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Interactive effects of atmospheric oxidising pollutants and heat waves on the risk of residential mortality. 大气氧化污染物和热浪对居民死亡风险的交互影响。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-02-21 DOI: 10.1080/16549716.2024.2313340
Nan Ren, Huimin Huang, Baoying Liu, Chuancheng Wu, Jianjun Xiang, Quan Zhou, Shuling Kang, Xiaoyang Zhang, Yu Jiang

Background: The impact of heat waves and atmospheric oxidising pollutants on residential mortality within the framework of global climate change has become increasingly important.

Objective: In this research, the interactive effects of heat waves and oxidising pollutants on the risk of residential mortality in Fuzhou were examined. Methods We collected environmental, meteorological, and residential mortality data in Fuzhou from 1 January 2016, to 31 December 2021. We then applied a generalised additive model, distributed lagged nonlinear model, and bivariate three-dimensional model to investigate the effects and interactions of various atmospheric oxidising pollutants and heat waves on the risk of residential mortality.

Results: Atmospheric oxidising pollutants increased the risk of residential mortality at lower concentrations, and O3 and Ox were positively associated with a maximum risk of 2.19% (95% CI: 0.74-3.66) and 1.29% (95% CI: 0.51-2.08). The risk of residential mortality increased with increasing temperature, with a strong and long-lasting effect and a maximum cumulative lagged effect of 1.11% (95% CI: 1.01, 1.23). Furthermore, an interaction between atmospheric oxidising pollutants and heat waves may have occurred: the larger effects in the longest cumulative lag time on residential mortality per 10 µg/m3 increase in O3, NO2 and Ox during heat waves compared to non-heat waves were [-3.81% (95% CI: -14.82, 8.63)]; [-0.45% (95% CI: -2.67, 1.81)]; [67.90% (95% CI: 11.55, 152.71)]; 16.37% (95% CI: 2.43, 32.20)]; [-3.00% (95% CI: -20.80, 18.79)]; [-0.30% (95% CI: -3.53, 3.04)]. The risk on heat wave days was significantly higher than that on non-heat wave days and higher than the separate effects of oxidising pollutants and heat waves.

Conclusions: Overall, we found some evidence suggesting that heat waves increase the impact of oxidising atmospheric pollutants on residential mortality to some extent.

背景:在全球气候变化的框架下,热浪和大气氧化污染物对居民死亡的影响变得越来越重要:本研究探讨了热浪和氧化污染物对福州居民死亡风险的交互影响。方法:我们收集了福州从 2016 年 1 月 1 日至 2021 年 12 月 31 日的环境、气象和居民死亡数据。然后,我们应用广义加法模型、分布式滞后非线性模型和双变量三维模型研究了各种大气氧化污染物和热浪对居民死亡风险的影响和相互作用:大气氧化污染物在浓度较低时增加了居民死亡风险,O3 和 Ox 与居民死亡风险呈正相关,最大风险分别为 2.19% (95% CI: 0.74-3.66) 和 1.29% (95% CI: 0.51-2.08)。居民死亡风险随着温度的升高而增加,具有强烈而持久的影响,最大累积滞后效应为 1.11% (95% CI: 1.01, 1.23)。此外,大气氧化污染物与热浪之间可能存在相互作用:与非热浪相比,热浪期间 O3、NO2 和 Ox 每增加 10 µg/m3 对居民死亡率的最大累积滞后效应为 [-3.81%(95% 置信区间:-14.82,8.63)];[-0.45%(95% 置信区间:-2.67,1.81)];[67.90%(95% 置信区间:11.55,152.71)];[16.37%(95% 置信区间:2.43,32.20)];[-3.00%(95% 置信区间:-20.80,18.79)];[-0.30%(95% 置信区间:-3.53,3.04)]。热浪天的风险明显高于非热浪天,也高于氧化污染物和热浪的单独影响:总之,我们发现一些证据表明,热浪在一定程度上增加了氧化性大气污染物对居民死亡率的影响。
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引用次数: 0
Methodology for adapting a co-created early childhood development intervention and implementation strategies for use by frontline workers in India and Guatemala: a systematic application of the FRAME-IS framework. 在印度和危地马拉,前线工作者采用共同创造的儿童早期发展干预措施和实施战略的方法:FRAME-IS 框架的系统应用。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-05-10 DOI: 10.1080/16549716.2024.2338324
Amruta Bandal, Sara Hernández, Revan Mustafa, Karyn Choy, Namrata Edwards, Magdalena Guarchaj, Marinés Mejía Alvarez, Anushree Sane, Scott Tschida, Chetna Maliye, Ann Miller, Abhishek Raut, Roopa Srinivasan, Morgan Turner, Bradley H Wagenaar, Ilgi Ertem, Maria Del Pilar Grazioso, Subodh S Gupta, Vibha Krishnamurthy, Peter Rohloff

