ABSTRACT
BACKGROUND: Healthcare workers (HCWs) in lower- and middle-income countries (LMICs) face unique, intersectional threats to their mental health at work. Despite the existence of recommendations for multi-tiered interventions to promote and protect occupational mental health for HCWs, there remain significant challenges to implementation worldwide. METHODS: FHI 360, a global development organization, developed a novel technical assistance framework to accompany partners, including government and healthcare leaders to design, implement, improve, or evaluate any mental health and psychosocial support intervention. The EpiC Project, implemented by FHI 360, has utilized this framework in four countries (Vietnam, Philippines, Paraguay and Sri Lanka) specifically to guide the development of locally adapted occupational mental health interventions for HCWs. FINDINGS: Each country applied this framework in various project cycle phases and in their unique local contexts; all countries reported positive developments in the advancement of their chosen interventions. CONCLUSIONS/APPLICATION TO PRACTICE: With the application of an adaptable, evidence-based technical assistance framework to guide collaborative consultation for project design, implementation, improvement, and/or evaluation, locally led teams pivoted from a solely "mental health" approach to more comprehensive, evidence-based interventions that framed mental health for HCWs as an occupational health priority. This allowed for teams advising interventions in LMICs to consider unique workplace, structural and policy-level factors rather than focusing solely on individual mental health strategies.
Subject(s)
Developing Countries , Health Personnel , Humans , Health Personnel/psychology , Mental Health , Occupational Health , Philippines , Sri Lanka , Health Promotion/methodsABSTRACT
BACKGROUND: Doxorubicin/bleomycin/vinblastine/dacarbazine (ABVD) plus involved-field radiation therapy (IFRT) is the gold-standard treatment for early and advanced stages of Hodgkin lymphoma (HL). We evaluated the outcomes of patients according to prognosis at diagnosis and over time to determine who achieved complete remission (CR). PATIENTS AND METHODS: Treatment-naive patients under the age of 75 years at all stages of HL were eligible. The favorable group (FG) contained patients with stage IA-IIIA disease without bulky areas who achieved CR after the third cycle of ABVD. They received only IFRT at 25 Gy. Patients in the unfavorable group (UG) exhibited stages IIIB and IV HL. The UG also included all patients with bulky disease and the subset of the FG without CR after 3 cycles of ABVD, ie, slow responders (FGSR). The UG received 6 cycles of ABVD plus IFRT at 30 Gy to bulky areas at diagnosis or to those areas remaining positive after the third cycle of ABVD. RESULTS: In total, 584 patients were evaluable: 285 of them belonged to the FG, and 299 to the UG. Rates of CR were 98% and 85% for the FG and the UG, respectively (P < .001). Sixty patients in the FG received 6 cycles of ABVD because they had not achieved CR after 3 cycles (ie, the FGSR subgroup). The 5-year event-free survival rate was 89% for the FG, 66% for the FGSR, and 72% for the UG (P < .001). The overall survival at 5 years was significantly better for the FG (98%) than for the FGSR (87%) and the UG (88%; P < .001). CONCLUSION: Patients from the FG demonstrated excellent outcomes compared with those from the FGSR and UG, despite receiving less chemotherapy and fewer doses of IFRT.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Hodgkin Disease/therapy , Adolescent , Adult , Aged , Bleomycin/administration & dosage , Child , Combined Modality Therapy , Dacarbazine/administration & dosage , Disease-Free Survival , Doxorubicin/administration & dosage , Drug Administration Schedule , Female , Hodgkin Disease/mortality , Hodgkin Disease/pathology , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Neoplasm Staging , Prognosis , Radiotherapy , Radiotherapy Dosage , Remission Induction , Risk Factors , Vinblastine/administration & dosage , Young AdultABSTRACT
Se describe, por primera vez en Perú, la ocurrencia de un brote intrahospitalario de cólera neonatal. Del 09 al 13 de febrero de 1992, se presentaron cuatro casos de diarrea en neonatos de un servicio de Recién Nacidos del Hospital Nacional Edgardo Rebagliati Martins (HNERM) del Instituto Peruano de Seguridad Social (IPSS), en quienes se aisló Vibrio cholerae 01 El Tor Ogawa. El estudio descriptivo permitió identificar al día 08 de febrero como período probable de exposición, compatible con un patrón de transmisión por fuente común. El estudio microbiológico no demostró presencia de portadores asintomáticos entre las madres de los casos ni entre el personal de salud del Servicio. Se sugiere la posibilidad de transmisión a través de un vehículo común contaminado. Dada la ausencia de cuadro clínico clásico de presentación en los casos neonatales, se subraya la importancia de mejorar la definición, de caso probable de cólera infantil para la vigilancia epidemiológica, así como insistir en las medidas de prevención del cólera a nivel hospitalario
Subject(s)
Humans , Male , Female , Infant, Newborn , Cholera/diagnosis , Infant, Newborn , Peru , Vibrio cholerae/isolation & purification , Cholera/prevention & control , Cross Infection/prevention & controlABSTRACT
Se realizó un estudio en 35 sueros de agricultores (mayor ó igual a 13 años), residentes en el distrito de Sapillica, provincia de Ayabaca, departamento de Piura, a fin de determinar anticuerpos IgM e IgG a Borrelia burgdorferi utilizando la prueba de ELISA (kig Sigma Diagnostic, MO-USA). 3 (8.57 por ciento) de los 35 sueros fueron positivos con valores de indice de 1.34, 1.78 y 1.08. El descarte de reacción cruzada con otras pruebas: Venereal Disease Research Laboratory, anticuerpos treponémicos fluorescentes (FTA), factor reumatoideo (RF), reacción de aglutinación microscópica (RAM) para leptospira interrogans y biflexa y anticuerpo antinucleares (ANA), fueron negativos en todos los sueros positivos a Borrelia burgdorferi, con excepción de una muestra que fue reactiva a FTA. Los agricultores investigados han sido considerados como grupo de riesgo para Borreliosis de Lyme, por el tipo de actividad laboral que realizan y por la presencia de Haemaphysalis leporispalustris e Ixodes en Piura. Los resultados obtenidos demostraron la presencia IgM e IgG a títulos mayores del valor positivo de corte e índice, que sugieren infección producida por Borrelia burgdorferi
