Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 34.630
Filtrar
1.
Rev. enferm. UERJ ; 32: e77903, jan. -dez. 2024.
Artigo em Inglês, Espanhol, Português | LILACS-Express | LILACS | ID: biblio-1554456

RESUMO

Objetivo: compreender as percepções e as ações de uma equipe multiprofissional em saúde quanto à prática da medicina tradicional indígena em uma Casa de Atenção à Saúde Indígena. Método: estudo qualitativo descritivo, realizado em uma de Casa de Apoio à Saúde Indígena em um município do Pará, que incluiu oito profissionais de uma equipe multiprofissional. A coleta de dados foi realizada no ano de 2018 e estes foram examinados pelo método da análise de conteúdo. Resultados: inserção e prática do cristianismo; ritos e lideranças xamânicas; e postura da equipe de multidisciplinar foram as categorias elencadas, que apontam os entendimentos e atuações da equipe multiprofissional e da organização espacial da Casa de Saúde do município. Considerações finais: há novos costumes e valores entre as etnias, em virtude da aproximação de grupos religiosos, cujas ações foram registradas e apreendidas pela equipe de trabalhadores em saúde.


Objective: understanding the perceptions and actions of a multi-professional health team regarding the practice of traditional indigenous medicine in an Indigenous Health Care Center. Method: this is a descriptive qualitative study carried out in an Indigenous Health Support Center in a municipality in the state of Pará, which included eight professionals from a multi-professional team. Data was collected in 2018 and examined using the content analysis method. Results: insertion and practice of Christianity; shamanic rites and leadership; and the attitude of the multidisciplinary team were the categories listed, which point to the understandings and actions of the multi-professional team and the spatial organization of the Health Center in the municipality. Final considerations: there are new customs and values among ethnic groups, due to the approach of religious groups, whose actions were recorded and apprehended by the team of health workers.


Objetivo: comprender las percepciones y acciones de un equipo multidisciplinario de salud sobre la práctica de la medicina tradicional indígena en una Casa de Atención para la Salud Indígena. Método: estudio descriptivo cualitativo, realizado en una Casa de Apoyo a la Salud Indígena de un municipio de Pará, que incluyó ocho profesionales de un equipo multidisciplinario. La recolección de datos se realizó en 2018 y los datos fueron sometidos al método de análisis de contenido. Resultados: inserción y práctica del cristianismo; ritos y líderes chamánicos; y actitud del equipo multidisciplinario fueron las categorías enumeradas, que indican la percepción y las acciones del equipo multidisciplinario y la organización espacial de la Casa de Salud del municipio. Consideraciones finales: existen nuevas costumbres y valores entre las etnias, debido a la presencia de grupos religiosos, el equipo de los trabajadores de la salud registró y aprendió las acciones de los indígenas.

2.
Univ. salud ; 26(2): D16-D27, mayo-agosto 2024. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1553971

RESUMO

Introducción: La pandemia por COVID-19 ha afectado significativamente la calidad de los servicios de cuidado de la salud. Objetivo: Analizar los efectos en los atributos de la calidad en salud de los servicios de atención de enfermedades diferentes a la COVID-19 en Colombia, durante el periodo 2020-2022. Materiales y métodos: Se analizaron 24 artículos de alcance nacional y otros específicos de departamentos como Antioquia, Córdoba, Santander y Cundinamarca. Resultados: La pandemia por COVID-19 impactó la calidad de los servicios en la atención de enfermedades como cáncer, accidentes cerebrovasculares y de eventos como la interrupción voluntaria del embarazo. Conclusión: La calidad de la salud se vio afectada en todas sus dimensiones durante las fases de la pandemia, especialmente en la población con enfermedades crónicas y relacionadas con la salud infantil y materna. Además, se destacaron respuestas como el uso de la telemedicina y de la atención domiciliaria para contribuir a la calidad de la salud en Colombia.


Introduction: The COVID-19 pandemic has significantly affected the quality of health care services. Objective: To analyze the effects of COVID-19 on the quality of health care services focused on treating diseases other than COVID-19 in Colombia during the 2020-2022 period. Materials and methods: 24 articles were analyzed, which included some studies focused on national issues and others specific to the departments of Antioquia, Cordoba, Santander, and Cundinamarca. Results: The COVID-19 pandemic affected the quality of health services caring for diseases such as cancer, strokes, and critical circumstances like voluntary termination of pregnancy. Conclusion: All dimensions of health care were affected during the pandemic, especially impacting populations with chronic diseases and diseases related to child and maternal health. It is important to highlight that telemedicine and home care contributed to improving the quality of health in Colombia.


