 to November 8, 2020 in Gwangju metropolitan city. The HVRS program consisted of scenarios of three nursing cases, hypertension, diabetes mellitus, and stroke. Data were analyzed SPSS version 25.0 for Windows. RESULTS: At the completion of HVRS, significant differences were found between groups in knowledge of home-visits (t = 4.73, p < .001), self-confidence (t = 6.63, p < .001), self-efficacy (t = 3.13, p = .002), and clinical competency (t = 4.13, p < .001). No significant difference was shown between groups in nursing knowledge about strokes, a subcategory of knowledge pertaining to home visits. CONCLUSION: The HVRS program developed for undergraduate nursing students is effective in improving knowledge of home-visits, self-confidence, self-efficacy, and clinical competency for nursing students.


Assuntos
Bacharelado em Enfermagem , Treinamento por Simulação , Estudantes de Enfermagem , Realidade Virtual , Competência Clínica , Simulação por Computador , Visita Domiciliar , Humanos , Desenvolvimento de Programas
12.
J Korean Acad Nurs ; 51(4): 478-488, 2021 Aug.
Artigo em Coreano | MEDLINE | ID: mdl-34497256

RESUMO

PURPOSE: This study aimed to develop and examine the effects of a prenatal program on environmental health behavior using cartoon comics among Korean pregnant women. METHODS: This study used a non-equivalent control group pre-test/post-test design. The program used cartoon comics to explore environmental health behaviors during pregnancy. The program consisted of the following four components: environmental toxicants during pregnancy, avoiding particulate matter during pregnancy, environmental toxicants during baby care, and making a healthy environment for children. In total, 35 pregnant women participated in the study: 18 in the experimental group and 17 in the control group. Data collection and program adaptation were conducted between November 3, 2020 and January 19, 2021. The effect of the prenatal education program was evaluated by t-test and repeated measures ANOVA. RESULTS: Learning experience (t = - 2.35, p = .025), feasibility (t = - 2.46, p = .019), satisfaction (t = - 2.23, p = .032) were higher in the experimental group than in the control group in the first post-test. Feasibility (t = - 2.40, p = .022) was higher in the experimental group than in the control group in the second post-test. Repeated-measures ANOVA showed significant interactions between time and group in environmental susceptibility (F = 9.31, p < .001), self-efficacy (F = 3.60, p = .033), and community behavior (F = 5.41, p = .007). CONCLUSION: This study demonstrates the need for a prenatal education program to promote environmental health perceptions and behavior during pregnancy. We suggest a prenatal class adopting the creative cartoon comics to promote the maternal environmental health behaviors.


Assuntos
Desenhos Animados como Assunto , Saúde Ambiental/educação , Gestantes/educação , Educação Pré-Natal , Adulto , Currículo , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Gravidez , Cuidado Pré-Natal , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Autoeficácia
15.
PLoS One ; 16(9): e0257890, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34587210

