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The Influencing Factors of Psychosocial Adaptation of Cancer Patients: A Systematic Review and Meta-Analysis. 癌症患者社会心理适应的影响因素:系统回顾与元分析》。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-11 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241278814
Hanjing Zhu, Linning Yang, Hongfan Yin, Xia Yuan, Jia Gu, Yan Yang

Purpose: The psycho-social adaptation of cancer patients is very important, which affects the treatment, rehabilitation process and prognosis of patients, and is closely related to the subjective well-being and quality of life of patients. However, the key factors affecting the psycho-social adjustment of cancer patients are not clear yet. This study aims to evaluate the psycho-social adaptation of cancer patients and its influencing factors based on a meta-analysis.

Basic procedures: The Systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist and guided by the society-to-cell model framework. Literature retrieval was conducted from the construction of the library to December 2023.

Main findings: Fourteen pieces of literature were included in this study, with a total sample size of 2922 cases. Among the 14 literatures included, 9 were in English and 5 were in Chinese, published between 1991 and 2021. All of the 14 literatures were cross-sectional studies. According to the society-to-cells model framework, the influencing factors are divided into 5 levels: society, community, family, individual, and physiology. However, studies related to the cellular level are lacking.

Principal conclusions: The psychosocial adaptation of cancer patients is affected by physiology, individual, family, community and society, among which age, education level, disease uncertainty, hope level, psychological pain, self-efficacy, social support, coping styles (facing, avoidance, submission, and emotion-oriented) are the main factors affecting the psychosocial adaptation of cancer patients. However, studies related to the cellular level are lacking. This may be due to the fact that most of the factors from the individual to the society level are intervenable, and most studies focus more on the mining of these levels of factors. However, the biological basis is crucial to the occurrence and development of diseases, and needs to be paid attention to by nursing staff, and further research on this level needs to be strengthened in the future.

目的:癌症患者的社会心理适应非常重要,它影响着患者的治疗、康复过程和预后,与患者的主观幸福感和生活质量密切相关。然而,影响癌症患者社会心理适应的关键因素尚不明确。本研究旨在基于荟萃分析评估癌症患者的社会心理适应及其影响因素:系统综述按照系统综述和荟萃分析首选报告项目(PRISMA)清单进行,并以社会到细胞模型框架为指导。文献检索从建库开始至 2023 年 12 月结束:本研究共纳入 14 篇文献,样本量共计 2922 例。在这 14 篇文献中,有 9 篇英文文献和 5 篇中文文献,发表于 1991 年至 2021 年之间。14 篇文献均为横断面研究。根据社会到细胞模型框架,影响因素分为 5 个层面:社会、社区、家庭、个人和生理。主要结论:主要结论:癌症患者的社会心理适应受生理、个体、家庭、社区和社会的影响,其中年龄、受教育程度、疾病的不确定性、希望程度、心理痛苦、自我效能感、社会支持、应对方式(面对、回避、顺从和情绪导向)是影响癌症患者社会心理适应的主要因素。然而,与细胞水平相关的研究却很缺乏。这可能是由于从个人到社会层面的大多数因素都是可以干预的,而且大多数研究更侧重于挖掘这些层面的因素。然而,生物学基础对疾病的发生和发展至关重要,需要护理人员予以重视,今后还需进一步加强对这一层面的研究。
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引用次数: 0
Identifying Patient Subpopulations with Significant Race-Sex Differences in Emergency Department Disposition Decisions. 识别急诊科处置决定中存在显著种族-性别差异的患者亚群。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-05 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241277724
Peter Lin, Nilay T Argon, Qian Cheng, Christopher S Evans, Benjamin Linthicum, Yufeng Liu, Abhishek Mehrotra, Laura Murphy, Mehul D Patel, Serhan Ziya

Background/objectives: The race-sex differences in emergency department (ED) disposition decisions have been reported widely. Our objective is to identify demographic and clinical subgroups for which this difference is most pronounced, which will facilitate future targeted research on potential disparities and interventions.

Methods: We performed a retrospective analysis of 93 987 White and African-American adults assigned an Emergency Severity Index of 3 at 3 large EDs from January 2019 to February 2020. Using random forests, we identified the Elixhauser comorbidity score, age, and insurance status as important variables to divide data into subpopulations. Logistic regression models were then fitted to test race-sex differences within each subpopulation while controlling for other patient characteristics and ED conditions.