Introdução: A pandemia de COVID-19 afetou significativamente a qualidade dos serviços de saúde. Objetivo: Analisar os efeitos da COVID-19 nos atributos de qualidade em saúde dos serviços de atenção a outras doenças além da COVID-19 na Colômbia, durante o período 2020-2022. Materiais e métodos: foram analisados 24 artigos de âmbito nacional e outros específicos de departamentos como Antioquia, Córdoba, Santander e Cundinamarca. Resultados: A pandemia da COVID-19 impactou a qualidade dos serviços no cuidado de doenças como câncer, acidente vascular cerebral e eventos como a interrupção voluntária da gravidez. Conclusão: A qualidade da saúde foi afetada em todas as suas dimensões durante as fases da pandemia, especialmente na população com doenças crônicas e doenças relacionadas à saúde infantil e materna. Além disso, foram destacadas respostas como o uso da telemedicina e do atendimento domiciliar para contribuir para a qualidade da saúde na Colômbia.


Assuntos
Humanos , Masculino , Feminino , Atenção à Saúde , Acessibilidade aos Serviços de Saúde
3.
Ann Glob Health ; 90(1): 47, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39070076

RESUMO

Background: The COVID-19 pandemic resulted in drops in access to and availability of a number of evidence-based interventions (EBIs) known to reduce under-5 mortality (U5M) across a wide range of countries, including Rwanda. We aimed to understand the strategies and contextual factors associated with preventing or mitigating drops nationally and subnationally, and the extent to which previous efforts to reduce U5M supported the maintenance of healthcare delivery. Methods: We used a convergent mixed methods implementation science approach, guided by hybrid implementation research and resiliency frameworks. We triangulated data from three sources: desk review of available documents, existing routine data from the health management information system, and key informant interviews (KIIs). We analyzed quantitative data through scatter plots using interrupted time series analysis to describe changes in EBI access, uptake, and delivery. We used a Poisson regression model to estimate the impact of COVID-19 on health management information system indicators, adjusting for seasonality. We used thematic analysis of coded interviews to identify emerging patterns and themes. Results: We found moderate 4% (IRR = 0.96; 95%CI: 0.93, 1.00) and 5% (IRR = 0.95; 95%CI: 0.92, 0.99) drops in pentavalent and rotavirus 2 doses vaccines administered, respectively. Nationally, there was a 5% drop in facility-based delivery (IRR = 0.95; 95%CI: 0.92, 0.99). Lockdown and movement restrictions and community and health-worker fear of COVID-19 were barriers to service delivery early in the pandemic. Key implementation strategies to prevent or respond to EBI drops included leveraging community-based healthcare delivery, data use for decision-making, mentorship and supervision, and use of digital platform. Conclusions: While Rwanda had drops in some EBIs early in the pandemic, especially during the initial lockdown, this was rapidly identified, and response implemented. The resiliency of the health system was associated with the Rwandan health system's ability to learn and adapt, encouraging a flexible response to fit the situation.


Assuntos
COVID-19 , Ciência da Implementação , SARS-CoV-2 , Humanos , Ruanda/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Pré-Escolar , Atenção à Saúde/organização & administração , Lactente , Mortalidade Infantil , Prática Clínica Baseada em Evidências , Recém-Nascido , Análise de Séries Temporais Interrompida
4.
Port J Public Health ; : 1-8, 2024 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-39070594

RESUMO

Introduction: Respiratory diseases, ranking the third in Portugal, contribute significantly to illness and mortality. Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death globally. Identifying high-risk individuals and implementing early treatment is crucial due to the variability of COPD symptoms and exacerbations. This study aimed to identify effective strategies for preventing exacerbations and complications. Methods: A Delphi involving 15 experts was performed. Experts included physicians, nurses, health managers, policymakers, public health experts, and patient organizations. Consensus was achieved at 73.3% for each strategy using a scale ranging from "agree" to "disagree." Three rounds were conducted to address six questions related to early diagnosis and patient follow-up. Challenges faced by the Portuguese Health System in managing COPD, obstacles in COPD exacerbation diagnosis and management, and effective strategies to overcome barriers were identified in the first round. The second and third rounds involved analyzing the gathered information and voting on each indicator to achieve consensus, respectively. Indicators were categorized into constraints and barriers, and strategies for reducing COPD exacerbations and disease burden. Results: Out of a total of 134 valid indicators generated, 108 achieved consensus. Among the indicators agreed upon by experts, 18 pertained to barriers, challenges, and constraints, while 90 focused on action strategies for COPD. Among the strategies formulated, 25 consensus indicators target prevention strategies, 24 consensus indicators aim to enhance COPD referrals, and 41 consensus indicators focus on mitigating COPD exacerbations and reducing the overall disease burden. Discussion/Conclusion: This study emphasizes the need for integrated investment in respiratory healthcare and recognition of the impact of COPD on patients, healthcare systems, and economies. Prevention and appropriate treatment of exacerbations are crucial for effective COPD management and reducing associated morbidity and mortality. Experts highlight the importance of improving coordination between different levels of care, integrating information systems, and decentralizing hospital responsibilities. The COVID-19 pandemic has further emphasized the importance of individual and collective respiratory health, necessitating investment in health promotion and COPD awareness.


