The medical competence of health care providers in sub-Saharan Africa: Evidence from 16 127 providers across 11 countries.

Despite a consensus that quality of care is critically deficient in low-income countries, few nationally representative studies provide comparable measures of quality of care across countries. To address this gap, we used nationally representative data from in-person administrations of clinical vignettes to measure the competence of 16 127 health care providers across 11 sub-Saharan African countries. Rather than large variations across countries, we found that 81% of the variation in competence is within countries and the characteristics of health care providers do not explain most of this variation. Professional qualifications-including cadre and education-are only weakly associated with competence: across our sample, one-third of nurses are more competent than the average doctor in the same country and one-quarter of doctors are less competent than the average nurse. Finally, while younger cohorts do tend to be more competent, perhaps reflecting improvements in medical education, it would take 25 decades of turnover to improve care by 10 percentage points, on average, if we were to rely on such improvements alone. These patterns necessitate a fundamentally different approach to health care human resource management, calling into question typical staffing policies based on qualifications and seniority rather than directly measured quality.

Clinical features and potential markers of disease in idiopathic non-histaminergic angioedema, a real-life study.

Idiopathic non-histaminergic acquired angioedema (InH-AAE) is a rare disease, with unknown etiology and pathogenesis, characterized by recurrent clinical manifestations and resistance to antihistamines and corticosteroids. We aim to evaluate clinical features and potential markers of disease in an Italian cohort of patients with InH-AAE. We enrolled 26 patients diagnosed with InH-AAE. Information about clinical features, treatments, routine laboratory investigations, immunological and genetic tests were collected. We assessed plasma levels of complement components, angiogenic and lymphangiogenic mediators, proinflammatory cytokines and chemokines, and activity of phospholipases A2. Finally, patients underwent nailfold videocapillaroscopy (NVC); both quantitative and qualitative capillaroscopic parameters were analyzed. Plasma levels of VEGFs were similar in healthy controls and in InH-AAE patients. ANGPT1 was decreased in InH-AAE patients compared to controls while ANGPT2 was similar to controls. Interestingly, the ANGPT2/ANGPT1 ratio (an index of vascular permeability) was increased in InH-AAE patients compared to controls. sPLA2 activity, elevated in patients with C1-INH-HAE, showed differences also when measured in InH-AAE patients. TNF-α concentration was higher in InH-AAE patients than in healthy controls, conversely, the levels of CXCL8, and IL-6 were similar in both groups. At the NVC, the capillary loops mainly appeared short and tortuous in InH-AAE patients. InH-AAE represents a diagnostic challenge. Due to the potential life-threatening character of this condition, a prompt identification of the potentially bradykinin-mediated forms is crucial. A better comprehension of the mechanism involved in InH-AAE would also lead to the development of new therapeutic approaches to improve life quality of patients affected by this disabling disease.

Human resource challenges in health systems: evidence from ten African countries.

Sub-Saharan Africa has fewer medical workers per capita than any region of the world, and that shortage has been highlighted consistently as a critical constraint to improving health outcomes in the region. This paper draws on newly available, systematic, comparable data from ten countries in the region to explore the dimensions of this shortage. We find wide variation in human resources performance metrics, both within and across countries. Many facilities are barely staffed, and effective staffing levels fall further when adjusted for health worker absences. However, caseloads-while also varying widely within and across countries-are also low in many settings, suggesting that even within countries, deployment rather than shortages, together with barriers to demand, may be the principal challenges. Beyond raw numbers, we observe significant proportions of health workers with very low levels of clinical knowledge on standard maternal and child health conditions. This work demonstrates that countries may need to invest broadly in health workforce deployment, improvements in capacity and performance of the health workforce, and on addressing demand constraints, rather than focusing narrowly on increases in staffing numbers.

Analysis of the lateral push-off in the freestyle flip turn.

