Patient, tumor, and health system factors affecting groin node dissection rates in vulvar carcinoma: Results from a population-based analysis

Abstract Introduction: Malaria interventions including use of Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment (IPTp-SP) and distribution of Insecticide Treated Nets (ITNs) have been implemented through ante-natal clinic (ANC) services in Ghana. Yet, the high ANC attendance is not commensurate with the uptake of these interventions, with missed opportunities to deliver the interventions. This study sought to assess the health system factors affecting access and delivery of IPTp-SP and ITN as defined by the Ghana Malaria Policy Guideline to eligible pregnant women attending ANC clinic sessions.Methods: A quantitative cross-sectional study was conducted in the Volta Region of Ghana, with data collected across three levels of health care delivery facilities, including hospitals, health centres and Community-Based Health Planning Service (CHPS) compounds. Data collection included structured observation checklists to document the communication and interaction between the ANC health staff and pregnant women. Additionally, structured questionnaires were used to elicit information on cadre, trainings attended, knowledge and delivery practices of health workers on IPTp-SP and ITN. Stata 16 was used for data analysis, and a defined delivery algorithm was used to compute appropriate and inappropriate delivery practices, using the Ghana policy directive as a guide. Predictors of appropriate delivery were determined using logistic regression analysis. Results: Approximately 97% of the 680 ANC observations had complete information for analysis. Of these, 78% (511) were eligible for IPTp-SP after excluding women who have less than 16 weeks of gestation, G6PD deficient, malaria positive and have taken 5 doses of IPTp-SP prior to day of observation. Appropriate delivery of IPTp-SP was 76% (390). Despite the availability of SP, 15% (75) of all eligible women were not offered the medication and 37% (44) of inappropriate delivery was due to stock out. ITNs were appropriately delivered to 59% (139) out of 237 eligible women. Thirty-two percent (77) of eligible women, mostly continuing ANC clients, were not given ITN despite stock availability. Conclusions: IPTp-SP was appropriately delivered to 76% of clients as compared to 59% in the case of ITN. Despite stock availability, IPTp-SP and ITN were not delivered to some eligible women. This highlights health worker related factors influencing delivery.

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Assessing health system factors affecting access and delivery of IPTp-SP and ITN to pregnant women attending ANC clinics in Ghana

BMC Health Services Research ◽

10.1186/s12913-021-07055-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Virtue Fiawokome De-Gaulle ◽

Pascal Magnussen ◽

Joseph Kamgno ◽

Wilfred Mbacham ◽

Verner N. Orish ◽

...

Keyword(s):

Health System ◽

Pregnant Women ◽

Health Workers ◽

Care Delivery ◽

Health Planning ◽

Intermittent Preventive Treatment ◽

Health Staff ◽

Factors Affecting ◽

Delivery Practices ◽

System Factors

Abstract Introduction Malaria interventions including use of Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment (IPTp-SP) and distribution of Insecticide Treated Nets (ITNs) have been implemented through ante-natal clinic (ANC) services in Ghana. Yet, the high ANC attendance is not commensurate with the uptake of these interventions, with missed opportunities to deliver the interventions. This study sought to assess the health system factors affecting access and delivery of IPTp-SP and ITN as defined by the Ghana Malaria Policy Guideline to eligible pregnant women attending ANC clinic sessions. Methods A quantitative cross-sectional study was conducted in the Volta Region of Ghana, with data collected across three levels of health care delivery facilities, including hospitals, health centres and Community-Based Health Planning Service (CHPS) compounds. Data collection included structured observation checklists to document the communication and interaction between the ANC health staff and pregnant women. Additionally, structured questionnaires were used to elicit information on cadre, trainings attended, knowledge and delivery practices of health workers on IPTp-SP and ITN. Stata 16 was used for data analysis, and a defined delivery algorithm was used to compute appropriate and inappropriate delivery practices, using the Ghana policy directive as a guide. Predictors of appropriate delivery were determined using logistic regression analysis. Results Approximately 97% of the 680 ANC observations had complete information for analysis. Of these, 78% (511/657) were eligible for IPTp-SP after excluding women who have less than 16 weeks of gestation, G6PD deficient, malaria positive and have taken 5 doses of IPTp-SP prior to day of observation. Appropriate delivery of IPTp-SP was 76% (390/511). Despite the availability of SP, 15% (75/511) of all eligible women were not offered the medication and 37% (44/119) of inappropriate delivery was recorded during periods of stock out. ITNs were appropriately delivered to 59% (139) out of 237 eligible women. Thirty-two percent (77/237) of eligible women, mostly continuing ANC clients, were not given ITN despite stock availability. Conclusions IPTp-SP was appropriately delivered to most of the eligible pregnant women compared to ITN. While stock out of both intervention could account for inappropriate delivery, despite stock availability, IPTp-SP and ITN were not delivered to some eligible women.