Results: In each subpopulation, African-American women were less likely to be admitted than White men with odds ratios as low as 0.304 (95% confidence interval (CI): [0.229, 0.404]). African-American men had smaller admission odds compared to White men in subpopulations of 41+ years of age or with very low/high Elixhauser scores, odds ratios being as low as 0.652 (CI: [0.590, 0.747]). White women were less likely to be admitted than White men in subpopulations of 18 to 40 or 41 to 64 years of age, with low Elixhauser scores, or with Self-Pay or Medicaid insurance status with odds ratios as low as 0.574 (CI: [0.421, 0.784]).

Conclusions: While differences in likelihood of admission were lessened by younger age for African-American men, and by older age, higher Elixhauser score, and Medicare or Commercial insurance for White women, they persisted in all subgroups for African-American women. In general, patients of age 64 years or younger, with low comorbidity scores, or with Medicaid or no insurance appeared most prone to potential disparities in admissions.

背景/目的:急诊科(ED)处置决定中的种族性别差异已被广泛报道。我们的目的是找出这种差异最明显的人口和临床亚群,这将有助于今后对潜在的差异和干预措施进行有针对性的研究:我们对 2019 年 1 月至 2020 年 2 月期间在 3 家大型急诊室分配到急诊严重程度指数为 3 的 93 987 名白人和非裔美国成年人进行了回顾性分析。利用随机森林,我们确定了埃利克豪斯(Elixhauser)合并症评分、年龄和保险状况作为将数据划分为亚人群的重要变量。然后,在控制其他患者特征和急诊室条件的情况下,我们拟合了逻辑回归模型,以检验每个亚人群中的种族-性别差异:结果:在每个亚人群中,非裔美国女性入院的几率低于白人男性,几率比低至 0.304(95% 置信区间 (CI):[0.229, 0.404])。在 41 岁以上或 Elixhauser 评分极低/极高的亚人群中,非裔美国男性的入院几率小于白人男性,几率比低至 0.652(CI:[0.590, 0.747])。在年龄介于 18 至 40 岁或 41 至 64 岁、Elixhauser 分数较低、具有自费或医疗补助保险身份的亚人群中,白人女性比白人男性的入院几率更低,几率比低至 0.574(CI:[0.421, 0.784]):非裔美国男性入院可能性的差异因年龄较小而缩小,白人女性入院可能性的差异因年龄较大、Elixhauser 评分较高以及医疗保险或商业保险而缩小,但非裔美国女性入院可能性的差异在所有亚组中都持续存在。一般来说,64 岁或以下、合并症评分较低、有医疗补助或无保险的患者最容易出现潜在的入院差异。
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引用次数: 0
Exploring the Impact of COVID-19 on Cervical Cancer Screening Services: A Qualitative Study of Healthcare Providers' and Women's Perspectives and Experiences. 探索 COVID-19 对宫颈癌筛查服务的影响:医疗保健提供者和妇女的观点与经验定性研究》。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-03 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241275883
Fennie Mantula, Yoesrie Toefy

A qualitative exploration was conducted to analyse the reasons behind the low utilisation of cervical cancer screening services in Gwanda district, Zimbabwe, focusing on the impact of the COVID-19 pandemic. The study involved 5 focus group discussions with 36 women, utilising maximum variation sampling to explore the effects of COVID-19 on screening coverage. Additionally, in-depth interviews were conducted with 25 health-care providers from primary health facilities and the provincial hospital offering screening services. The results suggest a decline in the progress of the cervical cancer screening programme due to the disruptions caused by COVID-19 which subsequently reduced women's access to screening and treatment services. It was anticipated that restoring women's confidence in adherence to screening would require time post-pandemic. Moreover, findings highlighted the potential progression of undetected precursor lesions to advanced cancer stages during non-screening periods, which may increase future cervical cancer morbidity and mortality. The findings underscore the importance of integrating cervical cancer screening messaging within broader health communication strategies to emphasise the significance of health interventions for overall well-being. This study recommends the adoption of more efficient screening methods, such as Human-Papillomavirus self-sampling to mitigate future disruptions in screening services, thereby guiding policymakers towards implementing best screening approaches.