There is little evidence on optimizing the effectiveness and implementation of evidence-based early childhood development (ECD) interventions when task-shifted to frontline workers. In this Methods Forum paper, we describe our adaptation of the International Guide for Monitoring Child Development (GMCD) for task-shifting to frontline workers in Guatemala and India. In 2021-2022, implementers, trainers, frontline workers, caregivers, and international GMCD experts collaborated to adapt the GMCD for a task shifted implementation by frontline workers. We used an eight-step co-creating process: assembling a multidisciplinary team, training on the existing package, working groups to begin modifications, revision of draft modifications, tailoring of visual materials and language, train-the-trainers activities, pilot frontline worker trainings, final review and feedback. Preliminary effectiveness of adaptations was evaluated through narrative notes and group-based qualitative feedback following pilot trainings with 16 frontline workers in India and 6 in Guatemala. Final adaptations included: refining training techniques to match skill levels and learning styles of frontline workers; tailoring all visual materials to local languages and contexts; design of job aids for providing developmental support messages; modification of referral and triage processes for children in need of enhanced support and speciality referral; and creation of post-training support procedures. Feedback from pilot trainings included: (1) group consensus that training improved ECD skills and knowledge across multiple domains; and (2) feedback on ongoing needed adjustments to pacing, use of video-based vs. role-playing materials, and time allocated to small group work. We use the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) framework to document our adaptations. The co-creating approach we use, as well as systematic documentation of adaptation decisions will be of use to other community-based early childhood interventions and implementation strategies.

在将任务转移给一线工作者时,如何优化循证儿童早期发展(ECD)干预措施的效果和实施,目前还鲜有证据。在本方法论坛文件中,我们介绍了我们对《儿童发展监测国际指南》(GMCD)的改编,以便在危地马拉和印度将任务转移给一线工作者。2021-2022 年间,实施者、培训师、一线工作者、护理人员和《儿童发展监测国际指南》的国际专家通力合作,对《儿童发展监测国际指南》进行了改编,以便由一线工作者进行任务转移实施。我们采用了八步共同创造流程:组建多学科团队、培训现有教材包、工作组开始修改、修改草案的修订、视觉材料和语言的定制、培训员培训活动、一线工作者试点培训、最终审查和反馈。在对印度的 16 名前线工作者和危地马拉的 6 名前线工作者进行试点培训后,通过叙述性说明和基于小组的定性反馈,对修改的初步效果进行了评估。最终的调整包括:改进培训技巧,使其符合一线工作者的技能水平和学习风格;根据当地语言和环境调整所有视觉材料;设计提供发展支持信息的工作辅助工具;修改需要加强支持和专科转诊的儿童的转诊和分流流程;以及制定培训后支持程序。试点培训的反馈包括(1) 小组一致认为培训提高了幼儿发展的技能和多个领域的知识;(2) 对节奏、视频材料与角色扮演材料的使用以及分配给小组工作的时间不断进行必要调整的反馈。我们使用 "基于证据的实施策略的调整和修改报告框架"(FRAME-IS)来记录我们的调整。我们采用的共同创造方法以及对调整决定的系统性记录将对其他基于社区的幼儿干预措施和实施策略有所帮助。
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引用次数: 0
Evaluating the implementation of person-centred care and simulation-based learning in a midwifery education programme in the Democratic Republic of Congo: a study protocol. 评估刚果民主共和国助产士教育课程中以人为中心的护理和模拟学习的实施情况:研究方案。
IF 2.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-31 Epub Date: 2024-06-25 DOI: 10.1080/16549716.2024.2370097
Frida Temple, Ewa Carlsson Lalloo, Marie Berg, Urban Berg, Alumeti Munyali Désiré, Olivier Nyakio, Aline Mulunda, Malin Bogren

Background: Investing in midwives educated according to international standards is crucial for achieving Sustainable Development Goals in maternal and newborn health. Applying a person-centred care approach and using simulation-based learning to improve the learning experience for midwifery students may enhance the quality of childbirth care. This protocol describes a study evaluating the implementation of person-centred approach and simulation-based learning in childbirth as part of a midwifery education programme at the Evangelical University in Africa, DRC.

Methods: The research will be exploratory and guided by an implementation research framework. Ethical approval has been obtained. Facilitators working at the programme's five clinical practice sites will be trained in: 1) Introducing person-centred childbirth care using a training programme called'Mutual Meetings'; and 2) integrating simulation-based learning, specifically by using the three courses: Essential Care of Labor, Bleeding after Birth, and Vacuum Extraction. Data will include interviews with midwifery students, facilitators and clinical preceptors, and maternal and neonatal outcomes from birth registers.

Discussion: By integrating a validated and culturally adapted person-centred care training programme and simulation-based learning into a midwifery education programme and clinical practice sites, the findings from the study anticipate an improvement in the quality of childbirth care. Training facilitators in these methodologies aim to effectively mitigate maternal and neonatal adverse outcomes. The findings are expected to provide valuable recommendations for governments, policymakers, and healthcare providers in the DRC and beyond, contributing to significant improvements in midwifery education and aligning with global health priorities, including the Sustainable Development Goals.

Trial registration: The study was registered retrospectively with the ISRCTN registry on the 23rd of February 2024. The registration number is: ISRCTN10049855.

