48 results on '"Ruano AL"'
Search Results
2. Clinicopathologic Features of 2018 American Society of Clinical Oncology/College of American Pathologists Fluorescence In Situ Hybridization Group 3 Breast Carcinoma (Human Epidermal Growth Factor Receptor 2 Chromosome 17 Centromere Ratio <2.0 and Average Human Epidermal Growth Factor Receptor 2 Copy Number ≥6.0).
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Wilcock D, Sirohi D, Albertson D, Cleary AS, Coleman JF, Jedrzkiewicz J, Mahlow J, Ruano AL, and Gulbahce HE
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- Humans, Female, Middle Aged, Aged, Adult, Immunohistochemistry, Aged, 80 and over, Gene Dosage, Biomarkers, Tumor genetics, Biomarkers, Tumor metabolism, Biomarkers, Tumor analysis, United States, Pathologists, In Situ Hybridization, Fluorescence, Receptor, ErbB-2 genetics, Receptor, ErbB-2 metabolism, Breast Neoplasms genetics, Breast Neoplasms pathology, Breast Neoplasms metabolism, Breast Neoplasms diagnosis, Chromosomes, Human, Pair 17 genetics, Centromere genetics, Centromere metabolism
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Context.—: The American Society of Clinical Oncology/College of American Pathologists 2018 update of the human epidermal growth factor receptor 2 (HER2) testing guideline includes a fluorescence in situ hybridization (FISH) group with a HER2 to chromosome 17 centromere (CEP17) ratio less than 2.0 and HER2 copy number 6.0 or greater (group 3), which requires integrated review of HER2 immunohistochemistry (IHC)., Objective.—: To assess the clinicopathologic features of group 3 patients and determine features associated with HER2-positive status after workup., Design.—: Cases submitted for HER2 FISH between January 2019 and June 2022 were identified, and relevant clinicopathologic information was obtained., Results.—: One hundred forty-two HER2 FISH cases (1.6%) were group 3. In 52 cases (36.6%) IHC was negative (0/1+), in 3 (2.8%) IHC was positive (3+), and in 86 (60.6%) IHC was 2+. Annotated IHC 2+ slides were recounted by a second reviewer in targeted areas, where 16 of 86 (18.6%) had a HER2:CEP17 ratio less than 2.0 and a HER2 copy number of 4.0 or greater to less than 6.0 (HER2 negative). After combined IHC/FISH review, 74 of 142 (52.1%) were classified as HER2 positive. HER2 copy number/cell was higher in HER2-positive compared with HER2-negative cases after the workup. The extent and intensity of staining in IHC 2+ cases did not correlate with the level of gene amplification. Twenty percent of HER2-positive patients achieved pathologic complete response., Conclusions.—: About half of group 3 cases were classified as HER2 positive after additional workup. Pathologic complete response rates in HER2-positive cases were lower than expected for group 1 (HER2:CEP17 ratio ≥2.0; HER2 copy number ≥4.0) patients. IHC-targeted FISH recounts may be redundant and may potentially lead to classification of some patients as HER2 negative, resulting in withholding of targeted therapy., (© 2024 College of American Pathologists.)
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- 2024
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3. Male Invasive Lobular Breast Cancer: Clinicopathologic Features Including Recurrence Score Results From a Population-Based Database.
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Balatico M, Ruano AL, Cleary AS, Lomo L, and Gulbahce HE
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- Male, Humans, Breast Neoplasms pathology, Carcinoma, Lobular pathology, Carcinoma, Ductal, Breast pathology
- Abstract
Competing Interests: The authors have no relevant financial interest in the products or companies described in this article.
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- 2024
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4. Social accountability and sexual and reproductive health-implications for research and practice.
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Steyn PS, Boydell V, Contractor S, Cordero JP, and Ruano AL
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- Humans, Social Responsibility, Reproductive Health, Sexual Behavior
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- 2024
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5. Metaplastic Breast Carcinoma: Clinicopathologic Features and Recurrence Score Results From a Population-based Database.
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McMurtry V, Cleary AS, Ruano AL, Lomo L, and Gulbahce HE
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- Humans, Female, Proportional Hazards Models, SEER Program, Registries, Prognosis, Carcinoma, Ductal, Breast genetics, Breast Neoplasms genetics, Breast Neoplasms epidemiology
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Objectives: Metaplastic breast carcinoma (MBC) is a rare, aggressive form of cancer comprising epithelial and mesenchymal elements. The purpose of this study was to use population-based data to review the clinicopathologic, molecular features, and outcomes of MBC., Methods: Surveillance, Epidemiology, and End Results Program (SEER) data were used to identify MBC and invasive ductal carcinoma (IDC), no special type (NOS) between 2004 and 2015. Results from Oncotype DX's 21-gene assay linked to SEER registries were included for hormone receptor (HR)-positive tumors. χ 2 analysis was performed to determine the differences between MBC and IDC. Kaplan-Meier curves and multivariate Cox proportional hazards models were used for breast cancer specific death (BCSD)., Results: Compared with IDC, NOS (n=509,864), MBC (n=3876) were more likely to present at an older age, be black, have negative lymph nodes, be >2 cm, grade 3, and triple negative (TN). All subtypes [HR-positive/human epidermal growth receptor 2 (HER2)-negative, HR-positive/HER2-positive, HR-negative/HER2-positive, and TN] had higher BCSD than IDC, NOS. 22.3% of MBC cases were HR-positive. HR-positive MBCs tested for a recurrence score (RS) 65% were high-risk compared with 16.8% of IDC, NOS. Within the MBC cohort, no significant differences in BCSD were identified with respect to different molecular subtypes. In a fully adjusted model, TN or HER2-positive status did not adversely affect BCSD compared with HR-positive MBC., Conclusions: All molecular subtypes of MBC had a poorer prognosis compared with IDC, NOS. The different molecular subtypes of MBC did not affect the BCSD. HR-positive MBC patients had a significantly higher high-risk RS than IDC, NOS patients., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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6. Quantitative Imaging Analysis Fluorescence In Situ Hybridization Validation for Clinical HER2 Testing in Breast Cancer.
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Wilcock DM, Moore KH, Rowe L, Mahlow J, Jedrzkiewicz J, Cleary AS, Lomo L, Ruano AL, Gering M, Bradshaw D, Maughan M, Tran P, Burlingame J, Davis R, Affolter K, Albertson DJ, Adelhardt P, Kim JT, Coleman JF, Deftereos G, Gulbahce EH, and Sirohi D
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- Humans, Female, In Situ Hybridization, Fluorescence methods, Receptor, ErbB-2 analysis, Biomarkers, Tumor analysis, Breast Neoplasms diagnostic imaging, Breast Neoplasms genetics
- Abstract
Context.—: Quantitative imaging is a promising tool that is gaining wide use across several areas of pathology. Although there has been increasing adoption of morphologic and immunohistochemical analysis, the adoption of evaluation of fluorescence in situ hybridization (FISH) on formalin-fixed, paraffin-embedded tissue has been limited because of complexity and lack of practice guidelines., Objective.—: To perform human epidermal growth factor receptor 2 (HER2) FISH validation in breast carcinoma in accordance with the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) 2018 guideline., Design.—: Clinical validation of HER2 FISH was performed using the US Food and Drug Administration-approved dual-probe HER2 IQFISH (Dako, Carpinteria, California) with digital scanning performed on a PathFusion (Applied Spectral Imaging, Carlsbad, California) system. Validation parameters evaluated included z-stacking, classifier, accuracy, precision, software, and hardware settings. Finally, we evaluated the performance of digital enumeration on clinical samples in a real-world setting., Results.—: The accuracy samples showed a final concordance of 95.3% to 100% across HER2 groups 1 to 5. During clinical implementation for HER2 groups 2, 3, and 4, we achieved a final concordance of 76% (95 of 125). Of these cases, only 8% (10 of 125) had discordances with clinical impact that could be identified algorithmically and triaged for manual review., Conclusions.—: Digital FISH enumeration is a useful tool to improve the efficacy of HER2 FISH enumeration and capture genetic heterogeneity across HER2 signals. Excluding cases with high background or poor image quality and manual review of cases with ASCO/CAP group discordances can further improve the efficiency of digital HER2 FISH enumeration., (© 2023 College of American Pathologists.)
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- 2023
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7. The many revelations of and about inequality data in the context of COVID-19: introducing a special issue on COVID-19 and inequality.
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Hosseinpoor AR, Nambiar D, Kirkby K, Ruano AL, and McFeeley S
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- Humans, Socioeconomic Factors, COVID-19
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- 2023
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8. Interventions and policy approaches to promote equity in breastfeeding.
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Vilar-Compte M, Pérez-Escamilla R, and Ruano AL
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- Female, Humans, Policy, Socioeconomic Factors, Breast Feeding, Mothers
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- 2022
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9. How can we best help this patient? Exploring mental health therapists' reflections on medication-free care for patients with psychosis in Norway.
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Oedegaard CH, Ruano AL, Blindheim A, Veseth M, Stige B, Davidson L, and Engebretsen IMS
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Background: Since 2015, Norwegian Regional Health Authorities have followed new government policy and gradually implemented medication-free services for patients with psychosis. The aim of this qualitative study was to explore the tension between policy and practice, and how health care workers in Bergen reflect on their role in implementing medication-free treatment., Methods: We performed three focus group discussions including 17 therapists working within medication free services, asking about their experiences with this new treatment program. We used Systematic Text Condensation for data analysis. The findings were discussed using Michael Lipsky's theoretical framework on the role public health workers play in policy implementation., Findings: Following Norway's new policy was challenging for the therapists in our study, particularly balancing a patient's needs with treatment guidelines, the legal framework and available resources. Therapists had an overarching wish to help patients through cooperation and therapeutic alliance, but their alliance was sometimes fragile, and the therapists worried about patients' conditions worsening., Conclusions: Democratization of treatment choices, with the aim of empowering patients in mental health care, challenges the level of professional discretion given that patients and therapists might have conflicting goals. Balancing the desire to help, professional responsibility, the perceived lack of resources, and certain patient choices created conditions that can leave therapists feeling disempowered in and alienated from their work., Trial Registration: N/A., (© 2022. The Author(s).)