我们进行了一项定性研究,分析了津巴布韦 Gwanda 地区宫颈癌筛查服务利用率低的原因,重点关注 COVID-19 大流行的影响。这项研究包括与 36 名妇女进行的 5 次焦点小组讨论,利用最大变异抽样来探讨 COVID-19 对筛查覆盖率的影响。此外,还对提供筛查服务的基层医疗机构和省级医院的 25 名医护人员进行了深入访谈。结果表明,由于 COVID-19 的干扰,宫颈癌筛查计划的进展有所下降,妇女获得筛查和治疗服务的机会也随之减少。预计大流行过后,恢复妇女坚持筛查的信心需要时间。此外,研究结果还强调,在未进行筛查期间,未被发现的前驱病变可能会发展到癌症晚期,这可能会增加未来宫颈癌的发病率和死亡率。研究结果强调了将宫颈癌筛查信息纳入更广泛的健康传播战略的重要性,以强调健康干预对整体健康的重要意义。本研究建议采用更有效的筛查方法,如人类乳头状瘤病毒自我采样,以减少未来筛查服务的中断,从而指导政策制定者实施最佳筛查方法。
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引用次数: 0
The Effects of Ghana's Free Maternal and Healthcare Policy on Maternal and Infant Healthcare: A Scoping Review. 加纳免费孕产妇保健政策对孕产妇和婴儿保健的影响:范围审查》。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-03 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241274481
Emefa Awo Adawudu, Kizito Aidam, Elisha Oduro, Dennis Miezah, Allison Vorderstrasse

Ghana was the first sub-Saharan country to implement a National Health Insurance Scheme (NHIS). In furtherance of the nation's Universal Health Coverage (UHC) goals, in 2008, Ghana actualized plans for a Free Maternal Healthcare Policy (FMHCP) under the NHIS. The FMHCP was aimed at removing financial barriers to accessing maternal and neonatal health services. This scoping review was conducted to map out the literature on the effects of the FMHCP under the NHIS on the utilization of maternal and infant health care in Ghana. Six databases including CINAHL, PubMed, Sage Journals, Academic Search Premier, Science Direct, and Medline were searched in conducting this review with key terms. A total of 175 studies were retrieved after the search and finally, 23 articles were included in the study after various stages of elimination. The review followed the reporting guidelines stated in the Preferred Reporting Items for Systematic and Meta-analyses Extensions for Scoping Reviews (PRISMA-ScR). The results showed an overall increase in the utilization of antenatal care, facility-based delivery, and postnatal care services. However, certain systemic issues persist regarding access to maternal and infant healthcare. Socio-demographic inequalities such as maternal level of education, place of residence, and economic status likewise barriers such as the existence of out-of-pocket payments, long distance to health facilities, and poor distribution of resources in rural areas hindered the utilization of maternal and infant healthcare. The country faces significant work to eliminate existing barriers and inequalities to ensure that it achieves its UHC goals.

加纳是第一个实施国家健康保险计划(NHIS)的撒哈拉以南国家。为了推进国家的全民健康保险(UHC)目标,加纳于 2008 年在国家健康保险计划下实施了免费孕产妇保健政策(FMHCP)计划。免费孕产妇保健政策旨在消除获得孕产妇和新生儿保健服务的经济障碍。本范围审查旨在对有关加纳国家医疗保险计划下的免费孕产妇保健政策对利用孕产妇和婴儿保健服务的影响的文献进行梳理。本综述使用关键术语检索了六个数据库,包括 CINAHL、PubMed、Sage Journals、Academic Search Premier、Science Direct 和 Medline。搜索后共检索到 175 项研究,经过不同阶段的筛选,最终有 23 篇文章被纳入本研究。本综述遵循了《系统和元分析扩展范围综述的首选报告项目》(PRISMA-ScR)中规定的报告指南。结果显示,产前护理、设施内分娩和产后护理服务的利用率总体有所提高。然而,在获得母婴保健服务方面,某些系统性问题依然存在。社会人口方面的不平等,如孕产妇的教育水平、居住地和经济状况,同样阻碍了孕产妇和婴儿保健服务的利用,如存在自付费用、距离医疗机构较远以及农村地区资源分配不均等问题。该国面临着消除现有障碍和不平等现象的艰巨任务,以确保实现全民保健目标。
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引用次数: 0
Evaluating the Barriers and Facilitators to Implementing a Novel Referral System for Outpatient Geriatric Services: The Geri-Hub Quality Improvement Initiative. 评估实施新型老年病门诊转诊系统的障碍和促进因素:老年枢纽质量改进计划》。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241274482
Guillaume Lim Fat, Kristina M Kokorelias, Erica Foronda, Bindhu Sadasivan, Lindy Romanovsky

Background: In healthcare systems prioritizing care of older adults, resource limitations and escalating demand often impede access to outpatient specialized geriatric services.