背景:投资培养接受过国际标准教育的助产士对于实现孕产妇和新生儿健康方面的可持续发展目标至关重要。采用以人为本的护理方法和模拟学习来改善助产士学生的学习体验,可以提高分娩护理的质量。本协议描述了一项研究,评估在刚果(金)非洲福音大学助产教育课程中实施以人为本的护理方法和模拟学习的情况:研究将以实施研究框架为指导,进行探索性研究。已获得伦理批准。在该计划的五个临床实践地点工作的指导人员将接受以下方面的培训:1) 使用名为 "相互会议 "的培训计划,引入以人为本的分娩护理;以及 2) 整合模拟学习,特别是通过使用三门课程:分娩基本护理、产后出血和真空吸引术。数据将包括对助产士学生、主持人和临床指导者的访谈,以及出生登记册中产妇和新生儿的结果:讨论:通过在助产士教育课程和临床实践场所中融入经过验证且符合当地文化的 "以人为本 "护理培训计划和模拟学习,研究结果预计将提高分娩护理的质量。对助产士进行这些方法的培训旨在有效减轻孕产妇和新生儿的不良后果。研究结果有望为刚果(金)及其他国家的政府、政策制定者和医疗服务提供者提供有价值的建议,促进助产教育的显著改善,并与包括可持续发展目标在内的全球健康优先事项保持一致:该研究于 2024 年 2 月 23 日在 ISRCTN 注册中心进行了回顾性注册。注册号为:ISRCTN10049855。
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引用次数: 0
Did the COVID-19 quarantine policies applied in Cochabamba, Bolivia mitigated cases successfully? an interrupted time series analysis. 在玻利维亚科恰班巴实施的 COVID-19 检疫政策是否成功缓解了病例?
IF 2.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-31 Epub Date: 2024-07-01 DOI: 10.1080/16549716.2024.2371184
Rodrigo K Arce Cardozo, Osvaldo Fonseca-Rodríguez, Yercin Mamani Ortiz, Miguel San Sebastian, Frida Jonsson

Background: The COVID-19 pandemic prompted varied policy responses globally, with Latin America facing unique challenges. A detailed examination of these policies' impacts on health systems is crucial, particularly in Bolivia, where information about policy implementation and outcomes is limited.

Objective: To describe the COVID-19 testing trends and evaluate the effects of quarantine measures on these trends in Cochabamba, Bolivia.

Methods: Utilizing COVID-19 testing data from the Cochabamba Department Health Service for the 2020-2022 period. Stratified testing rates in the health system sectors were first estimated followed by an interrupted time series analysis using a quasi-Poisson regression model for assessing the quarantine effects on the mitigation of cases during surge periods.

Results: The public sector reported the larger percentage of tests (65%), followed by the private sector (23%) with almost double as many tests as the public-social security sector (11%). In the time series analysis, a correlation between the implementation of quarantine policies and a decrease in the slope of positive rates of COVID-19 cases was observed compared to periods without or with reduced quarantine policies.

Conclusion: This research underscores the local health system disparities and the effectiveness of stringent quarantine measures in curbing COVID-19 transmission in the Cochabamba region. The findings stress the importance of the measures' intensity and duration, providing valuable lessons for Bolivia and beyond. As the global community learns from the pandemic, these insights are critical for shaping resilient and effective health policy responses.

