Climate Change and Health: Local Solutions to Local Challenges.

PURPOSE OF REVIEW: Climate change has direct impacts on human health, but those impacts vary widely by location. Local health impacts depend on a large number of factors including specific regional climate impacts, demographics and human vulnerabilities, and existing local adaptation capacity. There is a need to incorporate local data and concerns into climate adaptation plans and evaluate different approaches. RECENT FINDINGS: The Centers for Disease Control and Prevention (CDC) has provided funding, technical assistance, and an adaptation framework to assist localities with climate planning and activities. The differing processes with which states, cities, and tribes develop and implement adaptation plans have been observed. We outline examples of the implementation of CDC's framework and activities for local adaptation, with a focus on case studies at differing jurisdictional levels (a state, a city, and a sovereign tribe). The use of local considerations and data are important to inform climate adaptation. The adaptable implementation of CDC's framework is helping communities protect health.

Practices suggested in social media for birth plans.

OBJECTIVE: To describe and analyze the practices suggested in social media for the elaboration of Birth Plans, available on Blogs/Sites and not included in the WHO recommendations. METHOD: Qualitative, exploratory, descriptive study with thematic analysis. A total of 41 e-mail addresses were selected for analysis among the 200 web addresses previously identified between March and July 2016. Three web addresses were in Portugal and the others in Brazil. RESULTS: 48 practices not included in the recommendations of the World Health Organization (WHO) were identified. CONCLUSION: Blogs/Websites, as means of transmission, circulation and production of knowledge, enable the horizontal expression of values, encourage women to plan the events considered important for their deliveries and put childbirth decisions on the hands of women, which has caused controversy in the discourse of humanization of childbirth.

A multi-stakeholder approach in optimising patients' needs in the benefit assessment process of new metastatic breast cancer treatments.

There is a growing understanding as science evolves that different cancer types require different approaches to treatment evaluation, especially in the metastatic stages. The introduction of new metastatic breast cancer (MBC) treatments may be hindered by several elements, including the availability of relevant evidence related to disease-specific outcomes, the benefit assessment process around the evaluation of the clinical benefit and the patients' need of new treatments. The Steering Committee (SC) found that not all issues relevant to MBC patients are consistently considered in the current benefit assessment process of new treatments. Among these are overall survival, time-to-event endpoints (e.g. progression-free survival), patients' priorities, burden of disease, MBC-specific quality of life, value in delaying chemotherapy, route of administration, side effects and toxicities, treatment adherence and the benefit of real-world evidence. This paper calls on decision makers to (1) Include MBC-specific patient priorities and outcomes in the overall benefit assessments of new MBC treatments; (2) Enhance multi-stakeholder collaboration in order to improve MBC patient outcomes.

Practices suggested in social media for birth plans / Prácticas sugeridas en las redes sociales sobre la planificación de los partos / Práticas sugeridas em mídias sociais para planos de parto

ABSTRACT Objective: To describe and analyze the practices suggested in social media for the elaboration of Birth Plans, available on Blogs/Sites and not included in the WHO recommendations. Method: Qualitative, exploratory, descriptive study with thematic analysis. A total of 41 e-mail addresses were selected for analysis among the 200 web addresses previously identified between March and July 2016. Three web addresses were in Portugal and the others in Brazil. Results: 48 practices not included in the recommendations of the World Health Organization (WHO) were identified. Conclusion: Blogs/Websites, as means of transmission, circulation and production of knowledge, enable the horizontal expression of values, encourage women to plan the events considered important for their deliveries and put childbirth decisions on the hands of women, which has caused controversy in the discourse of humanization of childbirth.

