scholarly journals A Snapshot of Grassroots Primary Care and Tuberculosis Control in India—a US Fulbright–Nehru Scholar Program Experience

2017 ◽  
Vol 12 (02) ◽  
pp. 26
Author(s):  
Sonal Shah Parikh ◽  
Juzar Ali ◽  
Sanjay Bhatt ◽  
DV Bala ◽  
◽  
...  
Keyword(s):  
Primary Care ◽  
Treatment Success ◽  
Tertiary Care ◽  
World Health ◽  
Tuberculosis Control ◽  
District Health ◽  
Public And Private ◽  
Rural And Urban ◽  
Organization Strategy ◽  
Health Organization

The Department of Community Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Medical College, Ahmedabad, India, under the aegis of the US Fulbright–Nehru Scholar Program, reviewed the rural and urban primary and district health delivery system, with focus on primary care, child and maternal health and tuberculosis control. The National Health Mission program in India utilizes public and private resources and partnerships to optimally increase access, referrals and improve quality of care. As a collateral, the Revised National Tuberculosis Program, within its broader umbrella, incorporates digital-based locally applicable innovative approaches to tuberculosis (TB) control, to implement the World Health Organization strategy of the Directly Observed Treatment Short-course (DOTS) program. With this approach the program has consistently maintained a high treatment success rate. However, the deficiencies in the program include the loss to follow-up of missing persons with TB, incomplete data in some cases, and erratic coordination between private, academic, public health primary and tertiary care centers.

scholarly journals The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Osman Abdullahi ◽  
Ngari Moses ◽  
Deche Sanga ◽  
Willetts Annie
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Clinical Signs ◽  
World Health ◽  
Routine Practice ◽  
Public And Private ◽  
Systematic Screening ◽  
Tb Treatment ◽  
Resource Limited ◽  
Health Organization

AbstractThe World Health Organization (WHO) criteria for diagnosing and treating Tuberculosis (TB) includes clinical signs, therefore not requiring bacteriological laboratory confirmation. In resource-limited settings, including Kenya, this empirical TB treatment is routine practice however limited data exist on patient clinical outcomes when comparing the method of diagnosis. We evaluated TB treatment outcomes comparing clinically diagnosed and bacteriologically confirmed TB, 6 months after starting treatment of TB in a rural county in Kenya. Our analysis compared patients with a clinical versus a bacteriologically confirmed TB diagnosis. In this retrospective analysis, we included all adults (≥ 18 years) starting treatment of TB and followed up for 6 months, within the County TB surveillance database from 2012 to 2018. Patients included from both public and private facilities. The TB treatment outcomes assessed included treatment success, treatment failure, death, defaulted and transferred out. We used survival regression models to assess effect of type of diagnosis on TB treatment outcome defining time at risk from date of starting treatment to experiencing one of the treatment outcomes or completing 6-months of treatment. A total of 12,856 patients; median age 37 [IQR 28 − 50] years were included. 7639 (59%) were male while 11,339 (88%) were pulmonary TB cases. Overall, 11,633 (90%) were given first-line TB treatment and 3791 (29%) were HIV infected. 6472 (50%) of the patients were clinically diagnosed of whom 4521/6472 (70%) had a negative sputum/GeneXpert test. During the study 5565 person-years (PYs) observed, treatment success was 82% and 83% amongst clinically and bacteriologically diagnosed patients (P = 0.05). There were no significant differences in defaulting (P = 0.70) or transfer out (P = 0.19) between clinically and bacteriologically diagnosed patients. Mortality was significantly higher among clinically diagnosed patients: 639 (9.9%) deaths compared to 285 (4.5%) amongst the bacteriologically diagnosed patients; aHR 5.16 (95%CI 2.17 − 12.3) P < 0.001. Our study suggests survival during empirical TB treatment is significantly lower compared to patients with laboratory evidence, irrespective of HIV status and age. To improve TB treatment outcomes amongst clinically diagnosed patients, we recommend systematic screening for comorbidities, prompt diagnosis and management of other infections.