背景:COVID-19 大流行在全球范围内引发了不同的政策应对措施,而拉丁美洲则面临着独特的挑战。详细研究这些政策对卫生系统的影响至关重要,尤其是在政策实施和结果信息有限的玻利维亚:描述 COVID-19 检测趋势,并评估检疫措施对玻利维亚科恰班巴这些趋势的影响:利用科恰班巴省卫生局 2020-2022 年期间的 COVID-19 检测数据。首先估算了卫生系统各部门的分层检测率,然后使用准泊松回归模型进行间断时间序列分析,以评估检疫对缓解激增期病例的影响:公共部门报告的检测比例最高(65%),其次是私营部门(23%),检测次数几乎是公共社会保障部门(11%)的两倍。在时间序列分析中,与没有实施或减少实施检疫政策的时期相比,实施检疫政策与 COVID-19 阳性率斜率下降之间存在相关性:这项研究强调了当地卫生系统的差异以及严格检疫措施在遏制科恰班巴地区 COVID-19 传播方面的有效性。研究结果强调了措施强度和持续时间的重要性,为玻利维亚及其他国家提供了宝贵的经验。随着全球社会从这一流行病中吸取教训,这些见解对于制定有弹性和有效的卫生政策应对措施至关重要。
{"title":"Did the COVID-19 quarantine policies applied in Cochabamba, Bolivia mitigated cases successfully? an interrupted time series analysis.","authors":"Rodrigo K Arce Cardozo, Osvaldo Fonseca-Rodríguez, Yercin Mamani Ortiz, Miguel San Sebastian, Frida Jonsson","doi":"10.1080/16549716.2024.2371184","DOIUrl":"10.1080/16549716.2024.2371184","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic prompted varied policy responses globally, with Latin America facing unique challenges. A detailed examination of these policies' impacts on health systems is crucial, particularly in Bolivia, where information about policy implementation and outcomes is limited.</p><p><strong>Objective: </strong>To describe the COVID-19 testing trends and evaluate the effects of quarantine measures on these trends in Cochabamba, Bolivia.</p><p><strong>Methods: </strong>Utilizing COVID-19 testing data from the Cochabamba Department Health Service for the 2020-2022 period. Stratified testing rates in the health system sectors were first estimated followed by an interrupted time series analysis using a quasi-Poisson regression model for assessing the quarantine effects on the mitigation of cases during surge periods.</p><p><strong>Results: </strong>The public sector reported the larger percentage of tests (65%), followed by the private sector (23%) with almost double as many tests as the public-social security sector (11%). In the time series analysis, a correlation between the implementation of quarantine policies and a decrease in the slope of positive rates of COVID-19 cases was observed compared to periods without or with reduced quarantine policies.</p><p><strong>Conclusion: </strong>This research underscores the local health system disparities and the effectiveness of stringent quarantine measures in curbing COVID-19 transmission in the Cochabamba region. The findings stress the importance of the measures' intensity and duration, providing valuable lessons for Bolivia and beyond. As the global community learns from the pandemic, these insights are critical for shaping resilient and effective health policy responses.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11218584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The contextual awareness, response and evaluation (CARE) diabetes project: study design for a quantitative survey of diabetes prevalence and non-communicable disease risk in Ga Mashie, Accra, Ghana. 糖尿病背景认识、应对和评估 (CARE) 项目:加纳阿克拉 Ga Mashie 地区糖尿病患病率和非传染性疾病风险定量调查的研究设计。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-02-07 DOI: 10.1080/16549716.2023.2297513
Swaib Abubaker Lule, Sandra Boatemaa Kushitor, Carlos S Grijalva-Eternod, Kafui Adjaye-Gbewonyo, Olutobi Adekunle Sanuade, Mawuli Komla Kushitor, Lydia Okoibhole, Raphael Awuah, Leonard Baatiema, Irene Akwo Kretchy, Daniel Arhinful, Ama de-Graft Aikins, Kwadwo Koram, Edward Fottrell

Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual Awareness, Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed methods study that aims to understand diabetes in the Ga Mashie area of Accra, identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities.

据估计,加纳 3.3%至 8.3%的成年人患有糖尿病,而且患病率预计还会上升。由于缺乏专门针对加纳人口设计的具有成本效益的糖尿病预防计划,因此亟需引起重视。情境意识、应对和评估(CARE):加纳糖尿病项目是一项混合方法研究,旨在了解阿克拉 Ga Mashie 地区的糖尿病情况,确定基于社区的干预机会,并为未来的糖尿病预防和控制战略提供信息。本文介绍了 CARE 项目中定量调查的研究设计。调查将在加纳阿克拉人口稠密的 Ga Mashie 地区进行。家庭调查将采用简单随机抽样的方法,从 2021 年加纳人口和住房普查中确定的 80 个普查区中抽取家庭。经过培训的调查员将对年龄≥ 25 岁的常住居民进行访谈并收集数据。孕妇和在过去六个月内分娩的妇女将被排除在外。数据分析将采用描述性和推论性统计相结合的方法,所有分析都将考虑到分组抽样设计。分析将描述糖尿病、其他疾病和相关风险因素的发病率,并确定糖尿病与身体、社会和行为参数之间的关系。这项调查将为糖尿病的诱因和后果提供证据,促进加纳城市预防和控制糖尿病及其他非传染性疾病的工作,并对其他低收入社区具有借鉴意义。
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引用次数: 0
Financial inclusion for people with disability: a scoping review. 残疾人的金融包容性:范围界定审查。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-05-10 DOI: 10.1080/16549716.2024.2342634
Louise Puli, Natasha Layton, Diane Bell, Abu Zafar Shahriar

Background: Financial exclusion is a human rights issue affecting health equity. Evidence demonstrates that financial exclusion is exacerbated for people with disability and those in low- to middle-income countries (LMIC). Barriers to financial access include limited demand for services, banking inadequacies in catering to people with disability, and insufficiently accessible information technologies (ICT) and infrastructure.

Objectives: This scoping review sought to identify barriers to and facilitators of financial inclusion for people with disability in LMIC. As a secondary objective, the study explored the potential of financial education and ICT utilisation as viable strategies for enhancing financial inclusion.

Methods: This review utilised the Arksey and O'Malley framework and PRISMA Checklist for systematic literature examination and data extraction. The WHO's Environmental Factors guided the analysis to propose potential interventions and to generate recommendations.

Results: The review analysed 26 publications from various global regions and fields including finance, business, technology, health and disability policy. It identified consistent financial inclusion barriers for people with disability, resulting in a set of global recommendations across attitudes, environment, technology, services, and policy.

Conclusions: Recommendations include using ICT, digital innovation and multi-stakeholder collaboration to address the financial barriers experienced by people with disability. These efforts, rooted in social justice, aim to include people with disability in LMIC as valued financial sector participants, promoting health and equity.

