Importance of Health Policy and Systems Research for Strengthening Rehabilitation in Health Systems: a call to action to accelerate progress

During the last few decades, the field of rehabilitation has experienced substantial development, growth, and acceptance. Rehabilitation addresses the impact of a health condition on a person's everyday life by optimizing their functioning and reducing their experience of disability. Rehabilitation expands the focus of health beyond preventative and curative care to ensure people with a health condition can remain as independent as possible and participate in education, work, and meaningful life roles.1 A definition of rehabilitation for research purposes has been recently published.2 Scientific and clinical research have generated a body of knowledge that strongly supports the use of many rehabilitation interventions with positive outcomes in various populations and health conditions.

Importancia de la investigación sobre políticas y sistemas de salud para el fortalecimiento de la rehabilitación en los sistemas sanitarios. Un llamado a la acción para acelerar el progreso / Importance of health policy and systems research for strengthening rehabilitation in health systems. A call to action to accelerate progress.

Durante las últimas décadas, el campo de la rehabilitación ha experimentado un desarrollo, crecimiento y aceptación sustanciales. La rehabilitación es un conjunto de intervenciones que aborda el impacto de una afección médica en la vida cotidiana de una persona de tal manera que optimiza su funcionamiento y reduce su experiencia de discapacidad. Del mismo modo, la rehabilitación amplía el enfoque de la salud más allá de la atención preventiva y curativa para garantizar que las personas con un problema de salud puedan continuar siendo lo más independientes posible y participando en la educación, el trabajo y los roles significativos de la vida1. Recientemente se ha publicado una definición de rehabilitación para fines investigativos2. La investigación científica y clínica ha generado un cúmulo de conocimientos que respaldan firmemente el uso de muchas intervenciones de rehabilitación con resultados positivos en diversas poblaciones y problemas de salud.

Over the past few decades, the field of rehabilitation has experienced substantial development, growth and acceptance. Rehabilitation is a set of interventions that addresses the impact of a medical condition on a person's daily life in a way that optimizes their functioning and reduces their experience of disability. Similarly, rehabilitation broadens the focus of healthcare beyond preventive and curative care to ensure that people with a health condition can continue to be as independent as possible and participate in education, work and meaningful life roles1. A definition of rehabilitation has recently been published for research purposes2. Scientific and clinical research has generated a body of knowledge that strongly supports the use of many rehabilitation interventions with positive outcomes in a variety of populations and health problems. scientific and clinical research has generated a body of knowledge that strongly supports the use of many rehabilitation interventions with positive outcomes in a variety of populations and health problems.

The value and impact of embedded implementation research: insights from Latin America and the Caribbean

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Estrategias para aumentar el impacto de la investigación sobre recursos humanos para la salud en la elaboración de políticas / Strategies for increasing the impact of research on human resources for health policy development

A pesar del reconocimiento mundial de la importancia de los recursos humanos para la salud (RHS) en el logro de objetivos de los sistemas de salud, muy poco se sabe sobre que intervenciones realmente funciona, para quién y en qué circunstancias, especialmente para los países de ingreso bajo y mediano. Varios eventos importantes e informes técnicos han pedido mayor financiación y capacidad para la investigación de los RHS en los últimos años y como resultado de ello se han establecido varias iniciativas. Sin embargo, el progreso ha sido lento. Las siguientes estrategias pueden ser las más valiosas para asegurar la relevancia de la evidencia generada para tomar decisiones y su contribución para fortalecer los sistemas de salud. La primera es promover los procesos nacionales para establecer prioridades para la investigación de RHS con participación activa de los decisores. La segunda es hacer esfuerzos conscientes para ampliar la investigación primaria para tratar las necesidades prioritarias y desarrollar mecanismos sostenibles para evaluar el impacto de las estrategias actuales o nuevas de RHS para alimentar al proceso de elaboración de políticas. La tercera es invertir en el desarrollo de revisiones sistemáticas para sintetizar la evidencia disponible y adaptar la metodología de las mismas a fin de hacerlas más adecuadas a los tipos de preguntas y la naturaleza de la investigación sobre temas de RHS. La cuarta y más importante es utilizar sistemáticamente un enfoque de sistemas para enmarcar y tratar preguntas de investigación. Mientras que un enfoque circunscrito puede ser más atractivo y simple, los sistemas de salud y los problemas que ellos enfrentan, no lo son. El disponer de mayor evidencia que tenga en consideración la complejidad de los sistemas de salud y especialmente los recursos humanos para la salud, generará un avance en el conocimiento en esta área y significará un gran paso en la calidad y utilidad de la evidencia generada.

