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Background and Objective@#Primary care providers are key players in providing quality care to patients and advancing Universal Health Care (UHC). However, effective and quality healthcare delivery may be affected by inadequate knowledge and failure to adhere to evidence-based guidelines among providers. The Philippine Primary Care Studies (PPCS) is a five-year program that pilot tested interventions aimed at strengthening the primary care system in the country. Evidence-based training modules for healthcare providers were administered in Sorsogon and Bataan from the years 2018 to 2021. Module topics were selected based on common health conditions encountered by providers in rural and remote settings. This program aimed to evaluate the effectiveness of training in increasing provider knowledge.@*Methods@#A series of training workshops were conducted among 184 remote- and 210 rural-based primary care providers [nurses, midwives, barangay or village health workers (BHWs)]. They covered four modules: essential intrapartum and newborn care (EINC), integrated management of childhood illness (IMCI), non-communicable diseases (NCD), and geriatrics. A decision support system (UpToDate) was provided as a supplementary resource for all participants. We administered pre-tests and post-tests consisting of multiple-choice questions on common health conditions. Data was analyzed using paired one-tailed t-test, with an alpha of 0.05.@*Results@#The knowledge of nurses, midwives, and BHWs improved after the training workshops were conducted. The largest increase from pre-test to post-test scores were observed among the midwives, with a mean difference (MD) of 32.9% (95% CI 23.9 to 41.9) on the EINC module, MD of 25.0% (95% CI 16.6 to 33.4) in the geriatrics module, and MD of 13.5% (95% CI 6.9 to 20.1) in the NCDs module. The nurses had the greatest improvement in the IMCI module (MD 10.8%, 95% CI 2.5 to 19.1). The knowledge of BHWs improved in all participated modules, with greatest improvement in the NCD module (MD 9.0%, 95% CI 5.77 to 12.14). @*Conclusions@#Primary care workshops, even if conducted as single-sessions and on a short-term basis, are effective in improving short-term knowledge of providers. However, this may not translate to long-term knowledge and application in practice. Furthermore, comparisons across provider categories cannot be made as participant composition for each training workshop varied. Ultimately, this study shows enhancing provider knowledge and competence in primary care will therefore require regular and diverse learning interventions and access to clinical decision support tools.
Subject(s)
Capacity Building , Health Workforce , Philippines , Primary Health CareABSTRACT
AbstractIntroduction: This paper aims to develop a data warehouse (AD-SISCOLO) in order to support the management of the cervical cancer screening program in the municipality of Rio de Janeiro/Brazil. As a part of the management process, the program managers of the municipality perform tedious manual work in order to calculate a series of performance indicators and then take decisions based on them. Methods AD-SISCOLO was implemented using the Pentaho BI Suite Business Intelligence Platform and the MySQL database management system. The indicators to be calculated and visualized in the tool were based on the municipal data of the cytopathology and histopathology tests from January 2012 until December 2014, which was obtained from the Information System of Cervical Cancer (SISCOLO) after a record linkage process. The follow-up indicators were based on a simplified version of the Brazilian guidelines for the cervical cancer screening. Results AD-SISCOLO allows the visualization of a set of test-based and follow-up indicators from different views and dimensions, which enable managers to monitor all the phases of the screening process and to identify the process' failures. Conclusions Compared with the current available environments in Brazil, AD-SISCOLO is unique in its visualization of the follow-up indicators of groups of women, according to their test results and age. Thereby it provides presentation flexibility to suit the program manager's needs.
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RESUMO A disposição final de Resíduos Sólidos Urbanos (RSU) em aterros sanitários é discutida, neste artigo, sob o contexto de conflitos ambientais. Nessa perspectiva, foi analisado o conflito ambiental no âmbito do Aterro Sanitário de Puxinanã (ASP), na Paraíba, no período compreendido entre julho de 2009 a agosto de 2014. Foram abordadas e aplicadas técnicas que contribuíram para a análise e o entendimento do conflito ambiental em pauta, em nível macro, auxiliando com informações necessárias à tomada de decisão. A localização do ASP, dentro da bacia hidrográfica do principal manancial que abastece toda a população urbana do município de Puxinanã (PB), somada à disposição dos RSU do município de Campina Grande (PB) nesse aterro, acentuou o conflito. Pela modelagem do conflito por meio do Modelo Grafo para Resolução de Conflitos (GMCR), foram apontadas alternativas de solução, em função dos jogadores envolvidos e dos interesses de cada um. Nos três cenários simulados, a construção de um novo aterro para Puxinanã, além da disposição dos RSU de Campina Grande em aterro próprio, foi indicada como equilíbrio do conflito.
ABSTRACT The final disposal of Municipal Solid Waste (MSW) landfill is discussed in this article in the context of environmental conflicts. From this perspective, the environmental conflict was analysed under the Puxinanã Landfill (ASP), in Paraiba, in the period from July 2009 to August 2014. Techniques were addressed and implemented, and they contributed to the analysis and understanding of environmental conflict in question, at the macro level, assisting with necessary information for decision making. The location of the ASP within hydrographic basin of the main spring that supplies the entire urban population of the municipality of Puxinanã (PB), plus the disposal of MSW of Campina Grande (PB) municipality in this landfill, aggravated the conflict. Through modeling the conflict using the Graph Model for Conflict Resolution (GMCR), some alternative solutions were identified according to the players involved and the interests of each part. In the three simulated scenarios, the construction of a new landfill for Puxinanã, as well as disposal of MSW Campina Grande in the landfill, was identified as an equilibrium for the conflict.