RESUMEN Objetivo: Describir y analizar las prácticas sugeridas en las redes sociales como Blogs/Sitios, no recomendadas por la OMS, sobre la planificación de los partos. Método: Se trata de un estudio cualitativo, exploratorio y descriptivo, de análisis temático. Entre marzo y julio de 2016, se seleccionaron 41 direcciones electrónicas de 200 identificadas con antelación. Tres estaban situadas en Portugal y las demás, en Brasil. Resultados: Se identificaron 48 prácticas no citadas entre las recomendaciones de la Organización Mundial de la Salud (OMS). Conclusión: Los Blogs/Sitios, al ser vehículos de transmisión, circulación y producción de conocimientos, permiten la expresión de valores de manera horizontal, instigando a las mujeres a planificar eventos considerados importantes para sus partos y a transferir las decisiones de las prácticas del parto para sí, lo que ha generado controversia en el discurso de la humanización del trabajo de parto.

RESUMO Objetivo: Descrever e analisar práticas sugeridas nas mídias sociais para elaboração de Planos de Partos disponíveis em Blogs/Sites e que não constam nas recomendações da OMS. Método: Estudo qualitativo, exploratório, descritivo, de análise temática. Foram selecionados para análise 41 endereços eletrônicos dos 200 previamente identificados, entre março e julho de 2016. Três endereços eletrônicos estavam sitiados em Portugal e os demais no Brasil. Resultados: Foram identificadas 48 práticas não citadas entre as recomendações da Organização Mundial da Saúde (OMS). Conclusões: Os Blogs/Sites, por serem ferramentas de transmissão, circulação e produção de conhecimentos, possibilitam a expressão de valores de forma horizontal, instigando mulheres ao planejamento dos eventos considerados importantes para seus partos e deslocando as decisões das práticas de parto para si, o que tem provocado polêmica no discurso da humanização do parto.

Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events.

Mass gathering events are associated with major public health challenges. The 2014 Lancet Series on the new discipline of mass gatherings medicine was launched at the World Health Assembly of Ministers of Health in Geneva in May, 2014. The Series covered the planning and surveillance systems used to monitor public health risks, public health threats, and experiences of health-care providers from mass gathering events in 2012 and 2013. This follow-up Review focuses on the main public health issues arising from planned mass gathering events held between 2013 and 2018. We highlight public health and research data on transmission of infectious diseases and antibiotic-resistant bacteria, mass casualty incidents, and non-communicable diseases, including thermal disorders. In the events discussed in this Review, the combination of a large influx of people, many from countries with outbreak-prone infectious diseases, with a high degree of crowd interactions imposed substantial burdens on host countries' health systems. The detection and transmission of antibiotic-resistant bacteria in pilgrims attending the Kumbh Mela and the Hajj raise concern of possible globalisation from mass-gathering religious events. Priorities for further investments and opportunities for research into prevention, surveillance, and management of these public health issues are discussed.

Mammography Adherence: Creation of a Process Change Plan to Increase Usage Rates.

BACKGROUND: Mammography is the optimal tool to mitigate breast cancer morbidity and mortality; however, in many healthcare settings, mammography adherence rates are decreasing. OBJECTIVES: This nurse-led quality improvement project was conducted to improve patient adherence to annual mammography screening. METHODS: Data collection included clinical information from the electronic health record, chart reviews, tracking documentation used by the clinic's social worker, interviews with staff, observation of the clinical setting, creation of a process flow map to identify barriers, and identification of internal and external resources. Strategies to reduce barriers included communication with staff about problems, a streamlined referral process, a scripted message about mammography, an up-front assessment of financial and social barriers to adherence, and an early referral to resources. FINDINGS: A pre-process change chart audit showed a 22% mammography adherence rate. The post-process change rate was 51%, representing a statistically significant difference in adherence.

Improving social skills in care management provided by nurses: intervention research.

OBJECTIVE: to analyze the process of introducing an educational intervention for the improvement of social skills in care management provided by nurses. METHOD: intervention research, according to its complexity, carried out in a South-Brazilian public university hospital. To identify learning needs, 11 nurses were interviewed and educational meetings were held with 20 participants, who evaluated with open-ended questions: what they would stop doing; what they would continue doing; and what they would start doing on the issues addressed. The data was analyzed comprehensively. RESULTS: we developed 30 educational hours on social skills of communication, work, assertiveness, and other themes inherent in care management mentioned by the participants as deficient. The evaluation revealed intentions of advances in: self-monitoring, communication, empathy, assertiveness, leadership and search for knowledge. Monthly meetings on care management were formally requested by the institution. FINAL CONSIDERATIONS: social skills are intertwined in care management relationships and their improvement has proved to be dialogical, recursive and hologrammatic.