Prepayment schemes

2017 ◽  
Author(s):  
Jan Abel Olsen
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Three Dimensions ◽  
World Health ◽  
Health Coverage ◽  
Public And Private ◽  
Revenue Collection ◽  
Otto Von Bismarck ◽  
Health Organization ◽  
Universal Health

This chapter considers two different ways of organizing revenue collection in statutory healthcare schemes: social health insurance and taxation. The two models are commonly referred to as ‘Bismarck vs Beveridge’ after the men associated with the origin of these systems: the first German chancellor Otto von Bismarck (1815–1898), and the British economist Lord William Beveridge (1879–1963). The differences between these two compulsory prepayment schemes are discussed and compared with private health insurance. Based on a simple diagram introduced by the World Health Organization, three dimensions of coverage are illustrated. Some policy dilemmas are highlighted when attempting to achieve universal health coverage. Finally, various combinations of public and private prepayment schemes are discussed.

scholarly journals Managing the Return to Football During the COVID-19 Pandemic: A Survey of the Head Team Physicians of the Football Bowl Subdivision Programs

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712199204
Author(s):  
Alexander D. Slabaugh ◽  
John W. Belk ◽  
Jonathan C. Jackson ◽  
Richard J. Robins ◽  
Eric C. McCarty ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
National Collegiate Athletic Association ◽  
College Football ◽  
Cross Sectional Study ◽  
Return To Play ◽  
World Health ◽  
Cross Sectional ◽  
Football Bowl Subdivision ◽  
Health Organization

Background: COVID-19 is a severe respiratory virus that spreads via person-to-person contact through respiratory droplets. Since being declared a pandemic in early March 2020, the World Health Organization had yet to release guidelines regarding the return of college or professional sports for the 2020-2021 season. Purpose: To survey the head orthopedic surgeons and primary care team physicians for the National Collegiate Athletic Association (NCAA) Football Bowl Subdivision (FBS) football teams so as to gauge the management of common COVID-19 issues for the fall 2020 college football season. Study Design: Cross-sectional study. Methods: The head team orthopaedic surgeons and primary care physicians for all 130 FBS football teams were surveyed regarding their opinions on the management of college football during the COVID-19 pandemic. A total of 30 questions regarding testing, return-to-play protocol, isolating athletes, and other management issues were posed via email survey sent on June 5, 2020. Results: Of the 210 team physicians surveyed, 103 (49%) completed the questionnaire. Overall, 36.9% of respondents felt that it was unsafe for college athletes to return to playing football during fall 2020. While the majority of football programs (96.1%) were testing athletes for COVID-19 as they returned to campus, only 78.6% of programs required athletes to undergo a mandatory quarantine period before resuming involvement in athletic department activities. Of the programs that were quarantining their players upon return to campus, 20% did so for 1 week, 20% for 2 weeks, and 32.9% quarantined their athletes until they had a negative COVID-19 test. Conclusion: While US Centers for Disease Control and Prevention guidelines evolve and geographic regions experience a range of COVID-19 infections, determining a universal strategy for return to socialization and participation in sports remains a challenge. The current study highlighted areas of consensus and strong agreement, but the results also demonstrated a need for clarity and consistency in operations, leadership, and guidance for medical professionals in multiple areas as they attempt to safely mitigate risk for college football players amid the COVID-19 pandemic.

Identification and Management of Psychosocial and Developmental Problems in Community-Based, Primary Care Pediatric Practices

PEDIATRICS ◽  
1992 ◽  
Vol 89 (3) ◽  
pp. 480-485 ◽  
Author(s):  
Sarah McCue Horwitz ◽  
Philip J. Leaf ◽  
John M. Leventhal ◽  
Brian Forsyth ◽  
Kathy Nixon Speechley
Keyword(s):  
Primary Care ◽  
Child Behavior Checklist ◽  
Social Issues ◽  
Young Patients ◽  
Well Being ◽  
World Health ◽  
Developmental Problems ◽  
Active Intervention ◽  
Health Organization ◽  
New Morbidity

