Dialogues in health最新文献

Background

Global public health was recently hampered by reported widespread spread of new coronavirus illness, although morbidity and fatality rates were low. Future coronavirus infection rates may be accurately predicted over a long-time horizon, using novel bio-reliability approach, being especially well suitable for environmental multi-regional health and biological systems. The high regional dimensionality along with cross-correlations between various regional datasets being challenging for conventional statistical tools to manage.

Methods

To assess future risks of epidemiological outbreak in any province of interest, novel spatio-temporal technique has been proposed. In a multicenter, population-based environment, assess raw clinical data using state-of-the-art, cutting-edge statistical methodologies.

Results

Authors have developed novel reliable long-term risk assessment methodology for future coronavirus infection outbreaks.

Conclusions

Based on national clinical patient monitoring raw dataset, it is concluded that although underlying data set data quality is questionable, the proposed method may be still applied.

Background

Despite the assurance of universal health coverage, large disparities exist in access to surgery in the state of Chiapas. The purpose of this study was to determine the effectiveness of the surgical referral system at hospitals operated by the Ministry of Health in Chiapas.

Methods

13 variables were extracted from surgical referrals data from three public hospitals in Chiapas over a three-year period. Interviews were performed of health care workers involved in the referral system and surgical patients. The quantitative and qualitative data was analyzed convergently and reported using a narrative approach.

Findings

In total, only 47.4% of referred patients requiring surgery received an operation. Requiring an elective, gynecological, or orthopedic surgery and each additional surgery cancellation were significantly associated with lower rates of receiving surgery. The impact of gender and surgical specialty, economic fragility of farmers, dependence upon economic resources to access care, pain leading people to seek care, and futility leading patients to abandon the public system were identified as main themes from the mixed methods analysis.

Interpretation

Surgical referral patients in Chiapas struggle to navigate an inefficient and expensive system, leading to delayed care and forcing many patients to turn to the private health system. These mixed methods findings provide a detailed view of often overlooked limitations to universal health coverage in Chiapas. Moving forward, this knowledge must be applied to improve referral system coordination and provide hospitals with the necessary workforce, equipment, and protocols to ensure access to guaranteed care.

Funding

Harvard University and the Abundance Fund provided funding for this project. Funding sources had no role in the writing of the manuscript or decision to submit it for publication.

Psychological safety is a multidimensional, dynamic phenomenon that concerns team members' perception of whether it is safe to take interpersonal risks at work. It is particularly important within health care teams who need to work interdependently to coordinate safe patient care within a highly complex, variable and high-stakes work environment. High levels of psychological safety have clear benefits for patient safety by improving the delivery of clinical care and promoting health care providers' job satisfaction and well-being. Feeling psychologically safe can enable team members to engage in speaking up behavior, such as asking questions, pointing out mistakes, or reporting errors. Several studies have explored psychological safety in health care teams and its impact on patient safety. These studies have highlighted the importance of psychological safety in health care organizations and provided strategies for promoting psychological safety. Psychological safety in health care involvement with patients can improve patient engagement.

Background

The aggregation of Indigenous peoples from Pacific Island nations as ‘Pacific peoples’ in literature may mask diversity in the health needs of these different groups. The aim of this study was to examine the heterogeneity of Pacific groups according to ethnicity and country of birth.

Methods

Anonymised individual-level linkage of administrative data identified all NZ residents aged 30–74 years on 31 March 2013 with known ethnicity and country of birth. All participants were described according to ethnicity and country of birth. Pacific participants were also described according to the number of ethnicities they identified.

Findings

A total of 2,238,039 NZ residents were included, of whom 117,957 (5·0%) were Pacific. Nearly two-thirds of Pacific peoples (65·7%) were born overseas, ranging from 45·3% (Cook Islands Māori) to 82·7% (Fijian) (Māori 2·3%, non-Māori non-Pacific 28·9%). Among NZ-born Pacific peoples, 46·9% (Samoan) to 81·9% (Fijian) were multi-ethnic; the proportion was much lower for overseas-born Pacific peoples (ranging from 3·7% [Tongan] to 23·9% [Tokelauan]).

Interpretation

There is substantial heterogeneity among Pacific peoples in their country of birth and identification with sole or multiple ethnicities. Assumptions regarding homogeneity in the needs of Pacific peoples are not appropriate and government statistics should therefore disaggregate Pacific peoples whenever possible.

Funding

Supported by the Health Research Council of New Zealand and a part of Manawataki Fatu Fatu, a programme of research funded by the National Heart Foundation of New Zealand and Healthier Lives – He Oranga Hauora – National Science Challenge of New Zealand.