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- 2022
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10. Cesarean delivery rates, hospital readiness and quality of clinical management in Ethiopia: national results from two cross-sectional emergency obstetric and newborn care assessments.
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Beyene MG, Zemedu TG, Gebregiorgis AH, Ruano AL, and Bailey PE
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- Emergency Service, Hospital, Ethiopia, Female, Humans, Infant, Newborn, Pregnancy, Quality of Health Care, Cesarean Section statistics & numerical data, Hospitals statistics & numerical data
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Background: Cesarean delivery (CD) rates have reached epidemic levels in many high and middle income countries while increasingly, low income countries are challenged both by high urban CD rates and high unmet need in rural areas. The managing authority of health care institutions often plays a role in these disparities. This paper shows changes between 2008 and 2016 in Ethiopian CD rates, readiness of hospitals to provide CD and quality of clinical care, while highlighting the role of hospital management authority., Methods: This secondary data analysis draws from two national cross-sectional studies to assess emergency obstetric and newborn care. The sample includes 111 hospitals in 2008 and 316 hospitals in 2016, and 275 women whose CD chart was reviewed in 2008 and 568 in 2016. Descriptive statistics are used to describe our primary outcome measures: population- and institutional-based CD rates; hospital readiness to perform CD; quality of clinical management, including the relative size of Robson classification groups., Results: The national population CD rate increased from 2008 to 2016 (< 1 to 2.7%) as did all regional rates. Rates in 2016 ranged from 24% in urban settings to less than 1% in several rural regions. The institutional rate was 54% in private for-profit hospitals in 2016, up from 46% in 2008. Hospital readiness to perform CDs increased in public and private for-profit hospitals. Only half of the women whose charts were reviewed received uterotonics after delivery of the baby, but use of prophylactic antibiotics was high. Partograph use increased from 9 to 42% in public hospitals, but was negligible or declined elsewhere. In 2016, 40% of chart reviews from public hospitals were among low-risk nulliparous women (Robson groups 1&2)., Conclusions: Between 2008 and 2016, government increased the availability of CD services, improved public hospital readiness and some aspects of clinical quality. Strategies tailored to further reduce the high unmet need for CD and what appears to be an increasing number of unnecessary cesareans are discussed. Adherence to best practices and universal coverage of water and electricity will improve the quality of hospital services while the use of the Robson classification system may serve as a useful quality improvement tool., (© 2021. The Author(s).)
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- 2021
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11. Decolonizing Health Governance: A Uganda Case Study on the Influence of Political History on Community Participation.
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Mulumba M, Ruano AL, Perehudoff K, and Ooms G
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- Health Policy, Humans, Social Responsibility, Uganda, Community Participation, Human Rights
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This paper presents a case study of how colonial legacies in Uganda have affected the shape and breadth of community participation in health system governance. Using Habermas's theory of deliberative democracy and the right to health, we examine the key components required for decolonizing health governance in postcolonial countries. We argue that colonization distorts community participation, which is critical for building a strong state and a responsive health system. Participation processes grounded in the principles of democracy and the right to health increase public trust in health governance. The introduction and maintenance of British laws in Uganda, and their influence over local health governance, denies citizens the opportunity to participate in key decisions that affect them, which impacts public trust in the government. Postcolonial societies must tackle how imported legal frameworks exclude and limit community participation. Without meaningful participation, health policy implementation and accountability will remain elusive., Competing Interests: Competing interests: None declared., (Copyright © 2021 Mulumba, Ruano, Perehudoff, and Ooms.)
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- 2021
12. Understanding inequities in health and health systems in Latin America and the Caribbean: a thematic series.
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Ruano AL, Rodríguez D, Rossi PG, and Maceira D
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- Caribbean Region, Humans, Latin America, Delivery of Health Care organization & administration, Health Status Disparities
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Latin America, with its culturally and ethnically diverse populations, its burgeoning economies, high levels of violence, growing political instability, and its striking levels of inequality, is a region that is difficult to define and to understand. The region's health systems are deeply fragmented and segmented, which poses great challenges related to the provision of quality of care and overall equity levels in health and in Latin American society at large. Market, social, and political forces continue to push towards the poorly regulated privatization of public health care in many countries within the region, in detriment of public healthcare services where management capacities are limited.In this first collection of papers, we showcase how the region has tackled, with different levels of success, the incorporation of innovative health system reforms aimed at strengthening governance, participation, and the response to the growing epidemiological and demographic demands of its diverse population. We are delighted that this Special Collection will remain open to house future papers from Latin America and the Caribbean. The region has important experiences and lessons to share with the world. We look forward to learning more about how researchers and practitioners continue to experiment and innovate in their struggle to reach equity in health for all. This thematic series is a platform where the region's lessons and approaches can be shared with the global community of Health Policy and Systems Researchers.
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- 2021
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13. Unmasking power as foundational to research on sexual and reproductive health and rights.
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Schaaf M, Kapilashrami A, George A, Amin A, Downe S, Boydell V, Samari G, Ruano AL, Nanda P, and Khosla R
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- Health Policy, Humans, Reproductive Health, Sexual Behavior
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Competing Interests: Competing interests: None declared.
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- 2021
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14. Realizing the right to health in Latin America, equitably.
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Villar Uribe M, Escobar ML, Ruano AL, and Iunes RF
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- Caribbean Region, Health Care Reform trends, Human Rights trends, Humans, Latin America, Social Planning, Health Services Accessibility trends, Healthcare Disparities trends, Right to Health trends, Universal Health Insurance trends
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This special issue "Realizing the Right to Health in Latin America and the Caribbean" provides an overview of one of the most challenging objectives of health systems: equity and the realization of the right to health. In particular, it concentrates on the issues associated with such a challenge in countries suffering of deep inequity. The experience in Latin America and the Caribbean demonstrates that the efforts of health systems to achieve Universal Health Coverage are necessary but not sufficient to achieve an equitable realization of the right to health for all. The inequitable realization of all other human rights also determines the realization of the right to health.
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- 2021
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15. Axes of alienation: applying an intersectional lens on the social contract during the pandemic response to protect sexual and reproductive rights and health.
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Dasgupta J, Schaaf M, Contractor SQ, Banda A, Viana M, Kashyntseva O, and Ruano AL
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- COVID-19, Coronavirus Infections epidemiology, Female, Global Health, Health Services Accessibility, Humans, Pneumonia, Viral epidemiology, Reproductive Health, Reproductive Health Services, Sexual Health, Coronavirus Infections prevention & control, Pandemics prevention & control, Pneumonia, Viral prevention & control, Politics, Reproductive Rights
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While economic inequalities have been a key focus of attention through the COVID 19 pandemic, gendered relations of power at every level have undermined health rights of women, girls and gender diverse individuals. Sexual and reproductive health rights (SRHR) have always been sites of power contestations within families, societies, cultures, and politics; these struggles are exacerbated by economic, racial, religious, caste, citizenship status, and other social inequities, especially in times of crisis such as these. Policy responses to the COVID pandemic such as lockdown, quarantine, contact tracing and similar measures are premised on the existence of a social contract between the government and the people and among people, with the health sector playing a key role in preventive and curative care.We propose the use of an intersectional lens to explore the impact of the COVID-19 pandemic on the social contract, drawing on our field experiences from different continents particularly as related to SRHR. Along with documenting the ways in which the pandemic hinders access to services, we note that it is essential to interrogate state-society relations in the context of vulnerable and marginalized groups, in order to understand implications for SRHR. Intersectional analysis takes on greater importance now than in non-pandemic times as the state exercises more police or other powers and deploys myriad ways of 'othering'.We conclude that an intersectional analysis should not limit itself to the cumulative disadvantages and injustices posed by the pandemic for specific social groups, but also examine the historical inequalities, structural drivers, and damaged social contract that underlie state-society relationships. At the same time, the pandemic has questioned the status quo and in doing so it has provided opportunities for disruption; for re-imagining a social contract that reaches across sectors, and builds community resilience and solidarities while upholding human rights and gender justice. This must find place in future organizing and advocacy around SRHR.
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- 2020
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16. Health equity and COVID-19: global perspectives.
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Shadmi E, Chen Y, Dourado I, Faran-Perach I, Furler J, Hangoma P, Hanvoravongchai P, Obando C, Petrosyan V, Rao KD, Ruano AL, Shi L, de Souza LE, Spitzer-Shohat S, Sturgiss E, Suphanchaimat R, Uribe MV, and Willems S
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- COVID-19, Humans, Socioeconomic Factors, Coronavirus Infections epidemiology, Global Health statistics & numerical data, Health Equity, Health Status Disparities, Pandemics, Pneumonia, Viral epidemiology
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The COVID-19 is disproportionally affecting the poor, minorities and a broad range of vulnerable populations, due to its inequitable spread in areas of dense population and limited mitigation capacity due to high prevalence of chronic conditions or poor access to high quality public health and medical care. Moreover, the collateral effects of the pandemic due to the global economic downturn, and social isolation and movement restriction measures, are unequally affecting those in the lowest power strata of societies. To address the challenges to health equity and describe some of the approaches taken by governments and local organizations, we have compiled 13 country case studies from various regions around the world: China, Brazil, Thailand, Sub Saharan Africa, Nicaragua, Armenia, India, Guatemala, United States of America (USA), Israel, Australia, Colombia, and Belgium. This compilation is by no-means representative or all inclusive, and we encourage researchers to continue advancing global knowledge on COVID-19 health equity related issues, through rigorous research and generation of a strong evidence base of new empirical studies in this field.
