8,836 results
Search Results
2. "A piece of paper is not the same as having someone to talk to": accessing post-diagnostic dementia care before and since COVID-19 and associated inequalities.
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Giebel C, Hanna K, Tetlow H, Ward K, Shenton J, Cannon J, Butchard S, Komuravelli A, Gaughan A, Eley R, Rogers C, Rajagopal M, Limbert S, Callaghan S, Whittington R, Shaw L, and Gabbay M
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, SARS-CoV-2, COVID-19 epidemiology, Caregivers psychology, Dementia psychology, Health Services Accessibility economics, Health Services Accessibility standards, Healthcare Disparities, Social Work
- Abstract
Background: Social support services such as day care centres are important in post-diagnostic dementia care to enable people living with dementia stay at home for longer. Little research has addressed potential inequalities in access, with no research on variations before and since COVID-19. The aim of this study was to explore inequalities in social support service usage before and since the pandemic., Methods: Unpaid carers and people living with dementia were interviewed over the phone about their experiences of accessing social support services before and since the COVID-19 pandemic. Transcripts were analysed for key themes using inductive and deductive thematic analysis., Results: Fifty participants (42 unpaid carers; eight people living with dementia) were interviewed, and five themes identified: (1) Service issues; (2) Access issues; (3) Relying on own initiative; (4) New inequalities due to COVID-19; and (5) Missing out on the benefits of support services. Participants reported transport, finances, and location as factors reducing their ability to access support service pre-COVID, with inequalities remaining and at times exacerbated since. Carers and people living with dementia also reported struggling with accessing basic necessities during COVID, including food and medicines., Conclusions: Considering the benefits of accessing support services, resourced procedures and facilities are needed to maintain access to support services with more accessible remote support provision, enabling people from all backgrounds to access the care they need.
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- 2021
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3. "No Papers. No Doctor" : A Qualitative Study of Access to Maternity Care Services for Undocumented Immigrant Women in Denmark.
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Funge JK, Boye MC, Johnsen H, and Nørredam M
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- Adult, Child, Denmark, Female, Humans, Pregnancy, Qualitative Research, Emigrants and Immigrants, Health Services Accessibility, Maternal Health Services, Undocumented Immigrants
- Abstract
The purpose of this study is to explore undocumented immigrant women's experiences of, as well as their access to, maternity care services during pregnancy in Denmark. Recruiting through the two branches of a non-governmental organization (NGO)-driven health clinic in Denmark, we conducted 21 semi-structured interviews with undocumented immigrant women in Denmark from January 2018 to January 2019. The undocumented immigrant women experienced barriers such as fear of deportation, concerns about payment for services, and uncertainties about rules for access. Many of them described depending on NGO-driven initiatives to access maternity care services and found these as providing a safe environment for care. Our findings contribute insights towards understanding the health behavior of undocumented immigrant women and highlight the need for inclusive care to safeguard the health of the women and their children.
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- 2020
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4. Exercise-based Rehabilitation to Improve Exercise Tolerance of Severe COVID-19 Survivors: A Review Paper.
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Nazir, Arnengsih, Tiksnadi, Badai Bhatara, and Ridzki, Mochammad Farhan Fajrial Aditama
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HEALTH services accessibility ,HUMAN services programs ,THERAPEUTICS ,EXERCISE therapy ,SEVERITY of illness index ,EXERCISE intensity ,STRENGTH training ,EXERCISE tolerance ,AEROBIC exercises ,QUALITY of life ,ENDURANCE sports training ,COVID-19 ,CARDIAC rehabilitation ,POSTURAL balance - Abstract
Objectives: This review aimed to determine the form, results, and barriers to exercise-based rehabilitation programs for severe COVID-19 survivors. Methods: Searching for the article was carried out from August to October 2021. We used the PubMed database as a search media with the keywords (['COVID-19' OR 'COVID 19' OR 'SARS CoV-2'... [ABSTRACT FROM AUTHOR]
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- 2024
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5. Contrasting current challenges from the Brazilian and Canadian national health systems: The Besrour Papers: a series on the state of family medicine in Canada and Brazil.
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Ponka D, Pinto LF, Whalen-Browne M, Meuser A, Prado JC Jr, Michaelides O, and Rouleau K
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- Brazil, Canada, Capacity Building, Delivery of Health Care, Integrated trends, Family Practice education, Global Health, Health Services Accessibility organization & administration, Humans, Poverty, Primary Health Care organization & administration, Delivery of Health Care, Integrated standards, Family Practice standards, Health Services Accessibility standards, Primary Health Care standards
- Abstract
Objective: To compare the national health systems of Canada and Brazil and how both countries have addressed similar challenges in their primary care sectors., Composition of the Committee: A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with colleagues in Brazil and collaborated to undertake a between-country comparison, comparing and contrasting various elements of both countries' efforts to strengthen primary care over the past few decades., Methods: Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of family medicine in Canada and Brazil., Report: The Brazilian and Canadian primary care systems are faced with similar challenges, including geography, demographic changes, population health inequities, and gaps in universal access to comprehensive primary care services. Although the approaches to addressing these challenges are different in both settings, they highlight the central importance of family physicians in both systems. Both countries continue to face considerable challenges in the context of mental health services in primary care. It remains important for Canada to draw lessons from the primary care systems and reforms of other countries, such as Brazil., (Copyright© the College of Family Physicians of Canada.)
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- 2019
6. Maternal and neonatal implementation for equitable systems. A study design paper.
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Ekirapa-Kiracho E, Tetui M, Bua J, Muhumuza Kananura R, Waiswa P, Makumbi F, Atuyambe L, Ajeani J, George A, Mutebi A, Kakaire A, Namazzi G, Paina L, and Namusoke Kiwanuka S
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- Adult, Female, Focus Groups, Health Services Research, Humans, Infant, Newborn, Maternal Health Services standards, Power, Psychological, Pregnancy, Prenatal Care organization & administration, Quality of Health Care standards, Research Design, Rural Health Services standards, Uganda, Capacity Building organization & administration, Health Services Accessibility organization & administration, Maternal Health Services organization & administration, Quality of Health Care organization & administration, Rural Health Services organization & administration
- Abstract
Background: Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability., Objectives: The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach., Methods: The study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis., Conclusions: This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory approach.
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- 2017
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7. Developing family practice to respond to global health challenges: The Besrour Papers: a series on the state of family medicine in the world.
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Arya N, Dahlman B, Gibson C, Ponka D, Haq C, Rouleau K, and Hansel S
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- Africa South of the Sahara, Capacity Building, Cuba, Delivery of Health Care, Integrated trends, Family Practice education, Global Health, Health Services Accessibility organization & administration, Humans, Poverty, Primary Health Care organization & administration, Delivery of Health Care, Integrated standards, Family Practice standards, Health Services Accessibility standards, Primary Health Care standards
- Abstract
Objective: To assess family medicine's role in developing strong, coordinated, community-based, integrated health care systems in low-resource settings globally., Composition of the Committee: A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with selected international colleagues with expertise in international family medicine practice, health systems and capacity building, and teaching to map family medicine globally and give a bird's eye view of family medicine internationally., Methods: Following a background literature review, the authors collectively reflected on their substantial international experience to attempt to describe best practices for various contexts., Report: With the failure of vertical, disease-oriented models to provide sustained improvements in health outcomes, the need to develop integrated primary care involving the most appropriate health professionals for differing contexts is becoming apparent worldwide. Health system planning is required to develop policies on health professional training to achieve this. Advocating and offering appropriate incentives for, and coordination of, local opportunities within the health system also becomes paramount. The adaptability and generalist nature of family medicine allows it to respond to the unique needs of a given population. Family physicians with adequate financial and physical resources can function most effectively as members of interdisciplinary teams, thus providing valuable, comprehensive health services in any area of the world., (Copyright© the College of Family Physicians of Canada.)
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- 2017
8. Joint position paper on rural surgery and operative delivery.
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Iglesias S, Kornelsen J, Woollard R, Caron N, Warnock G, Friesen R, Miles P, Vogt Haines V, Batchelor B, Blake J, Mazowita G, Wyman R, Geller B, and de Klerk B
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- Canada, Delivery, Obstetric standards, Family Practice, Female, General Surgery education, General Surgery standards, Gynecology education, Gynecology standards, Health Planning, Health Policy, Humans, Obstetrics education, Obstetrics standards, Patient Safety, Pregnancy, Program Evaluation, Rural Health, Societies, Medical, Workforce, Cesarean Section standards, Community Networks, Health Services Accessibility, Health Services Needs and Demand, Maternal Health Services standards, Physicians supply & distribution, Rural Health Services standards, Surgical Procedures, Operative standards
- Abstract
Our professional organizations have prepared this paper as part of an integrated, multidisciplinary plan to ensure the availability of well-trained practitioner teams to sustain safe, effective and high-quality rural surgical and operative delivery services. Without these robust local (or nearby) surgical services, sustaining rural maternity care is much more difficult. This paper describes the "network model" as a health human resources solution to meet the surgical needs, including operative delivery, of rural residents; outlines necessary policy directions for achieving this solution; and poses a series of enabling recommendations.
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- 2015
9. Conceptual framework on barriers and facilitators to implementing perinatal mental health care and treatment for women: the MATRIx evidence synthesis.
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Webb R, Ford E, Shakespeare J, Easter A, Alderdice F, Holly J, Coates R, Hogg S, Cheyne H, McMullen S, Gilbody S, Salmon D, and Ayers S
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- Female, Humans, Pregnancy, Health Services Accessibility organization & administration, Mental Disorders therapy, Mental Health Services organization & administration, Perinatal Care organization & administration
- Abstract
Background: Perinatal mental health difficulties can occur during pregnancy or after birth and mental illness is a leading cause of maternal death. It is therefore important to identify the barriers and facilitators to implementing and accessing perinatal mental health care., Objectives: Our research objective was to develop a conceptual framework of barriers and facilitators to perinatal mental health care (defined as identification, assessment, care and treatment) to inform perinatal mental health services., Methods: Two systematic reviews were conducted to synthesise the evidence on: Review 1 barriers and facilitators to implementing perinatal mental health care; and Review 2 barriers to women accessing perinatal mental health care. Results were used to develop a conceptual framework which was then refined through consultations with stakeholders., Data Sources: Pre-planned searches were conducted on MEDLINE, EMBASE, PsychInfo and CINAHL. Review 2 also included Scopus and the Cochrane Database of Systematic Reviews., Review Methods: In Review 1, studies were included if they examined barriers or facilitators to implementing perinatal mental health care. In Review 2, systematic reviews were included if they examined barriers and facilitators to women seeking help, accessing help and engaging in perinatal mental health care; and they used systematic search strategies. Only qualitative papers were identified from the searches. Results were analysed using thematic synthesis and themes were mapped on to a theoretically informed multi-level model then grouped to reflect different stages of the care pathway., Results: Review 1 included 46 studies. Most were carried out in higher income countries and evaluated as good quality with low risk of bias. Review 2 included 32 systematic reviews. Most were carried out in higher income countries and evaluated as having low confidence in the results. Barriers and facilitators to perinatal mental health care were identified at seven levels: Individual (e.g. beliefs about mental illness); Health professional (e.g. confidence addressing perinatal mental illness); Interpersonal (e.g. relationship between women and health professionals); Organisational (e.g. continuity of carer); Commissioner (e.g. referral pathways); Political (e.g. women's economic status); and Societal (e.g. stigma). These factors impacted on perinatal mental health care at different stages of the care pathway. Results from reviews were synthesised to develop two MATRIx conceptual frameworks of the (1) barriers and (2) facilitators to perinatal mental health care. These provide pictorial representations of 66 barriers and 39 facilitators that intersect across the care pathway and at different levels., Limitations: In Review 1 only 10% of abstracts were double screened and 10% of included papers methodologically appraised by two reviewers. The majority of reviews included in Review 2 were evaluated as having low ( n = 14) or critically low ( n = 5) confidence in their results. Both reviews only included papers published in academic journals and written in English., Conclusions: The MATRIx frameworks highlight the complex interplay of individual and system level factors across different stages of the care pathway that influence women accessing perinatal mental health care and effective implementation of perinatal mental health services., Recommendations for Health Policy and Practice: These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to perinatal mental health care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services; and quality training for health professionals with protected time to do it., Future Work: Further research is needed to examine access to perinatal mental health care for specific groups, such as fathers, immigrants or those in lower income countries., Trial Registration: This trial is registered as PROSPERO: (R1) CRD42019142854; (R2) CRD42020193107., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR 128068) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.