Introdução: As doenças respiratórias são uma das principais causas de doença e morte, ocupando o terceiro lugar em Portugal. Globalmente, a Doença Pulmonar Obstrutiva Crónica (DPOC) é a terceira principal causa de morte, a seguir às doenças cardiovasculares e ao acidente vascular cerebral. Identificar indivíduos de alto risco e implementar tratamento precoce é crucial devido à variabilidade dos sintomas e exacerbações na DPOC. Este estudo teve como objetivo determinar estratégias eficazes para prevenir exacerbações e complicações relacionadas. Métodos: Foi desenvolvido um estudo Delphi que envolveu 15 especialistas de diversas áreas, incluindo médicos, enfermeiros, gestores de saúde, decisores políticos, especialistas em saúde pública e representantes de organizações de pessoas com doença. Os especialistas utilizaram uma escala, variando de "Concordo" a "Discordo", para alcançar um nível de consenso de 73,3% para cada estratégia. Foram realizadas três rodadas para abordar seis perguntas relacionadas com o diagnóstico precoce e seguimento dos doentes. A primeira ronda centrou-se na identificação dos principais desafios enfrentados pelo sistema de saúde português na gestão da DPOC, dos obstáculos na identificação e gestão das exacerbações da DPOC e das estratégias eficazes para ultrapassar as barreiras identificadas. A segunda e a terceira rondas envolveram a análise da informação recolhida e a votação de cada indicador para obter consenso. Os indicadores resultantes foram categorizados em dois grupos: barreiras, desafios e constrangimentos na gestão da DPOC e estratégias de ação para melhorar a prevenção, a referenciação e diminuir exacerbações e o peso desta doença. Resultados: De um total de 134 indicadores válidos gerados, 108 obtiveram consenso. Dos indicadores consensualizados pelos peritos, 18 dizem respeito a barreiras, desafios e constrangimentos, enquanto 90 são referentes a estratégias de ação para a DPOC. Entre as estratégias formuladas, 25 indicadores com consenso visam estratégias de prevenção, 24 indicadores com consenso têm como alvo a referenciação da DPOC e 41 indicadores com consenso concentram-se em mitigar as exacerbações da DPOC e reduzir a carga da doença. Discussão/Conclusão: Este estudo enfatiza a necessidade de investimento integrado na saúde respiratória e o reconhecimento do impacto da DPOC na vida das pessoas, nos sistemas de saúde e na economia. A prevenção e o tratamento adequado das exacerbações são cruciais para uma gestão eficaz da DPOC e para reduzir a morbidade e a mortalidade associadas. Os especialistas destacam a importância de melhorar a coordenação entre diferentes níveis de cuidados, integrar sistemas de informação e descentralizar as responsabilidades hospitalares. A pandemia da COVID-19 reforçou a importância da saúde respiratória individual e coletiva, enfatizando a necessidade de investir na promoção da saúde e na consciencialização sobre a DPOC.

5.
Vaccine X ; 19: 100523, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39070930

RESUMO

Objective: Although vaccination confidence is declining globally, there is little detailed information from low- and middle-income countries about factors influencing routine vaccination behavior in these contexts. Methods: In mid-2022, we surveyed people who gave birth in Kenya between 2017-2022, and asked them about their children's vaccination history and about hypothesized correlates of vaccination per the Behavioural and Social Drivers of Vaccination model. Results: Of 873 children in this sample, 117 (13%) were under-vaccinated (i.e., delayed or missing vaccine dose(s)) - and under-vaccination was more common among births during the COVID-19 pandemic (2020-2022) versus pre-pandemic (2017-2019). In multi-level multivariable models, children of respondents who expressed concerns about serious side effects from vaccines had significantly higher odds of missed vaccine dose(s) (aOR 2.06, 95 % CI 1.14-3.72), and there was a strong association between having more safety concerns now versus before the COVID-19 pandemic (aOR missed dose(s) 4.44, 95 % CI 1.71-11.51; aOR under-vaccination 3.03, 95 % CI 1.28-7.19). People with greater trust in health workers had lower odds of having a child with missed vaccine dose(s) (aOR 0.85, 95 % CI 0.75-0.97). People who reported higher patient-centered quality of vaccination care had much lower odds of having children with delayed or missed vaccine dose(s) (aOR missed dose(s) 0.14, 95 % CI 0.04-0.58; aOR under-vaccination 0.27, 95 % CI 0.10-0.79). Conclusions: These findings highlight potential strategies to improve vaccine coverage: greater focus on patient-centered quality of care, training healthcare workers on how to address safety concerns about vaccines, and building trust in the health care system and in health workers.