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- 2020
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17. Global Health in the Age of COVID-19: Responsive Health Systems Through a Right to Health Fund.
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Friedman EA, Gostin LO, Maleche A, Nilo A, Foguito F, Rugege U, Stevenson S, Gitahi G, Ruano AL, Barry M, Hossain S, Lucien F, Rusike I, Hevia M, Alwan A, Cameron E, Farmer P, Flores W, Hassim A, Mburu R, Mukherjee J, Mulumba M, Pūras D, and Periago MR
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- Betacoronavirus, COVID-19, Capacity Building organization & administration, Communicable Disease Control economics, Health Priorities organization & administration, Humans, Pandemics, SARS-CoV-2, Communicable Disease Control organization & administration, Coronavirus Infections epidemiology, Financing, Organized organization & administration, Global Health, International Cooperation, Pneumonia, Viral epidemiology
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We propose that a Right to Health Capacity Fund (R2HCF) be created as a central institution of a reimagined global health architecture developed in the aftermath of the COVID-19 pandemic. Such a fund would help ensure the strong health systems required to prevent disease outbreaks from becoming devastating global pandemics, while ensuring genuinely universal health coverage that would encompass even the most marginalized populations. The R2HCF's mission would be to promote inclusive participation, equality, and accountability for advancing the right to health. The fund would focus its resources on civil society organizations, supporting their advocacy and strengthening mechanisms for accountability and participation. We propose an initial annual target of US$500 million for the fund, adjusted based on needs assessments. Such a financing level would be both achievable and transformative, given the limited right to health funding presently and the demonstrated potential of right to health initiatives to strengthen health systems and meet the health needs of marginalized populations-and enable these populations to be treated with dignity. We call for a civil society-led multi-stakeholder process to further conceptualize, and then launch, an R2HCF, helping create a world where, whether during a health emergency or in ordinary times, no one is left behind., Competing Interests: Competing interests: None declared., (Copyright © 2020 Friedman et al.)
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- 2020
18. Triangulating data sources for further learning from and about the MDSR in Ethiopia: a cross-sectional review of facility based maternal death data from EmONC assessment and MDSR system.
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Hadush A, Dagnaw F, Getachew T, Bailey PE, Lawley R, and Ruano AL
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- Cause of Death, Cross-Sectional Studies, Ethiopia epidemiology, Female, Humans, Maternal Mortality, Pregnancy, Pregnancy Complications mortality, Health Facilities statistics & numerical data, Information Storage and Retrieval, Maternal Death statistics & numerical data
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Background: Triangulating findings from MDSR with other sources can better inform maternal health programs. A national Emergency Obstetric and Newborn Care (EmONC) assessment and the Maternal Death Surveillance and Response (MDSR) system provided data to determine the coverage of MDSR implementation in health facilities, the leading causes and contributing factors to death, and the extent to which life-saving interventions were provided to deceased women., Methods: This paper is based on triangulation of findings from a descriptive analysis of secondary data extracted from the 2016 EmONC assessment and the MDSR system databases. EmONC assessment was conducted in 3804 health facilities. Data from interview of each facility leader on MDSR implementation, review of 1305 registered maternal deaths and 679 chart reviews of maternal deaths that happened form May 16, 2015 to December 15, 2016 were included from the EmONC assessment. Case summary reports of 601 reviewed maternal deaths were included from the MDSR system., Results: A maternal death review committee was established in 64% of health facilities. 5.5% of facilities had submitted at least one maternal death summary report to the national MDSR database. Postpartum hemorrhage (10-27%) and severe preeclampsia/eclampsia (10-24.1%) were the leading primary causes of maternal death. In MDSR, delay-1 factors contributed to 7-33% of maternal deaths. Delay-2, related to reaching a facility, contributed to 32% & 40% of maternal deaths in the EmONC assessment and MDSR, respectively. Similarly, delay-3 factor due to delayed transfer of mothers to appropriate level of care contributed for 29 and 22% of maternal deaths. From the EmONC data, 72% of the women who died due to severe pre-eclampsia or eclampsia were given anticonvulsants while 48% of those dying of postpartum haemorrhage received uterotonics., Conclusion: The facility level implementation coverage of MDSR was sub-optimal. Obstetric hemorrhage and severe preeclampsia or eclampsia were the leading causes of maternal death. Delayed arrival to facility (Delay 2) was the predominant contributing factor to facility-based maternal deaths. The limited EmONC provision should be the focus of quality improvement in health facilities.
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- 2020
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19. Healthcare workers' clinical knowledge on maternal and newborn care in Ethiopia: findings from 2016 national EmONC assessment.
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Zemedu TG, Teshome A, Tadesse Y, Bekele A, Keyes E, Bailey P, and Ruano AL
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- Adult, Cross-Sectional Studies, Ethiopia epidemiology, Female, Health Knowledge, Attitudes, Practice, Health Personnel education, Health Services Research, Humans, Infant, Newborn, Pregnancy, Young Adult, Health Personnel standards, Maternal-Child Health Services standards
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Background: Improving maternal and newborn health indicators are key if Ethiopia is to achieve the Sustainable Development Goals. To do so, women need access to skilled attendance at birth and emergency obstetric and newborn care. To maximize their impact, understanding gaps in workers' knowledge is required to remedy the weakness. This assessment determines knowledge levels of clinical management of maternal and newborn healthcare and factors that influence knowledge., Methods: This study used data from the National Emergency Obstetric and Neonatal Care assessment conducted in 2016. Provider knowledge for MNH was assessed by interviewing providers. Respondents were scored on each question by calculating the number of correct responses provided out of the total possible answers, and standardizing this to a scale of 100. Mixed linear regression was used to determine individual and contextual factors associated with the score., Results: A total of 3800 interviews with complete data were included in this study. Most respondents were diploma midwives (73%), BSc midwives (11%) and diploma nurses (10%). On average, midwives scored 60 out of 100 on the question regarding the primary aspects of focused antenatal care and elements of a birth plan. Half of the midwives and health officers, and one-third of nurses knew to provide a loading dose of magnesium sulphate. Midwives scored 90% on the steps of active management of third stage of labor. In the mixed linear regression, working in a private for profit facility, health center/clinic, rural area, or in a facility with a protocol on referral/counter referral predicted lower knowledge scores. More positive scores were associated with work environments that had a computer, internet, and protocols on safe abortion care, management of selected obstetric topics, integrated management of pregnancy, childbirth, postnatal, and newborn, care for low birth weight including kangaroo mother care, and treatment of infection in young infants., Conclusion: With regard to most knowledge related questions, health officers and midwives scored similarly. Providers scored substantially better on routine intrapartum and newborn care than on aspects related to care for complications. A substantial proportion of providers indicated that they would never give a loading dose of magnesium sulphate.
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- 2019
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20. Readiness to treat and factors associated with survival of newborns with breathing difficulties in Ethiopia.
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Gobezie WA, Bailey P, Keyes E, Ruano AL, and Teklie H
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- Cross-Sectional Studies, Delivery, Obstetric methods, Ethiopia epidemiology, Female, Health Facilities, Health Services Research, Humans, Infant, Newborn, Pregnancy, Resuscitation methods, Asphyxia Neonatorum mortality, Asphyxia Neonatorum therapy, Resuscitation mortality
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Background: Ethiopia is one of five countries that account for half of the world's 2.6 million newborn deaths. A quarter of neonatal deaths in Ethiopia are caused by birth asphyxia. Understanding different dimensions of the quality of care for newborns with breathing difficulties can lead to improving service provision environments and practice. We describe facility readiness to treat newborns with breathing difficulties, the extent to which newborn resuscitation is provided, and by modeling the survival of newborns with difficulties breathing, we identify key factors that suggest how mortality from asphyxia can be reduced., Methods: We carried out a secondary analysis of the 2016 Ethiopia Emergency Obstetric and Newborn Care Assessment that included 3804 facilities providing childbirth services and 2433 chart reviews of babies born with difficulties breathing. We used descriptive statistics to assess health facilities' readiness to treat these newborns and a binary logistic regression to identify factors associated with survival., Results: Over one-quarter of facilities did not have small-sized masks (size 0 or 1) to complete the resuscitation kits. Among the 2190 cases with known survival status, 49% died before discharge, and among 1035 cases with better data quality, 29% died. The odds of surviving birth asphyxia after resuscitation increased eightfold compared to newborns not resuscitated. Other predictors for survival were the availability of a newborn corner, born at term or post-term, normal birth weight (≥2500 g) and delivered by cesarean or assisted vaginal delivery., Conclusion: The survival status of newborns with birth asphyxia was low, particularly in the primary care facilities that lacked the required resuscitation pack. Newborns born in a facility with better data quality were more likely to survive than those born in facilities with poor data quality. Equipping health centers/clinics with resuscitation packs and reducing the incidence of preterm and low birth weight babies should improve survival rates.
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- 2019
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21. Does Information and Communication Technology Add Value to Citizen-Led Accountability Initiatives in Health? Experiences from India and Guatemala.