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- 2024
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10. The impact of health insurance on hypertension care: a household fixed effects study in India.
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Feng Z, Chen Q, Jiao L, Ma X, Atun R, Geldsetzer P, Bärnighausen T, and Chen S
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- Humans, India, Adult, Middle Aged, Male, Female, Adolescent, Young Adult, Health Surveys, Family Characteristics, Hypertension epidemiology, Hypertension therapy, Insurance, Health statistics & numerical data, Insurance Coverage statistics & numerical data, Health Services Accessibility statistics & numerical data
- Abstract
Introduction: Hypertension is highly prevalent in India, but the proportion of patients achieving blood pressure control remains low. Efforts have been made to expand health insurance coverage nationwide with the aim of improving overall healthcare access. It is critical to understand the role of health insurance coverage in improving hypertension care., Methods: We used secondary data from the nationally representative sample of adults aged 15-49 years from the 2015-2016 National Family Health Survey (NFHS) in India. We defined the hypertension care cascade as four successive steps of (1) screened, (2) diagnosed, (3) treated, and (4) controlled, and operationalized these variables using blood pressure measurements and self-reports. We employed household fixed effect models that conceptually matched people with and without insurance within the household, to estimate the impact of insurance coverage on the likelihood of reaching each care cascade step, while controlling for a wide range of additional individual-level variables., Results: In all 130,151 included individuals with hypertension, 20.4% reported having health insurance. For the insured hypertensive population, 79.8% (95% Confidence Interval: 79.3%-80.3%) were screened, 49.6% (49.0%-50.2%) diagnosed, 14.3% (13.9%-14.7%) treated, and 7.9% (7.6%-8.2%) controlled, marginally higher than the percentages for the uninsured 79.8% (79.5%-80.0%), 48.2% (47.9%-48.6%), 13.3% (13.1%-13.5%), and 7.5% (7.4%-7.7%) for each cascade step, respectively. From the household fixed effects model, health insurance did not show significant impact on the hypertension care cascade, with the estimated relative risks of health insurance 0.97 (0.93-1.02), 0.97 (0.91-1.03), 0.95 (0.77-1.30), and 0.97 (0.65-1.10) for each cascade step, respectively. We further performed stratified analyses by sociodemographic and behavioral risk factors and a sensitivity analysis with district fixed effects, all of which yielded results that confirmed the robustness of our main findings., Conclusions: Health insurance did not show significant impact on improving hypertension care cascade among young and middle-aged adults with hypertension in India. Innovative strategies for overcoming practical barriers to healthcare services in addition to improving financial access are needed to address the large unmet need for hypertension care., (© 2024. The Author(s).)
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- 2024
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11. Clinical Nutrition and Human Rights. An International Position Paper
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Régis Hankard, Diana Cardenas, Rocco Barazzoni, Gil Hardy, Dolores Rodriguez-Ventimilla, Maria Isabel Toulson Davisson Correia, Winai Ungpinitpong, Juan B. Ochoa, Katerina Zakka, André Briend, Cristina Cuerda, Teresa Pounds, Karin Papapietro, Charles Bermúdez, Cardenas, D., Correia, M. I. T. D., Ochoa, J. B., Hardy, G., Rodriguez-Ventimilla, D., Bermudez, C. E., Papapietro, K., Hankard, R., Briend, A., Ungpinitpong, W., Zakka, K. M., Pounds, T., Cuerda, C., and Barazzoni, R.
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0301 basic medicine ,Human Rights ,030309 nutrition & dietetics ,media_common.quotation_subject ,Medicine (miscellaneous) ,030209 endocrinology & metabolism ,Clinical nutrition ,Critical Care and Intensive Care Medicine ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,Right to Health ,Nursing ,Disease-related malnutrition ,Human rights ,Medicine ,Humans ,Disease ,Medical nutrition therapy ,Obligation ,media_common ,0303 health sciences ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Right to health ,business.industry ,Nutritional Support ,Malnutrition ,medicine.disease ,Artificial nutrition therapy ,Patient Rights ,Nutrition Assessment ,Right to food ,Food ,Health ,Position paper ,030211 gastroenterology & hepatology ,Nutrition Therapy ,business - Abstract
The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political, and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.
- Published
- 2021
12. Barriers and delays in access to abortion care: a cross-sectional study of people traveling to obtain care in England and the Netherlands from European countries where abortion is legal on broad grounds.
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Wollum A, De Zordo S, Zanini G, Mishtal J, Garnsey C, and Gerdts C
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- Pregnancy, Female, Humans, Cross-Sectional Studies, Netherlands, England, Abortion, Legal, Health Services Accessibility, Abortion, Induced
- Abstract
Introduction: This study characterized the extent to which (1) financial barriers and (2) abortion care-seeking within a person's country of residence were associated with delays in abortion access among those travelling to England and the Netherlands for abortion care from European countries where abortion is legal on broad grounds in the first trimester but where access past the first trimester is limited to specific circumstances., Methodology: We drew on cross-sectional survey data collected at five abortion clinics in England and the Netherlands from 2017 to 2019 (n = 164). We assessed the relationship between difficulty paying for the abortion/travel, acute financial insecurity, and in-country care seeking on delays to abortion using multivariable discrete-time hazards models., Results: Participants who reported facing both difficulty paying for the abortion procedure and/or travel and difficulty covering basic living costs in the last month reported longer delays in accessing care than those who had no financial difficulty (adjusted hazard odds ratio: 0.39 95% CI 0.21-0.74). This group delayed paying other expenses (39%) or sold something of value (13%) to fund their abortion, resulting in ~ 60% of those with financial difficulty reporting it took them over a week to raise the funds needed for their abortion. Having contacted or visited an abortion provider in the country of residence was associated with delays in presenting abroad for an abortion., Discussion: These findings point to inequities in access to timely abortion care based on socioeconomic status. Legal time limits on abortion may intersect with individuals' interactions with the health care system to delay care., (© 2024. The Author(s).)
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- 2024
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13. The health of detainees and the role of primary care: Position paper of the European Forum for Primary Care.
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Groenewegen, Peter, Dirkzwager, Anja, van Dam, Anke, Massalimova, Dina, Sirdifield, Coral, and Smith, Lauren
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- *
HEALTH services accessibility , *PRISONERS , *PRIMARY health care , *CONTINUUM of care , *POLICY sciences , *MEDICAL needs assessment - Abstract
This position paper aims to increase awareness among primary care practitioners and policymakers about the specific and complex health needs of people who experience incarceration. We focus on the importance of primary care and of continuity of care between prison and community. We highlight what is known from the literature on the health of people who experience incarceration, on the organisation of prison health care, and on the role of primary care both during and after detention. We present three case descriptions of detainees' encounters with the organisation of prison health care in three European countries. Finally, we describe the position that the European Forum for Primary Care takes. Prisoners and ex-prisoners have a worse physical and mental health compared with a cross-section of the population. However, access to good quality treatment and care is often worse than in the outside situation. In particular, well-organised primary care in the prison context could benefit prisoners and, indirectly, society at large. Moreover, continuity of care between the community and the prison situation needs improvement. [ABSTRACT FROM AUTHOR]
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- 2022
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14. Exploring the health consequences of armed conflict: the perspective of Northeast Ethiopia, 2022: a qualitative study.
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Arage MW, Kumsa H, Asfaw MS, Kassaw AT, Dagnew EM, Tunta A, Kassahun W, Addisu A, Yigzaw M, Hailu T, and Tenaw LA
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- Humans, Female, Pregnancy, Aged, Ethiopia, Qualitative Research, Armed Conflicts, Health Services Accessibility, Violence
- Abstract
Background: Conflict is a complicated topic with a multidimensional consequences for community health. Its effects have a broad pattern, starting from direct war-related morbidity and mortality caused by bullets and bombs to indirect consequences due to the interruption of the delivery of preventive and curative health services. This study aimed to explore the health consequences of the northern Ethiopian conflict in the North Wollo zone, northeast Ethiopia, in 2022., Methods: This descriptive qualitative study was conducted from May to June 2022 on six conflict-affected Woredas in the north Wollo zone. A total of 100 purposively selected participants, which included patients, pregnant women, elders, community and religious leaders, and health professionals, were interviewed using IDI and FGD. The data was entered, coded, and analyzed using Open Code version 4.03. Thematic analysis approach employed to conduct the interpretation. Data was presented using descriptive statistics in the form of texts and tables., Results: The findings indicate that the conflict has caused a profound consequence on population health. It has resulted in a wide range of direct and indirect consequences, ranging from war-related casualties, famine, and disruptions of supply chains and forced displacement to instances of violence and rape associated with insecurity. The conflict also caused a breakdown in the health system by causing distraction of health infrastructure, fleeing of health workers and shortage of medication, together with insecurity and lack of transportation, which greatly affected the provision and utilization of health services. Additionally, the conflict has resulted in long-term consequences, such as the destruction of health facilities, interruption of immunization services, posttraumatic stress disorders, and lifelong disabilities. The coping strategies utilized were using available traditional medicines and home remedies, obtaining medications from conflict-unaffected areas, and implementing home-to-home healthcare services using available supplies., Conclusion: The Northern Ethiopian conflict has an impact on community health both directly and indirectly through conflict-related causalities and the breakdown of the health system and health-supporting structures. Therefore, this study recommends immediate rehabilitation interventions for damaged health infrastructure and affected individuals., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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15. Rethinking 'need' for clinical support in transgender and gender non‐conforming children without clinical classification: Learning from 'the paper I almost wrote'.