RESUMO

BACKGROUND: In disease control, the program officers are vital to the successful implementation of control strategies. However, poor knowledge of the disease and its control, staff attrition, and lack of intentional training for new staff can lead to under-performance and ineffectiveness of interventions. Thus, the Nigeria Field Epidemiology and Laboratory Training Program, in collaboration with National Malaria Elimination Program, planned a malaria short course (MSC) to strengthen the capacity of current program managers and incoming staff. To guide the development of the curriculum for the MSC, we conducted a needs assessment survey to ascertain the perceived usefulness of the MSC, the priority rating of MSC thematic domains and associated factors. METHODS: Overall, 384 purposively selected respondents across ten states and the Federal Capital Territory in Nigeria were interviewed. These comprised malaria and non-malaria control program staff at state, local government area (LGA) and ward levels. We administered a structured questionnaire to elicit information on socio-demographics, training needs, priority malaria thematic domains, perceived course usefulness and willingness of ministries/organizations to release staff to attend the MSC. Data were analyzed using descriptive and inferential statistics at p<0.05. RESULTS: Mean age was 43.9 (standard deviation: 7.6 years), 172 (44.8%) were females. Of the 384 respondents, 181 (47.1%), 144 (37.5%) and 59 (15.4%) were at the ward, LGA and state levels, respectively. Seventy-two (18.8%) had never worked in malaria control program. Majority (98.7%, n = 379) reported the need for further training, 382 (99.5%) opined that the course would be useful, and all affirmed their employers' willingness towards their participation at the training. Respondents rated high the domains of basic malariology, malaria treatment, malaria prevention, surveillance/data management, use of computers, leadership skills, program management and basic statistics. Predictors of malaria topical domains' high rating were gender (odds ratio (OR) = 6.77; 95% CI:3.55-12.93) and educational qualifications (OR = 0.48; 95% CI:0.26-0.89). CONCLUSIONS: A malaria short course is a necessity and appropriate for program officers at different levels of health administration in Nigeria to achieve malaria elimination, taking into consideration the challenges of human resource retention. The outcome of this study should inform the curriculum and the delivery of the MSC.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Pessoal de Saúde/educação , Malária/epidemiologia , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Adulto , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
16.
Bull Cancer ; 108(11): 1019-1029, 2021 Nov.
Artigo em Francês | MEDLINE | ID: mdl-34556293

RESUMO

The Institut Curie initiated a therapeutic patient education activity in 2011 by creating several programs. Coordinated and animated by different multidisciplinary teams, these functioned autonomously, with a different initial educational assessment for each one. This organization broke up the patient's educational pathway, and the educational offer, which sometimes proved to be redundant, most often corresponding to the needs shared by all cancer patients. The transversal therapeutic education unit allowed the creation of a single educational pathway per patient. It was necessary to imagine a common initial educational assessment. How can we move from eight specific educational assessments to a single educational assessment? After the harmonization of the different workshops, we moved from seven programs with several workshops to one program with eight themes and 26 workshops. Then several working groups led to the creation of a common, unique framework for the initial educational assessment. In seven months, a total of 119 unique educational assessments were carried out. The majority of those who wanted to undertake an educational process were women (96%). 7% had localized breast cancer, and 66% were undergoing treatment. Each workshop chosen corresponded to a need identified during the assessment. The themes mostly requested were nutrition, communication, and pain. Several advantages have been felt in the implementation of this educational assessment: single entry for the patient reinforced therapeutic alliance, transversal reading of the patient's educational needs. What remains to be done is to train therapeutic education practitioners about this global vision.


Assuntos
Academias e Institutos , Avaliação Educacional/métodos , Educação de Pacientes como Assunto/métodos , Desenvolvimento de Programas/métodos , Neoplasias da Mama/terapia , Dor do Câncer , Comunicação , Exercício Físico , Feminino , França , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Fenômenos Fisiológicos da Nutrição , Educação de Pacientes como Assunto/organização & administração , Autocuidado , Fatores Sexuais , Sexualidade , Fatores de Tempo
17.
Nutrients ; 13(9)2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34578885

RESUMO

The obesity epidemic in adolescents from Middle Eastern (ME) backgrounds necessitates co-designed and culturally-responsive interventions. This study's objective was to gather the opinions, attitudes, capabilities, opportunities and motivations of ME adolescents residing in Australia on healthy eating and physical activity (PA) behaviours to inform a future prevention program. Five focus groups were conducted, with 32 ME participants, aged 13-18 years, recruited via purposive and snowball sampling. More participants were female (n = 19) and from lower socioeconomic areas (n = 25). A reflexive thematic analysis was performed using the Capability, Opportunity, Motivation-Behaviour (COM-B) model as the coding framework. Limited nutritional knowledge and cooking skills accompanied by a desire to make dietary changes were reported. Local and school facilities provided adolescents with PA opportunities, but participants declared safety concerns and limited opportunities for females and older grade students. Social support from family and friends were enablers for both healthy eating and PA. Cravings and desire for cultural foods influenced food choices. Individual and/or group approaches using social media and face-to-face format were recommended for future programs. To enable PA and dietary behaviour changes, interventions should be specifically tailored for ME adolescents to improve their nutrition literacy and skills, along with providing safe environments for sport in conjunction with social support.