Beyond cost-effectiveness, morbidity and mortality: a comprehensive evaluation of priority setting for HIV programming in Uganda.

BACKGROUND: While there has been progress in controlling the HIV epidemic, HIV still remains a disease of global concern. Some of the progress has been attributed to increased public awareness and uptake of public health interventions, as well as increased access to anti- retroviral treatment and the prevention of vertical HIV transmission. These interventions would not have been possible without substantial investments in HIV programs. However, donor fatigue introduces the need for low income countries to maximize the benefits of the available resources. This necessitates identification of priorities that should be funded. Evaluating prioritization processes would enable decision makers to assess the effectiveness of their processes, thereby designing intervention strategies. To date most evaluations have focused on cost-benefit analyses, which overlooks additional critical impacts of priority setting decisions. Kapiriri & Martin (2010) developed and validated a comprehensive framework for evaluating PS in low income countries. The objective of this paper report findings from a comprehensive evaluation of priority setting for HIV in Uganda, using the framework; and to identify lessons of good practice and areas for improvement. METHODS: This was a qualitative study based on forty interviews with decision makers and policy document review. Data were analysed using INVIVO 10, and based on the parameters in Kapiriri et al's evaluation framework. RESULTS: We found that HIV enjoys political support, which contributes to the availability of resources, strong planning institutions, and participatory prioritization process based on some criteria. Some of the identified limitations included; undue donor and political influence, priorities not being publicized, and lack of mechanisms for appealing the decisions. HIV prioritization had both positive and negative impacts on the health system. CONCLUSIONS: The framework facilitated a more comprehensive evaluation of HIV priority setting. While there were successful areas, the process could be strengthened by minimizing undue influence of external actors, and support the legitimate institutions to set priorities and implement them. These should also institute mechanisms for publicizing the decisions, appeals and increased accountability. While this paper looked at HIV, the framework is flexible enough to be used in evaluating priority setting for other health programs within similar context.

Predictors of midwives' intention to provide planned home birth services to low-risk women: A theory of planned behaviour approach.

OBJECTIVE: Planned home birth may increase women's access to skilled midwives in all settings. Using theory to understand and predict midwives' intention regarding planned home birth services is rare. Therefore, using the theory of planned behaviour, we determined the factors associated with midwives' intention to provide planned home birth services to low-risk women. DESIGN: This cross-sectional study adopted a quantitative approach and a survey. Stratified random sampling was used to recruit 226 midwives in Sokoto, Nigeria. Data-including descriptive statistic and multiple linear regression analyses-were analysed using SPSS 23 and significant was set at 0.05. SETTING: Ten public health facilities in Sokoto, northwestern Nigeria. PARTICIPANTS: Among all 460 midwives (women aged 20-60 years), working in the maternity wards of health facilities in Sokoto, a sample of 226 midwives was calculated using a power of 0.80 and a 95% confidence interval. FINDINGS: The multiple linear regression analyses confirmed that the major factors associated with midwives' intention to provide planned home birth services were midwives' attitude towards planned home birth (p < .001) and midwives' previous experience with planned home birth practice (p = .008). CONCLUSIONS AND IMPLICATIONS: The theory of planned behaviour is a useful framework for identifying factors that affect midwives' intention to provide planned home birth services. While future research may employ a qualitative approach to explore other factors, planned home birth education campaigns should target information that enhances positive attitude and encourages midwives to provide planned home birth services.

You Don't Know What You Don't Know: Using Nominal Group Technique to Identify and Prioritize Education Topics for Regional Hospitals.