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Horowicz, Edmund
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- *
SOCIAL support , *HEALTH services accessibility , *SOCIAL stigma , *GENDER dysphoria , *GENDER identity , *GENDER nonconformity , *NEEDS assessment , *NEED (Psychology) , *MEDICAL needs assessment , *BIOETHICS , *CHILDREN - Abstract
There have been ongoing debates as to how, or even whether, we should clinically classify gender diversity in children through clinical classification manuals. So‐called 'depathologizing' is argued as being vital to address the stigma that these children are somehow disordered or sick. Yet one argument in favour of continued clinical classification for transgender and gender non‐conforming children is that it better facilitates access to specialist psychological support. I argue that whilst continued clinical classification offers a seemingly pragmatic solution to ensuring access, it does in fact obscure our understanding of the individual needs of these children. In this paper I address fundamental issues that aim to better our understanding of need and thus why a child may benefit from specialist support. I do so by critiquing a paper I nearly wrote, which argued for the ongoing continued classification of gender incongruence in children. Ultimately, I argue that specialist psychological support and care should be driven by the needs of the individual child, as determined by the child and those involved with their care. By bettering our understanding as to why specialist psychological support may be beneficial for some, we move past the focus of such specialist support being provided because of the child's gender diversity. Methodologically the paper may be unusual, in comparison to traditional normative counter‐argumentative bioethical position papers, but by presenting an argument for depathologization of gender diversity of children in this way there is also an alternative insight into the methods of bioethics. [ABSTRACT FROM AUTHOR]
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- 2021
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16. Strategies to optimise culturally appropriate perioperative care for Aboriginal and Torres Strait Islander peoples: A discussion paper.
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Joye, Maureen and Foran, Paula
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PERIOPERATIVE care ,INDIGENOUS Australians ,NURSE liaisons ,HEALTH services accessibility ,PATIENT advocacy ,OPERATING room nurses ,NURSE-patient relationships ,HEALTH equity ,EVIDENCE-based nursing ,NURSING interventions ,TRUST - Abstract
The disparity in health outcomes between Indigenous and non-indigenous Australians continues to increase. Barriers to accessing health care, particularly surgical treatment, contribute to health inequalities among Indigenous Australians. Despite a positive correlation between improved patient experiences and health outcomes, there is little research available on nursing interventions to improve Indigenous patients' perioperative health care treatment. This discussion paper investigates culturally appropriate and evidence- based nursing interventions that can be applied in the perioperative setting to improve the surgical experience of Indigenous patients. It was shown that establishing trust among Aboriginal and Torres Strait Islander patients through anaesthetic nurse practices and advocating for family involvement is critical in providing culturally safe care and enhancing patient experiences. Indigenous health liaison officers were also identified as a valuable resource in bridging cultural and communication gaps between health care providers and Indigenous patients. These findings demonstrate that using tailored nursing strategies while providing perioperative care to Indigenous Australians can enhance their perioperative health care experience and contribute to improving health outcomes of Indigenous Australians. It is therefore recommended that perioperative nurses adopt these strategies; however, further research is needed to investigate implementation of an enhanced role for anaesthetic nurses, advocating for family involvement and referral to Indigenous health liaison officers. Such research should evaluate the impact of these new holistic and patient-centred approaches on the health outcomes and experiencecs of Indigenous patients. [ABSTRACT FROM AUTHOR]
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- 2023
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17. Meningococcal vaccines: WHO position paper on the use of multivalent meningococcal conjugate vaccines in countries of the African meningitis belt.
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- *
PREVENTION of epidemics , *HEALTH policy , *PUBLIC health surveillance , *IMMUNIZATION , *HEALTH services accessibility , *CROWDS , *PUBLIC health , *BACTERIAL meningitis , *MENINGOCOCCAL vaccines , *MEDICAL protocols , *RISK assessment , *VACCINATION mandates , *INFECTIOUS disease transmission - Abstract
The article presents an addendum to the position paper on the use of meningococcal conjugate vaccines (MMCV) in the African meningitis belt issued by the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) on Immunization at its meeting in September 2023. Topics include the WHO off-label recommendations for meningococcal vaccines and vaccination that apply to countries in the African meningitis belt and research priorities on the impact of Men5CV vaccine.
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- 2024
18. White paper for global Palliative Care advocacy: recommendations from a PAL-LIFE expert advisory Group of the Pontifical Academy for Life, Vatican City
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Mary Callaway, Julianna Yong, M. R. Rajagopal, Sami Alsirafy, Katherine Pettus, Eduardo Bruera, Eduardo Garralda, Emmanuel Luyirika, Thomas Sitte, Daniela Mosoiu, Christina M. Puchalski, John Y. Rhee, Nunziata Comoretto, Carlos Centeno, Liliana De Lima, and Kathleen M. Foley
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Position statement ,Palliative care ,Certification ,Consensus ,Delphi Technique ,Attitude of Health Personnel ,Advisory Committees ,Development ,Global Health ,Vatican City ,Health Services Accessibility ,Academic institution ,03 medical and health sciences ,0302 clinical medicine ,White paper ,Medicine ,Humans ,030212 general & internal medicine ,Palliative Medicine ,development ,General Nursing ,Medical education ,advocacy ,palliative care ,business.industry ,Catholicism ,position statement ,Global ,General Medicine ,Advocacy ,Holy See ,global ,Anesthesiology and Pain Medicine ,Special Reports ,030220 oncology & carcinogenesis ,Ciencias de la Salud [Materias Investigacion] ,business - Abstract
Background: The Pontifical Academy for Life (PAV) is an academic institution of the Holy See (Vatican), which aims to develop and promote Catholic teachings on questions of biomedical ethics. Palliative care (PC) experts from around the world professing different faiths were invited by the PAV to develop strategic recommendations for the global development of PC (“PAL-LIFE group”). Design: Thirteen experts in PC advocacy participated in an online Delphi process. In four iterative rounds, participants were asked to identify the most significant stakeholder groups and then propose for each, strategic recommendations to advance PC. Each round incorporated the feedback from previous rounds until consensus was achieved on the most important recommendations. In a last step, the ad hoc group was asked to rank the stakeholders' groups by order of importance on a 13-point scale and to propose suggestions for implementation. A cluster analysis provided a classification of the stakeholders in different levels of importance for PC development. Results: Thirteen stakeholder groups and 43 recommendations resulted from the first round, and, of those, 13 recommendations were chosen as the most important (1 for each stakeholder group). Five groups had higher scores. The recommendation chosen for these top 5 groups were as follows: (1) Policy makers: Ensure universal access to PC; (2) Academia: Offer mandatory PC courses to undergraduates; (3) Healthcare workers: PC professionals should receive adequate certification; (4) Hospitals and healthcare centers: Every healthcare center should ensure access to PC medicines; and (5) PC associations: National Associations should be effective advocates and work with their governments in the process of implementing international policy framework. A recommendation for each of the remaining eight groups is also presented. Discussion: This white paper represents a position statement of the PAV developed through a consensus process in regard to advocacy strategies for the advancement of PC in the world.
- Published
- 2018
19. 'A piece of paper is not the same as having someone to talk to': accessing post-diagnostic dementia care before and since COVID-19 and associated inequalities
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Sarah Butchard, Aravind Komuravelli, Ruth Eley, Steve Callaghan, Jacqueline Cannon, Hilary Tetlow, Carol Rogers, Justine Shenton, Manoj Rajagopal, Rosie Whittington, Clarissa Giebel, Stan Limbert, Mark Gabbay, Lisa Shaw, Kerry Hanna, Kym Ward, and Anna Gaughan
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Adult ,Male ,Social Work ,Day care ,Health Services Accessibility ,03 medical and health sciences ,Social support ,0302 clinical medicine ,Nursing ,medicine ,Humans ,Dementia ,030212 general & internal medicine ,Healthcare Disparities ,Aged ,Social policy ,Service (business) ,030214 geriatrics ,Social work ,SARS-CoV-2 ,Research ,lcsh:Public aspects of medicine ,Health Policy ,Public Health, Environmental and Occupational Health ,Health services research ,COVID-19 ,lcsh:RA1-1270 ,Middle Aged ,medicine.disease ,Caregivers ,Female ,Thematic analysis ,Psychology - Abstract
Background Social support services such as day care centres are important in post-diagnostic dementia care to enable people living with dementia stay at home for longer. Little research has addressed potential inequalities in access, with no research on variations before and since COVID-19. The aim of this study was to explore inequalities in social support service usage before and since the pandemic. Methods Unpaid carers and people living with dementia were interviewed over the phone about their experiences of accessing social support services before and since the COVID-19 pandemic. Transcripts were analysed for key themes using inductive and deductive thematic analysis. Results Fifty participants (42 unpaid carers; eight people living with dementia) were interviewed, and five themes identified: (1) Service issues; (2) Access issues; (3) Relying on own initiative; (4) New inequalities due to COVID-19; and (5) Missing out on the benefits of support services. Participants reported transport, finances, and location as factors reducing their ability to access support service pre-COVID, with inequalities remaining and at times exacerbated since. Carers and people living with dementia also reported struggling with accessing basic necessities during COVID, including food and medicines. Conclusions Considering the benefits of accessing support services, resourced procedures and facilities are needed to maintain access to support services with more accessible remote support provision, enabling people from all backgrounds to access the care they need.
- Published
- 2021
20. Canadian Association of Radiologists White Paper on De-identification of Medical Imaging: Part 2, Practical Considerations.
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Parker, William, Jaremko, Jacob L., Cicero, Mark, Azar, Marleine, El-Emam, Khaled, Gray, Bruce G., Hurrell, Casey, Lavoie-Cardinal, Flavie, Desjardins, Benoit, Lum, Andrea, Sheremeta, Lori, Lee, Emil, Reinhold, Caroline, Tang, An, and Bromwich, Rebecca
- Subjects
- *
ALGORITHMS , *ARTIFICIAL intelligence , *DATA encryption , *DATABASE management , *DIAGNOSTIC imaging , *HEALTH services accessibility , *MACHINE learning , *MEDICAL protocols , *DICOM (Computer network protocol) , *COVID-19 pandemic - Abstract
The application of big data, radiomics, machine learning, and artificial intelligence (AI) algorithms in radiology requires access to large data sets containing personal health information. Because machine learning projects often require collaboration between different sites or data transfer to a third party, precautions are required to safeguard patient privacy. Safety measures are required to prevent inadvertent access to and transfer of identifiable information. The Canadian Association of Radiologists (CAR) is the national voice of radiology committed to promoting the highest standards in patient-centered imaging, lifelong learning, and research. The CAR has created an AI Ethical and Legal standing committee with the mandate to guide the medical imaging community in terms of best practices in data management, access to health care data, de-identification, and accountability practices. Part 2 of this article will inform CAR members on the practical aspects of medical imaging de-identification, strengths and limitations of de-identification approaches, list of de-identification software and tools available, and perspectives on future directions. [ABSTRACT FROM AUTHOR]
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- 2021
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21. Patient blood management in India - Review of current practices and feasibility of applying appropriate standard of care guidelines. A position paper by an interdisciplinary expert group.