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Schaaf M, Chhabra S, Flores W, Feruglio F, Dasgupta J, and Ruano AL
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- Delivery of Health Care, Developing Countries, Guatemala, Health Personnel, Human Rights, Humans, India, Models, Organizational, Quality of Health Care, Communication, Community Participation, Information Technology, Social Responsibility
- Abstract
Information and Communication Technology (ICT) may facilitate the collection and dissemination of citizen-generated data to enhance governmental accountability for the fulfillment of the right to health. The aim of this multiple case study research was to distill considerations related to the implementation of ICT and health accountability projects, describe the added operational value of ICT tools (as compared to similar projects that do not use ICT), and make preliminary statements regarding government responsiveness to accountability demands through ICT projects. In all three projects, the need for relationship building, continuous community engagement and technical support, and training for volunteers or service users was identified. Government responsiveness to the data varied, suggesting that political will is lacking in certain contexts. Despite these challenges, ICT initiatives provided an easy, accessible, and low-risk platform for reporting violations and demanding accountability from service providers and decision-makers. ICT-enabled citizen generated data can add significant operational value and some political value to project activities and goals, and may affect systems change when it is part of a broad-based, multi-level civil societal and governmental effort to improve health care quality., Competing Interests: Competing interests: None declared.
- Published
- 2018
22. Showcasing the contribution of social sciences to health policy and systems research.
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Topp SM, Scott K, Ruano AL, and Daniels K
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- Government Programs, Health Equity, Humans, Qualitative Research, Health Policy, Health Services Research, Public Health, Social Sciences
- Abstract
Background: This Special Issue represents a critical response to the frequent silencing of qualitative social science research approaches in mainstream public health journals, particularly in those that inform the field of health policy and systems research (HPSR), and the study of equity in health., Methods: This collection of articles is presented by SHAPES, the thematic working group of Health Systems Global focused on social science approaches to research and engagement in health policy and systems. The issue aims to showcase how qualitative and theory-driven approaches can contribute to better promoting equity in health within the field of HPSR., Results: This issue builds on growing recognition of the complex social nature of health systems. The articles in this collection underscore the importance of employing methods that can uncover and help explain health system complexities by exploring the dynamic relationships and decision-making processes of the human actors within. Articles seek to highlight the contribution that qualitative, interpretivist, critical, emancipatory, and other relational methods have made to understanding health systems, health policies and health interventions from the perspective of those involved. By foregrounding actor perspectives, these methods allow us to explore the impact of vital but difficult-to-measure concepts such as power, culture and norms., Conclusion: This special issue aims to highlight the critical contribution of social science approaches. Through the application of qualitative methods and, in some cases, development of theory, the articles presented here build broader and deeper understanding of the way health systems function, and simultaneously inform a more people-centred approach to collective efforts to build and strengthen those systems.
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- 2018
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23. Community health workers and accountability: reflections from an international "think-in".
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Schaaf M, Fox J, Topp SM, Warthin C, Freedman LP, Robinson RS, Thiagarajan S, Scott K, Maboe T, Zanchetta M, Ruano AL, Kok M, and Closser S
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- Female, Humans, Male, Qualitative Research, Socioeconomic Factors, Trust, Community Health Workers organization & administration, Health Services Accessibility organization & administration, Primary Health Care organization & administration, Social Responsibility
- Abstract
Community health workers (CHWs) are frequently put forward as a remedy for lack of health system capacity, including challenges associated with health service coverage and with low community engagement in the health system, and expected to enhance or embody health system accountability. During a 'think in', held in June of 2017, a diverse group of practitioners and researchers discussed the topic of CHWs and their possible roles in a larger "accountability ecosystem." This jointly authored commentary resulted from our deliberations. While CHWs are often conceptualized as cogs in a mechanistic health delivery system, at the end of the day, CHWs are people embedded in families, communities, and the health system. CHWs' social position and professional role influence how they are treated and trusted by the health sector and by community members, as well as when, where, and how they can exercise agency and promote accountability. To that end, we put forward several propositions for further conceptual development and research related to the question of CHWs and accountability.
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- 2018
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24. Oral medicine acceptance in infants and toddlers: measurement properties of the caregiver-administered Children's acceptance tool (CareCAT).
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Blume J, Ruano AL, Wang S, Jackson DJ, Tylleskär T, and Strand LI
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- Administration, Oral, Child, Preschool, Cross-Sectional Studies, Female, Humans, Infant, Male, Proxy, Reproducibility of Results, Anti-Bacterial Agents administration & dosage, Caregivers psychology, Patient Acceptance of Health Care, Surveys and Questionnaires
- Abstract
Background: Developing age-appropriate medications remains a challenge in particular for the population of infants and toddlers, as they are not able to reliably self-report if they would accept and consequently take an oral medicine. Therefore, it is common to use caregivers as proxies when assessing medicine acceptance. The outcome measures used in this research field differ and most importantly lack validation, implying a persisting gap in knowledge and controversy in the field. The newly developed Caregiver-administered Children's Acceptance Tool (CareCAT) is based on a 5-point nominal scale, with descriptors of medication acceptance behavior. This cross-sectional study assessed the measurement properties of the tool with regards to the user's understanding and its intra- and inter-rater reliability., Methods: Participating caregivers were enrolled at a primary healthcare facility where their children (median age 6 months) had been prescribed oral antibiotics. Caregivers, trained observers and the tool developer observed and scored on the CareCAT tool what behavior children exhibited when receiving the medicine (n = 104). The video-records of this process served as replicate observations (n = 69). After using the tool caregivers were asked to explain their observations and the tool descriptors in their own words. The tool's reliability was assessed by percentage agreement and Cohen's unweighted kappa coefficients of agreement for nominal scales., Results: The study found that caregivers using CareCAT had a satisfactory understanding of the tool's descriptors. Using its dichotomized scores the tool reliably was strong for acceptance behavior (agreement inter-rater 84-88%, kappa 0.66-0.76; intra-rater 87-89%, kappa 0.68-0.72) and completeness of medicine ingestion (agreement inter-rater 82-86%, kappa 0.59-0.67; intra-rater 85-93%, kappa 0.50-0.70)., Conclusions: The CareCAT is a low-cost, easy-to-use and reliable instrument, which is relevant to assess acceptance behavior and completeness of medicine ingestion, both of which are of significant importance for developing age-appropriate medications in infants and toddlers.
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- 2018
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25. Development and validation of a Screening Questionnaire of Family Mistreatment against Older Adults for use in primary care settings in Mexico.
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Ruelas-González MG, Pelcastre-Villafuerte BE, Monterrubio-Flores E, Alcalde-Rabanal JE, Ortega-Altamirano DV, Ruano AL, and Saturno Hernández PJ
- Subjects
- Aged, Cross-Sectional Studies, Female, Humans, Male, Mexico, Primary Health Care standards, Psychometrics statistics & numerical data, Reproducibility of Results, Risk Assessment, Elder Abuse diagnosis, Geriatric Assessment statistics & numerical data, Mass Screening standards, Surveys and Questionnaires standards
- Abstract
The abuse of older adults is a serious public health issue that can be difficult to identify at the first level of care. Medical and nursing personnel are sometimes unable to identify older adults who suffer family mistreatment. This can occur when victims feel shame or as a result of cultural factors. In the light of this, healthcare personnel require a screening tool that can be used to identify signs of mistreatment. The aim of this study was to develop and validate a screening tool for detecting the familial mistreatment of older adults in primary care settings. A mixed method cross-sectional study was carried out in three phases between 2009 and 2012 in Mexico. The formative phase involved using a qualitative methodology to identify terms that older adults use to identify practices defined as forms of mistreatment. On this basis, the second phase involved the design of a screening tool through the formation of items in collaboration with a panel of experts. These items were tested on older adults to ensure their intelligibility. Finally, validity and reliability levels were evaluated through the application of the screening tool to a sample of older adults at a primary care facility and at a legal centre. These findings were discussed with gerontologists, and the data were analysed through an exploratory factor analysis with orthogonal rotation and Cronbach's alpha using STATA v13. From the results, we generated a screening tool that is culturally and socially tailored to older adults in Mexico. The tool has a Cronbach's alpha of 0.89, a sensitivity value of 86% (p < .05) and a specificity value of 90% (p < .05) for positive answers to the tool's 15 items. Applying this tool at the first level of care could limit damage to older adults' health and could lower the frequency of emergency room use in hospitals., (© 2017 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.)
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- 2018
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26. Medicinal plants used as anthelmintics: Ethnomedical, pharmacological, and phytochemical studies.
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Romero-Benavides JC, Ruano AL, Silva-Rivas R, Castillo-Veintimilla P, Vivanco-Jaramillo S, and Bailon-Moscoso N
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- Anthelmintics chemistry, Humans, Medicine, Traditional methods, Phytotherapy methods, Anthelmintics pharmacology, Plants, Medicinal chemistry
- Abstract
Intestinal parasites delay mental and physical development in children. Infection with these parasites can result in complications during pregnancy and alter the health of newborns, which has long-term effects on educational attainment and economic productivity. The appearance of resistance against classical drug treatments generates interest in the development of new deworming alternatives. We think that research of new plants species may reveal potential antiparasitic compounds. This review is focused on the use of plants and secondary metabolites against intestinal parasites. We discuss the use of plants in traditional medicine and the use of plant secondary metabolites tried in in vitro and in vivo models when available., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)
- Published
- 2017
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27. Looking forward to the next 15 years: innovation and new pathways for research in health equity.