BACKGROUND: Our 121-bed children's hospital is a quaternary care referral center for a 33-county region. Referring hospitals asked for Pediatric Acute Care Education Sessions (PACES). To determine which topics to prioritize for these sessions, nominal group technique (NGT) methods were used to obtain stakeholder-prioritized consensus on education topics. METHODS: Five NGT sessions were conducted over 6 weeks at referring hospitals throughout central and northern California. Each session lasted ∼90 minutes and engaged a diverse multidisciplinary group of stakeholders. At these sessions, stakeholders answered the question "What are your top 5 clinical topics that should be prioritized by PACES?" NGT numeric ranking methods were used to determine prioritized topics. A thematic analysis was performed on the session transcripts. RESULTS: The 5 sessions had 43 total participants, including nurses, respiratory therapists, physicians, and administrators. The top 4 prioritized topics were sepsis, diabetic ketoacidosis, respiratory failure or support, and bronchiolitis and/or respiratory syncytial virus. Unique education needs for each hospital were also uncovered in the NGT discussion. Three qualitative themes emerged from the discussion: diverse educational needs, the need for guidelines on telemedicine and transfer, and relationship building. CONCLUSIONS: The use of NGT to engage multisite, multidisciplinary stakeholders helped to inform an education program. The use of NGT methods provided rich information that would not have been obtained through surveys alone and helped facilitate relationship building. The PACES group was able to identify and prioritize education topics of interest to referring community hospitals.

Improving social skills in care management provided by nurses: intervention research / Mejoramiento de habilidades sociales en gerencia del cuidado practicada por enfermeros: una investigación-intervención / Aprimoramento de habilidades sociais à gerência do cuidado praticada por enfermeiros: pesquisa-intervenção

ABSTRACT Objective: to analyze the process of introducing an educational intervention for the improvement of social skills in care management provided by nurses. Method: intervention research, according to its complexity, carried out in a South-Brazilian public university hospital. To identify learning needs, 11 nurses were interviewed and educational meetings were held with 20 participants, who evaluated with open-ended questions: what they would stop doing; what they would continue doing; and what they would start doing on the issues addressed. The data was analyzed comprehensively. Results: we developed 30 educational hours on social skills of communication, work, assertiveness, and other themes inherent in care management mentioned by the participants as deficient. The evaluation revealed intentions of advances in: self-monitoring, communication, empathy, assertiveness, leadership and search for knowledge. Monthly meetings on care management were formally requested by the institution. Final considerations: social skills are intertwined in care management relationships and their improvement has proved to be dialogical, recursive and hologrammatic.

RESUMEN Objetivo: analizar el proceso de implementación de una intervención educativa para el mejoramiento de habilidades sociales en gestión del cuidado en enfermeros. Método: investigación-intervención, bajo la luz de la complejidad, realizada en un hospital universitario público sur-brasileño. Se entrevistó a 11 enfermeros para identificar las necesidades de aprendizaje y se realizaron encuentros educativos con 20 participantes, que evaluaron con cuestiones abiertas: lo que dejarían de hacer, lo que continuarían haciendo y lo que comenzarían a hacer en las temáticas abordadas. Los datos fueron analizados comprensivamente. Resultados: se desarrollaron 30 horas educativas sobre habilidades sociales de comunicación, asertividad, de trabajo y otras temáticas inherentes a la gestión del cuidado mencionadas por los participantes como deficitarias. La evaluación reveló intenciones de progreso en: automonitoría, comunicación, empatía, asertividad, liderazgo y búsqueda de conocimiento. Solicitaron formalmente a la institución encuentros mensuales sobre la gestión del cuidado. Consideraciones finales: las habilidades sociales se entrelazan en las relaciones de la gestión del cuidado y su mejoramiento se reveló dialógico, recursivo y hologramático.