6.
Crit Care Resusc ; 26(2): 153-158, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-39072237

RESUMO

Objective: Intensive care unit (ICU) cost estimates are critical to achieving healthcare system efficiency and sustainability. We aimed to review the published literature describing ICU costs in Australia. Design: A systematic review was conducted to identify studies that estimated the cost of ICU care in Australia. Studies conducted in specific patient cohorts or on specific treatments were excluded. Data sources: Relevant studies were sourced from a previously published review (1970-2016), a systematic search of MEDLINE and EMBASE (2016-5 May 2023), and reference checking. Review methods: A tool was developed to assess study quality and risk of bias (maximum score 57/57). Total and component costs were tabulated and indexed to 2022 Australian Dollars. Costing methodologies and study quality assessments were summarised. Results: Six costing studies met the inclusion criteria. Study quality scores were low (15/41 to 35/47). Most studies were conducted only in tertiary metropolitan public ICUs; sample sizes ranged from 100 to 10,204 patients. One study used data collected within the past 10 years. Mean daily ICU costs ranged from $966 to $5381 and mean total ICU admission costs $4888 to $14,606. Three studies used a top-down costing approach, deriving cost estimates from budget reports. The other three studies used both bottom-up and top-down costing approaches. Bottom-up approaches collected individual patient resource use. Conclusions: Available ICU cost estimates are largely outdated and lack granular data. Future research is needed to estimate ICU costs that better reflect current practice and patient complexity and to determine the best methods for generating these estimates.

7.
Disabil Rehabil ; : 1-8, 2024 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-39072497

RESUMO

PURPOSE: To examine the burden of treatment (BoT) experienced by people with Amyotrophic Lateral Sclerosis (ALS) in Argentina. METHODS: Qualitative methodological design based on semi-structured interviews. Nineteen semi-structured interviews were conducted (PwALS = 7, informal caregivers= 12). The interview guides were designed based on the literature and BoT theory. Data were analysed following a framework analysis approach. RESULTS: The research highlighted the arduous journey toward obtaining a diagnosis, marked by delays influenced by healthcare system inefficiencies, lack of disease awareness and pandemic-related anxiety. Receiving the diagnosis was a destabilising experience, triggering the need to reframe self-identity, a new reality. As the disease progressed, patients encountered significant challenges in their daily activities and basic tasks, affecting their ability to work, communicate, and manage personal care. The burden extended beyond the patients to their primary caregivers. Access to specialised care, bureaucratic complexities in securing treatment, and the financial impact of managing the disease posed substantial challenges. CONCLUSION: The findings offer valuable insights into the experiences of PwALS and their caregivers in Argentina. They underscore the need for increased disease awareness, improved access to specialised care, and enhanced support networks to alleviate the burdens PwALS and their families face.


Streamlined pathways for patients with amyotrophic lateral sclerosis in Argentina are necessary to ensure timely access to comprehensive support and interventions, laying the foundation for holistic rehabilitation.There is a need to encourage clear communication between healthcare providers and patients to establish ongoing dialogue incorporating emotional, social, and psychological aspects into rehabilitation, aligning with patient-centric approaches.There is a need to develop and implement adaptive rehabilitation strategies to sustain independence and enhance quality of life for amyotrophic lateral sclerosis patients, addressing the physical, emotional, and social implications of the disease's progression.Rehabilitation professionals should advocate for systemic improvements to ensure equitable access to therapies and support alleviate financial burdens, enabling a comprehensive, patient-focused approach to rehabilitation.

8.
Telemed J E Health ; 2024 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-39072681

RESUMO

Background: Indigenous people are often neglected in eye health research and service delivery programs, despite having a greater burden of vision loss, most of which is avoidable. The objective of this work was to improve access to specialist eye care for Indigenous Australians living in rural and remote areas, by providing direct access to expert diagnostic services based in metropolitan areas through a tele-ophthalmology system. Methods: Over a four-year study period, 13 remote communities in Queensland and the Northern Territory were identified that had limited or no access to eye screening services. Relationships with health service providers in the communities were established to codesign a sustainable model of service delivery and referral pathways to ensure that patients identified with eye issues received appropriate treatment. Results: Over the course of the study, screening records from 378 patients were uploaded to a web-based telehealth system and diagnosed by ophthalmologists. From these examinations, 64 new cases of diabetic retinopathy (DR) were identified (including 2 cases of proliferative DR and 4 cases of severe nonproliferative DR), and diabetic macular edema was noted in 18 patients. The majority of participants screened had no eye problems, which enables the removal of these patients from the queues of overwhelmed specialist lists, improving service efficiency. The study also demonstrates capacity building of healthcare workers to perform eye screening and improved patient health awareness where the retinal cameras were used as an educational tool. Conclusions: A valuable screening service has been established in the target areas, where access to ophthalmic services has been improved for residents of the study screening locations. Routine eye examination (instead of opportunistic eye examination) is feasible for early detection of some eye diseases for remote and rural patients.