Objectives: This study, theoretically guided by the Consolidated Framework for Implementation Research (CFIR), aimed to explore barriers and facilitators in implementing a centralized "Geri-Hub." The Geri-Hub is a centralized intake system established within 2 hospital systems to coordinate outpatient and community-based services for older adults, aiming to connect them with the most appropriate care in a timely manner.

Methods: Qualitative insights were gathered from healthcare professionals at 2 academic institutions in the process of consolidating services. Through open-ended surveys and semi-structured interviews, we solicited feedback on referral management, waiting times, and overall work experiences.

Results: Thirteen frequently referring providers and a cohort of 9 geriatricians, along with 4 administrators, contributed to the study. Geriatricians emphasized streamlined referrals, flexible scheduling for urgent cases, and a target wait time of 3 months. Administrators stressed standardized referral procedures, defined roles, and accessible referral information.

Discussion: The findings underscored the need for straightforward referral processes, enhanced communication on referral statuses, and reduced wait times. Optimizing these processes could potentially mitigate resource utilization issues and improve patient outcomes in healthcare systems. This research highlights the critical role of timely access to geriatric services during transformative phases in healthcare delivery.

背景:在优先照顾老年人的医疗保健系统中,资源限制和不断增长的需求往往阻碍了门诊老年病专科服务的获取:本研究以实施研究综合框架(CFIR)为理论指导,旨在探讨实施集中式 "老年病中心 "的障碍和促进因素。Geri-Hub 是在两家医院系统内建立的一个集中接收系统,旨在协调老年人的门诊和社区服务,及时为他们提供最合适的医疗服务:方法:在整合服务的过程中,从两家学术机构的医疗保健专业人员那里收集定性见解。通过开放式调查和半结构化访谈,我们征求了有关转诊管理、等待时间和整体工作经验的反馈意见:13 名经常转诊的医疗机构和 9 名老年病学专家以及 4 名管理人员参与了研究。老年病科医生强调要简化转诊程序、灵活安排紧急病例的时间以及 3 个月的目标等待时间。管理人员则强调标准化的转诊程序、明确的角色定位和便捷的转诊信息:讨论:研究结果表明,有必要制定简单明了的转诊流程、加强转诊状态的沟通并缩短等待时间。优化这些流程有可能缓解医疗系统中的资源利用问题,并改善患者的治疗效果。这项研究强调了在医疗服务转型阶段及时获得老年病服务的关键作用。
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引用次数: 0
Primary Healthcare Marketing: A Bibliometric Study and Research Agenda. 初级保健营销:文献计量学研究与研究议程》。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-28 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241266648
Piotr Rościszewski, Mariusz Stępień, Justyna Berniak-Woźny

The evolution of our lives has forced changes to the healthcare system and consequently established healthcare marketing as an essential element of health services, including primary health care (PHC). This article aims to analyze the size, structure, and dynamics of research on primary healthcare marketing to identify the main topics and research trends in this area. The authors conducted a bibliographic analysis based on the methods of performance analysis and scientific mapping. The bibliographical analysis covered 1981 publications selected from the Scopus database and was carried out with the use of the MS Excel and VOSviewer applications. The results were supplemented with an in-depth analysis of 34 publications selected based on bibliographic coupling analysis to determine key research trends and results, which increased the understanding of the research area. The conducted research proves that the issue of marketing in primary health care is rarely addressed by researchers, which translates into very limited research results and little impact on the decision-making process in this area. This research field requires much greater commitment, especially in the areas indicated in the future research agenda recommendations.