The importance of psychological and social issues for children's well-being has long been recognized and their importance in the practice of pediatrics is well documented. However, many of the studies looking at this issue have emphasized psychiatric problems rather than issues commonly referred to as the new morbidity. The goal of this research was to refocus interest on the problems of the new morbidity. This study examined the rates and predictors of psychological problems in 19 of 23 randomly chosen pediatric practices in the greater New Haven area. Families of all 4- to 8-year-old children were invited to participate and to complete the Child Behavior Checklist prior to seeing a clinician. Clinicians completed a 13-category checklist of psychosocial and developmental problems based on a World Health Organization-sponsored primary care, child-oriented classification system. Of the 2006 eligible families, 1886 (94%) participated. Clinicians identified at least one psychosocial or developmental problem in 515 children (27.3%). Thirty-one percent of the children with problems received no active intervention, 40% received intervention by the clinician, and 16% were referred to specialty services. Not surprisingly, children whose problems were rated as moderate or severe were twice as likely to be referred compared with children with mild problems. Recognition of a problem was related to four characteristics: if the visit was for well child rather than acute care; if the clinician felt he or she knew a child well; if the child was male; and if the child had unmarried parents (all P ≤ .05). The data suggest that, when asked to use a taxonomy appropriate for primary care, clinicians recognize problems in many 4- to 8-year-old children (515/1886; 27.3%). This rate is considerably higher than the rates previously reported. Further, many children with identified problems (56%) were reported by their clinicians to receive some form of active intervention. Characteristics of the visit (type of visit, clinician's knowledge of a child) that influence the recognition of problems were also identified. These results suggest that investigators must define what types of problems they are interested in and under what circumstances to determine accurately what pediatric practitioners know about psychosocial and developmental problems in their young patients and families.

scholarly journals A pilot study comparing pattern of damage sustained among instruments from different surgical units in a tertiary care centre in Nepal – reappraising the role of instrument reprocessing in retaining their value

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 102
Author(s):  
Sunil Munakomi ◽  
Roshan Shah ◽  
Sangam Shrestha
Keyword(s):  
Tertiary Care ◽  
Health Spending ◽  
Pivotal Role ◽  
World Health ◽  
Tertiary Care Centre ◽  
Surgical Equipment ◽  
Surgical Units ◽  
Wear And Tear ◽  
Health Organization

Background: The quality of instruments plays a pivotal role in governing safe operating room culture. The reprocessing system followed in the institution determines their durability thereby ensuring patient safety as well as minimizing health spending. Rigorous reprocessing in a centralized instrument reprocessing department by well trained staff following formulated guidelines helps to achieve the target of “safe surgery saves lives” as formulated by the World Health Organization. Methods: We sought to determine the patterns of wear and tear sustained among sets of surgical equipment from two surgical units that had been sent to the repair department within a year of their purchase. Analysis of similar changes in the joints of the instrument, as well as pattern of fractures sustained was performed. Results: All patterns of wear and tear were common in both the general surgical arm and neurosurgical counterpart, with the exception of fractures and mal-alignments. Similar study was performed examining changes in the joints. Stains were the most commonly observed change pattern in both sets of instruments. Fractures were most frequent in the working ends in both sets of instruments. Conclusion: There is an alarming incidence of wear and tear patterns in the instruments used in the surgical units, even within the first year of their use. This supports the strict implementation of reprocessing guidelines by well trained workers and their quality assessments via audit checks. The quality of the purchased instruments also plays a pivotal role.

scholarly journals Cross-cultural differences in the epidemiology of unexplained fatigue syndromes in primary care

2003 ◽  
Vol 182 (3) ◽  
pp. 205-209 ◽  
Author(s):  
Petros Skapinakis ◽  
Glyn Lewis ◽  
Venetsanos Mavreas
Keyword(s):  
Primary Care ◽  
Secondary Analysis ◽  
Composite International Diagnostic Interview ◽  
Developed Countries ◽  
Diagnostic Interview ◽  
World Health ◽  
Less Developed Countries ◽  
Cross Cultural Differences ◽  
International Data ◽  
Health Organization