RESUMO Objetivo: analisar o processo de implementação de uma intervenção educativa para o aprimoramento de habilidades sociais à gerência do cuidado em enfermeiros. Método: pesquisa-intervenção, à luz da complexidade, realizada em hospital universitário público sul-brasileiro. Entrevistaram-se 11 enfermeiros para identificar necessidades de aprendizado e implementaram-se encontros educativos com 20 participantes, que avaliaram com questões abertas: o que deixariam de fazer, o que continuariam fazendo e o que iniciariam a fazer nas temáticas abordadas. Os dados foram analisados compreensivamente. Resultados: desenvolveram-se 30 horas educativas sobre habilidades sociais de comunicação, e de trabalho, assertividade, e outras temáticas inerentes à gerência do cuidado mencionadas pelos participantes como deficitárias. A avaliação revelou intenções de avanços em: automonitoria, comunicação, empatia, assertividade, liderança e busca por conhecimento. Solicitaram formalmente à instituição encontros mensais sobre gerência do cuidado. Considerações finais: as habilidades sociais entrelaçam-se nas relações da gerência do cuidado e o seu aprimoramento revelou-se dialógico, recursivo e hologramático.

Autonomous and dependent-The dichotomy of birth: A feminist analysis of birth plans in Sweden.

OBJECTIVE: To elicit pregnant women's perceptions of childbirth as expressed in their birth plans, and through a feminist lens analyse their wishes, fears, values, and beliefs about childbirth, as well as their expectations on partner and midwife. DESIGN: This study used qualitative content analysis, identifying subcategories, categories, and an overall theme in data gathered from women's written birth plans. A feminist theoretical framework underpinned the research. SETTING: A middle-sized city in northern Sweden. PARTICIPANTS: 132 women who gave birth in an obstetrician-led hospital labour ward between March and June 2016 and consented to grant access to their birth plans and antenatal and intrapartum electronic medical records. FINDINGS: Three categories emerged: 'Keeping integrity intact through specific requests and continuous dialogue with the midwife', 'A preference towards a midwife-supported birth regardless of method of pain relief", and '"Help my partner help me" - Women anticipating partner involvement.' The overall theme linking the categories together was: 'Autonomous and dependent - The dichotomy of birth', portraying women's ambiguity before birth -expressing a wish to remain in control while simultaneously letting go of control by entrusting partner and midwifewith decision-making regarding their own bodies. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Women primarily desired a natural, midwife-supported birth and favoured a relationship-based, woman-centred model of care, based on the close interaction between woman, partner, and midwife. Midwives need to be aware of women's ambiguous reliance on them and the power they have to influence women's birth choices and birth experiences. Feminist theory and values in midwifery practice may be useful to inspire a maternity care based on women's wishes and expectations, acknowledging and valuing women's voices, and embracing the sanctity of birth and of the birthing woman's body.

Evidence for national universal eye health plans.

Many low- and middle-income countries use national eye-care plans to guide efforts to strengthen eye-care services. The World Health Organization recognizes that evidence is essential to inform these plans. We assessed how evidence was incorporated in a sample of 28 national eye-care plans generated since the Universal eye health: a global action plan 2014-2019 was endorsed by the World Health Assembly in 2013. Most countries (26, 93%) cited estimates of the prevalence of blindness and 18 countries (64%) had set targets for the cataract surgical rate in their plan. Other evidence was rarely cited or used to set measurable targets. No country cited evidence from systematic reviews or solution-based research. This limited use of evidence reflects its low availability, but also highlights incomplete use of existing evidence. For example, despite sex-disaggregated data and cataract surgical coverage being available from surveys in 20 countries (71%), these data were reported in the eye health plans of only nine countries (32%). Only three countries established sex-disaggregated indicators and only one country had set a target for cataract surgical coverage for future monitoring. Countries almost universally recognized the need to strengthen health information systems and almost one-third planned to undertake operational or intervention research. Realistic strategies need to be identified and supported to translate these intentions into action. To gain insights into how a country can strengthen its evidence-informed approach to eye-care planning, we reflect on the process underway to develop Kenya's seventh national plan (2019-2023).