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Ruano AL, Shadmi E, Furler J, Rao K, San Sebastián M, Villar Uribe M, and Shi L
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- Forecasting, History, 21st Century, Humans, Biomedical Research history, Biomedical Research trends, Delivery of Health Care trends, Health Equity history, Health Equity trends, Social Justice history, Social Justice trends
- Abstract
Since our launch in 2002, the International Journal for Equity in Health (IJEqH) has furthered our collective understanding of equity in health and health services by providing a platform on which academics and practitioners can share their work. Today, we celebrate our fifteenth anniversary with an article collection that presents a call for new and novel research in equity in health and we invite our authors to use new approaches and methods, and to focus on emerging areas of research related to health equity in order to set the stage for the next fifteen years of health equity research.Our anniversary issue provides a platform for expanding the conceptualization, diversity of populations and study designs, and for increasing the use of novel methodologies in the field. The IJEqH has helped to support the wider group of researchers, policymakers and practitioners with a commitment to social justice and equity but there is still more to do. With the help of the highly committed editorial team and editorial board, the innovative work of researchers worldwide, and the countless of hours dedicated by hundreds of reviewers, we are confident in the IJEqH's ability to continue supporting the dissemination of health equity research for years to come.
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- 2017
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28. Engaging with complexity to improve the health of indigenous people: a call for the use of systems thinking to tackle health inequity.
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Hernández A, Ruano AL, Marchal B, San Sebastián M, and Flores W
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- Cultural Diversity, Humans, Poverty, Socioeconomic Factors, Delivery of Health Care standards, Health Services, Indigenous standards, Healthcare Disparities standards, Quality Improvement standards, Universal Health Insurance standards
- Abstract
The 400 million indigenous people worldwide represent a wealth of linguistic and cultural diversity, as well as traditional knowledge and sustainable practices that are invaluable resources for human development. However, indigenous people remain on the margins of society in high, middle and low-income countries, and they bear a disproportionate burden of poverty, disease, and mortality compared to the general population. These inequalities have persisted, and in some countries have even worsened, despite the overall improvements in health indicators in relation to the 15-year push to meet the Millennium Development Goals. As we enter the Sustainable Development Goals (SDGs) era, there is growing consensus that efforts to achieve Universal Health Coverage (UHC) and promote sustainable development should be guided by the moral imperative to improve equity. To achieve this, we need to move beyond the reductionist tendency to frame indigenous health as a problem of poor health indicators to be solved through targeted service delivery tactics and move towards holistic, integrated approaches that address the causes of inequalities both inside and outside the health sector. To meet the challenge of engaging with the conditions underlying inequalities and promoting transformational change, equity-oriented research and practice in the field of indigenous health requires: engaging power, context-adapted strategies to improve service delivery, and mobilizing networks of collective action. The application of systems thinking approaches offers a pathway for the evolution of equity-oriented research and practice in collaborative, politically informed and mutually enhancing efforts to understand and transform the systems that generate and reproduce inequities in indigenous health. These approaches hold the potential to strengthen practice through the development of more nuanced, context-sensitive strategies for redressing power imbalances, reshaping the service delivery environment and fostering the dynamics of collective action for political reform.
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- 2017
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29. The right to health of non-nationals and displaced persons in the sustainable development goals era: challenges for equity in universal health care.
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Brolan CE, Forman L, Dagron S, Hammonds R, Waris A, Latif L, and Ruano AL
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- Guidelines as Topic, Humans, Organizational Objectives, Refugees, United Nations, Global Health standards, Health Services Accessibility standards, Human Rights standards, Transients and Migrants
- Abstract
Introduction: Under the Millennium Development Goals (MDGs), United Nations (UN) Member States reported progress on the targets toward their general citizenry. This focus repeatedly excluded marginalized ethnic and linguistic minorities, including people of refugee backgrounds and other vulnerable non-nationals that resided within a States' borders. The Sustainable Development Goals (SDGs) aim to be truly transformative by being made operational in all countries, and applied to all, nationals and non-nationals alike. Global migration and its diffuse impact has intensified due to escalating conflicts and the growing violence in war-torn Syria, as well as in many countries in Africa and in Central America. This massive migration and the thousands of refugees crossing borders in search for safety led to the creation of two-tiered, ad hoc, refugee health care systems that have added to the sidelining of non-nationals in MDG-reporting frameworks., Conclusion: We have identified four ways to promote the protection of vulnerable non-nationals' health and well being in States' application of the post-2015 SDG framework: In setting their own post-2015 indicators the UN Member States should explicitly identify vulnerable migrants, refugees, displaced persons and other marginalized groups in the content of such indicators. Our second recommendation is that statisticians from different agencies, including the World Health Organization's Gender, Equity and Human Rights programme should be actively involved in the formulation of SDG indicators at both the global and country level. In addition, communities, civil society and health justice advocates should also vigorously engage in country's formulation of post-2015 indicators. Finally, we advocate that the inclusion of non-nationals be anchored in the international human right to health, which in turn requires appropriate financing allocations as well as robust monitoring and evaluation processes that can hold technocratic decision-makers accountable for progress.
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- 2017
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30. The alkylphospholipid edelfosine shows activity against Strongyloides venezuelensis and induces apoptosis-like cell death.
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Legarda-Ceballos AL, Rojas-Caraballo J, López-Abán J, Ruano AL, Yepes E, Gajate C, Mollinedo F, and Muro A
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- Animals, Dose-Response Relationship, Drug, Female, Larva drug effects, Mice, Phosphorylcholine analogs & derivatives, Phosphorylcholine pharmacology, Strongyloidiasis parasitology, Antineoplastic Agents pharmacology, Apoptosis drug effects, Phospholipid Ethers pharmacology, Strongyloides drug effects
- Abstract
Strongyloidiasis is widely distributed in the tropical and subtropical areas. Ivermectin is the drug of choice for the treatment. However, the concerns about relying treatment on a single drug make identification of new molecules a priority. Alkylphospholipid analogues, including edelfosine, are a group of synthetic compounds that have shown activity against some parasites. The objective was to assess the in vitro and in vivo activity of edelfosine, miltefosine, perifosine against Strongyloides venezuelensis. Moreover, apoptosis-like mechanism in larvae after treatment was studied. Edelfosine displayed the highest activity and the best selectivity index (LD50=49.6 ± 5.4μM, SI=1.1) compared to miltefosine or perifosine. Third stage larvae after culture with edelfosine were not able to develop an infection in mice. Treatment of mice with edelfosine showed reduction of 47% in parasitic females allocated in the gut. Moreover, DNA fragmentation was observed by TUNEL staining in larvae treated with edelfosine. These results suggest that edelfosine could be an effective drug against strongyloidiasis, probably through induction of apoptosis-like cell death., (Copyright © 2016 Elsevier B.V. All rights reserved.)
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- 2016
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31. Reflections on the Unintended Consequences of the Promotion of Institutional Pregnancy and Birth Care in Burkina Faso.
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Melberg A, Diallo AH, Ruano AL, Tylleskär T, and Moland KM
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- Burkina Faso, Delivery, Obstetric statistics & numerical data, Female, Health Facilities statistics & numerical data, Health Services Accessibility, Humans, Pregnancy, Prenatal Care methods, Rural Population statistics & numerical data, Maternal Health Services statistics & numerical data
- Abstract
The policy of institutional delivery has been the cornerstone of actions aimed at monitoring and achieving MDG 5. Efforts to increase institutional births have been implemented worldwide within different cultural and health systems settings. This paper explores how communities in rural Burkina Faso perceive the promotion and delivery of facility pregnancy and birth care, and how this promotion influences health-seeking behaviour. A qualitative study was conducted in South-Western Burkina Faso between September 2011 and January 2012. A total of 21 in-depth interviews and 8 focus group discussions with women who had given birth recently and community members were conducted. The data were analyzed using qualitative content analysis and interpreted through Merton's concept of unintended consequences of purposive social action. The study found that community members experienced a strong pressure to give birth in a health facility and perceived health workers to define institutional birth as the only acceptable option. Women and their families experienced verbal, economic and administrative sanctions if they did not attend services and adhered to health worker recommendations, and reported that they felt incapable of questioning health workers' knowledge and practices. Women who for social and economic reasons had limited access to health facilities found that the sanctions came with increased cost for health services, led to social stigma and acted as additional barriers to seek skilled care at birth. The study demonstrates how the global and national policy of skilled pregnancy and birth care can occur in unintentional ways in local settings. The promotion of institutional care during pregnancy and at birth in the study area compromised health system trust and equal access to care. The pressure to use facility care and the sanctions experienced by women not complying may further marginalize women with poor access to facility care and contribute to worsened health outcomes.
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- 2016
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32. Abuse and discrimination towards indigenous people in public health care facilities: experiences from rural Guatemala.
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Cerón A, Ruano AL, Sánchez S, Chew AS, Díaz D, Hernández A, and Flores W
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- Female, Focus Groups, Guatemala ethnology, Humans, Male, Population Groups psychology, Qualitative Research, Rural Population, Population Groups ethnology, Quality of Health Care standards, Racism trends
- Abstract
Background: Health inequalities disproportionally affect indigenous people in Guatemala. Previous studies have noted that the disadvantageous situation of indigenous people is the result of complex and structural elements such as social exclusion, racism and discrimination. These elements need to be addressed in order to tackle the social determinants of health. This research was part of a larger participatory collaboration between Centro de Estudios para la Equidad y Gobernanza en los Servicios de Salud (CEGSS) and community based organizations aiming to implement social accountability in rural indigenous municipalities of Guatemala. Discrimination while seeking health care services in public facilities was ranked among the top three problems by communities and that should be addressed in the social accountability intervention. This study aimed to understand and categorize the episodes of discrimination as reported by indigenous communities., Methods: A participatory approach was used, involving CEGSS's researchers and field staff and community leaders. One focus group in one rural village of 13 different municipalities was implemented. Focus groups were aimed at identifying instances of mistreatment in health care services and documenting the account of those who were affected or who witnessed them. All of the 132 obtained episodes were transcribed and scrutinized using a thematic analysis., Results: Episodes described by participants ranged from indifference to violence (psychological, symbolic, and physical), including coercion, mockery, deception and racism. Different expressions of discrimination and mistreatment associated to poverty, language barriers, gender, ethnicity and social class were narrated by participants., Conclusions: Addressing mistreatment in public health settings will involve tackling the prevalent forms of discrimination, including racism. This will likely require profound, complex and sustained interventions at the programmatic and policy levels beyond the strict realm of public health services. Future studies should assess the magnitude of the occurrence of episodes of maltreatment and racism within indigenous areas and also explore the providers' perceptions about the problem.