9.
Children (Basel) ; 11(7)2024 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-39062302

RESUMO

BACKGROUND: In 2020, a multiprofessional panel was set up in collaboration with the Italian FightTheStroke Foundation family association to produce evidence-based recommendations for the management and neuromotor rehabilitation of persons with cerebral palsy aged 2-18 years to implement in clinical practice in Italy. METHODS: The recommendations of these care pathways were developed according to the American Academy for Cerebral Palsy and Developmental Medicine guidelines for Care Pathways Development and the Grading of Recommendations Assessment Development and Evaluation working group for adoption, adaptation, or de novo development of recommendations from high-quality guidelines (GRADE-ADOLOPMENT). RESULTS: Four strong positive recommendations were developed regarding comprehensive management, and twenty-four addressed neuromotor treatment. CONCLUSIONS: A holistic, individualized approach was affirmed in terms of both multidimensional patient profile and interdisciplinary management in a network with the school where children and adolescents are integrated. It was defined that all motor rehabilitation approaches must be individually tailored considering age and developmentally appropriate activities as interventions and goals, in light of the reference curves addressing prognosis for Gross Motor Function and Manual Ability Classification Systems. Intervention must be structured with adaptations of the task and/or of the context (objects and environment) based on the analysis of the child's skills to support motivation and avoid frustration.

10.
Health Econ Rev ; 14(1): 58, 2024 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-39066939

RESUMO

BACKGROUND: During the 14th Five-Year Plan, China aims to transform rural migrants into urban citizens and ensure equal access to public services to enhance new urbanization. Understanding migrant workers' settlement intentions is crucial for their citizenship development. Based on the fundamental role of the right to life and health, equalization of basic public health services is essential. Therefore, understanding the potential impact of public health services equalization on the settlement intention of migrant workers is crucial in China's new urbanization. METHOD: In this study, we utilized data from the 2017 wave of China Migrants Dynamic Survey (CMDS) and employed the Propensity Score Matching method to investigate the impact of basic public health service equalization policy on the settlement intention of migrant workers. Additionally, we utilized the Mediation Effect Model to uncover the impact mechanism. RESULTS: Our findings indicate that basic public health service equalization policy has a significant positive effect on increasing the settlement intention of migrant workers, with an even greater effect observed among the low-income group, the cross-provincial subsample, and the new generation subsample. The results of the Mediation Effect Model suggest that Basic public health service equalization policy can bolster the subjective integration willingness and subjective identity of migrant workers, thereby enhancing their settlement intention. CONCLUSION: Based on the results, we propose to strengthen the promotion of the basic public health service equalization policy and expand the coverage of health records to further increase the settlement intention of migrant workers.

11.
Artigo em Inglês | MEDLINE | ID: mdl-39063396

RESUMO

During the COVID-19 pandemic, tele-mental health (TMH) was a viable approach for providing accessible mental and behavioral health (MBH) services. This study examines the sociodemographic disparities in TMH utilization and its effects on healthcare resource utilization (HCRU) and medical expenditures in Mississippi. Utilizing a cohort of 6787 insured adult patients at the University of Mississippi Medical Center and its affiliated sites between January 2020 and June 2023, including 3065 who accessed TMH services, we observed sociodemographic disparities between TMH and non-TMH cohorts. The TMH cohort was more likely to be younger, female, White/Caucasian, using payment methods other than Medicare, Medicaid, or commercial insurers, residing in rural areas, and with higher household income compared to the non-TMH cohort. Adjusting for sociodemographic factors, TMH utilization was associated with a 190% increase in MBH-related outpatient visits, a 17% increase in MBH-related medical expenditures, and a 12% decrease in all-cause medical expenditures (all p < 0.001). Among rural residents, TMH utilization was associated with a 205% increase in MBH-related outpatient visits and a 19% decrease in all-cause medical expenditures (both p < 0.001). This study underscores the importance of addressing sociodemographic disparities in TMH services to promote equitable healthcare access while reducing overall medical expenditures.


Assuntos
COVID-19 , Gastos em Saúde , Acessibilidade aos Serviços de Saúde , Telemedicina , Humanos , COVID-19/epidemiologia , COVID-19/economia , Mississippi/epidemiologia , Feminino , Masculino , Gastos em Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/economia , Pessoa de Meia-Idade , Adulto , Telemedicina/estatística & dados numéricos , Telemedicina/economia , Serviços de Saúde Mental/estatística & dados numéricos , Serviços de Saúde Mental/economia , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Idoso , Pandemias/economia , SARS-CoV-2 , Adulto Jovem
12.
BMJ Open ; 14(7): e082507, 2024 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-39059803