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Gandhi, Ajay, Görlinger, Klaus, Nair, Sukesh, Kapoor, Poonam, Trikha, Anjan, Mehta, Yatin, Handoo, Anil, Karlekar, Anil, Kotwal, Jyoti, John, Joseph, Apte, Shashikant, Vohra, Vijay, Gupta, Gajendra, Tiwari, Aseem, Rani, Anjali, and Singh, Shweta
- Subjects
- *
MEDICAL personnel , *HEALTH facilities , *PLATELET function tests , *HEALTH services accessibility , *HEMORRHAGE - Abstract
In a developing country like India, with limited resources and access to healthcare facilities, dealing with massive hemorrhage is a major challenge. This challenge gets compounded by pre-existing anemia, hemostatic disorders, and logistic issues of timely transfer of such patients from peripheral hospitals to centers with adequate resources and management expertise. Despite the awareness amongst healthcare providers regarding management modalities of bleeding patients, no uniform Patient Blood Management (PBM) or perioperative bleeding management protocols have been implemented in India, yet. In light of this, an interdisciplinary expert group came together, comprising of experts working in transfusion medicine, hematology, obstetrics, anesthesiology and intensive care, to review current practices in management of bleeding in Indian healthcare institutions and evaluating the feasibility of implementing uniform PBM guidelines. The specific intent was to perform a gap analysis between the ideal and the current status in terms of practices and resources. The expert group identified interdisciplinary education in PBM and bleeding management, bleeding history, viscoelastic and platelet function testing, and the implementation of validated, setting-specific bleeding management protocols (algorithms) as important tools in PBM and perioperative bleeding management. Here, trauma, major surgery, postpartum hemorrhage, cardiac and liver surgery are the most common clinical settings associated with massive blood loss. Accordingly, PBM should be implemented as a multidisciplinary and practically applicable concept in India in a timely manner in order to optimize the use the precious resource blood and to increase patients' safety. [ABSTRACT FROM AUTHOR]
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- 2021
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22. Culturally Congruent Health Care of COVID-19 in Minorities in the United States: A Clinical Practice Paper From the National Coalition of Ethnic Minority Nurse Associations
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Martha A. Dawson, Sandy Littlejohn, Leo-Felix M. Jurado, Elizabeth Aquino, Lillian Tom-Orme, Norma G. Cuellar, Young Shin Lee, Mary Joy Garcia-Dia, Eun-Ok Im, and Debra A. Toney
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,Ethnic group ,Health Services Accessibility ,03 medical and health sciences ,Race (biology) ,Betacoronavirus ,0302 clinical medicine ,Nursing ,Health care ,Epidemiology ,medicine ,Ethnicity ,Humans ,030212 general & internal medicine ,Social determinants of health ,Sociology ,Healthcare Disparities ,Pandemics ,General Nursing ,Minority Groups ,030504 nursing ,business.industry ,SARS-CoV-2 ,COVID-19 ,Health Status Disparities ,Health equity ,United States ,Clinical Practice ,Socioeconomic Factors ,0305 other medical science ,business ,Coronavirus Infections - Abstract
Introduction: Race and ethnicity along with social determinants of health have been identified as risk factors for COVID-19. The purpose of this clinical paper is to provide an overview of the National Coalition of Ethnic Minority Nurse Associations (NCEMNA), present COVID-19 epidemiological data on five racial–ethnic groups, identify culturally congruent health care strategies for each group, and provide directions for practice and research. Method: NCEMNA collaborated to provide a clinical paper that addresses information about COVID-19 and culturally congruent health care in five racial–ethnic groups. Results: Every organization presented common themes across the different groups and unique perspectives that each group is faced with during this challenge. Discussion: This article provides an introduction to the issues that minority groups are facing. It is imperative that data are collected to determine the extent of the impact of COVID-19 in diverse communities in the country.
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- 2020
23. Feasibility and acceptability of involving bilingual community navigators to improve access to health and social care services in general practice setting of Australia.
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Mistry SK, Harris E, Li X, and Harris MF
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- Humans, Feasibility Studies, Australia, Social Support, Health Services Accessibility, General Practice
- Abstract
Background: Patients from culturally and linguistically diverse (CALD) backgrounds often face difficulties in accessing health and social care services. This study explored the feasibility and acceptability of involving community health workers (CHWs) as bilingual community navigators (BCNs) in general practice setting, to help patients from CALD backgrounds access health and social care services in Australia., Methods: This research was conducted in two general practices in Sydney where most patients are from specific CALD backgrounds (Chinese in one practice and Samoan in other). Three CHWs trained as BCNs were placed in these practices to help patients access health and social care service. A mixed-method design was followed to explore the feasibility and acceptability of this intervention including analysis of a record of services provided by BCNs and post-intervention qualitative interviews with patients, practice staff and BCNs exploring the feasibility and acceptability of the BCNs' role. The record was analyzed using descriptive statistics and interviews were audio-recorded, transcribed, and thematically analyzed., Results: BCNs served a total of 95 patients, providing help with referral to other services (52.6%), information about appointments (46.3%), local resources (12.6%) or available social benefits (23.2%). Most patients received one service from BCNs with the average duration of appointments being half an hour. Overall, BCNs fitted in well within the practices and patients as well as staff of participating practices accepted them well. Their role was facilitated by patients' felt need for and acceptance of BCNs' services, recruitment of BCNs from the patient community, as well as BCNs' training and motivation for their role. Major barriers for patients to access BCNs' services included lack of awareness of the BCNs' roles among some patients and practice staff, unavailability of information about local culture specific services, and inadequate time and health system knowledge by BCNs. Limited funding support and the short timeframe of the project were major limitations of the project., Conclusion: BCNs' placement in general practice was feasible and acceptable to patients and staff in these practices. This first step needs to be followed by accredited training, development of the workforce and establishing systems for supervision in order to sustain the program. Future research is needed on the extension of the intrevention to other practices and culture groups., (© 2023. The Author(s).)
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- 2023
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24. Availability of medical abortion medicines in eight countries: a descriptive analysis of key findings and opportunities.
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Grossman A, Prata N, Williams N, Ganatra B, Lavelanet A, Läser L, Asmani C, Elamin H, Ouedraogo L, Rahman MM, Conneh-Duworko MJ, Tehoungue BZ, Chanza H, Phiri H, Bhattarai B, Dhakal NP, Ojo OA, Afolabi K, Kabuteni TJ, Hailu BG, Moses F, Dlamini-Nqeketo S, Zulu T, and Rehnström Loi U
- Subjects
- Female, Humans, Pregnancy, Mifepristone, Misoprostol, South Africa, Drug Industry legislation & jurisprudence, Abortion, Induced legislation & jurisprudence, Abortion, Induced methods, Abortifacient Agents, Internationality legislation & jurisprudence, Health Services Accessibility legislation & jurisprudence
- Abstract
Background: In recent years a growing number of manufacturers and medical abortion products have entered country markets and health systems, with varying degrees of quality and accessibility. An interplay of factors including pharmaceutical regulations, abortion laws, government policies and service delivery guidelines and provider's knowledge and practices influence the availability of medical abortion medicines. We assessed the availability of medical abortion in eight countries to increase understanding among policymakers of the need to improve availability and affordability of quality-assured medical abortion products at regional and national levels., Methods: Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines in Bangladesh, Liberia, Malawi, Nepal, Nigeria, Rwanda, Sierra Leone and South Africa between September 2019 and January 2020., Results: Registration of abortion medicines-misoprostol or a combination of mifepristone and misoprostol-was established in all countries assessed, except Rwanda. Mifepristone and misoprostol regimen for medical abortion was identified on the national essential medicines list/standard treatment guidelines for South Africa as well as in specific abortion care service and delivery guidelines for Bangladesh, Nepal, Nigeria, and Rwanda. In Liberia, Malawi, and Sierra Leone-countries with highly restrictive abortion laws and no abortion service delivery guidelines or training curricula-no government-supported training on medical abortion for public sector providers had occurred. Instead, training on medical abortion was either limited in scope to select private sector providers and pharmacists or prohibited. Community awareness activities on medical abortion have been limited in scope across the countries assessed and where abortion is broadly legal, most women do not know that it is an option., Conclusion: Understanding the factors that influence the availability of medical abortion medicines is important to support policymakers improve availability of these medicines. The landscape assessments documented that medical abortion commodities can be uniquely impacted by the laws, policies, values, and degree of restrictions placed on service delivery programs. Results of the assessments can guide actions to improve access., (© 2023. World Health Organization.)
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- 2023
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25. Identifying critical steps towards improved access to innovation in cancer care: a European CanCer Organisation position paper
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Luzia Travado, Denis Lacombe, Martine Piccart, Peter Naredi, Pierre Bedossa, Gunnar Saeter, Etienne Brain, Ian Banks, David Cameron, Paolo G. Casali, Arturo Chiti, Katrine Riklund, Matti Aapro, Suzanne Wait, Riccardo Soffietti, Martin Schrappe, Philip Poortmans, Hein Van Poppel, Per J. Nilsson, Leticia De Mattos-Arruda, Alain Astier, Daniel Kelly, and Riccardo A. Audisio
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Cancer Research ,Scrutiny ,Psychological intervention ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,Multidisciplinary approach ,Neoplasms ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Healthcare Disparities ,Reimbursement ,business.industry ,Therapies, Investigational ,Environmental resource management ,Information technology ,Public relations ,Europe ,Oncology ,030220 oncology & carcinogenesis ,Sustainability ,Position paper ,business ,Delivery of Health Care - Abstract
In recent decades cancer care has seen improvements in the speed and accuracy of diagnostic procedures; the effectiveness of surgery, radiation therapy and medical treatments; the power of information technology; and the development of multidisciplinary, specialist-led approaches to care. Such innovations are essential if we are to continue improving the lives of cancer patients across Europe despite financial pressures on our healthcare systems. Investment in innovation must be balanced with the need to ensure the sustainability of healthcare budgets, and all health professionals have a responsibility to help achieve this balance. It requires scrutiny of the way care is delivered; we must be ready to discontinue practices or interventions that are inefficient, and prioritise innovations that may deliver the best outcomes possible for patients within the limits of available resources. Decisions on innovations should take into account their long-term impact on patient outcomes and costs, not just their immediate costs. Adopting a culture of innovation requires a multidisciplinary team approach, with the patient at the centre and an integral part of the team. It must take a whole-system and whole-patient perspective on cancer care and be guided by high-quality real-world data, including outcomes relevant to the patient and actual costs of care; this accurately reflects the impact of any innovation in clinical practice. The European CanCer Organisation is committed to working with its member societies, patient organisations and the cancer community at large to find sustainable ways to identify and integrate the most meaningful innovations into all aspects of cancer care.
- Published
- 2017
26. White Paper for the WHO International Meeting of World Pharmacopoeias: Value of Pharmacopoeial Standards for Access to Quality Medicines.
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DRUGSTORES , *HEALTH services accessibility , *INTERPROFESSIONAL relations , *MEETINGS , *PATIENT safety , *PHARMACEUTICAL industry , *PHARMACY information services , *QUALITY assurance , *WORLD health , *COVID-19 pandemic - Abstract
The article discusses healthcare systems for the world, medicines play an important role in treating illness, preventing disease, and ultimately, saving lives. Topics include a broader sense, medicines have valuable to society as tools to protect the public health; and the quality of medicines has ensured by the control of many factors such as the quality of components.
- Published
- 2020
27. Developing an integrated emergency medical services in a low-income country like Nepal: a concept paper.
- Author
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Bhandari, Deepak and Yadav, Nabin Krishna
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EMERGENCY medical services , *HEALTH services accessibility , *HEALTH status indicators , *INCOME , *INTEGRATED health care delivery , *INTERPROFESSIONAL relations , *MEDICAL care costs , *POVERTY , *GOVERNMENT aid - Abstract
Background: The main aim of emergency medical services (EMS) should be to provide universal emergency medical care which is EMS system available to all those who need it. Most of the developed countries have an integrated EMS system that is accessible by a single dial number in the whole country. Nepal does not have a proper EMS system. We conducted a literature review regarding methods of developing an integrated EMS system in Nepal. Result: The fragmented system, high demand–low supply, inequity with the service, and inadequately trained responders are major problems associated with EMS in Nepal. Nepal too should develop an integrated single dial number EMS system to meet the current demand of EMS. Having a paramedic in ambulances as the first responders will prevent chaos and save critical time. Funding models have to be considered while developing an EMS considering the capital as well as operational cost. Conclusion: Nepal can develop a public private partnership model of EMS where capital cost is provided by the government and operational cost by other methods. Community-based insurance system looks more feasible in a country like Nepal for generating operational cost. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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28. A community engaged primary healthcare strategy to address rural school student inequities: a descriptive paper.
