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‣ Rationalizing health care in a changing world: the need to know

Warren, Kenneth S
Fonte: Health Transition Centre, National Centre for Epidemiology and Population Health, The Australian National University Publicador: Health Transition Centre, National Centre for Epidemiology and Population Health, The Australian National University
Tipo: Artigo de Revista Científica Formato: 45552 bytes; application/pdf
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The World Development Report 1993 announced that global life expectancy was then 65. Experience in the developed world suggests that the World Health Organization’s dictum, ‘health is a state of complete physical, mental and social well-being’, is simply not attainable for the foreseeable future. As physical health has improved, mental problems have become more prominent and a sense of well-being has declined. Furthermore, as the population ages and medical technology improves, the cost of health care grows almost exponentially. Since the population of the developed world is continuing to age and aging is spreading rapidly throughout the developing world, knowledge is the principal way of dealing with this seemingly intractable problem: we must know, quantitatively, the age-specific causes of ill health, and we must know which means of prevention and treatment are effective. Finally, we must apply that knowledge rationally.; no

‣ (MS) The Deployment Health Surveillance Program: vision and challenges of health surveillance for Australian military cohorts

Barton, C.; Dobson, A.; Treloar, S.; McClintock, C.; McFarlane, A.
Fonte: Public Health Assoc Australia Inc Publicador: Public Health Assoc Australia Inc
Tipo: Artigo de Revista Científica
Publicado em //2008 Português
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The Australian Government has supported the establishment of a Deployment Health Surveillance Program for the Australian Defence Force. Although some health screening mechanisms already exist for Australian Defence Force personnel, until now health data have been used largely for clinical management at an individual level and have not been aggregated to identify trends in health and risk factors in the shorter or longer term. We identify challenges for and potential benefits of health surveillance in the military context, describe features of the Program and progress to date. Retrospective and cross-sectional projects based on deployments to the Near North Area of Influence since 1997 are under way. A planned prospective model of health surveillance for those deploying to the Middle East promises more timely attention to any emerging health problems for military personnel and veterans.; Christopher A. Barton, Annette Dobson, Susan A. Treloar, Christine McClintock and Alexander C. McFarlane; The definitive version may be found at www.wiley.com

‣ Requiring Influenza Vaccination for Health Care Workers

Anikeeva, O.; Braunack-Mayer, A.; Rogers, W.
Fonte: Amer Public Health Assoc Inc Publicador: Amer Public Health Assoc Inc
Tipo: Artigo de Revista Científica
Publicado em //2009 Português
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Annual influenza vaccination for health care workers has the potential to benefit health care professionals, their patients, and their families by reducing the transmission of influenza in the health care setting. Furthermore, staff vaccination programs are cost-effective for health care institutions because of reduced staff illness and absenteeism. Despite international recommendations and strong ethical arguments for annual influenza immunization for health care professionals, staff utilization of vaccination remains low. We have analyzed the ethical implications of a variety of efforts to increase vaccination rates, including mandatory influenza vaccination. A program of incentives and sanctions may increase health care worker compliance with fewer ethical impediments than mandatory vaccination.; Olga Anikeeva, Annette Braunack-Mayer and Wendy Rogers

‣ Does health service utilisation vary by remoteness? South Australian population data and the Accessibility and Remoteness Index of Australia

Eckert, K.; Taylor, A.; Wilkinson, D.
Fonte: Public Health Assoc Australia Inc Publicador: Public Health Assoc Australia Inc
Tipo: Artigo de Revista Científica
Publicado em //2004 Português
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Objective: To compare rates of self-reported use of health services between rural, remote and urban South Australians. Methods: Secondary data analysis from a population-based survey to assess health and well-being, conducted in South Australia in 2000. In all, 2, 454 adults were randomly selected and interviewed using the computer-assisted telephone interview (CATI) system. We analysed health service use by Accessibility and Remoteness Index of Australia (ARIA) category. Results:There was no statistically significant difference in the median number of uses of the four types of health services studied across ARIA categories. Significantly fewer residents of highly accessible areas reported never using primary care services (14.4% vs. 22.2% in very remote areas), and significantly more reported high use (≥6 visits, 29.3% vs. 21.5%). Fewer residents of remote areas reported never attending hospital (65.6% vs. 73.8% in highly accessible areas). Frequency of use of mental health services was not statistically significantly different across ARIA categories. Very remote residents were more likely to spend at least one night in a public hospital (15.8%) than were residents of other areas (e. g. 5.9% for highly accessible areas). Conclusion: The self-reported frequency of use of a range of health services in South Australia was broadly similar across ARIA categories. However...