背景:财务排斥是一个影响健康公平的人权问题。有证据表明,对于残疾人和中低收入国家(LMIC)的人来说,金融排斥现象更为严重。获得金融服务的障碍包括对服务的需求有限、银行在满足残疾人需求方面存在不足,以及信息技术(ICT)和基础设施不够无障碍:本次范围界定审查旨在确定低收入和中等收入国家中残疾人获得金融服务的障碍和促进因素。作为次要目标,本研究探讨了金融教育和信息与传播技术利用作为提高金融包容性的可行战略的潜力:本综述采用 Arksey 和 O'Malley 框架以及 PRISMA 核对表进行系统的文献检查和数据提取。世界卫生组织的环境因素为分析提供了指导,以提出潜在的干预措施并产生建议:审查分析了来自全球不同地区和领域(包括金融、商业、技术、卫生和残疾人政策)的 26 篇出版物。它确定了残疾人在金融包容性方面面临的一致障碍,并由此提出了一系列涉及态度、环境、技术、服务和政策的全球性建议:建议包括利用信息和通信技术、数字创新和多方利益相关者的合作来解决残疾人遇到的金融障碍。这些努力植根于社会正义,旨在将低收入和中等收入国家的残疾人作为金融部门的重要参与者,促进健康和公平。
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引用次数: 0
Distances to emergency departments and non-urgent utilization of medical services: a systematic review. 到急诊室的距离与非急诊医疗服务的使用:系统回顾。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-06-03 DOI: 10.1080/16549716.2024.2353994
Uma Kelekar, Debasree Das Gupta, Nicole Theis-Mahon, Emily Fashingbauer, Boyen Huang

Background: The use of Emergency Departments (EDs) for non-urgent medical conditions is a global public health concern.

Objectives: A systematic review, guided by a registered protocol (PROSPERO: CRD42023398674), was conducted to interpret the association between distance as a measure of healthcare access and the utilization of EDs for non-urgent care in high- and middle-income countries.

Methods: The search was conducted on 22 August 2023 across five databases using controlled vocabulary and natural language keywords. Eligibility criteria included studies that examined non-urgent care, and featured concepts of emergency departments, non-urgent health services and distance, reported in English. Articles and abstracts where patients were transported by ambulance/paramedic services, referred/transferred from another hospital to an ED, or those that measured distance to an ED from another health facility were excluded. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework informed the quality of evidence.

Results: Fifteen articles met the inclusion criteria. All studies demonstrated satisfactory quality with regard to study design, conduct, analysis and presentation of results. Eight (53.3%) of the studies (1 paediatric, 4 all ages/adult, 3 ecological) found a moderate level of evidence of an inverse association between distance and ED visit volume or utilization for non-urgent medical conditions, while the remaining studies reported very low or low evidence.

Conclusions: Half of the studies reported non-urgent ED use to be associated with shortest distance traveled or transportation time. This finding bears implications for healthcare policies aiming to reduce ED use for non-urgent care.

背景:急诊室(ED)用于治疗非急诊病症是一个全球性的公共卫生问题:在注册协议(PROSPERO:CRD42023398674)的指导下,我们进行了一项系统性综述,目的是解释在中高收入国家,作为医疗服务可及性衡量标准的距离与急诊室非急诊使用率之间的关联:搜索于 2023 年 8 月 22 日在五个数据库中使用控制词汇和自然语言关键词进行。资格标准包括以英语报告的非紧急护理研究,以及以急诊科、非紧急医疗服务和距离等概念为特色的研究。患者由救护车/辅助医疗服务转运、从其他医院转诊/转入急诊室或测量从其他医疗机构到急诊室的距离的文章和摘要均被排除在外。根据 "建议、评估、发展和评价分级"(GRADE)框架对证据质量进行评估:结果:15 篇文章符合纳入标准。所有研究在研究设计、实施、分析和结果陈述方面都表现出令人满意的质量。其中 8 项(53.3%)研究(1 项儿科研究、4 项所有年龄/成人研究、3 项生态学研究)发现了中等程度的证据,证明距离与急诊室就诊量或非紧急医疗状况的使用率之间存在反比关系,而其余研究报告的证据程度很低或很低:半数研究报告称,非急诊急诊室的使用与最短的旅行距离或交通时间有关。这一发现对旨在减少急诊室非急诊使用的医疗保健政策具有重要意义。
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引用次数: 0
Quality and resilience of clinical laboratories in Rwanda: a need for sustainable strategies. 卢旺达临床实验室的质量和复原力:需要可持续战略。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-06-03 DOI: 10.1080/16549716.2024.2358633
Vincent Rusanganwa, Innocent Nzabahimana, Magnus Evander

Background: Quality healthcare is a global priority, reliant on robust health systems for evidence-based medicine. Clinical laboratories are the backbone of quality healthcare facilitating diagnostics, treatment, patient monitoring, and disease surveillance. Their effectiveness depends on sustainable delivery of accurate test results. Although the Strengthening Laboratory Management Towards Accreditation (SLMTA) programme has enhanced laboratory quality in low-income countries, the long-term sustainability of this improvement remains uncertain.