RESUMO

OBJECTIVE: In Ethiopia, information about health system responsiveness (HSR) in conflict-affected areas is limited. No previous local study was conducted on the assessment of HSR at the community level. Hence, the study assessed HSR for intrapartum care in conflict-affected areas in Amhara region, Ethiopia. DESIGN: Community-based cross-sectional study design. SETTING: Wadila, Gayint and Meket districts, Amhara region, Ethiopia. PARTICIPANTS: The participants were 419 mothers who gave birth in conflict-affected areas within the last 6 months. The study included all mothers who gave birth at health facilities but excluded those who delivered at home, critically ill or unable to hear. OUTCOME: HSR was the outcome variable. In this regard, the study assessed how mothers were treated and the situation in which they were cared for in relation to their experience during the conflict. METHODS: We conducted the study in the community, where we analysed eight domains of HSR to identify 30 measurement items related to intrapartum care responsiveness. The domains we looked at were dignity (4), autonomy (4), confidentiality (2), communication (5), prompt attention (5), social support (3), choice (3) and basic amenities (4). We used a multiple linear regression model to analyse the data, and in this model, we used an unstandardized ß coefficient with a 95% CI and a p value of less than 0.05 to determine the factors significantly associated with HSR. RESULTS: The findings of our study revealed that the overall proportion of HSR in intrapartum care was 45.11% (95% CI: 40.38 to 49.92). The performance of responsiveness was the lowest in the autonomy, choice and prompt attention domains at 35.5%, 49.4% and 52.0%, respectively. Mothers living in urban areas (ß=4.28; 95% CI: 2.06 to 6.50), government employees (ß=4.99; 95% CI: 0.51 to 9.48), those mothers stayed at the health facilities before delivery/during conflict (ß=0.22; 95% CI: 0.09 to 0.35), those who were satisfied with the healthcare service (ß=0.69; 95% CI: 0.08 to 1.30) and those who perceived the quality of healthcare favourable (ß=0.96; 95% CI: 0.72 to 1.19) were more likely to rate HSR positively. On the other hand, joint decision-making for health (ß=-2.46; 95% CI: -4.81 to -0.10) and hospital delivery (ß=-3.62; 95% CI: -5.60 to -1.63) were negatively associated with HSR. CONCLUSION: In the Amhara region of Ethiopia, over 50% of mothers living in areas affected by conflict reported that health systems were not responsive with respect to intrapartum care. Therefore, all stakeholders should work together to ensure that intrapartum care is responsive to conflict-affected areas, with a focus on providing women autonomy and choice.


Assuntos
Apoio Social , Humanos , Etiópia , Estudos Transversais , Feminino , Adulto , Gravidez , Adulto Jovem , Parto Obstétrico , Serviços de Saúde Materna/normas , Conflitos Armados , Adolescente , Confidencialidade , Autonomia Pessoal , Comunicação , Assistência Perinatal/normas
13.
BMJ Open ; 14(7): e085398, 2024 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-39059801

RESUMO

OBJECTIVES: Increasingly, healthcare and public health strategists invite us to look at healthcare organisations as not just care providers but as anchor institutions (ie, large community-rooted organisations with significant impact in the local economy, social fabric and overall community well-being). In response, this study explores the mechanisms through which healthcare organisations can impact social determinants of health and communities in their local areas. DESIGN: We conducted case studies with interviews and synthesised the findings using a realist approach to produce a set of explanations (programme theory) of how healthcare organisations can have a positive impact on the overall well-being of local communities by operating as anchor institutions. SETTING: Secondary healthcare organisations in England, including mental health and community services. PARTICIPANTS: Staff from case study sites which were directly employed or actively engaged in the organisation's anchor institution strategy. Data collection took place from early June to the end of August 2023. RESULTS: We found four building blocks for effective anchor activity including employment, spending, estates and sustainability. Healthcare organisations-as anchor institutions-can improve the social determinants of health for their local communities through enabling accessible paths for local community recruitment and career progression; empowering local businesses to join supply chains boosting income and wealth; transforming organisational spaces into community assets; and supporting local innovation and technology to achieve their sustainability goals. These blocks need to be integrated across organisations on the basis of a population health approach promoted by supportive leadership, and in collaboration with a diverse range of local partners. CONCLUSIONS: Healthcare organisations have the potential for a positive impact on the overall well-being of local communities. Policymakers should support healthcare organisations to leverage employment, spending, estates and sustainability to help address the unequal distribution of the social determinants of health.


Assuntos
Determinantes Sociais da Saúde , Humanos , Inglaterra , Atenção Secundária à Saúde/organização & administração , Estudos de Casos Organizacionais , Serviços de Saúde Comunitária/organização & administração
14.
BMJ Open ; 14(7): e079599, 2024 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-39059804

RESUMO

INTRODUCTION: Cholecystectomy is one of the most common operations performed worldwide. Although laparoscopic surgery has been the 'gold-standard' approach for this operation, there is a paucity of global evidence around the variations of safe provision of cholecystectomy, including low-income and middle-income countries. This international collaborative study will allow contemporaneous data collection on the quality of cholecystectomies using measures covering infrastructure, care processes and outcomes, with the primary aim define the global variation in compliance with preoperative, intraoperative and postoperative audit standards. METHODS AND ANALYSIS: Global Evaluation of Cholecystectomy Knowledge and Outcomes is a prospective, international, multicentre, observational cohort study delivered by the GlobalSurg Collaborative. Consecutive patients undergoing cholecystectomy between 31 July 2023 and 19 November 2023 will be recruited, with follow-up at 30 days and 1-year postoperatively. The study will be undertaken at any hospital providing emergency or elective surgical services for biliary disease. The primary endpoint of this study is compliance with preoperative, intraoperative and postoperative audit standards. Secondary outcomes include rates of 30-day complications, achievement of critical view of safety and rates of gallbladder cancer. ETHICS AND DISSEMINATION: This project will not affect clinical practice and has been classified as clinical audit following research ethics review at University Hospital Birmingham NHS Trust. The protocol will be disseminated through the international GlobalSurg and CovidSurg network. TRIAL REGISTRATION NUMBER: NCT06223061.