‣ The South Australian Allied Health Workforce survey: helping to fill the evidence gap in primary health workforce planning

Whitford, D.; Smith, T.; Newbury, J.
Fonte: Australian Journal Primary Health, Australian Institute Primary Care & School Public Health Publicador: Australian Journal Primary Health, Australian Institute Primary Care & School Public Health
Tipo: Artigo de Revista Científica
Publicado em //2012 Português
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There is a lack of detailed evidence about the allied health workforce to inform proposed health care reforms. The South Australian Allied Health Workforce (SAAHW) survey collected data about the demographic characteristics, employment, education and recruitment and retention of allied health professionals in South Australia. The SAAHW questionnaire was widely distributed and 1539 responses were received. The average age of the sample was 40 years; males were significantly older than females, the latter making up 82% of respondents. Three-quarters of the sample worked in the city; 60% worked full time and the remainder in part-time, casual or locum positions. ‘Work–life balance’ was the most common attraction to respondents’ current jobs and ‘Better career prospects’ the most common reason for intending to leave. Practice in a rural location was influenced by rural background and rural experience during training. A greater proportion of Generation Y (1982–2000) respondents intended to leave within 2 years than Generation X (1961–81) or Baby Boomers (1943–60). Most respondents were satisfied with their job, although some reported lack of recognition of their knowledge and skills. Systematic, robust allied health workforce data are required for integrated and sustainable primary health care delivery.; Deirdre Whitford...

‣ Comprehensive school health, the social determinants of health, and the health status of children

Spurrell, Julie.
Fonte: Brock University Publicador: Brock University
Tipo: Electronic Thesis or Dissertation
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As children are becoming increasingly inactive and obese, there is an urgent need for effective early prevention and intervention programs. One solution is a comprehensive school health (CSH) program, a health promotion initiative aimed at educating students about healthy behaviours and lifestyles, which also provides a link between the school, students, families, and the surrounding community. The purpose of this study was to explore the relationship between different components of CSH programs, as well as three determinants of health (gender, social support, socio-economic status), and physical activity, on the aerobic fitness and body mass index (BMI) of children. A newly developed and pilot-tested survey derived from Health Canada's fourpart CSH model (instruction, social support, support services, and a healthy physical environment) was sent to elementary school principals. Data on the gender, physical activity, parental education, and social support levels of students from these schools were gathered from a previous study. Multiple regression procedures were conducted to estimate the relationships between CSH components, the social determinants of health, physical activity, and BMI and aerobic fitness. Results showed that three CSH components were significantly associated with both BMI and aerobic fitness values in children...

‣ Comprehensive school health : an ethnographic case study

Costas-Bradstreet, Christa.
Fonte: Brock University Publicador: Brock University
Tipo: Electronic Thesis or Dissertation
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The purpose of this ethnographic case study was to describe the characteristics of one school's Comprehensive School Health (CSH) initiative and to explore the experiences of school community members in order to gain an understanding of how one school embraced a Comprehensive School Health approach. An elementary school (grades Junior Kindergarten to six) in Burlington, Ontario was the research site for this study. Multiple methods of data collection (observations, document analysis, interviews) were used in keeping with the ethnographic and case study approach. The data were coded using both a deductive and then inductive process (Merriam, 1998). From a deductive perspective, the coding system and the subsequent identification of categories were based on a priori categories identified by using the elements of CSH based on the Comprehensive School Health Consensus Statement prepared by the Canadian Association of School Health and the research questions. Findings included the role that various school community members as well as the implementation of different programs and policies played in applying a CSH approach. The impact ofthe physical environment was described as well as successes and challenges related to the school's experience in implementing CSH. Three main themes emerged that characterized this school's experience. The first theme relates to the fundamental question about CSH which is the school community's understanding o/the concept. The second theme focused on positive school culture and the third and most diverse theme was that of capacity. Engaging in CSH is a complex and long-term undertaking involving both the school and greater community. Based on the experiences of this school's community members...