De nombreux pays à revenu faible et intermédiaire ont recours à des plans nationaux de santé oculaire pour guider les actions visant à renforcer les services d'ophtalmologie. L'Organisation mondiale de la Santé reconnaît qu'il est essentiel de disposer de données factuelles pour orienter ces plans. Nous avons évalué la manière dont ces données factuelles ont été intégrées à un échantillon de 28 plans nationaux de santé oculaire, élaborés depuis l'adoption par l'Assemblée Mondiale de la Santé, en 2013, du document Santé oculaire universelle: plan d'action mondial 2014­2019. La plupart des pays (26, soit 93%) ont indiqué utiliser des estimations de la prévalence de la cécité et 18 pays (64%) avaient fixé des objectifs relatifs au taux de chirurgie de la cataracte dans leur plan. D'autres types de données factuelles ont rarement été mentionnés ou utilisés pour définir des objectifs mesurables. Aucun pays n'a mentionné de données issues de revues systématiques ou de recherches fondées sur des solutions. Cette utilisation limitée des données factuelles reflète leur faible accessibilité, mais aussi l'usage incomplet des données existantes. Par exemple, bien que des enquêtes menées dans 20 pays (71%) donnent accès à des données ventilées par sexe et au taux de couverture de la chirurgie de la cataracte, seuls neuf pays (32%) ont reporté ces données dans leur plan de santé oculaire. Seuls trois pays ont mis en place des indicateurs ventilés par sexe et un seul a défini un objectif de couverture de la chirurgie de la cataracte pour en suivre l'évolution. La quasi-totalité des pays a reconnu qu'il était nécessaire de renforcer les systèmes d'information sanitaire et près d'un tiers prévoyait d'entreprendre des recherches opérationnelles ou interventionnelles. Il faudra définir et mettre en œuvre des stratégies réalistes pour passer de l'intention à l'action. Pour en savoir plus sur la manière dont un pays peut renforcer son approche d'élaboration de plans de santé oculaire à partir de données factuelles, nous nous intéressons à l'élaboration, en cours, du septième plan national du Kenya (2019­2023).

Muchos países con ingresos entre bajos y medios utilizan planes nacionales de atención oftalmológica para orientar los esfuerzos a fortalecer los servicios de atención oftalmológica. La Organización Mundial de la Salud reconoce que las pruebas son esenciales para informar a estos planes. Se evaluó cómo se incorporaron las pruebas en una muestra de 28 planes nacionales de atención oftalmológica generados desde que la Asamblea Mundial de la Salud aprobó Universal eye health: a global action plan 2014­2019 (Atención oftalmológica universal: un plan de acción mundial para 2014-2019) en 2013. La mayoría de los países (26, 93 %) citaron estimaciones de la prevalencia de la ceguera y 18 países (64 %) habían establecido metas para la tasa quirúrgica de cataratas en sus planes. Rara vez se citaron o utilizaron otras pruebas para establecer objetivos mensurables. Ningún país citó pruebas de revisiones sistemáticas o investigaciones basadas en soluciones. Este uso limitado de las pruebas refleja su baja disponibilidad, pero también destaca el uso incompleto de las pruebas existentes. Por ejemplo, a pesar de que los datos desglosados por sexo y la cobertura quirúrgica de cataratas están disponibles en las encuestas de 20 países (71 %), estos datos solo se reflejaron en los planes de atención oftalmológica de nueve países (32 %). Solo tres países establecieron indicadores desglosados por sexo y solo un país había establecido una meta para la cobertura quirúrgica de cataratas para el seguimiento futuro. Los países reconocieron casi universalmente la necesidad de fortalecer los sistemas de información sanitaria y casi un tercio tenía previsto realizar investigaciones operacionales o de intervención. Es necesario identificar y apoyar estrategias realistas para convertir estas intenciones en acciones. Para comprender mejor cómo un país puede fortalecer su enfoque basado en pruebas para la planificación de la atención oftalmológica, se ha analizado el proceso en curso para desarrollar el séptimo plan nacional en Kenia (2019-2023).