Despite global recognition of the importance of human resources for health (HRH) in achieving health system goals, very little is known about what works, for whom and under what circumstances, especially for low-income and middle-income countries. Several important events and reports have called for increased funding and capacity for HRH research in recent years and several initiatives have started as a result. Progress has been slow, however. The following strategies can be most valuable in ensuring the relevance of the generated evidence for decision making and its contribution to stronger health systems. The first is to promote national processes to set priorities for HRH research with active participation from decision makers. The second is to make conscious efforts to scale up primary research to address priority questions and to develop sustainable mechanisms to evaluate the impact of current or new HRH strategies to feed into the policy making process. The third is to invest in the development of systematic reviews to synthesize available evidence and in the adaptation of the underlying methods to make them more responsive to the type of questions and the nature of research involving HRH issues. The fourth and most important is to consistently use a systems approach in framing and addressing research questions. While a narrow approach may be more attractive and simple, health systems and the problems facing them are not. Increasing the body of evidence that takes into account the complexity of health systems, and particularly human resources for health, will advance knowledge in this area and will make big strides in the quality and usefulness of the generated evidence.

Setting research priorities by applying the combined approach matrix.

Background & objectives: Priority setting in health research is a dynamic process. Different organizations and institutes have been working in the field of research priority setting for many years. In 1999 the Global Forum for Health Research presented a research priority setting tool called the Combined Approach Matrix or CAM. Since its development, the CAM has been successfully applied to set research priorities for diseases, conditions and programmes at global, regional and national levels. This paper briefly explains the CAM methodology and how it could be applied in different settings, giving examples and describing challenges encountered in the process of setting research priorities and providing recommendations for further work in this field. Methods: The construct and design of the CAM is explained along with different steps needed, including planning and organization of a priority-setting exercise and how it could be applied in different settings. Results: The application of the CAM are described by using three examples. The first concerns setting research priorities for a global programme, the second describes application at the country level and the third setting research priorities for diseases. Interpretation & conclusions: Effective application of the CAM in different and diverse environments proves its utility as a tool for setting research priorities. Potential challenges encountered in the process of research priority setting are discussed and some recommendations for further work in this field are provided.

Determination of gestational age by transverse cerebellar diameter in third trimester of pregnancy

To assess the usefulness of transverse cerebellar diameter [TCD] as an independent parameter for gestational age assessment in third trimester of pregnancy. An observational study. Diagnostic Radiology Department, PNS Shifa, Karachi between April 2002 to July 2004. This study was performed on patients between 26-38 weeks of gestation with normal pregnancy. Grey scale antenatal ultrasonography was done with 3.5 MHz probe to measure fetal transverse cerebellar diameter and was correlated with gestational age in weeks. These cases were followed progressively at different periods of gestation throughout the pregnancy. Collected data was converted into variables which were analyzed by SPSS version 10, descriptive statistics included mean +/- standard deviation which were computed for TCD and other fetal biometry parameters. Transverse cerebellar diameter varied in a linear fashion in third trimester, while transverse cerebellar diameter/abdominal circumference [TCD/AC] ratio remained constant in second half of pregnancy. All the parameters were expressed by regression equations and correlation coefficients were found to be statistically significant [r=0.99 for TCD, r=0.98 for TCD/AC all p<0.0001]. This study signifies that transverse cerebellar diameter and TCD/AC ratio on serial sonography give an accurate idea of gestational age. Cases with intrauterine growth restriction can be diagnosed if local, nomogram can be prepared for different ethnic groups

Non dysraphic intramedullary spinal cord lipoma

True intramedullary spinal cord lipomas are extremely rare. Two cases of intramedullary spinal cord lipoma are presented. The patients did not exhibit any form of spinal dysraphism. The patients presented with gait difficulty, upper limb weakness, sphincter disturbance, dysesthesias and neck pain. The tumors were removed sub-totally and the neurological grade improved postoperatively in one of the patients