‣ Petroleum and Health Care: Evaluating and Managing Health Care's Vulnerability to Petroleum Supply Shifts

Hess, Jeremy; Bednarz, Daniel; Bae, Jaeyong; Pierce, Jessica
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
Publicado em /09/2011 Português
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Petroleum is used widely in health care—primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies—and few substitutes for it are available. This dependence theoretically makes health care vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in health care and explore historical associations between petroleum supply shocks and health care prices. These analyses confirm that petroleum products are intrinsic to modern health care and that petroleum supply shifts can affect health care prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting health care delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services.

‣ Exploring equity in uptake of the NHS Health Check and a nested physical activity intervention trial

Attwood, S.; Morton, K.; Sutton, S.
Fonte: Oxford Journals on behalf of the Faculty of Public Health of the Royal Colleges of Physicians of the United Kingdom Publicador: Oxford Journals on behalf of the Faculty of Public Health of the Royal Colleges of Physicians of the United Kingdom
Tipo: Article; published version
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This is the final published version. It first appeared at http://jpubhealth.oxfordjournals.org/content/early/2015/06/01/pubmed.fdv070.full.; Background Socio-demographic factors characterizing disadvantage may influence uptake of preventative health interventions such as the NHS Health Check and research trials informing their content. Methods A cross-sectional study examining socio-demographic characteristics of participants and non-participants to the NHS Health Check and a nested trial of very brief physical activity interventions within this context. Age, gender, Index of Multiple Deprivation (IMD) and ethnicity were extracted from patient records of four General Practices (GP) in England. Results In multivariate analyses controlling for GP surgery, the odds of participation in the Health Check were higher for older patients (OR 1.05, 95% CI 1.04?1.07) and lower from areas of greater deprivation (IMD Quintiles 4 versus 1, OR 0.37, 95% CI 0.18?0.76, 5 versus 1 OR 0.42, 95% CI 0.20?0.88). Older patients were more likely to participate in the physical activity trial (OR 1.04, 95% CI 1.02?1.06). Conclusions Younger patients and those living in areas of greater deprivation may be at risk of non-participation in the NHS Health Check...

‣ The Health Effects of jobs: Status, working conditions, or both?

D'Souza, Rennie; Strazdins, Lyndall; Clements, Mark; Broom, Dorothy; Parslow, Ruth; Rodgers, Bryan
Fonte: Public Health Association of Australia Publicador: Public Health Association of Australia
Tipo: Artigo de Revista Científica
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Background: This study investigates whether the association of job strain and insecurity with health differs by status. Methods: A cross-sectional study of 2,249 employed workers aged 40-44 years conducted in two regions in south-east Australia in 2000 used a self-completed questionnaire to collect data. Multivariate analyses were used to compare depression, anxiety, physical health and general practitioner (GP) visits over 12 months across categories of job strain and insecurity for three status groups (high, middle and low). Results: High job strain and job insecurity were independently associated with poor mental health, poor physical health and visits to the GP for all status groups when adjusted for confounders. High job strain was associated with depression (OR=2.46, 95% CI 1.96-3.07), anxiety (OR=2.56, 95% CI 2.05-3.20), lower mean physical health scores (-1.11, 95% CI -1.98 - -0.23), and more visits to the GP (IRR=1.20, 95% CI 1.05-1.37). High job insecurity also showed significant associations with depression (OR=3.03, 95% CI 2.03-4.53), anxiety (OR=2.66, 95% CI 1.81-3.91), and GP visits (IRR=1.27, 95% CI 1.01-1.60). There were no significant differences by status in the associations of job strain and insecurity with outcomes. Conclusion: High-status workers were just as likely as low-status workers to be exposed to adverse work conditions and both status groups showed similar health effects. Implications: Exposure to insecure and high-strain jobs is likely to rise as economies and labour markets respond to globalisation and political change. High status may not protect employees from either exposure or impact...