Assuntos
Colecistectomia , Humanos , Estudos Prospectivos , Projetos de Pesquisa , Estudos Multicêntricos como Assunto , Complicações Pós-Operatórias/epidemiologia , Colecistectomia Laparoscópica
15.
BMJ Open ; 14(7): e083866, 2024 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-39059805

RESUMO

OBJECTIVE: In 2023, Australian government emergency medical services (EMS) responded to over 4 million consumers, of which over 56% were not classified as an 'emergency', at the cost of AU$5.5 billion. We explored the viewpoints of politicians, policymakers, clinicians and consumers on how these non-emergency requests should be managed. DESIGN: A realist framework was adopted; a multidisciplinary team (including paramedicine, medicine and nursing) was formed; data were collected via semistructured focus groups or interviews, and thematic analysis was performed. SETTING AND PARTICIPANTS: 56 participants were selected purposefully and via open advertisement: national and state parliamentarians (n=3); government heads of healthcare disciplines (n=3); government policymakers (n=5); industry policymakers in emergency medicine, general practice and paramedicine (n=6); EMS chief executive officers, medical directors and managers (n=7); academics (n=8), frontline clinicians in medicine, nursing and paramedicine (n=8); and consumers (n=16). RESULTS: Three themes emerged: first, the reality of the EMS workload (theme titled 'facing reality'); second, perceptions of what direction policy should take to manage this ('no silver bullet') and finally, what the future role of EMS in society should be ('finding the right space'). Participants provided 16 policy suggestions, of which 10 were widely supported: increasing public health literacy, removing the Medical Priority Dispatch System, supporting multidisciplinary teams, increasing 24-hour virtual emergency departments, revising undergraduate paramedic university education to reflect the reality of the contemporary role, increasing use of management plans for frequent consumers, better paramedic integration with the healthcare system, empowering callers by providing estimated wait times, reducing ineffective media campaigns to 'save EMS for emergencies' and EMS moving away from hospital referrals and towards community care. CONCLUSIONS: There is a need to establish consensus on the role of EMS within society and, particularly, on whether the scope should continue expanding beyond emergency care. This research reports 16 possible ideas, each of which may warrant consideration, and maps them onto the standard patient journey.


Assuntos
Serviços Médicos de Emergência , Humanos , Austrália , Grupos Focais , Política , Pessoal Administrativo , Atitude do Pessoal de Saúde
16.
Trauma Surg Acute Care Open ; 9(1): e001503, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39005706

RESUMO

Background: Restorative justice interventions can help address the harm created by gun violence, although few restorative justice programs focus solely on survivors or loved ones of victims of gun violence. Our aim was to assess how gun violence impacts those injured by firearms through qualitative analysis of their lived experiences. Methods: From August 2022 to October 2023, we operated a program entitled Prescriptions for Repair in Durham, North Carolina, USA, which was supported by community groups, public government, and academia. Through a series of structured listening sessions using a restorative justice framework, trained community-based facilitators helped 30 participants (11 survivors of gun violence and 19 loved ones of victims of gun violence) tell their stories through a non-judgmental narrative process. We conducted a qualitative thematic analysis of the listening sessions from 19 participants to define the major lessons learned from survivors of gun violence. We summarized participant responses into individual-level and community-level views on how to 'make things as right as possible'. Results: The lived experiences of gun violence survivors and their loved ones confirmed the inherent value of structured listening programs, how poverty, race and racism impact gun violence, and the need to focus resources on children and youth. Conclusions: Listening to the survivors of gun violence through restorative justice programs can help address the personal and community harm resulting from gun violence. Level of evidence: Level IV, prospective observational study.