Assuntos
Dieta , Exercício Físico , Preferências Alimentares , Conhecimentos, Atitudes e Prática em Saúde , Instituições Acadêmicas , Apoio Social , Adolescente , Comportamento do Adolescente , Saúde do Adolescente , Austrália , Culinária , Feminino , Grupos Focais , Comportamentos Relacionados com a Saúde , Letramento em Saúde , Humanos , Masculino , Oriente Médio/etnologia , Obesidade/etiologia , Obesidade/prevenção & controle , Desenvolvimento de Programas , Segurança , Mídias Sociais , Fatores Socioeconômicos , Esportes
18.
Ir Med J ; 114(7): 415, 2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34520650

RESUMO

The Period of PURPLE Crying Program is an educational program delivered to parents of newborn children that aims to reduce the incidence of abusive head trauma/shaken baby syndrome1. The program was developed by a research-based, non-profit organisation and has already been implemented in many countries around the world. It educates parents on what to expect during the first few months of their newborn infant's life, allowing parents to become more informed and better prepared to care for their child. The recent surge in the number of cases of abusive head trauma in children during the COVID-19 pandemic has highlighted the need for greater resources being made available to parents. The Period of PURPLE Crying Program is one such resource that could be implemented in Ireland.


Assuntos
Maus-Tratos Infantis/prevenção & controle , Traumatismos Craniocerebrais/prevenção & controle , Educação em Saúde/organização & administração , Síndrome do Bebê Sacudido/prevenção & controle , Choro , Humanos , Lactente , Recém-Nascido , Irlanda , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Medição de Risco
19.
Sultan Qaboos Univ Med J ; 21(3): 365-372, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34522400

RESUMO

Objectives: This study aimed to identify indicators of proper programme development in the field of non-communicable diseases through the systematic review of existing literature. Methods: In this systematic review, a search was conducted through PubMed, Scopus, EMBASE, Web of Science, Google Scholar, Cochrane Library, ProQuest and grey literature. The search was limited to literature published between January 2000 and January 2019. Results: A total of 36 articles were found relevant to the study objectives. Data were obtained through these articles based on the context, input, process and product (CIPP) model. Seven subsets for context, five subsets for input, four subsets for process and six subsets for the product were identified. Conclusion: According to CIPP subsets, indicators such as programme definition, appropriate organisational culture, structure and evaluation must be considered to develop an appropriate programme to improve health services.


Assuntos
Doenças não Transmissíveis , Humanos , Doenças não Transmissíveis/terapia , Desenvolvimento de Programas
20.
Clin J Oncol Nurs ; 25(5): 523-529, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34533508

RESUMO

BACKGROUND: Throughout its evolution, lung cancer screening has remained an evidence-based tool to detect earlier-stage disease and improve survival. Many lung cancer screening programs are planned and developed in one central location, which limits patient access. OBJECTIVES: The purpose was to develop necessary and complex decentralized program components in affiliation with a large cancer care delivery system and a regional community hospital network in northeast Florida. METHODS: A program was pilot tested among five geographically diverse primary care offices for three years. The role of oncology nursing was crucial to achieve quality and efficacy in program development, regulatory compliance, and screening outcomes. FINDINGS: The program resulted in an increase in lung cancer screenings within the large healthcare network. The percentage of early-stage lung cancers identified increased, which led to improved patient outcomes and survival.


Assuntos
Detecção Precoce de Câncer , Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/diagnóstico , Cooperação do Paciente , Atenção Primária à Saúde , Desenvolvimento de Programas
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