The aim of this study was to examine the contact phase during the lateral push-off in the turn of front crawl swimming to determine which biomechanical variables (maximum normalized peak force, contact time, impulse, angle of knee flexion, and total turn time within 15 m) contribute to the performance of this turn technique. Thirty-four swimmers of state, national, and international competitive standard participated in the study. For data collection, the following equipment was used: an underwater force platform, a 30-Hz VHS video camera, and a MiniDv digital camera within an underwater box. Data are expressed as descriptive statistics. Inferential analyses were performed using Pearson's correlation and multiple linear regressions. All variables studied had a significant relationship with turn performance. We conclude that a turn executed with a knee flexion angle of between 100° and 120° provides optimum peak forces to generate impulses that allow the swimmer to lose less time in the turn without the need for an excessive force application and with less energy lost.

Desempenho visual de lentes de contato gelatinosas de diferentes tipos baseado na análise de frentes de onda / Optical performance of different soft contact lenses based on wavefront analysis

OBJETIVOS: Avaliar e comparar o desempenho visual, por meio da análise de frentes de onda, de seis diferentes tipos de lentes de contato gelatinosas [Cooperflex® (Coopervision), Frequency® 55 Aspheric (Coopervision), World Vision FW® (World Vision), Pure Vision® (Bausch & Lomb), Focus® Monthly (Ciba Vision), Focus® Choice AB (Ciba Vision)]. MÉTODOS: Realizou-se estudo prospectivo em amostra constituída por 130 olhos de 71 indivíduos portadores de miopia ou hipermetropia até 6,00D e astigmatismo até 1,50D, com acuidade visual corrigida com óculos igual ou superior a 20/20. Os sujeitos foram inicialmente submetidos ao exame clínico oftalmológico e posteriormente, ao exame de análise de frentes de onda com o aberrômetro LADARWave® (Alcon), em duas condições: sem correção óptica e em uso de um dos tipos de lente de contato incluídos no estudo, com grau correspondente ao equivalente esférico do paciente e corrigido pela distância vértice. Para análise de resultados os indivíduos foram divididos em seis grupos similares, sendo testado em cada grupo um dos tipos de lente incluídos no estudo. RESULTADOS: Mudanças nos valores das aberrações de alta ordem foram verificadas durante uso das lentes de contato. De 130 olhos estudados, 78 apresentaram aumento no valor de RMS total durante o uso da lente. Os seis tipos de lente estudados demonstraram tendência ao aumento no valor médio de RMS total durante seu uso, sem diferença estatisticamente significante entre as mesmas. O estudo demonstrou tendência ao aumento no valor médio das aberrações tipo "coma" durante o uso das lentes. As lentes Frequency® Aspheric e Cooperflex® apresentaram melhor desempenho visual em relação ao "coma". O estudo demonstrou tendência à diminuição no valor médio das aberrações esféricas durante o uso das lentes, sendo esta tendência maior nos pacientes míopes em relação aos hipermétropes. Foi demonstrado tendência ao aumento no valor médio de outras aberrações de alta ordem...

PURPOSE: To evaluate the visual performance by wavefront analyses of six different kinds of soft contact lenses: Cooperflex® (Cooper Vision), Frequency® 55 Aspheric (Cooper Vision), World Vision FW® (World Vision), Pure Vision® (Bausch & Lomb), Focus® Monthly (Ciba Vision) and Focus® Choice AB (Ciba Vision). METHODS: A prospective study was performed with 130 eyes of 71 myopic or hyperopic patients with astigmatism until 1.50 diopter and best corrected visual acuity 20/20 or better. The patients first underwent ophthalmic examination and then wavefront analyses without visual correction and wearing one of the different contact lenses included in the study. The patients were divided into six similar groups, each one tested with one of the six lenses included in the study. RESULTS: Changes at the values of high order aberrations were verified during the use of contact lenses. In 78 (60 percent) of the 130 analyzed eyes an increase at the RMS (rooth mean square) values during the use of contact lens was detected. All types of analyzed contact lenses showed an increase of "coma" aberrations due to contact lens use. Frequency® Aspheric and Cooperflex® had the best visual performance in relation to "coma". There was a decrease in the medium value of spherical aberrations during the use of contact lenses, higher in myopic patients than in the hyperopic. There was an increase in the other high order aberrations (that exclude the third order "coma" and fourth order spherical aberration) characterized by the component "others" on the aberrometry examination. Focus® Choice AB had the best visual performance of this component. CONCLUSION: The use of soft contact lenses modifies the performance of high order aberrations, showing an increase of the medium values of asymmetric Zernike aberrations. This was not observed for symmetric spherical aberrations. No statistically significant differences were observed between the performance of six kinds of...