我们生活的发展迫使医疗保健系统发生变化,从而使医疗保健营销成为包括初级医疗保健(PHC)在内的医疗保健服务的基本要素。本文旨在分析初级医疗保健营销研究的规模、结构和动态,以确定该领域的主要课题和研究趋势。作者根据绩效分析和科学绘图的方法进行了书目分析。书目分析涵盖了从 Scopus 数据库中选取的 1981 篇出版物,并使用 MS Excel 和 VOSviewer 应用程序进行了分析。此外,还对根据书目耦合分析选出的 34 篇出版物进行了深入分析,以确定主要研究趋势和成果,从而加深对研究领域的了解。所进行的研究证明,研究人员很少涉及初级卫生保健中的营销问题,这导致研究成果非常有限,对该领域的决策过程影响甚微。这一研究领域需要更大的投入,特别是在未来研究议程建议中指出的领域。
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引用次数: 0
Effects of COVID-19 Among People With Disabilities in Plumtree, Zimbabwe: A Mixed-Method Survey. COVID-19 在津巴布韦普拉姆特里残疾人中的影响:混合方法调查。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-27 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241274484
Lindiwe Ndlovu, Nicholas Mudonhi, Nomathemba Sibanda, Wilfred Njabulo Nunu, Norman Manyeruke

Introduction: Persons with disabilities are the most affected by rising pandemics worldwide. COVID-19 has affected people with disabilities in many areas of their lives; however, its impact has been overlooked. This study aimed to assess the effects of COVID-19 on people with disabilities in Plumtree, Zimbabwe, to develop a disability-inclusive approach in response to COVID-19.

Methods: A concurrent mixed-methods approach was used to collect qualitative and quantitative data from 7 key informants and ninety-two participants with disabilities, from January to May 2023. Quantitative data were analysed using STATA software version 12 and Microsoft Excel. Multiple Logistic Regression, Chi-square test, and paired-sample test were used to test for associations among COVID-19 cases, source of income, key challenges, and demographic characteristics. Qualitative data were analysed and presented in the form of themes.

Results: We recruited more females (56.5%) than males with disabilities, and more than half were unemployed (56.5%). In contrast, only 3.3% of the respondents were formally employed. The results also indicated a significant relationship between age and COVID-19 positivity (P = .025). The results also indicated that efforts were being made by government and non-governmental departments to assist people with disabilities during the pandemic through finance, food, awareness campaigns, and social support.

Conclusion: Restriction measures put in place disturbed the livelihood of people with disabilities in Plumtree. Therefore, entrepreneurship programmes targeting vulnerable groups, including people with disabilities, should be introduced to ensure that their sources of income are sustained despite emergencies or pandemics.

导言:残疾人是全球受流行病影响最大的群体。COVID-19 对残疾人生活的许多方面都产生了影响,但其影响却一直被忽视。本研究旨在评估 COVID-19 对津巴布韦普拉姆特里镇残疾人的影响,从而制定出一种兼顾残疾人的方法来应对 COVID-19:在 2023 年 1 月至 5 月期间,采用混合方法从 7 名关键信息提供者和 92 名残疾人参与者处收集定性和定量数据。定量数据使用 STATA 软件第 12 版和 Microsoft Excel 进行分析。使用多元 Logistic 回归、卡方检验和配对样本检验来检验 COVID-19 病例、收入来源、主要挑战和人口特征之间的关联。对定性数据进行了分析,并以主题的形式呈现:我们招募的残疾女性(56.5%)多于残疾男性,一半以上为失业者(56.5%)。相比之下,只有 3.3% 的受访者有正式工作。结果还表明,年龄与 COVID-19 阳性率之间存在显著关系(P = .025)。结果还表明,在大流行期间,政府和非政府部门正在努力通过财政、食品、宣传活动和社会支持等方式帮助残疾人:结论:所采取的限制措施扰乱了梅树镇残疾人的生活。因此,应引入针对弱势群体(包括残疾人)的创业计划,以确保他们的收入来源能够在紧急情况或流行病发生时得以维持。
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引用次数: 0
The Influence of Institutional Logics and Emotions on the Uptake of Cervical Cancer Screening: A Case Study From Xai-Xai, Mozambique. 制度逻辑和情感对接受宫颈癌筛查的影响:莫桑比克 Xai-Xai 案例研究》。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-27 eCollection Date: 2024-01-01 DOI: 10.1177/11786329231224619
Gefra Fulane, Maria Major, Cesaltina Lorenzoni, Khatia Munguambe

This study investigates the role of emotional attachment to competing institutional logics on women's uptake of cervical cancer screening in Mozambique. Through a qualitative study conducted in Xai-Xai, Southern Mozambique, we identify 2 concurrent logics in the context of screening: preservation logic, influenced by social-cultural norms, and the prevention logic, centered around screening. Women, affected by emotions such as shame, fear, and marital subordination, often become attached to the preservation logic, which influences their values and contradicts acceptance of screening. However, some women with marital autonomy may reflect on both logics and gradually detach themselves from the preservation norms and show their intention to adopt life-saving behavior by accepting screening. It is through their emotions that women show their attachment to and detachment from competing logics, reinforcing traditional norms on the one hand, or giving them the means to adopt preventive measures on the other. The study indicates that cultural expectations, shame and the desire to preserve intimacy tie women to the logic of preservation and have a negative impact on participation in cervical cancer screening. Consequently, to improve screening uptake in Mozambique, the authorities need to adapt screening to socio-cultural and emotional factors, empower women, and effectively engage communities.

