Lancet Glob Health 2019Published OnlineOctober 22, 2019 https://doi.org/10.1016/S2214-109X(19)30425-5
Global actions to reduce antimicrobial resistance (AMR) include optimising the use of antimicrobial medicines in human and animal health. In countries with weak healthcare regulation, this requires a greater understanding of the drivers of antibiotic use from the perspective of providers and consume...rs. In Bangladesh, there is limited research on household decision-making and healthcare seeking in relation to antibiotic use and consumption for humans and livestock. Knowledge is similarly lacking on factors influencing the supply and demand for antibiotics among qualified and unqualified healthcare providers. The aim of this study is to conduct integrated research on household decision-making for healthcare and antibiotic use, as well as the awareness, behaviours and priorities of healthcare providers and sellers of antibiotics to translate into policy development and implementation
more
BACKGROUND: Growing political attention to antimicrobial resistance (AMR) offers a rare opportunity for achieving meaningful action. Many governments have developed national AMR action plans, but most have not yet implemented policy interventions to reduce antimicrobial overuse. A systematic evidenc...e map can support governments in making evidence-informed decisions about implementing programs to reduce AMR, by identifying, describing, and assessing the full range of evaluated government policy options to reduce antimicrobial use in humans.
METHODS AND FINDINGS: Seven databases were searched from inception to January 28, 2019, (MEDLINE, CINAHL, EMBASE, PAIS Index, Cochrane Central Register of Controlled Trials, Web of Science, and PubMed). We identified studies that (1) clearly described a government policy intervention aimed at reducing human antimicrobial use, and (2) applied a quantitative design to measure the impact. We found 69 unique evaluations of government policy interventions carried out across 4 of the 6 WHO regions. These evaluations included randomized controlled trials (n = 4), non-randomized controlled trials (n = 3), controlled before-and-after designs (n = 7), interrupted time series designs (n = 25), uncontrolled before-and-after designs (n = 18), descriptive designs (n = 10), and cohort designs (n = 2). From these we identified 17 unique policy options for governments to reduce the human use of antimicrobials. Many studies evaluated public awareness campaigns (n = 17) and antimicrobial guidelines (n = 13); however, others offered different policy options such as professional regulation, restricted reimbursement, pay for performance, and prescription requirements. Identifying these policies can inform the development of future policies and evaluations in different contexts and health systems. Limitations of our study include the possible omission of unpublished initiatives, and that policies not evaluated with respect to antimicrobial use have not been captured in this review.
CONCLUSIONS: To our knowledge this is the first study to provide policy makers with synthesized evidence on specific government policy interventions addressing AMR. In the future, governments should ensure that AMR policy interventions are evaluated using rigorous study designs and that study results are published.
more
Young children are especially susceptible to exposure to trauma. Rates of abuse and neglect among this population are staggering. This article presents a review of relevant literature, including research findings specific to early childhood vulnerability to trauma, symptoms associated with traumatic... events, diagnostic validity of early childhood trauma, and treatments for young children. In the past, misconceptions about the mental health of young children have hindered accurate diagnosis and treatment of trauma-related mental illness. Due to the prevalence of trauma exposure in early childhood, counselors are encouraged to become familiar with ways that clients and families are impacted and methods for treatment. Implications for future research also are presented.
more
PLOS ONE | DOI:10.1371/journal.pone.0144057 December 14, 2015
Volume 2 · Supplement 4 · November 2016
ISSN 2055-66-40 – Print
Foreword
| ISSN 2055-66-59 – Online
www.viruseradication.com
Trastornos del desarrollo
Capítulo C.2
Traducción de la versión inglesa del 2014
Manual de Salud Mental Infantil y Adolescente de la IACAPAP
Dans cette perspective, nous espérons que notre expérience pratique dans ces domaines constituera un apport aux prochaines éditions de ce guide. Et si le renforcement des systèmes de santé peut ne pas être une science exacte et que l’approche universelle n’existe pas, cette publication dé...montre que la quantité de connaissances empiriques et les bonnes pratiques peuvent grandement contribuer à accélérer et à affiner les initiatives nationales du mieux possible afin d’adapter les besoins, les compétences et les circonstances.
more
As pandemias virais costumam representar sérias ameaças ao equilíbrio dos sistemas de saúde, ao impor-lhes demandas extraor-dinárias e sustentadas, que podem ultrapassar a capacidade de atendimento, no que diz respeito tanto aos insumos e às tecnologias disponíveis, quanto aos recurs...os humanos/profissionais capacitados. Trazem o enorme desafio de equilibrar igualdade entre as pessoas e equidade na distribuição de riscos e benefícios entre elas.