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Jones, Debra, Ballard, Jacqueline, Dyson, Robert, Macbeth, Peter, Lyle, David, Sunny, Palatty, Thomas, Anu, and Sharma, Indira
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- *
COMMUNITY health nursing , *HEALTH services accessibility , *HEALTH status indicators , *HIGH school students , *INTERPROFESSIONAL relations , *LABOR supply , *NURSING services , *PRIMARY health care , *RESEARCH funding , *RURAL conditions , *STRATEGIC planning , *SOCIOECONOMIC factors , *EDUCATIONAL attainment - Abstract
Aim: This descriptive paper aims to describe the design and implementation of a community engaged primary healthcare strategy in rural Australia, the Primary Healthcare Registered Nurse: Schools-Based strategy. This strategy seeks to address the health, education and social inequities confronting children and adolescents through community engaged service provision and nursing practice. Background: There have been increasing calls for primary healthcare approaches to address rural health inequities, including contextualised healthcare, enhanced healthcare access, community engagement in needs and solutions identification and local-level collaborations. However, rural healthcare can be poorly aligned to community contexts and needs and be firmly entrenched in health systems, marginalising community participation. Methods: This strategy has been designed to enhance nursing service and practice responsiveness to the rural context, primary healthcare principles, and community experiences and expectations of healthcare. The strategy is underpinned by a cross-sector collaboration between a local health district, school education and a university department of rural health. A research framework is being developed to explore strategy impacts for service recipients, cross-sector systems, and the establishment and maintenance of a primary healthcare nursing workforce. Findings: Although in the early stages of implementation, key learnings have been acquired and strategic, relationship, resource and workforce gains achieved. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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29. Rural Health Scenario – Role of family medicine: Academy of Family Physicians of India Position Paper.
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Kumar, Pratyush and Kumar, Raman
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- *
FAMILY medicine , *FAMILY roles , *RURAL health , *MEDICAL personnel , *PHYSICIANS , *HEALTH services accessibility - Abstract
Half the world’s people currently live in rural and remote areas. About 70% of the world’s 1.4 billion people who are extremely poor live in rural areas. The problem is that the majority of healthcare providers prefer to serve in urban areas. Only a comprehensive and systematic approach can address these inequities. India, the largest democratic republic in the world, possesses 2.4% of the world’s land area and supports 16% of the world’s population. According to census 2011, 68.84% of population resides in rural areas. Nearly 86% of all the medical visits in India are made by rural inhabitants with a majority still traveling more than 100 km to avail healthcare facility, of which 70%–80% is born out of pocket landing them in poverty. A country’s approach must systematically and simultaneously address legal coverage and rights, health worker shortages, extension of healthcare protection, and quality of care. Only then can equitable access for all be fully achieved. Those living in rural areas have access to health protection and services that meet the criteria of availability, affordability, accessibility, acceptability, and quality. Family medicine as a broad specialty has its role from womb till tomb. Family medicine is defined as a specialty of medicine which is concerned with providing comprehensive care to individuals and families by integrating biomedical, behavioral, and social sciences. As an academic discipline, it includes comprehensive healthcare services, education, and research. A family doctor provides primary and continuing care to the entire family within the communities; addresses physical, psychological, and social problems; and coordinates comprehensive healthcare services with other specialists, as needed. The practitioners in family medicine can play an important role in providing healthcare services to the suffering humanity. The general practitioner’s responsibility in Medicare includes management of emergencies, treatment of problems relating to various medical and surgical specialties, care of entire family in its environment, appropriate referrals, and follow-up. He or she is the first-level contact for the patients and his or her family. Family medicine is the ideal solution to growing rural healthcare challenges. This article is a formal position paper of the Academy of Family Physicians of India. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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30. Blood diseases in Africa: Redressing unjust disparities is an urgent unmet need.
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Makani J, Cavazzana M, Gupta K, Nnodu O, Odame I, Tshilolo L, Ware R, and Luzzatto L
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- Humans, Health Services Needs and Demand, Africa epidemiology, Health Services Accessibility, Hematologic Diseases
- Published
- 2022
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31. Black Canadians' Exposure to Everyday Racism: Implications for Health System Access and Health Promotion among Urban Black Communities.
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Husbands W, Lawson DO, Etowa EB, Mbuagbaw L, Baidoobonso S, Tharao W, Yaya S, Nelson LE, Aden M, and Etowa J
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- Female, Humans, Black People, Canada, HIV Infections prevention & control, Male, Adolescent, Adult, Middle Aged, Social Determinants of Health, Health Promotion, Racism, Health Services Accessibility, Healthcare Disparities
- Abstract
This study explores the social determinants of Black Canadians' exposure to everyday racism, its relationship to health system access, and implications for health promotion. We used data from the A/C Study survey on HIV transmission and prevention among Black Canadians. We implemented the survey (N = 1360) in 2018-2019 in Toronto and Ottawa-two large cities that together account for 42% of Canada's Black population-among self-identified Black residents aged 15-64 years, who were born in sub-Sahara Africa or the Caribbean or had a parent who was born in those regions. Participants reported racist encounters in the preceding 12 months using the Everyday Discrimination Scale. We assessed the socio-demographic correlates of racist experiences and the impact of racism on health system access using multivariable generalised linear models. Sixty percent of participants reported experiencing racism in the preceding 12 months. Based on the adjusted odds ratios, participants were more likely to experience racism if they were older, employed, Canadian-born, had higher levels of education, self-identified as LGBTQ + and reported generally moderate access to basic needs and adequate housing; and less likely to experience racism if they lived in Ottawa, self-identified as female or reported higher levels of social capital. Visiting a healthcare provider or facility, and difficulty accessing healthcare were associated with racist experiences. Racist experiences diminished the likelihood of being tested for HIV. Racist experiences were widespread, especially among those with higher levels of social wellbeing or greater exposure to Canadian institutions. Study participants also associated racist experiences with the healthcare system., (© 2022. The New York Academy of Medicine.)
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- 2022
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32. The global challenges and opportunities in the practice of rheumatology: white paper by the World Forum on Rheumatic and Musculoskeletal Diseases
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Joseph Flood, Yousef Al Weshahi, Tore K Kvien, Jamal Al Saleh, Femi Adelowo, Gerd-Rüdiger Burmester, Heather McDonald-Blumer, Lyn March, Mustafa Al Maini, Maurizio Cutolo, Kevin D. Pile, Carlos Pineda, and Carter Thorne
- Subjects
medicine.medical_specialty ,Population ageing ,Biomedical Research ,business.industry ,Public health ,Alternative medicine ,Developing country ,General Medicine ,Global Health ,Health Services Accessibility ,White paper ,Rheumatology ,Family medicine ,Scale (social sciences) ,Rheumatic Diseases ,Health care ,Physical therapy ,Global health ,Prevalence ,Medicine ,Humans ,Musculoskeletal Diseases ,business - Abstract
Rheumatic and musculoskeletal diseases (RMDs) represent a multitude of degenerative, inflammatory and auto-immune conditions affecting millions of people worldwide. Persons with these diseases may potentially experience severe chronic pain, joint damage, increasing disability and even death. With an increasingly ageing population, the prevalence and burden of RMDs are predicted to increase, placing greater demands on the global practice of rheumatology and related healthcare budgets. Effective treatment of RMDs currently faces a number of challenges in both the developed and developing world, and individual countries may face more specific local challenges. However, limited understanding of the burden of RMDs amongst public health professionals and policy-makers means that these diseases are often not considered a public health priority. The objective of this review is to increase awareness of the RMDs and to identify opportunities to address RMD challenges on both a local and global scale. On 26 September 2014, rheumatology experts from five different continents met at the World Forum on Rheumatic and Musculoskeletal Diseases (WFRMD) to discuss and identify some key challenges for the RMDs community today. The outcomes are presented in this review, focusing on access to rheumatology services, diagnostics and therapies, rheumatology education and training and on clinical trials, as well as investigator-initiated and epidemiological research. The long-term vision of the WFRMD is to increase perception of the RMDs as a major burden to society and to explore potential opportunities to improve global and local RMD care.
- Published
- 2014
33. Assistive technology policy : a position paper from the first global research, innovation, and education on assistive technology (GREAT) summit
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Malcolm MacLachlan, David Banes, Diane Bell, Johan Borg, Brian Donnelly, Michael Fembek, Ritu Ghosh, Rosemary Joan Gowran, Emma Hannay, Diana Hiscock, Evert-Jan Hoogerwerf, Tracey Howe, Friedbert Kohler, Natasha Layton, Siobhán Long, Hasheem Mannan, Gubela Mji, Thomas Odera Ongolo, Katherine Perry, Cecilia Pettersson, Jessica Power, Vinicius Delgado Ramos, Lenka Slepičková, Emma M. Smith, Kiu Tay-Teo, Priscille Geiser, and Hilary Hooks
- Subjects
Aging ,030506 rehabilitation ,Orthopedic Equipment ,Health Policy ,Rehabilitation ,Biomedical Engineering ,Physical Therapy, Sports Therapy and Rehabilitation ,Public Health, Global Health, Social Medicine and Epidemiology ,Global Health ,Self-Help Devices ,Health Services Accessibility ,03 medical and health sciences ,Speech and Hearing ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,0302 clinical medicine ,Humans ,Disabled Persons ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Power, Psychological ,Policy Making ,0305 other medical science ,Developing Countries ,Needs Assessment ,Quality of Health Care - Abstract
Increased awareness, interest and use of assistive technology (AT) presents substantial opportunities for many citizens to become, or continue being, meaningful participants in society. However, there is a significant shortfall between the need for and provision of AT, and this is patterned by a range of social, demographic and structural factors. To seize the opportunity that assistive technology offers, regional, national and sub-national assistive technology policies are urgently required. This paper was developed for and through discussion at the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit; organized under the auspices of the World Health Organization's Global Collaboration on Assistive Technology (GATE) program. It outlines some of the key principles that AT polices should address and recognizes that AT policy should be tailored to the realities of the contexts and resources available. AT policy should be developed as a part of the evolution of related policy across a number of different sectors and should have clear and direct links to AT as mediators and moderators for achieving the Sustainable Development Goals. The consultation process, development and implementation of policy should be fully inclusive of AT users, and their representative organizations, be across the lifespan, and imbued with a strong systems-thinking ethos. Six barriers are identified which funnel and diminish access to AT and are addressed systematically within this paper. We illustrate an example of good practice through a case study of AT services in Norway, and we note the challenges experienced in less well-resourced settings. A number of economic factors relating to AT and economic arguments for promoting AT use are also discussed. To address policy-development the importance of active citizenship and advocacy, the need to find mechanisms to scale up good community practices to a higher level, and the importance of political engagement for the policy process, are highlighted. Policy should be evidence-informed and allowed for evidence-making; however, it is important to account for other factors within the given context in order for policy to be practical, authentic and actionable. Implications for Rehabilitation The development of policy in the area of asssitive technology is important to provide an overarching vision and outline resourcing priorities. This paper identifies some of the key themes that should be addressed when developing or revising assistive technology policy. Each country should establish a National Assistive Technology policy and develop a theory of change for its implementation.