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- 2016
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33. Prevalence and factors associated with violence and abuse of older adults in Mexico's 2012 National Health and Nutrition Survey.
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Ruelas-González MG, Duarte-Gómez MB, Flores-Hernández S, Ortega-Altamirano DV, Cortés-Gil JD, Taboada A, and Ruano AL
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- Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Logistic Models, Male, Mexico epidemiology, Middle Aged, Risk Factors, Socioeconomic Factors, Surveys and Questionnaires, Domestic Violence statistics & numerical data, Elder Abuse statistics & numerical data, Violence statistics & numerical data
- Abstract
Background: Factors associated with violence and the abuse of older adults are understudied and its prevalence in Mexico has not been reported. The aim of this study was to identify the prevalence and factors associated with violence and abuse of older adults in Mexico., Methods: We used Mexico's 2012 National Health and Nutrition Survey, which included a sample of 8,894 individuals who are 60 years or older and who self-reported a negative health event related to robbery, aggression or violence in the previous 12 months. We used chi-squared test and Fisher's exact test to analyze the variables related to violence. Adjusted estimates were completed with multiple logistic regression models for complex surveys., Results: The prevalence of violence was 1.7 % for both men and women. In 95 % of the cases, the aggression was from an unknown party. Verbal aggressions were the most prevalent (60 %). Among men, physical aggression was more common. Violence frequently occurred in the home (37.6 %); however, men were primarily assaulted in public places (42.4 %), in comparison to women (30.7 %). There were also differences in the risk factors for violence. Among men, risk was associated with younger age (60-64 years), higher education (secondary school or above) and higher socioeconomic status. Among women, risk was associated with depression, not being the head of the family, and region of the country., Conclusions: Violence against older adults presents differently for men and women, which means it is necessary to increase knowledge about the dynamics of the social determinants of violence, particularly in regards to the role of education among men. The relatively low prevalence found in this study may reflect the difficulty and fear of discussing the topic of violence. This may occur because of cultural factors, as well as by the perception of helplessness perpetuated by the scarce access to social programs that ensure protection and problem solving with regards to the complex social determinants of individual and family violence that this population group endures.
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- 2016
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34. Interventions in Primary Care and their contributions to improving equity in health.
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Ruano AL, Furler J, and Shi L
- Subjects
- Humans, Health Equity, Primary Health Care
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- 2015
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35. Treatment with nitric oxide donors diminishes hyperinfection by Strongyloides venezuelensis in mice treated with dexamethasone.
- Author
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Ruano AL, López-Abán J, Fernández-Soto P, de Melo AL, and Muro A
- Subjects
- Animals, Female, Male, Mice, Mice, Inbred BALB C, Nitric Oxide physiology, Rats, Rats, Wistar, Dexamethasone pharmacology, Nitric Oxide Donors pharmacology, Strongyloidiasis drug therapy
- Abstract
The effects of using nitric oxide (NO) donors and inhibitors in experimental strongyloidiasis were showed using, both naïve and dexamethasone immunosuppressed BALB/c mice infected with Strongyloides venezuelensis. Aminoguanidine, an inhibitor of inducible NO synthase and LA419 a NO donor, were administered. Dexamethasone was used to induce immunosuppression. The study in BALB/c mice revealed increases in counts of fecal eggs, larvae in lungs and parasitic females following treatment with aminoguanidine, while mice treated with LA419 had limited egg output with low larval and adult recoveries. Mice immunosuppressed with dexamethasone developed hyperinfection with high long lasting fecal egg emission, high numbers of larvae in lungs and high numbers of parasitic females in the intestine even when the infection had already been cleared in non-immunosuppressed infected controls. Mice treated with dexamethasone and aminoguanidine had the highest egg output and the highest larva and parasitic female recovery showing a severe hyperinfection syndrome. In contrast, treatment with dexamenthasone and LA419 resulted in a controlled hyperinfection syndrome and these mice were able to eliminate the parasite. Therefore, NO modulation appears to be a determinant factor in severe strongyloidiasis and further studies should be conducted to confirm in other experimental models., (Copyright © 2015 Elsevier B.V. All rights reserved.)
- Published
- 2015
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36. From knowing our needs to enacting change: findings from community consultations with indigenous communities in Bangladesh.
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Hussain S, Ruano AL, Rahman A, Rashid SF, and Hill PS
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- Bangladesh, Community Health Planning standards, Health Status Disparities, Humans, Qualitative Research, Community Health Planning methods, Organizational Innovation, Population Groups, Quality of Life, Referral and Consultation
- Abstract
Introduction: Indigenous peoples are among the most marginalized peoples in the world due to issues relating to well-being, political representation, and economic production. The research consortium Goals and Governance for Global Health (Go4Health) conducted a community consultation process among marginalized groups across the global South aimed at including their voices in the global discourse around health in the post-2015 development agenda. This paper presents findings from the consultations carried out among indigenous communities in Bangladesh., Methods: For this qualitative study, our research team consulted the Tripura and Mro communities in Bandarban district living in the isolated Chittagong Hill Tracts region. Community members, leaders, and key informants working in health service delivery were interviewed. Data was analyzed using thematic analysis., Findings: Our findings show that remoteness shapes the daily lives of the communities, and their lack of access to natural resources and basic services prevents them from following health promotion messages. The communities feel that their needs are impossible to secure in a politically indifferent and sometimes hostile environment., Conclusion: Communities are keen to participate and work with duty bearers in creating the conditions that will lead to their improved quality of life. Clear policies that recognize the status of indigenous peoples are necessary in the Bangladeshi context to allow for the development of services and infrastructure.
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- 2015
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37. Health, equity and the post-2015 agenda: raising the voices of marginalized communities.
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Ruano AL, Friedman EA, and Hill PS
- Subjects
- Humans, Population Groups, Global Health, Goals, Health Services Needs and Demand, Health Status Disparities, Social Discrimination, Social Marginalization
- Abstract
In September 2012 the United Nations (UN) initiated a process that would extend and enhance the unfinished agenda of the Millennium Development Goals (MDGs), integrating a new vision for sustainable development beyond the year 2015. The initial consultation phase has been completed, with the UN and partner organizations undertaking eleven thematic consultations, including one on health. It is in this context that the European Commission (EC) has tasked the research consortium Goals and Governance for Global Health (Go4Health) with providing recommendations for the post-2015 health-related development goals and including voices that are routinely excluded from health-related decision-making processes. This has not been an easy task. It has led us to question how to define marginalization, how to access marginalized communities, as well as how community members could provide informed consent. The context of the communities we worked with was far removed from the reality of the post-2015 debates, where the MDGs and the new goals are remote and abstract, and where the promise of immediate benefit from participation could not be assured. Given the social, historical, cultural, ethnic and geographical diversity of our chosen community partners, and the diversity of their lived experiences, could their unique situations be generalized in ways that could influence the global debate? In this special issue, we have tried to explore the uniqueness and the commonalities of the issues and barriers that marginalized communities face all over the globe, and present them in individual papers that, together, provide a nuanced and complex picture of the challenges that face the post-2015 health-related agenda setting-process.
- Published
- 2014
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38. Making the post-MDG global health goals relevant for highly inequitable societies: findings from a consultation with marginalized populations in Guatemala.
- Author
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Ruano AL, Sánchez S, Jerez FJ, and Flores W
- Subjects
- Focus Groups, Guatemala, Humans, Population Groups, Qualitative Research, Rural Population, Surveys and Questionnaires, Global Health, Goals, Health Services Needs and Demand, Health Status Disparities, Social Discrimination
- Abstract
Introduction: The United Nations presented a set of Millennium Development Goals that aimed to improve social and economic development and eradicate poverty by 2015. Most low and middle-income countries will not meet these goals and today there is a need to set new development agenda, especially when it comes to health. The paper presents the findings from a community consultation process carried out within the Goals and Governance for Global Health (GO4Health) research consortium in Guatemala, which aims to identify community needs and expectations around public policies and health services., Methods: Through a participative and open consultation process with experts, civil society organizations and members of the research team, the municipalities of Tectitan and Santa Maria Nebaj were selected. A community consultation process was undertaken with community members and community leaders. Group discussions and in-depth interviews were conducted and later analyzed using thematic analysis, a qualitative method that can be used to analyze data in a way that allows for the identification of recurrent patterns that can be grouped into categories and themes, was used., Findings: Following the Go4Health framework's domains for understanding health-related needs, the five themes identified were health, social determinants of health, essential health needs and their provision, roles and responsibilities of relevant stakeholders and community participation in decision-making. Participants reported high levels of discrimination related to ethnicity, to being poor and to living in rural areas. Ethnicity played a major role in how community members feel they are cared for in the health system., Conclusion: Achieving health goals in a context of deep-rooted inequality and marginalization requires going beyond the simple expansion of health services and working with developing trusting relationships between health service providers and community members. Involving community members in decision-making processes that shape policies will contribute to a larger process of community empowerment and democratization. Still, findings from the region show that tackling these issues may prove complicated and require going beyond the health system, as this lack of trust and discrimination has permeated to all public policies that deal with indigenous and rural populations.