Purpose

The EAT-Lancet reference diet has been proposed as a healthy dietary pattern to reduce food-related climate impacts, but little is known regarding associations with bodyweight development. This study investigated adherence to the EAT-Lancet diet in midlife and development in weight and waist circumference (WC) after five years.

Design

The Danish Diet, Cancer and Health cohort recruited participants in 1993–1997. At baseline, data on diet, lifestyle, and anthropometry were collected. Participants self-reported weight and WC five years later. In total, 44,194 participants were included in analyses of weight (43,678 for WC). Baseline adherence to the EAT-Lancet diet was scored 0–14 points. Multiple linear regression was used to estimate associations between the EAT-Lancet diet and development in weight and WC after five years. Poisson regression was used to estimate risk ratios (RR) of obesity (≥30 kg/m²) or elevated WC.

Results

Adherence to the EAT-Lancet diet was not associated with follow-up weight, adjusting for baseline weight and confounders (11–14 vs 0–7 points β: -0.08, 95% CI: -0.27, 0.11 kg), but was associated with lower follow-up WC adjusting for baseline WC and confounders (β: -0.38, 95% CI: -0.69, -0.07 cm), and was associated with lower risk of obesity and elevated WC (RR 0.89, 95% CI: 0.82, 0.98, and 0.95, 95% CI: 0.93, 0.96, respectively).

Conclusion

Adherence to the EAT-Lancet diet in midlife was associated with lower WC but not weight after five years follow up, taking baseline into account. Our findings suggest that greater adherence to the EAT-Lancet diet does not contribute to development of obesity.

The Health Insurance Program (HIP) in Nepal is experiencing low enrolment and high dropout rates, but the causes of these issues have remained unknown. This study aimed to explore the causes of dropouts of the HIP implemented by the Health Insurance Board, Nepal.

We employed an exploratory qualitative research design. We purposefully selected the informants for the data collection who had previously enrolled and currently not renewed their insurance scheme. We gathered qualitative information from 16 in-depth interviews, four key informant interviews, and four focus group discussion in Palpa and Bardia Districts of Lumbini Province, Nepal. The qualitative data were analyzed using thematic analysis.

We identified two major themes and nine drop-out-related sub-themes. These were: unnecessary health insurance; negligence to renew; unable to pay the contribution amount; poor cooperation between institutions as well as insurees and insurers; limited coverage and ceiling amount; rigid processes to receive health services; health professionals' behaviors; poor quality healthcare services; inadequate information. Dropout-related factors were associated with personal or individual factors and institutional or policy-related (process-related) factors. The major causes/reasons for dropout include lengthy procedures, poor quality and unsatisfactory services, a lack of knowledge on health insurance norms and procedures, and health professionals' behavior towards insurees during treatment.

Information, education, and communication programs related to health insurance are still necessary to make the insurees familiar with the insurance systems and its processes. These factors could be taken into account by policymakers while planning interventions to minimize the low enrollment and high dropout.

Household food security, feeding practices, dietary diversity and coping strategies to household food insecurity are largely interconnected. Using a cross sectional study approach involving 162 mothers and care givers of children 0-36 months of age in Kole district of northern Uganda, this study examined the household food security status, child dietary diversity and household coping strategies. The study revealed that a slight majority of the households (55%) were food secure although with a low level of child dietary diversity experienced (68.1% for children 6-23 months age group and 55.3% for 24-36 months age group). We found that starch-based foods derived from cereals, roots and tubers were the most predominantly used food group in child feeding (82%), with limited consumption of other essential food groups, notably fruits, vegetables, meats and dairy products (18% combined). Additionally, only 57% of children 0 to 6 months old were receiving exclusive breastfeeding, and the introduction of complementary foods is often delayed and not well planned for those above 6 months of age. Results also showed that a wide range of coping strategies are employed however the major ones were, reliance on less preferred food (54.9%), limiting portions of meals (35.2%), reducing number of meals taken in a day (29%), and gathering wild fruits and harvesting immature crops (29.6%). It was observed that household food security is a strong determinant of child dietary diversity, may influence feeding practices and the range of coping strategies applicable to households when they experience food insecurity. Furthermore, nutritional education, household size and livelihood diversity play a significant role in determining household food security status, child dietary diversity and coping with food insecurity within rural households. In conclusion, addressing household food security, and coping strategies can play an important role in improving child feeding practices and dietary diversity in rural communities.

Background

In recent years, the health of migrants has become an important global public health issue. However, less is known about the current status of research activity among Nepalese migrants' health. This study aimed to assess the current status of research activity by analysing published peer review literature on Nepalese migrants' health.

Methods

A systematic search of published literature on Nepalese migrant workers' health was conducted in Scopus, Medline, CINAHL, Embase, PsycINFO and Web of Science, and a bibliometric analysis methodology was used. The search of databases retrieved 520 records, and a total of 161 papers were included in the analysis. Bibliometric analyses were performed in R and VoSViewer to create visualisation maps.