- Published
- 2018
34. Improving access in rheumatology: Evaluating the validity of a paper triage process involving an advanced practice physiotherapist through a retrospective chart review
- Author
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Aviva Lichtenstein MScPT, Brad McArthur MScPT, Kristin E. Musselman Pt, Cassie Bender MScPT, Chandra Farrer Pt, Kristin Bignell MScPT, and MHSc Theresa Kay Pt
- Subjects
Adult ,Male ,Canada ,medicine.medical_specialty ,Process (engineering) ,Decision Making ,Physical Therapy, Sports Therapy and Rehabilitation ,Sensitivity and Specificity ,Severity of Illness Index ,Health Services Accessibility ,Appointments and Schedules ,Rheumatic Diseases ,Chart review ,Internal medicine ,medicine ,Humans ,Referral and Consultation ,Aged ,Retrospective Studies ,business.industry ,Middle Aged ,medicine.disease ,Triage ,Rheumatology ,Physical Therapists ,Female ,Medical emergency ,Rheumatologists ,business - Abstract
Objectives: This study evaluated a standardized paper triage process conducted by an advanced practice physiotherapist (APP) at a rheumatology center. The aims were to (1) determine the concordance between paper triage priority assignment and the rheumatologist’s diagnosis; (2) determine the sensitivity and specificity of the paper triage process; and (3) assess reasons for incorrect priority ranking. Methods: Referrals were triaged by a formally trained APP into one of the three priorities, guided by a priority referral tool. A retrospective review of 192 charts was performed. Raw proportion of agreement between paper triage and rheumatologist’s diagnosis was supplemented by a prevalence-adjusted bias-adjusted kappa (PABAK). Priority categories were collapsed to calculate sensitivity and specificity. For discordant cases, additional information was collected from the referral and chart to identify potential features leading to discrepancy. Results: Overall agreement was 76%. The PABAK was 0.80 [95% confidence interval 0.70–0.90]. Sensitivity ranged 0.64–0.92 and specificity ranged 0.81–0.94, depending on the priority category. Forty-six cases were discordant, with the APP choosing a higher priority in 37 cases. An incorrect diagnosis from the family physician with no supporting information for the paper triage led to discordance in 16 cases. Conclusion: A standardized paper triage process conducted by an APP showed substantial concordance, sensitivity, and specificity.
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- 2018
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35. Digital health solutions to improve health care: a call for papers.
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Divya Lakhotia, Rapeepong Suphanchaimat, Walaiporn Patcharanarumol, Labrique, Alain, and Viroj Tangcharoensathien
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- *
PREVENTION of communicable diseases , *HEALTH services accessibility , *COMMUNICABLE diseases , *MIDDLE-income countries , *LIFE expectancy , *STAKEHOLDER analysis , *DIGITAL technology , *DIGITAL health , *MEDICAL care , *LABOR supply , *QUALITY assurance , *LOW-income countries , *HEALTH equity , *COVID-19 pandemic , *TELEMEDICINE , *HEALTH self-care - Abstract
The article discusses the role of digital health solutions in strengthening health systems and improving health care services. Topics discussed include the global challenge of health inequities with billions of people facing preventable diseases and premature deaths due to the lack of health care access, the interoperability of existing health data which is needed to implement digital solutions, and the periodical's calls for papers about digital health solutions.
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- 2024
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36. HIV Pre-Exposure Prophylaxis Medication for Adolescents and Young Adults: A Position Paper of the Society for Adolescent Health and Medicine
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Adam Leonard
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Adult ,Male ,030505 public health ,Adolescent ,Anti-HIV Agents ,Public Health, Environmental and Occupational Health ,Adolescent Health ,HIV Infections ,Health Services Accessibility ,Medication Adherence ,03 medical and health sciences ,Psychiatry and Mental health ,Sexual and Gender Minorities ,Young Adult ,0302 clinical medicine ,Pediatrics, Perinatology and Child Health ,Emtricitabine ,Humans ,Female ,Pre-Exposure Prophylaxis ,030212 general & internal medicine ,0305 other medical science ,Tenofovir - Abstract
Pre-exposure prophylaxis (PrEP) is a biomedical prevention intervention that has demonstrated high efficacy in reducing human immunodeficiency virus (HIV) transmission. While an increasing number of jurisdictions have endorsed the use of emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) for PrEP, access to PrEP varies widely. Adolescents and young adults (AYAs), especially those at high risk of HIV acquisition, such as young gay, bisexual, and other men having sex with men (YGBMSM) and individuals living in countries where HIV is endemic, face multiple barriers that limit their access to PrEP. This position paper provides context and recommendations for the promotion and use of PrEP among AYAs.
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- 2018
37. TimelinePTC: Development of a unified interface for pathways to care collection, visualization, and collaboration in first episode psychosis.
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Mathis, Walter S., Ferrara, Maria, Cahill, John, Karmani, Sneha, Tayfur, Sümeyra N., and Srihari, Vinod
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PSYCHOSES ,DATA entry ,DATA conversion ,HEALTH services accessibility ,ACQUISITION of data ,DIGITAL technology - Abstract
This paper presents TimelinePTC, a web-based tool developed to improve the collection and analysis of Pathways to Care (PTC) data in first episode psychosis (FEP) research. Accurately measuring the duration of untreated psychosis (DUP) is essential for effective FEP treatment, requiring detailed understanding of the patient's journey to care. However, traditional PTC data collection methods, mainly manual and paper-based, are time-consuming and often fail to capture the full complexity of care pathways. TimelinePTC addresses these limitations by providing a digital platform for collaborative, real-time data entry and visualization, thereby enhancing data accuracy and collection efficiency. Initially created for the Specialized Treatment Early in Psychosis (STEP) program in New Haven, Connecticut, its design allows for straightforward adaptation to other healthcare contexts, facilitated by its open-source codebase. The tool significantly simplifies the data collection process, making it more efficient and user-friendly. It automates the conversion of collected data into a format ready for analysis, reducing manual transcription errors and saving time. By enabling more detailed and consistent data collection, TimelinePTC has the potential to improve healthcare access research, supporting the development of targeted interventions to reduce DUP and improve patient outcomes. [ABSTRACT FROM AUTHOR]
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- 2024
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38. Evaluating diabetes care in primary healthcare centers in Abuja, Nigeria: a cross-sectional formative assessment.
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Orji, Ikechukwu A., Baldridge, Abigail S., Ikechukwu-Orji, Mercy U., Banigbe, Bolanle, Eze, Nelson C., Chopra, Aashima, Omitiran, Kasarachi, Iyer, Guhan, Odoh, Deborah, Alex-Okoh, Morenike, Reng, Rifkatu, Hirschhorn, Lisa R., Huffman, Mark D., and Ojji, Dike B.
- Subjects
DIAGNOSIS of diabetes ,TREATMENT of diabetes ,HEALTH services accessibility ,CROSS-sectional method ,MEDICAL protocols ,MEDICAL personnel ,RURAL health ,BLOOD sugar monitors ,MANAGEMENT information systems ,RESEARCH funding ,PRIMARY health care ,DESCRIPTIVE statistics ,RURAL health services ,ROUTINE diagnostic tests ,MEDICAL screening ,DRUGS ,DATA analysis software ,HEALTH information systems ,EQUIPMENT & supplies - Abstract
Introduction: Noncommunicable diseases (NCDs) are associated with high and rising burden of morbidity and mortality in sub-Saharan Africa, including Nigeria. Diabetes mellitus (DM) is among the leading causes of NCD-related deaths worldwide and is a foremost public health problem in Nigeria. As part of National policy, Nigeria has committed to implement the World Health Organization (WHO) Package of Essential Non-communicable Disease interventions for primary care. Implementing the intervention requires the availability of essential elements, including guidelines, trained staff, health management information systems (HMIS), equipment, and medications, in primary healthcare centers (PHCs). This study assessed the availability of the DM component of the WHO package, and the readiness of the health workers in these PHCs to implement a DM screening, evaluation, and management program to inform future adoption and implementation. Methods: This cross-sectional formative assessment adapted the WHO Service Availability and Readiness Assessment (SARA) tool to survey 30 PHCs selected by multistage sampling for readiness to deliver DM diagnosis and care in Abuja, Nigeria, between August and October 2021. The SARA tool was adapted to focus on DM services and the availability and readiness indicator scores were calculated based on the proportion of PHCs with available DM care services, minimum staff requirement, diagnostic tests, equipment, medications, and national guidelines/protocols for DM care within the defined SARA domain. Results: All 30 PHCs reported the availability of at least two full-time staff (median [interquartile range] = 5 [4–9]), which were mostly community health extension workers (median [interquartile range]) = 3 [1–4]. At least one staff member was recently trained in DM care in 11 PHCs (36%). The study also reported high availability of paper-based HMIS (100%), and DM screening services using a glucometer (87%), but low availability of DM job aids (27%), treatment (23%), and national guidelines/protocols (0%). Conclusion: This formative assessment of PHCs' readiness to implement a DM screening, evaluation, and management program in Abuja demonstrated readiness to integrate DM care into PHCs regarding equipment, paper-based HMIS, and nonphysician health workers' availability. However, strategies are needed to promote DM health workforce training, provide DM management guidelines, and supply essential DM medications. [ABSTRACT FROM AUTHOR]
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- 2024
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39. Brief Report: Supporting Access to HIV Care for Children and Youth During the COVID-19 Pandemic With Telemedicine and Rideshare.
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Koay WLA, Prabhakar S, Neilan A, Meyers J, Lee N, and Rakhmanina N
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- Adolescent, Ambulatory Care, COVID-19 virology, Child, Female, Humans, Male, Patient Satisfaction, Retrospective Studies, SARS-CoV-2 isolation & purification, COVID-19 epidemiology, HIV Infections therapy, Health Services Accessibility, Pandemics, Telemedicine, Transportation of Patients
- Abstract
Background: In response to the COVID-19 pandemic, we scaled up telemedicine and rideshare services for clinic and laboratory visits for pediatric and adolescent patients with HIV., Setting: HIV subspecialty program for patients aged 0-24 years at Children's National Hospital, Washington, DC., Methods: Using the χ2 and Wilcoxon rank sum tests, we compared demographics, visit and laboratory data, and rideshare usage among patients who scheduled telemedicine at least once (telemedicine) versus those who never scheduled telemedicine (no-telemedicine) during the pandemic (April-September 2020). We compared the number and proportion of scheduled and completed clinic visits before the pandemic (April-September 2019) with those during the pandemic., Results: We analyzed 178 pediatric and adolescent patients with HIV (median age 17.9 years, 89.3% Black, 48.9% male patients, 78.7% perinatally infected), of whom 70.2% and 28.6% used telemedicine and rideshare, respectively. Telemedicine patients scheduled more visits (236 vs 179, P < 0.0001) and completed a similar proportion of visits (81.8% vs 86.0%, P = 0.3805) compared with no-telemedicine patients. Laboratory testing rates (81.3% versus 98.5%, P = 0.0005) were lower in telemedicine patients compared with no-telemedicine patients. Rideshare usage (12.4% versus 26.5%, P = 0.0068) was lower in telemedicine versus no-telemedicine patients. During the pandemic, most of the patients (81.0%) had HIV RNA <200 copies/mL. The total number of completed visits and the proportion of visits completed were similar before and during the pandemic., Conclusion: Most of the pediatric and adolescent patients with HIV used telemedicine and maintained HIV RNA <200 copies/mL during the pandemic. Despite rideshare usage, laboratory testing rates were lower with telemedicine compared with in-person visits., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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40. Developing family practice to respond to global health challenges: The Besrour Papers: a series on the state of family medicine in the world
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Neil, Arya, Bruce, Dahlman, Christine, Gibson, David, Ponka, Cynthia, Haq, Katherine, Rouleau, and Stephanie, Hansel
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Practice ,Capacity Building ,Primary Health Care ,Delivery of Health Care, Integrated ,Cuba ,Humans ,Family Practice ,Global Health ,Poverty ,Africa South of the Sahara ,Health Services Accessibility - Abstract
To assess family medicine's role in developing strong, coordinated, community-based, integrated health care systems in low-resource settings globally.A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with selected international colleagues with expertise in international family medicine practice, health systems and capacity building, and teaching to map family medicine globally and give a bird's eye view of family medicine internationally.Following a background literature review, the authors collectively reflected on their substantial international experience to attempt to describe best practices for various contexts.With the failure of vertical, disease-oriented models to provide sustained improvements in health outcomes, the need to develop integrated primary care involving the most appropriate health professionals for differing contexts is becoming apparent worldwide. Health system planning is required to develop policies on health professional training to achieve this. Advocating and offering appropriate incentives for, and coordination of, local opportunities within the health system also becomes paramount. The adaptability and generalist nature of family medicine allows it to respond to the unique needs of a given population. Family physicians with adequate financial and physical resources can function most effectively as members of interdisciplinary teams, thus providing valuable, comprehensive health services in any area of the world.