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Critical Successful Factors Affecting Adoption of E-Health System in Developing Countries

SSRN Electronic Journal ◽

10.2139/ssrn.3522884 ◽

2020 ◽

Author(s):

Ahmad Tawfig Al-Radaideh ◽

Malik Alazzam

Keyword(s):

Developing Countries ◽

Health System ◽

Factors Affecting

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Unilateral or Bilateral Retroperitoneal Lymph Node Dissection in Nonseminoma Patients with Postchemotherapy Residual Tumour? Results from RETROP, a Population-based Mapping Study by the Swedish Norwegian Testicular Cancer Group

European Urology Oncology ◽

10.1016/j.euo.2021.02.002 ◽

2021 ◽

Author(s):

Axel Gerdtsson ◽

Anna Thor ◽

Anna Grenabo Bergdahl ◽

Bjarte Almås ◽

Ulf Håkansson ◽

...

Keyword(s):

Lymph Node ◽

Testicular Cancer ◽

Lymph Node Dissection ◽

Population Based ◽

Retroperitoneal Lymph Node Dissection ◽

Residual Tumour ◽

Node Dissection ◽

Mapping Study ◽

Retroperitoneal Lymph Node ◽

Cancer Group

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Cardiovascular disease prevalence in type 2 diabetes – an analysis of a large German statutory health insurance database

BMC Public Health ◽

10.1186/s12889-021-10381-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maximilian Gabler ◽

Silke Geier ◽

Lukas Mayerhoff ◽

Wolfgang Rathmann

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Health System ◽

Cardiovascular Complications ◽

Population Based ◽

Stratified Sample ◽

Icd 10 ◽

Definition Of ◽

Observation Period

Abstract Background The aim of this study was to determine the prevalence of cardiovascular disease in persons with type 2 diabetes mellitus (T2D) in Germany. Methods A claims database with an age- and sex-stratified sample of nearly 4 million individuals insured within the German statutory health system was used. All patients aged ≥18 years with T2D documented between 1 January 2015 and 31 December 2015 and complete retrospective documentation of ≥5 years (continuous enrollment in the German statutory health system) before 2015 were selected based on a validated algorithm. Cardiovascular disease (CVD) events were identified based on ICD-10 and OPS codes according to a previous clinical study (EMPA-REG OUTCOME trial). Results The prevalence of T2D in Germany in 2015 was 9.9% (n = 324,708). Using a narrow definition of CVD, the 6-year observation period prevalence of CVD was estimated as 46.7% [95% CI: 46.52%;46.86%]. Applying a wider CVD definition, the proportion of T2D patients who showed a history of CVD was 57.1% [95% CI: 56.9%;57.24%]. The prevalence of CVD in patients with T2D ranged from 36.3 to 57.1%, depending on the observation period and definition of CVD. Conclusions The results underline the need for a population-based registration of cardiovascular complications in T2D.

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Quantifying the Influence of Individual, Community, and Health System Factors on Quality of Life Among Inner-City African Americans With Type 2 Diabetes

The Science of Diabetes Self-Management and Care ◽

10.1177/0145721721996287 ◽

2021 ◽

pp. 014572172199628

Author(s):

Jennifer A. Campbell ◽

Alice Yan ◽

Renee E. Walker ◽

Lance Weinhardt ◽

Yang Wang ◽

...

Keyword(s):

Quality Of Life ◽

Type 2 Diabetes ◽

African Americans ◽

Inner City ◽

Health System ◽

Community Sample ◽

Primary Data ◽

System Factors

Purpose The purpose of this study is to examine the association of individual, community, and health system factors on quality of life among inner-city African Americans with type 2 diabetes. Methods Primary data from a cross-sectional study with a community sample of 241 inner-city African Americans with type 2 diabetes were analyzed. Paper-based surveys were administered in which the SF-12 was used to capture the physical component (PCS) and mental component (MCS) of quality of life. Four regression approaches (sequential, stepwise with backward and forward selection, and all possible subsets regression) were used to examine the influence of individual, community, and health system factors on PCS and MCS after adjusting for relevant covariates using a conceptual framework. Results In fully adjusted models, having less than a high school education and having major depression were associated with lower quality-of-life scores for MCS across all 4 regression approaches. Being employed was positively associated with better quality-of-life scores for PCS across all 4 regression approaches. PCS was higher across all 4 regression approaches for those reporting a history of trauma. At the health systems level, usual source of care was associated with better PCS across 3 regression approaches. Conclusions These results highlight key factors that influence quality of life among inner-city African Americans with type 2 diabetes that could be targets for interventions in this population. However, additional research is needed to understand existing pathways that may be driving many of these relationships.

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