BackgroundUnexplained fatigue has been extensively studied but most of the samples used were from Western countries.AimsTo present international data on the prevalence of unexplained fatigue and fatigue as a presenting complaint in primary care.MethodSecondary analysis of the World Health Organization study of psychological problems in general health care. A total of 5438 primary care attenders from 14 countries were assessed with the Composite International Diagnostic Interview.ResultsThe prevalence of unexplained fatigue of 1-month duration differed across centres, with a range between 2.26 (95% CI 1.17–4.33) and 15.05 (95% CI 10.85–20.49). Subjects from more-developed countries were more likely to report unexplained fatigue but less likely to present with fatigue to physicians compared with subjects from less developed countries.ConclusionsIn less-developed countries fatigue might be an indicator of unmet psychiatric need, but in more-developed countries it is probably a symbol of psychosocial distress.

scholarly journals Change in affordability of medications in Kazan in 2011 and 2015 as a reflection of state initiatives to regulate drug prices

2017 ◽  
Vol 98 (5) ◽  
pp. 822-826 ◽  
Author(s):  
Ch M Razzakova ◽  
L E Ziganshina
Keyword(s):  
Comparative Analysis ◽  
Generic Drugs ◽  
World Health ◽  
Price Ratio ◽  
Public And Private ◽  
Drug Prices ◽  
State Initiatives ◽  
Health Action ◽  
Medicine Prices ◽  
Health Organization

Aim. Performing comparative analysis of drug prices in 2011 and 2015 in Kazan to assess the effectiveness of state initiatives to ensure the affordability of medicines. Methods. The collection and processing of data was performed according to methodology developed by Health Action International and World Health Organization (WHO/HAI). We studied the availability and prices of 30 medicines in public and private pharmacies in Kazan in 2011 and 2015 and analyzed the procurement prices of the same medicines in inpatient hospitals. Recording and analysis were performed using standardized MS Excel WHO/HAI Workbook. Medicine prices were compared with international reference prices and were expressed as median price ratio. Results. The analysis showed a decrease in medicine prices in 2015 compared to 2011. In public and private sectors median price ratio of the originator brands reduced by about 3 times, and of the lowest price generics reduced by 1.5 times. A decrease in procurement prices by more than 2 times for generics and more than 6 times for the original brands was also revealed in 2015 in comparison with 2011. Conclusion. State initiatives to regulate drug prices contributed to the price reduction by 1.5-3 times in 2015 compared to 2011; changes in the procedures for the medicines procurement at the legislative level resulted in reduction of procurement prices by more than 2 times for generic drugs in 2015 compared to 2011.

scholarly journals Biomedical Waste Management in Kandahar City

2019 ◽  
pp. 40-48
Keyword(s):  
Health Care ◽  
Waste Management ◽  
International Standards ◽  
World Health ◽  
Human Beings ◽  
Public And Private ◽  
Biomedical Waste ◽  
Public And Private Hospitals ◽  
Health Organization ◽  
Health Care Centers

Biomedical wastes management is one of the most important issues in public health centers and it is a crucial issue for environmental sectors as well. Wrong and inappropriate management treat the life of human beings in Kandahar City. Currently the population of this city has exponentially increased than ever because of the immigration of many people from neighboring provinces. This research was conducted in 15 districts of Kandahar public and private health care centers to identify the current biomedical waste management in Kandahar city. The qualitative and quantitative date was collected through a questionnaire from public and private hospitals, clinics and health care centers. In addition, discarding, segregating, labeling, transporting and disposing system of biomedical waste were observed. The result showed that 65.3% newly hired biomedical waste staff not received training or instruction. Furthermore, the result indicates that 44% generated biomedical wastes are regulated by municipality and color coding is not followed accordingly. Current biomedical waste is not appropriate based on designed international standards and the criteria suggested by world health organization.