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- 2014
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39. Community participation in formulating the post-2015 health and development goal agenda: reflections of a multi-country research collaboration.
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Brolan CE, Hussain S, Friedman EA, Ruano AL, Mulumba M, Rusike I, Beiersmann C, and Hill PS
- Subjects
- Cooperative Behavior, Health Priorities, Humans, Organizational Objectives, Qualitative Research, Community Participation, Global Health, Goals, Health Services Needs and Demand, Health Status Disparities
- Abstract
Global discussion on the post-2015 development goals, to replace the Millennium Development Goals when they expire on 31 December 2015, is well underway. While the Millennium Development Goals focused on redressing extreme poverty and its antecedents for people living in developing countries, the post-2015 agenda seeks to redress inequity worldwide, regardless of a country's development status. Furthermore, to rectify the UN's top-down approach toward the Millennium Development Goals' formulation, widespread negotiations are underway that seek to include the voices of people and communities from around the globe to ground each post-2015 development goal. This reflexive commentary, therefore, reports on the early methodological challenges the Go4Health research project experienced in its engagement with communities in nine countries in 2013. Led by four research hubs in Uganda, Bangladesh, Australia and Guatemala, the purpose of this engagement has been to ascertain a 'snapshot' of the health needs and priorities of socially excluded populations particularly from the Global South. This is to inform Go4Health's advice to the European Commission on the post-2015 global goals for health and new governance frameworks. Five methodological challenges were subsequently identified from reflecting on the multidisciplinary, multiregional team's research practices so far: meanings and parameters around qualitative participatory research; representation of marginalization; generalizability of research findings; ethical research in project time frames; and issues related to informed consent. Strategies to overcome these methodological hurdles are also examined. The findings from the consultations represent the extraordinary diversity of marginal human experience requiring contextual analysis for universal framing of the post-2015 agenda. Unsurprisingly, methodological challenges will, and did, arise. We conclude by advocating for a discourse to emerge not only critically examining how and whose voices are being obtained at the community-level to inform the post-2015 health and development goal agenda, but also how these voices are being translated and integrated into post-2015 decision-making at national and global levels.
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- 2014
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40. Perceptions and experiences of access to public healthcare by people with disabilities and older people in Uganda.
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Mulumba M, Nantaba J, Brolan CE, Ruano AL, Brooker K, and Hammonds R
- Subjects
- Adolescent, Adult, Age Factors, Aged, Child, Child, Preschool, Female, Focus Groups, Health Services Needs and Demand, Health Status Disparities, Humans, Male, Middle Aged, Qualitative Research, Rural Population, Social Discrimination, Social Marginalization, Socioeconomic Factors, Uganda, Young Adult, Delivery of Health Care standards, Disabled Persons, Health Services Accessibility standards, Health Services for the Aged standards, Healthcare Disparities
- Abstract
Introduction: In the year 2000, a set of eight Millennium Development Goals (MDGs) were presented as a way to channel global efforts into the reduction of poverty and the promotion of social development. A global discussion regarding how to renew these goals is underway and it is in this context that the Goals and Governance for Global Health (Go4Health) research consortium conducted consultations with marginalized communities in Asia, Latin America, the Pacific and Africa as a way to include their voices in world's new development agenda. The goal of this paper is to present the findings of the consultations carried out in Uganda with two groups within low-resource settings: older people and people living with disabilities., Methods: This qualitative study used focus group discussions and key informant interviews with older people in Uganda's Kamwenge district, and with persons with disabilities from the Gulu region. Thematic analysis was performed and emerging categories and themes identified and presented in the findings., Findings: Our findings show that a sense of community marginalization is present within both older persons and persons living with disabilities. These groups report experiencing political sidelining, discrimination and inequitable access to health services. This is seen as the key reason for their poor health. Clinical services were found to be of low quality with little or no access to facilities, trained personnel, and drugs and there are no rehabilitative or mental health services available., Conclusion: Uganda must fulfil its international obligations and take progressive measures to meet the right to health for all its peoples, but especially allocate its limited resources to proactively support its most marginalized citizens. The growing impetus within post-2015 development negotiations to redress in-country health and other inequalities through a comprehensive systems approach is of importance in the Ugandan development context. This approach reflects the participant's perspectives, which also calls for a more equitable approach to health and development as opposed to a narrow, vertical focus on specific population groups, as was the case with the MDGs.
- Published
- 2014
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- View/download PDF
41. 'Born before arrival': user and provider perspectives on health facility childbirths in Kapiri Mposhi district, Zambia.
- Author
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Ng'anjo Phiri S, Fylkesnes K, Ruano AL, and Moland KM
- Subjects
- Adolescent, Adult, Attitude of Health Personnel, Confidentiality, Delivery, Obstetric economics, Delivery, Obstetric standards, Female, Focus Groups, Health Services Accessibility, Humans, Interviews as Topic, Male, Midwifery, Privacy, Qualitative Research, Spouses, Young Adult, Zambia, Delivery, Obstetric statistics & numerical data, Quality of Health Care, Safety, Trust
- Abstract
Background: Maternal mortality remains high in sub-Saharan Africa. Health facility intra-partum strategies with skilled birth attendance have been shown to be most effective to address maternal mortality. In Zambia, the health policy for pregnant women is to have facility childbirth, but less than half of the women utilize the facilities for delivery. 'Born before arrival' (BBA) describes childbirth that occurs outside health facility. With the aim to increase our understanding of trust in facility birth care we explored how users and providers perceived the low utilization of health facilities during childbirth., Methods: A qualitative study was conducted in Kapiri Mposhi, Zambia. Focus group discussions with antenatal clinic and outpatient department attendees were conducted in 2008 as part of the Response to Accountable priority setting and Trust in health systems project, (REACT). In-depth interviews conducted with women who delivered at home, their husbands, community leaders, traditional birth attendants, and midwives were added in 2011. Information was collected on perceptions and experiences of home and health facility childbirth, and reasons for not utilizing a facility at delivery. Data were analysed by inductive content analysis., Results: Perspectives of users and providers were grouped under themes that included experiences related to promotion of facility childbirth, responsiveness of health care providers, and giving birth at home. Trust and quality of care were important when individuals seek facility childbirth. Safety, privacy and confidentiality encouraged facility childbirth. Poor attitudes of health providers, long distances and lack of transport to facilities, costs to buy delivery kits, and cultural ideals that local herbs speed up labour and women should exhibit endurance at childbirth discouraged facility childbirth., Conclusion: Trust and perceived quality of care were important and influenced health care seeking at childbirth. Interventions that include both the demand and supply sides of services with prioritizing needs of the community could substantially improve trust and utilization of facilities at childbirth, and accelerate efforts to achieve MDG5.
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- 2014
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42. The process of social participation in primary health care: the case of Palencia, Guatemala.
- Author
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Ruano AL, Sebastián MS, and Hurtig AK
- Subjects
- Educational Status, Female, Guatemala, Humans, Male, Community Participation methods, Primary Health Care organization & administration, Social Participation
- Abstract
Background: In 2008, the World Health Organization issued a callback to the principles of primary health care, which renewed interests in social participation in health. In Guatemala, social participation has been the main policy for the decentralization process since the late 1990s and the social development council scheme has been the main means for participation for the country's population since 2002., Aim: The aim of this study was to explore the process of social participation at a municipal-level health commission in the municipality of Palencia, Guatemala., Methods: Analysis of legal and policy documents and in-depth interviews with institutional and community-level stakeholders of the commission., Results: The lack of clear guidelines and regulations means that the stakeholders own motivations, agendas and power resources play an important part in defining the roles of the participants. Institutional stakeholders have the human and financial power to make policies. The community-level stakeholders are token participants with little power resources. Their main role is to identify the needs of their communities and seek help from the authorities. Satisfaction and the perceived benefits that the stakeholders obtain from the process play an important part in maintaining the commission's dynamic, which is unlikely to change unless the stakeholders perceive that the benefit they obtain does not outweigh the effort their role entails., Conclusion: Without more uniformed mechanisms and incentives for municipalities to work towards the national goal of equitable involvement in the development process, the achievements will be fragmented and will depend on the individual stakeholder's good will., (© 2011 John Wiley & Sons Ltd.)
- Published
- 2014
- Full Text
- View/download PDF
43. The role of social participation in municipal-level health systems: the case of Palencia, Guatemala.
- Author
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Ruano AL
- Subjects
- Delivery of Health Care organization & administration, Guatemala, Health Policy, Humans, Social Participation, Urban Health Services organization & administration
- Abstract
Background: Social participation has been recognized as an important public health policy since the declaration of Alma-Ata presented it as one of the pillars of primary health care in 1978. Since then, there have been many adaptations to the original policy but participation in health is still seen as a means to make the health system more responsive to local health needs and as a way to bring the health sector and the community closer together., Objective: To explore the role that social participation has in a municipal-level health system in Guatemala in order to inform future policies and programs., Design: Documentary analysis was used to study the context of participation in Guatemala. To do this, written records and accounts of Guatemalan history during the 20th century were reviewed. The fieldwork was carried out over 8 months and three field visits were conducted between early January of 2009 and late March of 2010. A total of 38 in-depth interviews with regional health authorities, district health authorities, community representatives, and community health workers (CHWs) were conducted. Data were analyzed using thematic analysis., Results: Guatemala's armed civil struggle was framed in the cold war and the fight against communism. Locally, the war was fed by the growing social, political, and ethnic inequalities that existed in the country. The process of reconstructing the country's social fabric started with the signing of the peace agreements of 1996, and continued with the passing of the 2002 legal framework designed to promote decentralization through social participation. Today, Guatemala is a post-war society that is trying to foster participation in a context full of challenges for the population and for the institutions that promote it. In the municipality of Palencia, there are three different spaces for participation in health: the municipal-level health commission, in community-level social development councils, and in the CHW program. Each of these spaces has participants with specific roles and processes., Conclusions: True participation and collaboration among can only be attained through the promotion and creation of meaningful partnerships between institutional stakeholders and community leaders, as well as with other stakeholders working at the community level. For this to happen, more structured support for the participation process in the form of clear policies, funding and capacity building is needed.