- Published
- 2017
41. Maternal and neonatal implementation for equitable systems : a study design paper
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Ayub Kakaire, Elizabeth Ekirapa-Kiracho, Judith Ajeani, Ligia Paina, Lynn Atuyambe, Rornald Muhumuza Kananura, Fred Makumbi, Moses Tetui, Peter Waiswa, Aloysuis Mutebi, Gertrude Namazzi, John Bua, Asha George, and Suzanne N Kiwanuka
- Subjects
Adult ,Capacity Building ,Scale (ratio) ,Participatory action research ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,community health workers ,Pregnancy ,low-income countries ,Humans ,Maternal Health Services ,Uganda ,030212 general & internal medicine ,Neonatal health ,Quality of Health Care ,implementation science ,sustainability and local capacity ,participatory action research ,maternal and neonatal health ,business.industry ,Study Design Article ,lcsh:Public aspects of medicine ,030503 health policy & services ,Health Policy ,Environmental resource management ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,lcsh:RA1-1270 ,Prenatal Care ,Public Health, Global Health, Social Medicine and Epidemiology ,Focus Groups ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Research Design ,health insurance ,Female ,Original Article ,MANIFEST - Maternal and Neonatal Implementation for Equitable Systems Study ,Health Services Research ,Rural Health Services ,Power, Psychological ,0305 other medical science ,business - Abstract
Background: Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. Objectives: The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach. Methods: The study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis. Conclusions: This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory approach. Supplement: 4Special Issue: MANIFEST (Maternal and Neonatal Implementation for Equitable Systems Study)
- Published
- 2017
42. Using Community Health Workers to Address Barriers to Participation and Retention in Diabetes Prevention Program: A Concept Paper.
- Author
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Zare, Hossein, Delgado, Paul, Spencer, Michelle, Thorpe Jr., Roland J., Thomas, Laurine, Gaskin, Darrell J., Werrell, Lori K., and Carter, Ernest L.
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SOCIAL participation ,ONLINE information services ,PROFESSIONAL peer review ,SERVICES for caregivers ,HEALTH services accessibility ,SYSTEMATIC reviews ,TIME ,HOSPITAL health promotion programs ,MEDICAL care costs ,TYPE 2 diabetes ,HEALTH literacy ,CONCEPTUAL structures ,HEALTH behavior ,RESEARCH funding ,MEDLINE ,PATIENT education ,BEHAVIOR modification ,TRANSPORTATION ,PREDIABETIC state ,ADULTS - Abstract
Objective: The PreventionLink of Southern Maryland is a 5-year project to eliminate barriers to participation and retention in the National Diabetes Prevention Program (DPP) lifestyle change program to prevent or delay the onset of type 2 diabetes in adults with prediabetes. This is the study to identify the obstacles to participation and retention in the DPP lifestyle change program among high burden populations and learn how CHWs have reduced the identified barriers to participation and retention for high burden populations. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to conduct this literature review. We have used the Scopus and PubMed, including all types of studies and peer-reviewed documents published in English between 2010 and 2020. Results: From 131 identified articles, 18 articles were selected for qualitative synthesis. The reviewed literature documented following as main barriers to participate in a DPP lifestyle change program: time, cost, lack of transportation, cost of transportation, commute distance, technology access, access to facilities and community programs, caregiver responsibilities, lack of health literacy and awareness, and language. CHWs can address these barriers to participation and retention, they were involved in educating and supporting roles; they worked as bridges between healthcare providers and participants and as intervention team members. Conclusions: Diabetes prevention program participants with social determinant risk factors who most need CHW services are unlikely to have financial resources to pay for CHW services out-of-pocket. Hence, the public and private health plans that pay for their prediabetes care should consider paying for these CHW services and there is a need to trust more to CHW and have them as a "community health teams" member. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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43. Joint position paper on rural surgery and operative delivery
- Author
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Stuart, Iglesias, Jude, Kornelsen, Robert, Woollard, Nadine, Caron, Garth, Warnock, Randall, Friesen, Peter, Miles, Victoria, Vogt Haines, Bret, Batchelor, Jenny, Blake, Garey, Mazowita, Roy, Wyman, Brian, Geller, and Braam, de Klerk
- Subjects
Canada ,Health Services Needs and Demand ,Cesarean Section ,Health Policy ,Rural Health ,Delivery, Obstetric ,Community Networks ,Health Services Accessibility ,Obstetrics ,Health Planning ,Gynecology ,Pregnancy ,General Surgery ,Physicians ,Surgical Procedures, Operative ,Workforce ,Humans ,Female ,Maternal Health Services ,Patient Safety ,Rural Health Services ,Family Practice ,Societies, Medical ,Program Evaluation - Abstract
Our professional organizations have prepared this paper as part of an integrated, multidisciplinary plan to ensure the availability of well-trained practitioner teams to sustain safe, effective and high-quality rural surgical and operative delivery services. Without these robust local (or nearby) surgical services, sustaining rural maternity care is much more difficult. This paper describes the "network model" as a health human resources solution to meet the surgical needs, including operative delivery, of rural residents; outlines necessary policy directions for achieving this solution; and poses a series of enabling recommendations.Nos organisations professionnelles ont préparé cet article dans le cadre d’un plan multidisciplinaire intégré visant à assurer la disponibilité d’équipes soignantes bien formées pour offrir des services obstétricaux interventionnels et chirurgicaux sécuritaires, efficaces et de grande qualité en milieu rural. Sans de tels solides services chirurgicaux locaux (ou de proximité), il est beaucoup plus difficile d’assurer les soins obstétricaux en milieu rural. Cet article décrit le « modèle en réseau » comme une solution au chapitre des ressources humaines en santé pour répondre aux besoins chirurgicaux des populations rurales, y compris pour les services obstétricaux interventionnels. On y décrit aussi les orientations politiques nécessaires à l’application de cette solution et on formule une série de recommandations préparatoires.
- Published
- 2015
44. Musculoskeletal Urgent Care Centers Restrict Access for Patients with Medicaid Insurance Based on Policy and Location.
- Author
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Yousman LC, Hsiang WR, Jin G, Najem M, Mosier-Mills A, Khunte A, Jain S, Forman H, and Wiznia DH
- Subjects
- Ambulatory Care organization & administration, Ambulatory Care Facilities organization & administration, Cross-Sectional Studies, Geography, Health Services Accessibility organization & administration, Humans, Musculoskeletal Diseases economics, Musculoskeletal Diseases therapy, Orthopedics methods, Policy, United States, Ambulatory Care economics, Ambulatory Care Facilities economics, Health Services Accessibility economics, Medicaid statistics & numerical data, Orthopedics economics
- Abstract
Background: As the urgent care landscape evolves, specialized musculoskeletal urgent care centers (MUCCs) are becoming more prevalent. MUCCs have been offered as a convenient, cost-effective option for timely acute orthopaedic care. However, a recent "secret-shopper" study on patient access to MUCCs in Connecticut demonstrated that patients with Medicaid had limited access to these orthopaedic-specific urgent care centers. To investigate how generalizable these regional findings are to the United States, we conducted a nationwide secret-shopper study of MUCCs to identify determinants of patient access., Questions/purposes: (1) What proportion of MUCCs in the United States provide access for patients with Medicaid insurance? (2) What factors are associated with MUCCs providing access for patients with Medicaid insurance? (3) What barriers exist for patients seeking care at MUCCs?, Methods: An online search of all MUCCs across the United States was conducted in this cross-sectional study. Three separate search modalities were used to gather a complete list. Of the 565 identified, 558 were contacted by phone with investigators posing over the telephone as simulated patients seeking treatment for a sprained ankle. Thirty-nine percent (216 of 558) of centers were located in the South, 13% (71 of 558) in the West, 25% (138 of 558) in the Midwest, and 24% (133 of 558) in New England. This study was given an exemption waiver by our institution's IRB. MUCCs were contacted using a standardized script to assess acceptance of Medicaid insurance and identify barriers to care. Question 1 was answered through determining the percentage of MUCCs that accepted Medicaid insurance. Question 2 considered whether there was an association between Medicaid acceptance and factors such as Medicaid physician reimbursements or MUCC center type. Question 3 sought to characterize the prevalence of any other means of limiting access for Medicaid patients, including requiring a referral for a visit and disallowing continuity of care at that MUCC., Results: Of the MUCCs contacted, 58% (323 of 558) accepted Medicaid insurance. In 16 states, the proportion of MUCCs that accepted Medicaid was equal to or less than 50%. In 22 states, all MUCCs surveyed accepted Medicaid insurance. Academic-affiliated MUCCs accepted Medicaid patients at a higher proportion than centers owned by private practices (odds ratio 14 [95% CI 4.2 to 44]; p < 0.001). States with higher Medicaid physician reimbursements saw proportional increases in the percentage of MUCCs that accepted Medicaid insurance under multivariable analysis (OR 36 [95% CI 14 to 99]; p < 0.001). Barriers to care for Medicaid patients characterized included location restriction and primary care physician referral requirements., Conclusion: It is clear that musculoskeletal urgent care at these centers is inaccessible to a large segment of the Medicaid-insured population. This inaccessibility seems to be related to state Medicaid physician fee schedules and a center's affiliation with a private orthopaedic practice, indicating how underlying financial pressures influence private practice policies. Ultimately, the refusal of Medicaid by MUCCs may lead to disparities in which patients with private insurance are cared for at MUCCs, while those with Medicaid may experience delays in care. Going forward, there are three main options to tackle this issue: increasing Medicaid physician reimbursement to provide a financial incentive, establishing stricter standards for MUCCs to operate at the state level, or streamlining administration to reduce costs overall. Further research will be necessary to evaluate which policy intervention will be most effective., Level of Evidence: Level II, prognostic study., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2021 by the Association of Bone and Joint Surgeons.)
- Published
- 2021
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45. Diagnostic Accuracy of Digital Solutions for Screening for Cognitive Impairment: A Systematic Review and Meta-Analysis.