Objective: To explore the sustainability of quality performance in clinical laboratories in Rwanda following the conclusion of SLMTA.

Methods: A quasi-experimental design was adopted, involving 47 laboratories divided into three groups with distinct interventions. While one group received continuous mentorship and annual assessments (group two), interventions for the other groups (groups one and three) ceased following the conclusion of SLMTA. SLMTA experts collected data for 10 years through assessments using WHO's StepwiseLaboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. Descriptive and t-test analyses were conducted for statistical evaluation.

Results: Improvements in quality were noted between baseline and exit assessments across all laboratory groups (mean baseline: 35.3%, exit: 65.8%, p < 0.001). However, groups one and three experienced performance declines following SLMTA phase-out (mean group one: 64.6% in reference to 85.8%, p = 0.01; mean group three: 57.3% in reference to 64.7%, p < 0.001). In contrast, group two continued to enhance performance even years later (mean: 86.6%compared to 70.6%, p = 0.03).

Conclusion: A coordinated implementation of quality improvement plan that enables regular laboratory assessments to pinpoint and address the quality gaps is essential for sustaining quality services in clinical laboratories.

背景:高质量的医疗保健是全球的优先事项,有赖于以证据为基础的强大医疗系统。临床实验室是优质医疗保健的支柱,为诊断、治疗、患者监测和疾病监控提供便利。它们的有效性取决于能否持续提供准确的检验结果。尽管 "加强实验室管理,促进资质认定"(SLMTA)计划提高了低收入国家的实验室质量,但这种改善的长期可持续性仍不确定:目的:探讨卢旺达临床实验室质量绩效在加强实验室管理认证计划结束后的可持续性:方法:采用准实验设计,将 47 家实验室分为三组,采取不同的干预措施。其中一组持续接受指导和年度评估(第二组),其他各组(第一组和第三组)在 SLMTA 结束后停止干预。SLMTA 专家通过使用世卫组织的 "逐步实现实验室质量改进过程认证(SLIPTA)"核对表进行评估,收集了 10 年的数据。统计评估采用了描述性分析和 t 检验分析:结果:所有实验室组在基线和退出评估之间的质量都有所改善(平均基线:35.3%,退出:65.8%,p p = 0.01;第三组平均:57.3%,参照64.7%,p p = 0.03):结论:协调实施质量改进计划,定期进行实验室评估,找出并解决质量差距,对维持临床实验室的优质服务至关重要。
{"title":"Quality and resilience of clinical laboratories in Rwanda: a need for sustainable strategies.","authors":"Vincent Rusanganwa, Innocent Nzabahimana, Magnus Evander","doi":"10.1080/16549716.2024.2358633","DOIUrl":"10.1080/16549716.2024.2358633","url":null,"abstract":"<p><strong>Background: </strong>Quality healthcare is a global priority, reliant on robust health systems for evidence-based medicine. Clinical laboratories are the backbone of quality healthcare facilitating diagnostics, treatment, patient monitoring, and disease surveillance. Their effectiveness depends on sustainable delivery of accurate test results. Although the Strengthening Laboratory Management Towards Accreditation (SLMTA) programme has enhanced laboratory quality in low-income countries, the long-term sustainability of this improvement remains uncertain.</p><p><strong>Objective: </strong>To explore the sustainability of quality performance in clinical laboratories in Rwanda following the conclusion of SLMTA.</p><p><strong>Methods: </strong>A quasi-experimental design was adopted, involving 47 laboratories divided into three groups with distinct interventions. While one group received continuous mentorship and annual assessments (group two), interventions for the other groups (groups one and three) ceased following the conclusion of SLMTA. SLMTA experts collected data for 10 years through assessments using WHO's StepwiseLaboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. Descriptive and t-test analyses were conducted for statistical evaluation.</p><p><strong>Results: </strong>Improvements in quality were noted between baseline and exit assessments across all laboratory groups (mean baseline: 35.3%, exit: 65.8%, <i>p</i> < 0.001). However, groups one and three experienced performance declines following SLMTA phase-out (mean group one: 64.6% in reference to 85.8%, <i>p</i> = 0.01; mean group three: 57.3% in reference to 64.7%, <i>p</i> < 0.001). In contrast, group two continued to enhance performance even years later (mean: 86.6%compared to 70.6%, <i>p</i> = 0.03).</p><p><strong>Conclusion: </strong>A coordinated implementation of quality improvement plan that enables regular laboratory assessments to pinpoint and address the quality gaps is essential for sustaining quality services in clinical laboratories.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia. 开始然后停止:关于冈比亚各医疗中心疫苗接种不足的程度、预测因素和城乡差异模式的全国性登记研究。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-06-03 DOI: 10.1080/16549716.2024.2348788
Alieu Sowe, Fredinah Namatovu, Bai Cham, Per E Gustafsson

Objectives: Six million children were under-vaccinated in 2022. Our study aimed to 1) quantify the magnitude of under-vaccination variation between health facilities, 2) assess to which extent individual and health center level factors contributed to the variation, 3) identify individual and health facility factors associated with under-vaccination, and 4), explore rural vs. urban health facility variations.