本研究调查了莫桑比克妇女在接受宫颈癌筛查时对相互竞争的制度逻辑所产生的情感依恋。通过在莫桑比克南部赛赛(Xai-Xai)进行的一项定性研究,我们确定了筛查背景下的两种并存逻辑:受社会文化规范影响的保护逻辑和以筛查为中心的预防逻辑。妇女受到羞耻、恐惧和婚姻从属地位等情绪的影响,往往会依附于保护逻辑,这影响了她们的价值观,并与接受筛查相矛盾。然而,一些拥有婚姻自主权的妇女可能会对这两种逻辑进行反思,逐渐从保护规范中脱离出来,并通过接受筛查来表明自己采取挽救生命行为的意愿。妇女正是通过她们的情感表现出她们对相互竞争的逻辑的依恋和疏离,这些逻辑一方面强化了传统规范,另一方面也给了她们采取预防措施的手段。研究表明,文化期望、羞耻感和保持亲密关系的愿望将妇女束缚在保持亲密关系的逻辑中,对参与宫颈癌筛查产生了负面影响。因此,为了提高莫桑比克的筛查率,当局需要使筛查适应社会文化和情感因素,增强妇女的能力,并有效地让社区参与进来。
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引用次数: 0
Modelling the Wage Bill and Budget Space for Health Workforce in Ghana: Implications for Sustainable Health Professions Education Policy. 加纳卫生劳动力的工资法案和预算空间建模:对可持续卫生专业教育政策的影响》(Modelling the Wage Bill and Budget Space for Health Workforce in Ghana: Implications for Sustainable Health Professions Education Policy)。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-18 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241271568
Hamza Ismaila, Juliet Nabyonga-Orem, Yolande Heymans, Christmal Dela Christmals

Global discussions on health systems strengthening have lately tilted towards increasing investments in human resources for health to address health workforce challenges, especially shortages and employment. Countries have, as a result, increased investments in the health workforce by expanding the production and recruitment of the needed health workforce, with the resultant effects of increasing health workforce budget space and the unending clamour by health policy actors for further increases. Despite these calls, there has been no wage bill affordability and budget space analysis to rationalise the sustainable production of and demand for health workers, which is the thrust of Ghana's current health workforce policy and strategy. Using an adapted approach (the Asamani approach), the study modelled the supply of some essential health workers and their associated cost of employment, compared it with the modelled budget space for health workforce employment and then drew conclusions on the wage bill sustainability for policy consideration. Of the seven cadres considered in the study (doctors, professional nurses, midwives, enrolled nurses, community health nurses, pharmacists and biomedical scientists), who constitute about 97% of the wage bill, the study found the baseline stock to be 129 378 in 2022, which was estimated to increase to 199 715 by 2027 and 254 466 by 2032 with corresponding wage bills of US$869.4 million and US$ 1.1 billion, respectively, holding routine salary increases constant. The budget space for health was, meanwhile, projected to be US$899.3 million and US$1.1 billion in 2022 and 2032 respectively, out of a projected overall government fiscal space of US$7 billion per year. This study concludes that, given current levels and mix of production, Ghana was estimated to expend an average of 88% of its health budget space as wage bill cost. This was 54.4% over the global median and 95.6% over the African Region's median, making the current regime unsustainable.