- Author
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Magno, Marisa, Martins, Ana Isabel, Pais, Joana, Silva, Anabela G., and Rocha, Nelson Pacheco
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DIGITAL technology ,MEDICAL screening ,COGNITION disorders ,ELECTRONIC evidence ,HEALTH services accessibility - Abstract
The early detection of cognitive impairment is essential in order to initiate interventions and guarantee access to healthcare services. Digital solutions are emerging in the literature as an alternative approach to cognitive screening. Our primary goal is to synthesize the evidence on digital solutions' diagnostic ability to screen for cognitive impairment and their accuracy. A secondary goal is to distinguish whether the ability to screen for cognitive impairment varies as a function of the type of digital solution: paper-based or innovative digital solutions. A systematic review and meta-analysis of digital solutions' diagnostic accuracy were conducted, including 25 studies. Digital solutions presented a variable diagnostic accuracy range. Innovative digital solutions offered at least 0.78 of sensitivity but showed lower specificity levels than the other subgroup. Paper-based digital solutions revealed at least 0.72 of specificity, but sensitivity started at 0.49. Most digital solutions do not demand the presence of a trained professional and include an automatic digital screening system and scoring, which can enhance cognitive screening and monitoring. Digital solutions can potentially be used for cognitive screening in the community and clinical practice, but more investigation is needed for an evidence-based decision. A careful assessment of the accuracy levels and quality of evidence of each digital solution is recommended. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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46. Integrated Primary Care Teams (IPCT) pilot project in Quebec: a protocol paper
- Author
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Lily Lessard, Bernard Roy, Aurore Cockenpot, Jacinthe Pepin, Luc Mathieu, Roxane Borgès Da Silva, Arnaud Duhoux, Emmanuelle Jean, Francine Girard, Mélanie Perroux, Maxime Amar, Clémence Dallaire, Isabelle Brault, Jean-Pierre Bonin, Caroline Larue, Carl-Ardy Dubois, and Damien Contandriopoulos
- Subjects
Program evaluation ,primary healthcare team ,Quality Assurance, Health Care ,Best practice ,media_common.quotation_subject ,Pilot Projects ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,interdisciplinarity ,Nursing ,PRIMARY CARE ,Clinical Protocols ,Intervention (counseling) ,Protocol ,Medicine ,Humans ,Quality (business) ,030212 general & internal medicine ,Longitudinal Studies ,media_common ,Protocol (science) ,Patient Care Team ,Medical education ,Research ethics ,Health economics ,Primary Health Care ,business.industry ,030503 health policy & services ,Health services research ,Quebec ,General Medicine ,Health Services Research ,0305 other medical science ,business ,Delivery of Health Care ,Program Evaluation - Abstract
Introduction The overall aim of this project is to help develop knowledge about primary care delivery models likely to improve the accessibility, quality and efficiency of care. Operationally, this objective will be achieved through supporting and evaluating 8 primary care team pilot sites that rely on an expanded nursing role within a more intensive team-based, interdisciplinary setting. Methods and analysis The first research component is aimed at supporting the development and implementation of the pilot projects, and is divided into 2 parts. The first part is a logical analysis based on interpreting available scientific data to understand the causal processes by which the objectives of the intervention being studied may be achieved. The second part is a developmental evaluation to support teams in the field in a participatory manner and thereby learn from experience. Operationally, the developmental evaluation phase mainly involves semistructured interviews. The second component of the project design focuses on evaluating pilot project results and assessing their costs. This component is in turn made up of 2 parts. Part 1 is a pre-and-post survey of patients receiving the intervention care to analyse their care experience. In part 2, each patient enrolled in part 1 (around 4000 patients) will be matched with 2 patients followed within a traditional primary care model, so that a comparative analysis of the accessibility, quality and efficiency of the intervention can be performed. The cohorts formed in this way will be followed longitudinally for 4 years. Ethics and dissemination The project, as well as all consent forms and research tools, have been accepted by 2 health sciences research ethics committees. The procedures used will conform to best practices regarding the anonymity of patients.
- Published
- 2015
47. Assessment of access and utilization of adolescent and youth sexual and reproductive health services in western Ethiopia.
- Author
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Tilahun T, Bekuma TT, Getachew M, and Seme A
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- Adolescent, Cross-Sectional Studies, Ethiopia epidemiology, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Sexual Behavior statistics & numerical data, Surveys and Questionnaires, Young Adult, Family Planning Services statistics & numerical data, Health Services Accessibility statistics & numerical data, Reproductive Health, Reproductive Health Services statistics & numerical data
- Abstract
Background: Despite Ethiopia's enormous effort in youth-friendly service provision, little was investigated about the challenges of accessing sexual and reproductive health services in Western Ethiopia. Thus, this study aimed to assess factors associated with the utilization of adolescent and youth sexual and reproductive health services in this area., Methods: A community-based cross-sectional quantitative method mixed with the qualitative inquiry was conducted among 771 adolescents and youth aged 15 to 24 years from February 1 to 28, 2020. Data were collected through face-to-face interviews using pretested structured questionaries. Data were entered using EPI-INFO version 7.0 and analyzed by SPSS version 25. Descriptive analysis and logistic regressions were performed. The adjusted odds ratio with a 95% confidence interval was used and statistical significance was declared at P-value < 0.05. The qualitative inquiry was collected through in-depth interviews with service providers, focus group discussions, and observation checklists of service units in the study facilities. Data were analyzed thematically., Results: The mean age of participants was 18.99 years (SD ± 2.49). Two hundred seventeen (28.1%) of participants reported that they have ever heard about adolescents' and youth's reproductive health services. Only 66 (8.6%) have ever visited health facilities for sexual and reproductive health (SRH) services. Factors associated with the utilization of sexual and reproductive health service were age from 15 to 19 years (AOR = 0.36; 95%CI: 0.17, 0.76), history of having sexual intercourse(AOR = 5.34;95%CI: 2.53, 11.23), ever heard about sexual reproductive health service (AOR = 11.33; 95%CI: 5.59, 22.96), and visited a health facility for other health services (AOR = 5.12; 95%CI:1.72,15.24)., Conclusion: Sexual and reproductive health service utilization among adolescents and youth was found to be low. The factors associated with adolescents and youth sexual and reproductive health services utilization were age, history of ever having sexual intercourse, ever heard about SRH services, and visit the health facility for other services. Therefore, it is better if the concerned bodies work on improving awareness of adolescents and youth towards SRH services and integrating these services into other routine services.
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- 2021
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48. Advancing digital healthcare in Somalia: a review of modern technologies and their implications.
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Ahmed, Mohamed Mustaf, Dirie, Najib Isse, Mohamud, Abdirahman Khalif, Elmi, Abdikadir Hussein, Musa, Shuaibu Saidu, Alhammadi, Omar Abdulkarim Saeed, Lemma, Misha Abayneh, Uwamahoro, Joselyne, Bananeza, Roméo, Abdullahi, Yinusa, Othman, Zhinya Kawa, Hamid, Mohammed Raihanatu, Kasimieh, Omar, Labyad, Safouane, and Lucero-Prisno III, Don Eliseo
- Subjects
DIGITAL health ,HEALTH services accessibility ,SUSTAINABILITY ,TELEMEDICINE - Abstract
Somalia faces many challenges in providing adequate and accessible healthcare to its population, particularly in rural and remote areas. Lack of infrastructure, resources, and security hinders the delivery of quality health services and the prevention and control of diseases. However, modern technologies such as mobile phones, the Internet, and telemedicine offer new opportunities to digitize health care and improve health outcomes in Somalia. This paper explores the current state of healthcare in Somalia, the potential benefits, and challenges of using modern technologies to digitize healthcare, and the best practices and recommendations for implementing such technologies in the Somali context. This paper examines a telemedicine project that connects remote healthcare facilities with urban specialists. We assess its effectiveness and sustainability, showing its potential to improve healthcare in rural areas of Somalia. The review concludes that modern technologies can play a vital role in digitizing healthcare in Somalia, but they require careful planning, coordination, and evaluation to ensure their effectiveness and suitability. [ABSTRACT FROM AUTHOR]
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- 2024
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49. Corporate Social Responsibility and Social Needs in Health Care Sectors—A Critical Analysis of Social Innovation in the Health Sector in Taiwan.
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Chu, Winnie and Chu, Nain-Feng
- Subjects
CORPORATE culture ,TAIWANESE people ,HEALTH services accessibility ,DIFFUSION of innovations ,RURAL health ,INTERPROFESSIONAL relations ,HEALTH policy ,SOCIAL responsibility ,PRIVATE sector ,PUBLIC relations ,CORPORATIONS ,HEALTH care industry ,MEDICAL needs assessment ,ORGANIZATIONAL goals ,URBAN health ,MEDICAL care costs - Abstract
Background: Social innovation is often used as a mechanism to jump-start public–private partnerships to leverage resources to achieve social impact; the analysis of sustainability and the impact of corporate social responsibility (CSR) cannot be emphasized enough. Due to advances in the information and communication technology industry in Taiwan, this paper aims to explore whether these advancements drive CSR as a form of social innovation to meet health needs in Taiwan. Methodology: This paper uses a case study to look at CSR programs in the health sector in Taiwan. Corporations with diverse missions and different CSR approaches that are available on the internet are selected. The analysis of the case study takes a qualitative, exploratory approach to shed light on current initiatives. Results: The majority of CSR programs in Taiwan are private sector activities that emerged during the COVID-19 pandemic; current CSR activities in Taiwan are driven by awards, public relations, and external interests. Corporations in Taiwan have the potential to address the health care gaps of urban–rural health utilization among Taiwanese indigenous communities. It is recommended for corporations to (1) develop partnerships with public health experts or to (2) employ CSR personnel with health care backgrounds who can navigate the intersection between health, business, and policies to develop CSR strategies. Conclusions: Further evaluation of the projects mentioned in this paper to assess the direct and indirect impact on health outcomes could provide a more comprehensive understanding of the field of CSR in the health sector in Taiwan. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
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50. Disability Tax in the Welfare State: Uncertainty and Resentment about Disability Services in Finland.
- Author
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Katsui, Hisayo
- Subjects
HEALTH services accessibility ,IMMIGRANTS ,RESEARCH funding ,CHILDREN with disabilities ,ANGER ,MEDICAL care for people with disabilities ,INTERVIEWING ,QUESTIONNAIRES ,UNCERTAINTY ,CITIZENSHIP ,TAXATION ,SURVEYS ,HUMAN rights ,EXPERIENCE ,PUBLIC welfare ,PEOPLE with disabilities - Abstract
This paper focuses on the uncertainty and resentment that many persons with disabilities feel concerning their disability services in the welfare state of Finland. This paper elaborates on the theme through the lived citizenship of persons with disabilities using the key theory of disability tax as an analytical tool. The empirical data were collected through an online survey (n = 541) and six group interviews (n = 41) of persons with disabilities in 2023. The disability tax experiences are elaborated through four aspects: (1) rejected applications, (2) uncertain realisation, (3) laborious complaint mechanisms, and (4) the psycho–emotional effect. The findings of this study establish collective experiences of multi-layered disability tax throughout the disability services process. It concludes that disability services, which were originally planned to specifically ensure equal opportunities to participate in society for persons with disabilities, are increasingly becoming the very sources of burden as austerity has silently grown deeper over recent years and has become the clear policy of the current government. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
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