Methods: We used data from 61,839 children from The Gambia national routine vaccination register. We cross tabulated under-vaccination status across study variables and fitted two-level random intercept multilevel logistic regression models to measure variance, contribution to the variance, and factors associated with the variance and under-vaccination.

Results: We found that 7% of the prevalence of under-vaccination was due to variation between health facilities. Thirty-seven percent of the variation was explained by individual and health center variables. The variables explained 36% of the variance in urban and 19% in rural areas. Children who were not vaccinated at 4 months or with delayed history, due for vaccination in the rainy season, and health facilities with very small or large population to health worker ratios had higher under-vaccination odds.

Conclusion: Our study indicates that one of the pathways to improving vaccination coverage is addressing factors driving under-vaccination inequities between health facilities through urban-rural differentiated strategies.

目标:2022 年有 600 万儿童接种疫苗不足。我们的研究旨在:1)量化医疗机构之间疫苗接种不足的差异程度;2)评估个人和医疗中心层面的因素在多大程度上导致了这种差异;3)确定与疫苗接种不足相关的个人和医疗机构因素;4)探讨农村与城市医疗机构之间的差异:我们使用了冈比亚全国常规疫苗接种登记册中 61,839 名儿童的数据。我们对各研究变量的接种不足情况进行了交叉列表,并建立了两级随机截距多层次逻辑回归模型,以测量差异、对差异的贡献以及与差异和接种不足相关的因素:我们发现,7%的疫苗接种不足率是由于医疗机构之间的差异造成的。个人和医疗中心变量解释了 37% 的差异。这些变量解释了城市地区 36% 和农村地区 19% 的差异。4个月时未接种疫苗的儿童或病史延迟的儿童、在雨季接种疫苗的儿童以及人口与卫生工作者比率非常小或非常大的医疗机构的儿童接种不足的几率更高:我们的研究表明,提高疫苗接种覆盖率的途径之一是通过城乡差异策略解决造成医疗机构间疫苗接种不足不平等的因素。
{"title":"Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia.","authors":"Alieu Sowe, Fredinah Namatovu, Bai Cham, Per E Gustafsson","doi":"10.1080/16549716.2024.2348788","DOIUrl":"10.1080/16549716.2024.2348788","url":null,"abstract":"<p><strong>Objectives: </strong>Six million children were under-vaccinated in 2022. Our study aimed to 1) quantify the magnitude of under-vaccination variation between health facilities, 2) assess to which extent individual and health center level factors contributed to the variation, 3) identify individual and health facility factors associated with under-vaccination, and 4), explore rural vs. urban health facility variations.</p><p><strong>Methods: </strong>We used data from 61,839 children from The Gambia national routine vaccination register. We cross tabulated under-vaccination status across study variables and fitted two-level random intercept multilevel logistic regression models to measure variance, contribution to the variance, and factors associated with the variance and under-vaccination.</p><p><strong>Results: </strong>We found that 7% of the prevalence of under-vaccination was due to variation between health facilities. Thirty-seven percent of the variation was explained by individual and health center variables. The variables explained 36% of the variance in urban and 19% in rural areas. Children who were not vaccinated at 4 months or with delayed history, due for vaccination in the rainy season, and health facilities with very small or large population to health worker ratios had higher under-vaccination odds.</p><p><strong>Conclusion: </strong>Our study indicates that one of the pathways to improving vaccination coverage is addressing factors driving under-vaccination inequities between health facilities through urban-rural differentiated strategies.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of the COVID-19 pandemic on type 2 diabetes care and factors associated with care disruption in Kenya and Tanzania. COVID-19 大流行对肯尼亚和坦桑尼亚 2 型糖尿病护理的影响以及与护理中断相关的因素。
IF 2.6 3区 医学 Q1 Medicine Pub Date : 2024-12-31 Epub Date: 2024-05-22 DOI: 10.1080/16549716.2024.2345970
Richard E Sanya, Caroline H Karugu, Peter Binyaruka, Shukri F Mohamed, Lyagamula Kisia, Peter Kibe, Irene Mashasi, Grace Mhalu, Christopher Bunn, Manuela Deidda, Frances S Mair, Eleanor Grieve, Cindy M Gray, Sally Mtenga, Gershim Asiki

Background: The COVID-19 pandemic affected healthcare delivery globally, impacting care access and delivery of essential services.

Objectives: We investigated the pandemic's impact on care for patients with type 2 diabetes and factors associated with care disruption in Kenya and Tanzania.

Methods: A cross-sectional study was conducted among adults diagnosed with diabetes pre-COVID-19. Data were collected in February-April 2022 reflecting experiences at two time-points, three months before and the three months most affected by the COVID-19 pandemic. A questionnaire captured data on blood glucose testing, changes in medication prescription and access, and healthcare provider access.