Increment in Phototherapy After Adopting Delayed Cord Clamping Practice

2021 ◽  
pp. 097321792110607
Author(s):  
Chinmay Chetan ◽  
Nishant Banait ◽  
Vikramaditya Athelli ◽  
Bhvya Gupta ◽  
Prince Pareek ◽  
...  
Keyword(s):  
Tertiary Care ◽  
World Health ◽  
Care Hospital ◽  
Delayed Cord Clamping ◽  
Term Infants ◽  
Cord Clamping ◽  
Early Cord Clamping ◽  
Baseline Characteristics ◽  
Health Organization ◽  
Larger Sample

Introduction: World Health Organization (WHO) in 2014 recommended delayed cord clamping (DCC) in all babies who cry immediately after birth. Despite many benefits, there are concerns of increased rate of phototherapy in babies receiving DCC. This study was done to determine the increment in the rate of phototherapy required in infants managed with DCC vs infants managed with early cord clamping (ECC). Methods: A retrospective observational study was conducted in a tertiary care hospital in Pune, India. All the infants born between January 2018 and July 2018, for whom ECC was done, were compared with infants who were born between January 2019 and July 2019, after DCC policy was adopted. All the infants with birth weight ≥2 kg and gestation ≥35 weeks, who were with their mother, were included. Baseline characteristics were compared for both the groups. American Academy of Pediatrics guidelines for treatment of neonatal jaundice were used to determine the need for phototherapy. Number of infants in both the groups who required phototherapy were compared. Results: The ECC group had 565 infants while DCC group had 731 infants. There was no difference in the baseline characteristics of the 2 groups. Jaundice requiring phototherapy was noted in 31% of infants in the ECC group, compared to 45% in infants in the DCC group (relative risk: 1.47 [1.27-1.71] [ P < .001]). Conclusion: In this study, DCC increased the need for phototherapy by 47% in late preterm and term infants. Randomized control trials with larger sample size are required to confirm this finding.

scholarly journals Trends in tuberculosis incidence rates in the Region of Sousse (Tunisia) from 1992 to 2016

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Sahli ◽  
M Mellouli ◽  
M Limam ◽  
M El Ghardallou ◽  
A Mtiraoui ◽  
...  
Keyword(s):  
Current Trend ◽  
National Level ◽  
Incidence Rates ◽  
World Health ◽  
Epidemiological Surveillance ◽  
Tuberculosis Control ◽  
Tuberculosis Incidence ◽  
Significant Downward Trend ◽  
Development Goals ◽  
Health Organization

Abstract Introduction In 1993, the World Health Organization declared that tuberculosis is a public health emergency of global concern. All efforts were made in accordance with the Millennium Development Goals (MDGs) to reduce the burden of Tuberculosis. The MDG framework built into national priorities and development strategies has, in fact, strengthened epidemiological surveillance and the use of reliable data to make decisions based on objective data. These data are essential for planning, managing the activities of the National Tuberculosis program, monitoring and ongoing evaluation of its performance. In this context, we conducted this study to trace the trend of Tuberculosis incidence rate recorded in the Sousse Region between 1992 and 2016. Methods This is a longitudinal study of the registered data of tuberculosis cases in Sousse between 1992 and 2016. For the trend analysis the software JOINPOINT version 4.5.0.1 was used. This software offers the closest possible regression model of the different points and gives an annual percentage change (APC) with a 95% confidence interval. Results The highest TB incidence rates was recorded in 1993 (85.66 cases per 100 000 inhabitants). Between 1992 and 1997, there was a significant downward trend of TB incidence (APC = -23.2; 95% CI [-28.8, 1]). Between 1997 and 2004 the trend was stable. Between 2004 and 2016, there was a significant upward trend (APC = 8.3; 95% CI: [4.3, 12.4]). Conclusions At the national level, between 1992 and 2002, tuberculosis experienced a fall in incidence rates, as a result of an improvement in the socio-economic level and the organization of tuberculosis control. Since 2004, the trend has been rising. Increased tuberculosis control is advocated to end tuberculosis by 2030 in line with sustainable development goals. Key messages After a significant decrease, the tuberculosis incidence has increased significantly since 2004. The tuberculosis prevention efforts should be intensified to reverse the current trend.

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