- Published
- 2013
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44. Apoptotic mechanisms are involved in the death of Strongyloides venezuelensis after triggering of nitric oxide.
- Author
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Ruano AL, López-Abán J, Gajate C, Mollinedo F, De Melo AL, and Muro A
- Subjects
- Animals, Female, Gene Expression Profiling, Macrophages parasitology, Male, Mice, Mice, Inbred BALB C, Nitric Oxide metabolism, Nitric Oxide Synthase Type II biosynthesis, Rats, Rats, Wistar, Real-Time Polymerase Chain Reaction, Strongyloides immunology, Apoptosis, Nitric Oxide toxicity, Strongyloides drug effects
- Abstract
Despite progress in understanding the role of nitric oxide (NO) in the pathogenesis of helminth infections, the role in strongyloidosis is unknown. Firstly, we studied the production of NO in mice infected with Strongyloides venezuelensis as well as in macrophage cultures stimulated with parasite antigens. Somatic larvae 3 (L3) and excretory-secretory female antigens stimulate specific NO production measured by Griess reaction and expression of inducible NO synthase by RT-PCR and quantitative PCR. Moreover, mice infected with S. venezuelensis produce NO in migration stages. Secondly, we analysed the effect of NO production on L3 and females of S. venezuelensis using NO donors such as diethylenetriamine and 3,3-bis(aminoethyl)-1-hydroxy-2-oxo-1-triazene. Parasites died after NO donor treatment in a dose-dependent manner. Finally, apoptotic mechanisms are involved in the death of S. venezuelensis larvae., (© 2012 Blackwell Publishing Ltd.)
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- 2012
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45. 'It's the sense of responsibility that keeps you going': stories and experiences of participation from rural community health workers in Guatemala.
- Author
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Ruano AL, Hernández A, Dahlblom K, Hurtig AK, and Sebastián MS
- Abstract
Background: In 1978, the Alma-Ata declaration on primary health care (PHC) recognized that the world's health issues required more than just hospital-based and physician-centered policies. The declaration called for a paradigm change that would allow governments to provide essential care to their population in a universally acceptable manner. The figure of the community health worker (CHW) remains a central feature of participation within the PHC approach, and being a CHW is still considered to be an important way of participation within the health system., Methods: This study explores how the values and personal motivation of community health workers influences their experience with this primary health care strategy in in the municipality of Palencia, Guatemala. To do this, we used an ethnographic approach and collected data in January-March of 2009 and 2010 by using participant observation and in-depth interviews., Results: We found that the CHWs in the municipality had a close working relationship with the mobile health team and with the community, and that their positions allowed them to develop leadership and teamwork skills that may prove useful in other community participation processes. The CHWs are motivated in their work and volunteerism is a key value in Palencia, but there is a lack of infrastructure and growth opportunities., Conclusion: Attention should be paid to keeping the high levels of commitment and integration within the health team as well as keeping up supervision and economic funds for the program.
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- 2012
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46. Adherence to antiretroviral therapy in an urban, free-care HIV clinic in Guatemala City, Guatemala.
- Author
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Campbell JI, Ruano AL, Samayoa B, Estrado Muy DL, Arathoon E, and Young B
- Subjects
- Adult, Aged, Cross-Sectional Studies, Female, Guatemala, Humans, Male, Middle Aged, Socioeconomic Factors, Urban Population, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, Medication Adherence
- Abstract
Background: Numerous studies have demonstrated that, in addition to inherent qualities of antiretroviral (ARV) medications, adherence is affected by demographic, socioeconomic, and psychological factors. There are limited data about factors affecting adherence to antiretroviral therapy (ART) among HIV-infected persons in urban Guatemalan HIV care centers., Methods: Participants were patients at an urban, free-care public clinic in Guatemala City and obtained medications from a closed-pharmacy system. Nonpregnant patients ≥18 years who received medications from the Global Fund to Fight AIDS, Tuberculosis & Malaria, who had taken ARV medications for ≥12 weeks, who arrived for an appointment at the clinic, and who provided informed consent were interviewed. Adherence was measured using pharmacy pill counts and patient self-reports. Recent biological markers for each patient were collected from the clinic's database, and χ( 2) and descriptive statistics were used to analyze results., Results: Among 122 patients interviewed, mean adherence by pill count was 97%. A total of 110 patients (90%) had adherence ≥95% using pharmacy pill counts, and 108 (89%) had adherence ≥95% using self-reports. Virologic failure (viral load [VL] ≥500 copies/mL) was significantly less common among patients with ≥95% adherence (P = .02). Family and spousal support for treatment were significantly associated with ≥95% adherence (P = .01 and .003, respectively). The presence of stavudine (d4T) in a patient's regimen was significantly associated with <95% adherence according to self-reports (P < .01). The most common self-reported cause for missing medications was forgetfulness, followed by leaving medications at home. Inability to travel to the clinic was a major cause of missing medications, and only 51 patients (41.8%) reported always having sufficient economic resources to reach the clinic for appointments and to refill prescriptions., Conclusions: In this urban Central American population, high levels of adherence were measured by both self-report and pharmacy pill count. Socioeconomic and demographic conditions associated with adherence and specific reasons for missing medications were identified.
- Published
- 2010
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47. Vaccination against Strongyloides venezuelensis with homologue antigens using new immunomodulators.
- Author
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Vlaminck J, López-Abán J, Ruano AL, del Olmo E, and Muro A
- Subjects
- Adjuvants, Immunologic administration & dosage, Animals, Antibodies, Helminth biosynthesis, Antibodies, Helminth blood, Antigens, Helminth immunology, Blotting, Western, Enzyme-Linked Immunosorbent Assay, Feces parasitology, Female, Immunoglobulin G biosynthesis, Immunoglobulin G blood, Male, Mice, Parasite Egg Count, Rats, Rats, Wistar, Strongyloides immunology, Strongyloidiasis prevention & control, Vaccination
- Abstract
Control of Strongyloides stercoralis infection is based on antihelminthic treatment. However, the development of an efficient vaccine is an important goal for more effectively managing this disease. Different Strongyloides spp. antigen preparations have been previously tested but without satisfactory results. In the present study, we evaluated whether the doxycholic acid extract of Strongyloides venezuelensis stage 3 larvae was able to protect CD1 mice against a homologue infection. Moreover, we included saponins from Quillaja saponaria (Qs) and immunomodulatory substances, i.e., Phlebodium pseudoaureum hydroalcoholic extract (PAL) or the amino alcohol AA0029, which has an aliphatic chain of 14 carbon atoms with a hydrophilic amino alcohol head, where the amino group is protected with a butoxycarbonyl group. The DOCSv antigen, together with the adjuvant components, was emulsified in a non-mineral water/oil emulsion. We performed duplicate experiments with each of the 2 immunomodulators. The DOCSv antigen used with Qs+PAL induced high levels of protection in terms of fecal egg count reduction (93.2-99.4%), 86-88% in adult worm recovery, and reduction in swelling of the small intestine. Mice vaccinated with the DOCSv antigen, together with Qs+AA0029, showed a 73.7-97.0% reduction in fecal egg count, with reduction in inflammation of the small intestine. High levels of IgG and IgG2a were observed in mice vaccinated with Qs+AA0029+DOCSv, indicating a Th1 immune response. Also, vaccinated mice recognized bands of 34, 39, 43, 95, and 170 kDa in a Western blot.
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- 2010
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48. Social participation within a context of political violence: implications for the promotion and exercise of the right to health in Guatemala.
- Author
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Flores W, Ruano AL, and Funchal DP
- Subjects
- Community Participation psychology, Dissent and Disputes, Guatemala, Humans, Power, Psychological, Public Policy, Community Participation methods, Delivery of Health Care organization & administration, Human Rights, Politics, Violence
- Abstract
Social participation has been understood in many different ways, and there are even typologies classifying participation by the degree of a population's control in decision making. Participation can vary from a symbolic act, which does not involve decision making, to processes in which it constitutes the principal tool for redistributing power within a population. This article argues that analyzing social participation from a perspective of power relations requires knowledge of the historical, social, and economic processes that have characterized the social relations in a specific context. Applying such an analysis to Guatemala reveals asymmetrical power relations characterized by a long history of repression and political violence. The armed conflict during the second half of the 20th century had devastating consequences for a large portion of the population as well as the country's social leadership. The ongoing violence resulted in negative psychosocial effects among the population, including mistrust toward institutions and low levels of social and political participation. Although Guatemala made progress in creating spaces for social participation in public policy after signing the Peace Accords in 1996, the country still faces after-effects of the conflict. One important task for the organizations that work in the field of health and the right to health is to help regenerate the social fabric and to rebuild trust between the state and its citizens. Such regeneration involves helping the population gain the skills, knowledge, and information needed in order to participate in and affect formal political processes that are decided and promoted by various public entities, such as the legislative and executive branches, municipal governments, and political parties. This process also applies to other groups that build citizenship through participation, such as neighborhood organizations and school and health committees.
- Published
- 2009
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