[Optical performance of different soft contact lenses based on wavefront analysis]. / Desempenho visual de lentes de contato gelatinosas de diferentes tipos baseado na análise de frentes de onda.

PURPOSE: To evaluate the visual performance by wavefront analyses of six different kinds of soft contact lenses: Cooperflex (Cooper Vision), Frequency(R) 55 Aspheric (Cooper Vision), World Vision FW (World Vision), Pure Vision (Bausch & Lomb), Focus Monthly (Ciba Vision) and Focus Choice AB (Ciba Vision). METHODS: A prospective study was performed with 130 eyes of 71 myopic or hyperopic patients with astigmatism until 1.50 diopter and best corrected visual acuity 20/20 or better. The patients first underwent ophthalmic examination and then wavefront analyses without visual correction and wearing one of the different contact lenses included in the study. The patients were divided into six similar groups, each one tested with one of the six lenses included in the study. RESULTS: Changes at the values of high order aberrations were verified during the use of contact lenses. In 78 (60%) of the 130 analyzed eyes an increase at the RMS (rooth mean square) values during the use of contact lens was detected. All types of analyzed contact lenses showed an increase of 'coma' aberrations due to contact lens use. Frequency Aspheric and Cooperflex had the best visual performance in relation to 'coma'. There was a decrease in the medium value of spherical aberrations during the use of contact lenses, higher in myopic patients than in the hyperopic. There was an increase in the other high order aberrations (that exclude the third order 'coma' and fourth order spherical aberration) characterized by the component 'others' on the aberrometry examination. Focus Choice AB had the best visual performance of this component. CONCLUSION: The use of soft contact lenses modifies the performance of high order aberrations, showing an increase of the medium values of asymmetric Zernike aberrations. This was not observed for symmetric spherical aberrations. No statistically significant differences were observed between the performance of six kinds of lenses included at this study.

Respostas fisiológicas e biomecânicas de nadadores em diferentes intensidades de nado / Physiological and biomechanical responses of swimmers at different swimming intensities

O objetivo deste estudo foi analisar as respostas fisiológicas e biomecânicas de nadadores em diferentesintensidades de nado. A amostra, intencionalmente escolhida, foi composta por sete atletas que possuíam índices de participação em campeonato brasileiro absoluto. Foi utilizada como tarefa de estudo uma série de 8x200 metros nado livre com velocidades de 80, 85, 90, 95 e 100 do percentual de esforço de cada nadador.Como instrumento utilizou-se uma filmadora 60Hz e um lactímetro da Accusport mMol. No tratamento estatísticofez-se uso da estatística descritiva, análise de variância (ANOVA), post-hoc Tukey e correlação de Spearman,todos com nível de significância de 95. Buscou-se com a análise estatística identificar as diferenças entre os atletas para as variáveis lactato sanguíneo, frequência de braçada (FB) e dimensão de braçada (BR) nas diferentes intensidades. A partir dos resultados pode-se constatar que os atletas apresentaram diferenças estatisticamente significantes entre as intensidades de esforço, tanto nas respostas fisiológica quanto na biomecânica da técnica de nado, situação observada, principalmente, em níveis acima de 95 de esforço. Constatou-se também alta correlação entre as variáveis lactato com freqüência de braçada, e com o comprimento da braçada, e da freqüência de braçada com o comprimento de braçada, sendo as duas últimas inversas, indicando que a série utilizada foi adequada para analisar respostas fisiológica e biomecânica em nadadores. Os resultados possibilitaram concluir que com o aumento da intensidade há necessidade de ajustes mecânicos para que os atletas possam suportar diferentes velocidades. Também foi possível estabelecer a velocidade de nado ideal para cada zona energética, fornecendo subsídios para técnicos e atletas treinarem as variáveis velocidade e técnica de nado dentro das zonas energéticas específicas