最近,全球关于加强卫生系统的讨论倾向于增加对卫生人力资源的投资,以 应对卫生工作人员的挑战,特别是短缺和就业问题。因此,各国增加了对卫生人员队伍的投资,扩大了所需卫生人员队伍的生产和招聘,其结果是增加了卫生人员队伍的预算空间,卫生政策参与者也不断呼吁进一步增加预算。尽管有这些呼声,但一直没有对工资总额的承受能力和预算空间进行分析,以合理确定卫生工作人员的可持续生产和需求,而这正是加纳当前卫生工作人员政策和战略的主旨。这项研究采用了一种经过调整的方法(阿萨马尼方法),对一些基本卫生工作者的供应及其相关就业成本进行建模,将其与建模的卫生工作者就业预算空间进行比较,然后得出关于工资总额可持续性的结论,供政策考虑。在研究中考虑的七种干部(医生、专业护士、助产士、注册护士、社区保健护士、药剂师和生物医 学科学家)中,他们约占工资总额的 97%,研究发现 2022 年的基线存量为 129378 人,估计到 2027 年将增加到 199715 人,到 2032 年将增加到 254 466 人,在常规工资增长不变的情况下,相应的工资总额分别为 8.694 亿美元和 11 亿美元。与此同时,在政府每年预计 70 亿美元的总体财政空间中,预计 2022 年和 2032 年的卫生预算空间分别为 8.993 亿美元和 11 亿美元。本研究的结论是,考虑到目前的生产水平和生产组合,估计加纳平均 88% 的卫生预算空间将用于支付工资支出。这比全球的中位数高出 54.4%,比非洲地区的中位数高出 95.6%,使现行制度难以为继。
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引用次数: 0
Assessing the Carbon Footprint of Telemedicine: A Systematic Review. 评估远程医疗的碳足迹:系统回顾。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-11 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241271562
Casper van der Zee, Jennifer Chang-Wolf, Marc A Koopmanschap, Redmer van Leeuwen, Robert Pl Wisse

Background: Healthcare is responsible for 4% to 10% of carbon emissions worldwide, of which 22% is related to transport. Telemedicine emerged as a potential solution to reduce the footprint, for example, by reducing travel. However, a need to understand which variables to include in carbon footprint estimations in telemedicine limits our understanding of the beneficial impact telemedicine might have on our environment. This paper aims to systematically assess the reported carbon footprint and include variables assessed by the literature, comparing telemedicine with usual care.

Methods: The systematic review followed the PRISMA guidelines in PubMed, Medline, Embase and Scopus. A quality assessment was performed using a transparency checklist for carbon footprint calculators. Carbon emissions were evaluated based on four categories, including patient travel, and streamlined life cycle assessment (LCA) for assessing included variables relevant to telemedicine.

Results: We included 33 articles from 1117 records for analysis. The average transparency score was 38% (range 18%-68%). The median roundtrip travel distance for each patient was 131 km (interquartile range [IQR]: 60.8-351), or 25.6 kgCO2 (IQR: 10.6-105.6) emissions. There is high variance among included variables. Saved emissions are structurally underestimated by not including external factors such as a streamlined LCA.

Conclusions: Telemedicine aids in reducing emissions, with travel distance being the most significant contributor. Additionally, we recommend accounting for the LCA since it highlights important nuances. This review furthers the debate on assessing carbon footprint savings due to telemedicine.

背景:医疗保健占全球碳排放量的 4%至 10%,其中 22%与交通有关。远程医疗是减少碳足迹的潜在解决方案,例如通过减少旅行。然而,需要了解哪些变量应纳入远程医疗碳足迹估算,这限制了我们对远程医疗可能对环境产生的有益影响的理解。本文旨在系统地评估所报告的碳足迹,并纳入文献所评估的变量,对远程医疗与常规护理进行比较:方法:在 PubMed、Medline、Embase 和 Scopus 上进行的系统性综述遵循了 PRISMA 指南。采用碳足迹计算器透明度检查表进行了质量评估。碳排放量根据四个类别进行评估,包括患者旅行和简化生命周期评估(LCA),以评估与远程医疗相关的变量:我们从 1117 条记录中选取了 33 篇文章进行分析。平均透明度得分为 38%(范围为 18%-68%)。每位患者的往返距离中位数为 131 千米(四分位数间距 [IQR]:60.8-351),或 25.6 千克 CO2(四分位数间距 [IQR]:10.6-105.6)排放量。各变量之间存在很大差异。由于不包括简化生命周期评估等外部因素,节省的排放量被结构性低估:结论:远程医疗有助于减少排放,而旅行距离是最重要的因素。此外,我们建议考虑生命周期评估,因为它能突出重要的细微差别。这篇综述进一步推动了关于评估远程医疗所带来的碳足迹减少的讨论。
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Health Services Insights
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