Results: We recruited 1000 participants (500/country). Diabetes care was disrupted in both countries, with 34.8% and 32.8% of the participants reporting change in place and frequency of testing in Kenya, respectively. In Tanzania, 12.4% and 17.8% reported changes in location and frequency of glucose testing, respectively. The number of health facility visits declined, 14.4% (p < 0.001) in Kenya and 5.6% (p = 0.001) in Tanzania. In Kenya, there was a higher likelihood of severe care disruption among insured patients (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI][1.05-2.34]; p = 0.029) and a lower likelihood among patients residing in rural areas (aOR, 0.35[95%CI, 0.22-0.58]; p < 0.001). Tanzania had a lower likelihood of severe disruption among insured patients (aOR, 0.51[95%CI, 0.33-0.79]; p = 0.003) but higher likelihood among patients with low economic status (aOR, 1.81[95%CI, 1.14-2.88]; p = 0.011).

Conclusions: COVID-19 disrupted diabetes care more in Kenya than Tanzania. Health systems and emergency preparedness should be strengthened to ensure continuity of service provision for patients with diabetes.

背景:COVID-19 大流行影响了全球的医疗服务,影响了医疗服务的获取和基本服务的提供:我们调查了大流行对肯尼亚和坦桑尼亚 2 型糖尿病患者护理的影响以及与护理中断相关的因素:方法:我们在 COVID-19 前确诊的成人糖尿病患者中开展了一项横断面研究。数据收集时间为 2022 年 2 月至 4 月,反映了两个时间点的经历,即 COVID-19 大流行前三个月和受影响最严重的三个月。调查问卷收集了有关血糖检测、药物处方和获取途径的变化以及医疗服务提供者获取途径的数据:我们招募了 1000 名参与者(每个国家 500 名)。这两个国家的糖尿病护理都受到了干扰,在肯尼亚,分别有 34.8% 和 32.8% 的参与者表示检测地点和频率发生了变化。在坦桑尼亚,分别有 12.4% 和 17.8% 的参与者报告血糖检测地点和频率发生了变化。在坦桑尼亚,到医疗机构就诊的次数减少了 14.4%(P = 0.001)。在肯尼亚,投保患者出现严重护理中断的可能性较高(调整后的几率比 [aOR] 1.56,95% 置信区间 [CI][1.05-2.34];P = 0.029),居住在农村地区的患者发生的可能性较低(aOR,0.35[95%CI,0.22-0.58];P = 0.003),但经济状况较差的患者发生的可能性较高(aOR,1.81[95%CI,1.14-2.88];P = 0.011):结论:与坦桑尼亚相比,COVID-19 在肯尼亚对糖尿病治疗的干扰更大。结论:在肯尼亚,COVID-19 对糖尿病护理的干扰比坦桑尼亚更大。应加强卫生系统和应急准备,以确保为糖尿病患者提供服务的连续性。
{"title":"Impact of the COVID-19 pandemic on type 2 diabetes care and factors associated with care disruption in Kenya and Tanzania.","authors":"Richard E Sanya, Caroline H Karugu, Peter Binyaruka, Shukri F Mohamed, Lyagamula Kisia, Peter Kibe, Irene Mashasi, Grace Mhalu, Christopher Bunn, Manuela Deidda, Frances S Mair, Eleanor Grieve, Cindy M Gray, Sally Mtenga, Gershim Asiki","doi":"10.1080/16549716.2024.2345970","DOIUrl":"10.1080/16549716.2024.2345970","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic affected healthcare delivery globally, impacting care access and delivery of essential services.</p><p><strong>Objectives: </strong>We investigated the pandemic's impact on care for patients with type 2 diabetes and factors associated with care disruption in Kenya and Tanzania.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among adults diagnosed with diabetes pre-COVID-19. Data were collected in February-April 2022 reflecting experiences at two time-points, three months before and the three months most affected by the COVID-19 pandemic. A questionnaire captured data on blood glucose testing, changes in medication prescription and access, and healthcare provider access.</p><p><strong>Results: </strong>We recruited 1000 participants (500/country). Diabetes care was disrupted in both countries, with 34.8% and 32.8% of the participants reporting change in place and frequency of testing in Kenya, respectively. In Tanzania, 12.4% and 17.8% reported changes in location and frequency of glucose testing, respectively. The number of health facility visits declined, 14.4% (<i>p</i> < 0.001) in Kenya and 5.6% (<i>p</i> = 0.001) in Tanzania. In Kenya, there was a higher likelihood of severe care disruption among insured patients (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI][1.05-2.34]; <i>p</i> = 0.029) and a lower likelihood among patients residing in rural areas (aOR, 0.35[95%CI, 0.22-0.58]; <i>p</i> < 0.001). Tanzania had a lower likelihood of severe disruption among insured patients (aOR, 0.51[95%CI, 0.33-0.79]; <i>p</i> = 0.003) but higher likelihood among patients with low economic status (aOR, 1.81[95%CI, 1.14-2.88]; <i>p</i> = 0.011).</p><p><strong>Conclusions: </strong>COVID-19 disrupted diabetes care more in Kenya than Tanzania. Health systems and emergency preparedness should be strengthened to ensure continuity of service provision for patients with diabetes.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11123500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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