17.
BMJ Open ; 14(7): e079046, 2024 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-39043592

RESUMO

BACKGROUND: Telesurgery has become helpful in overcoming the current shortage of surgeons and reducing the barriers to timely and effective surgical intervention caused by long-distance travel, which is caused by distance, cost, complexity and frequent hazards. However, knowledge and attitude remain challenges in the implementation of such a system. OBJECTIVE: This study aimed to assess physicians' knowledge and attitude towards telesurgery and associated factors at resource-limited setting, Northwest Ethiopia. METHOD AND ANALYSIS: A simple random sampling method was carried out to choose study participants from each referral hospital, and data were collected using self-administered questionnaires. Descriptive and inferential statistics were applied to estimate knowledge and attitudes towards telesurgery among physicians and to identify factors associated with physician knowledge and attitudes towards telesurgery. STUDY DESIGN: Cross-sectional study design. SETTING: This study was conducted at six specialised referral hospitals and two specialised and teaching referral hospitals in the Amhara region, northwest Ethiopia. RESULT: 408 physicians were included for analysis, with a response rate of 96.45%. Among study participants, 47.8% and 43.1% had good knowledge and attitudes towards telesurgery, respectively. Educational status, digital literacy, source of information, computer training, digital health training and internet access in the organisation were factors associated with a physician's knowledge of telesurgery. Moreover, physician's knowledge, technology use, educational status, computer training, computer access and internet access in the organisation were factors associated with physicians' attitudes towards telesurgery. CONCLUSION AND RECOMMENDATION: Almost half of physicians had good knowledge, and less than half had a good attitude towards telesurgery, so healthcare policy-makers should improve physicians' digital literacy, technology use and internet access to enhance their knowledge and attitudes for future implementation.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Telemedicina , Humanos , Etiópia , Estudos Transversais , Masculino , Feminino , Adulto , Inquéritos e Questionários , Médicos/psicologia , Pessoa de Meia-Idade , Região de Recursos Limitados
18.
J Adv Nurs ; 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38953531

RESUMO

AIM: To describe key features of a co-designed nurse-led model of care intended to improve access to early medication abortion and long-acting reversible contraception in rural Australian general practice. DESIGN: Co-design methodology informed by the Experience-Based Co-Design Framework. METHODS: Consumers, nurses, physicians and key women's health stakeholders participated in a co-design workshop focused on the patient journey in seeking contraception or abortion care. Data generated at the workshop were analysed using Braun and Clarkes' six-step process for thematic analysis. RESULTS: Fifty-two participants took part in the co-design workshop. Key recommendations regarding setting up the model included: raising awareness of the early medication abortion and contraceptive implant services, providing flexible booking options, ensuring appointment availability, providing training for reception staff and fostering good relationships with relevant local services. Recommendations for implementing the model were also identified, including the provision of accessible information, patient-approved communication processes that ensure privacy and safety, establishing roles and responsibilities, supporting consumer autonomy and having clear pathways for referrals and complications. CONCLUSION: Our approach to experience-based co-design ensured that consumer experiences, values and priorities, together with practitioner insights, were central to the development of a nurse-led model of care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The co-designed nurse-led model of care for contraception and medication abortion is one strategy to increase access to these essential reproductive health services, particularly in rural areas, while providing an opportunity for nurses to work to their full scope of practice. IMPACT: Nurse-led care has gained global recognition as an effective strategy to promote equitable access to sexual and reproductive healthcare. Still, nurse-led contraception and abortion have yet to be implemented andevaluated in Australian general practice. This study will inform the model of care to be implemented and evaluated as part of the ORIENT trial to be completed in 2025. REPORTING METHOD: Reported in line with the Standards for Reporting Qualitative Research (SRQR) checklist. PATIENT OR PUBLIC CONTRIBUTION: Two consumer representatives contributed to the development of the co-design methodology as members of the ORIENT Intervention Advisory Group Governance Committee.

20.
Curr Pharm Teach Learn ; 16(10): 102125, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38955064

RESUMO

BACKGROUND: Initial education and training standards for pharmacists in Great Britain require early clinical exposure to patients using experiential work-based learning. However, there is poor evidence of this approach in some settings, such as paediatric care. The aim of this study was therefore to explore a novel model of experiential work-based learning for student pharmacists in a paediatric setting. METHODS: Fourth-year student pharmacists enrolled on a Master of Pharmacy programme were allocated five three-hour placement sessions at a paediatric hospital. Sessions consisted of a briefing, ward activities, scaffolded consultations with children and their carers, followed by a debriefing session with a clinical supervisor. Data were collected relating to the ward, patient details, student reported activities, learning outcomes and if follow up was required by a member of the clinical team. Data were cleaned, quality checked, then descriptive statistical analysis and inductive content analysis were conducted. MAIN FINDINGS: Seventy-four students took part in 28 individual sessions and 233 consultations were recorded. Consultations included a best-possible medical history (76%, n = 177), a satisfactory drug history (45%, n = 104), or discussed hospital discharge (11%, n = 26). Students were exposed to patients with diagnosed acute conditions (41%, n = 96) and chronic conditions (33%, n = 76), as well as children awaiting diagnosis (13%, n = 30). Students reported learning about the pathology, diagnosis and symptoms of paediatric conditions (48%, n = 81), medicines used in children (24%, n = 41), patient experiences of recieving care (15%, n = 25), carer experiences (2%, n = 3), the hospital environment (2%, n = 4), career progression (2%, n = 4), and experiences of social care (11%, n = 18). Findings were synthesised with existing entrustable professional activities from the literature to generate novel EPAs specific to paediatric settings. CONCLUSIONS: A paediatric setting offers a suitable environment to host experiential work-based learning in pharmacy education. Standards of initial education and training which require pharmacists to prescribe in Great Britain must recognise the importance of exposure to the health needs and experiences of children, young people's and carers prior to graduation.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...