Diante desse cenário de casos cada vez mais frequentes de COVID-19 na
população, surge a premente necessidade de se avaliarem as melhores práticas para a otimização da utilização dos meios e recursos disponíveis. Dessa forma, considerando o iminente risco de indisponibilidade de leitos de terapia intensiva e respiradores para todos os indivíduos, acometidos ou não pela doença, torna-se fundamental estabelecer critérios clínicos, técnicos e éticos, para a melhor utilização dos mesmos, para se conseguir otimizar resultado e gerar o maior benefício possível.
more
The “Wuppertal Call” – Contributions and Recommendations from an
International Conference on Eco-Theology and Ethics of Sustainability
Wuppertal, Germany, 16 – 19 June 2019
The social impacts of Covid-19 in Brazil: vulnerable populations and responses to the pandemic
Passados os primeiros meses da pandemia do novo coronavírus no Brasil, o Observatório Covid-19 Fiocruz, em parceria com a Editora Fiocruz e com o apoio da Rede SciELO Livros, traz para o público leitor... um conjunto de livros instantâneos sobre as análises nele realizadas desde que foi criado para subsidiar o seu combate. Nesta série Informação para Ação na Covid-19 será apresentado um balanço do conjunto de documentos (notas e relatórios técnicos, boletins, ensaios, informes, recomendações, ensaios, artigos, entre outros) produzidos em resposta à pandemia. Cada volume da série se estrutura em torno de um tema: aspectos globais da pandemia e da diplomacia em saúde; cenários epidemiológicos e vigilância em saúde; as políticas e a gestão dos serviços e sistemas de saúde; orientações para os cuidados e a saúde dos trabalhadores da saúde; impactos sociais e desigualdades sociais na pandemia. Com a publicação destes estudos em livros instantâneos e de acesso aberto colocamos à disposição do público o conjunto de informações e conhecimentos gerados no âmbito do Observatório Covid-19 Fiocruz, realizamos um balanço e uma reflexão sobre como chegamos ao cenário atual e apontamos caminhos para um futuro próximo. E, ao mesmo tempo, mantemos o registro histórico desse conhecimento produzido a quente, no calor da hora.
more
Data on asthma aetiology in Africa are scarce. We investigated the risk factors for asthma among schoolchildren (5–17 years) in urban Uganda. We conducted a case-control study, among 555 cases and 1115 controls. Asthma was diagnosed by study clinicians. The main risk factors for asthma were tertia...ry education for fathers (adjusted OR (95% CI); 2.32 (1.71–3.16)) and mothers (1.85 (1.38–2.48)); area of residence at birth, with children born in a small town or in the city having an increased asthma risk compared to schoolchildren born in rural areas (2.16 (1.60–2.92)) and (2.79 (1.79–4.35)), respectively; father’s and mother’s history of asthma; children’s own allergic conditions; atopy; and cooking on gas/electricity. In conclusion, asthma was associated with a strong rural-town-city risk gradient, higher parental socio-economic status and urbanicity. This work provides the basis for future studies to identify specific environmental/lifestyle factors responsible for increasing asthma risk among children in urban areas in LMICs.
more
PLoS Pathogens | www.plospathogens.org 1
February 2012 | Volume 8 | Issue 2 | e100246
The Government of Malawi’s Health Sector Strategic Plan II highlights the importance of service integration; however, in practice, this has not been fully realized. We conducted a mixed methods evaluation of efforts to systematically implement integrated family planning and immunization services i...n all health facilities and associated community sites in Ntchisi and Dowa districts during June 2016–September 2017. Methods included secondary analysis of service statistics (pre- and postintervention), focus group discussions with mothers and fathers of children under age one, and in-depth interviews with service providers, supervisors, and managers. Results indicate statistically significant increases in family planning users and shifts in use of family planning services from health facilities to community sites. The intervention had no effect on immunization doses administered or dropout rates. According to mothers and fathers, benefits of service integration included time savings, convenience, and improved understanding of services. Provision and use of integrated services were affected by availability of human resources and commodities, community linkages, data collection procedures and availability, sociocultural barriers, organization of services, and supervision and commitment of health surveillance assistants. The integration approach was perceived to be feasible and beneficial by clients and providers.
more
Cardiovascular disease (CVD) is the leading cause of global deaths, with the majority occurring in low- and middle-income countries (LMIC). The primary and secondary prevention of CVD is suboptimal throughout the world, but the evidence-practice gaps are much more pronounced in LMIC. Barriers at the... patient, health-care provider, and health system level prevent the implementation of optimal primary and secondary prevention. Identification of the particular barriers that exist in resource-constrained settings is necessary to inform effective strategies to reduce the identified evidence-practice gaps. Furthermore, targeting modifiable factors that contribute most significantly to the global burden of CVD, including tobacco use, hypertension, and secondary prevention for CVD will lead to the biggest gains in mortality reduction. We review a select number of novel, resource-efficient strategies to reduce premature mortality from CVD, including: (1) effective measures for tobacco control; (2) implementation of simplified screening and management algorithms for those with or at risk of CVD, (3) increasing the availability and affordability of simplified and cost-effective treatment regimens including combination CVD preventive drug therapy, and (4) simplified delivery of health care through task-sharing (non-physician health workers) and optimizing self-management (treatment supporters). Developing and deploying systems of care that address barriers related to the above, will lead to substantial reductions in CVD and related mortality.
more