Results

The retrieved documents were published in the last three decades, and a total of 533 researchers originating from 24 countries contributed to the literature. A large proportion of papers (n=22) were published in a single year, in 2019, and the number of authors per journal ranged from one to 14. The topmost preferred journals for publications in Nepalese migrants’ health were PLoS One (n=9), followed by the Journal of Immigration and Minority Health (n=6). The retrieved articles received 2425 citations, with an average of 15.1 citations per article. The study identified nine overlapping research domains (thematic areas) - infectious disease, non-communicable diseases, health and lifestyle, sexual and reproductive health, access to health services, workplace safety, maternal health, gender-based violence, and health system and policy.

Conclusion

The present bibliometric study fills an analytical gap in the field of migrat's health research in Nepal and provides evidence and insights to advocate the formulation of strategies to promote the migrants' health vulnerabilities often associated with individual-related hazards such as working in 'difficult, dirty, and dangerous (3Ds) working conditions.

Salt iodization is a positive exemplar of a sustainable public-private partnership in promoting better nutrition outcomes in many countries. However, the gains in the past decades are gradually being eroded, following laxity in policy implementation, monitoring and regulatory roles resulting in increasing access to non-labelled salt in the Nigerian market. This study was designed to evaluate the awareness, practices and perspectives on salt iodization and regulations among salt marketers and consumers in Ibadan, Oyo state.

This mixed-method study was carried out in seven major markets across Ibadan metropolis. A three-stage sampling technique was used to select 77 salt users/clients, 103 salt vendors, 12 salt wholesalers and four regulators/producers. Interviewer-administered questionnaire was used to collect information on types/brands of salt, handling, retail practices, awareness, and salt purchase preference. Structured in-depth interview was used to elicit information on existing regulations, compliance level, and monitoring activities. Descriptive statistics were used to analyse quantitative data. Interviews were tape-recorded, transcribed verbatim and analyzed thematically.

Males constituted 66.7%, 1.0% and 14.3% of respondents among wholesalers, retail vendors, and clients, respectively, with 100.0%, 58.3% and 84.4% having at least primary education. All wholesalers and 30.1% of retail vendors used shaded structure. About 67% of the wholesalers and 58.3% of the retailers sold branded salt. Clients’ basis for the use of non-branded salt included cheapness and greater quantity (54.5%), higher intensiveness/saltiness and greater quantity (22.1%), and cheaper cost (18.2%). Only 3% of the consumers were aware of mandatory salt iodization, 3.9% were aware of guidelines on salt marketing and only 18.2% handled salt safely. Safe handling practices were found among all wholesalers and 44.7% of the retailers. Qualitative findings revealed the existence of regulation on the production, packing and marketing of salts in Nigeria, however, enforcement and monitoring at the market level is weak.

The demand and use of industrial salt in food preparation remain widespread among consumers in Ibadan, Nigeria following limited awareness of salt iodization programme and its benefits. Regulations on salt marketing should be enforced at all levels and nutrition education on salt iodization should be intensified.

Background

For primary healthcare systems to bring care closer to the communities, the availability of appropriate human resources is crucial. The primary care workforce in the world is expanding to include non-physician health workers (NPHWs) to increase its capacity. Also, NPHWs as mid-level health providers (MLHPs) are currently being employed in high- and low-income countries to assist doctors and specialists to make up for the scarcity of health professionals. Given the wide prevalence in the deployment of NPHWs as mid-level health providers, this article collates recent evidence on the role of MLHPs in improving access to primary healthcare services, and their enablers and barriers in integrating them in primary care teams. The article also presents gaps in evidence and recommendations for the way forward.

Methods

A systematic search of contemporary literature published from January 2012 to September 2022 was undertaken using two bibliographic databases (PubMed and Cochrane) and hand searching the reference list of retrieved papers. Duplicates, papers older than ten years, and whose focus was not on primary healthcare were excluded. The papers finalised for appraisal were scrutinised for key themes and their summaries were collated for analysis. The papers comprised of twenty-four quantitative, twenty-three qualitative, and nine mixed approach study designs (n = 56) due to which a narrative approach was conducted as per guidelines.

Results

The review identified and presents the following themes - task shifting and its effectiveness in service delivery, quality of care, enablers and barriers of NPHWs in primary health care in both HIC and LMIC settings.

Conclusion

Task-shifting interventions need effective engagement and constant coordination with relevant stakeholders. For this, policymakers, public health researchers, healthcare professionals of all cadres and community members need to be involved across all stages of introduction and absorption of the cadre into the primary healthcare delivery system.