‣ The development of a model for dealing with secondary traumatic stress in mental health workers in Rwanda

lyamuremye,Jean Damascene; Brysiewicz,Petra
Fonte: Health SA Gesondheid (Online) Publicador: Health SA Gesondheid (Online)
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2015 Português
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INTRODUCTION: Mental health workers who listen to stories of fear, pain and distress of traumatised clients may develop deleterious emotional, cognitive and physical consequences (Cairns, 2007). This phenomenon has been called secondary traumatic stress (STS) (Perez, Jones, Englert, & Sachau, 2010). Rwanda is well-known for the 1994 genocide, with the death of hundreds of thousands of people in a planned campaign of violence. Numerous mental health workers operating in Rwanda were also victims of the violence and it has been suggested that there is a high level of STS in mental health workers in Rwanda (Iyamuremye & Brysiewicz, 2008). AIM: To develop a comprehensive model to manage the effects of STS in mental health workers operating in Rwanda METHOD: An action research project was initiated to develop this model and data for the model was collected through individual interviews with mental health workers (nurses, doctors, psychologists, trauma counsellors and social workers) as well as a quantitative tool measuring secondary traumatic stress (Trauma Attachment Belief Scale) in these health workers. RESULTS: The Intervention Model to Manage Secondary Traumatic Stress (IMMSTS) was synthesised from these findings and includes preventive...

‣ Health expectancy in the Russian Federation: a new perspective on the health divide in Europe

Andreev,Evgueni M.; McKee,Martin; Shkolnikov,Vladimir M.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/11/2003 Português
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OBJECTIVES: To compare life expectancy and healthy life expectancy in the Russian Federation and in countries of Eastern and Western Europe. METHODS: WHO mortality data and data on self-reported health from the World Values Survey and the Russian Longitudinal Monitoring Survey were used to compare the above three regions. Life expectancy was calculated using Sullivan's method, with years of life lived divided into healthy and unhealthy. The gap in healthy life expectancy between the Russian Federation and Western Europe was examined by decomposing the difference by gender and age. FINDINGS: The probability of remaining alive and healthy declines faster in the Russian Federation than in Western Europe, with the gap between Eastern Europe and the Russian Federation widening at older ages. In the Russian Federation, this rapid decline is due mainly to the high probability of death or of poor health for men and women, respectively. CONCLUSIONS: There is a large toll of premature male mortality in the Russian Federation but there also appears to be a substantial burden of ill-health among women. As in other countries, the responses of men and women to adversity differ, leading to premature death in men but survival in a poor state of health in women. Epidemiological studies including objective measures of health would help policy-makers to estimate more precisely the scale and nature of this problem. Policy-makers must recognize that health expectancy in the Russian Federation is reduced in both men and women.

‣ Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition

Makinen,M; Waters,H; Rauch,M; Almagambetova,N; Bitran,R; Gilson,L; McIntyre,D; Pannarunothai,S; Prieto,A.L; Ubilla,G; Ram,S
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2000 Português
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This paper summarizes eight country studies of inequality in the health sector. The analyses use household data to examine the distribution of service use and health expenditures. Each study divides the population into "income" quintiles, estimated using consumption expenditures. The studies measure inequality in the use of and spending on health services. Richer groups are found to have a higher probability of obtaining care when sick, to be more likely to be seen by a doctor, and to have a higher probability of receiving medicines when they are ill, than the poorer groups. The richer also spend more in absolute terms on care. In several instances there are unexpected findings. There is no consistent pattern in the use of private providers. Richer households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicate that intuition concerning inequalities could result in misguided decisions. It would thus be worthwhile to measure inequality to inform policy-making. Additional research could be performed using a common methodology for the collection of data and applying more sophisticated analytical techniques. These analyses could be used to measure the impact of health policy changes on inequality

‣ Health system reform and the role of field sites based upon demographic and health surveillance

Tollman,S.M; Zwi,A.B
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2000 Português
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Field sites for demographic and health surveillance have made well-recognized contributions to the evaluation of new or untested interventions, largely through efficacy trials involving new technologies or the delivery of selected services, e.g. vaccines, oral rehydration therapy and alternative contraceptive methods. Their role in health system reform, whether national or international, has, however, proved considerably more limited. The present article explores the characteristics and defining features of such field sites in low-income and middle-income countries and argues that many currently active sites have a largely untapped potential for contributing substantially to national and subnational health development. Since the populations covered by these sites often correspond with the boundaries of districts or subdistricts, the strategic use of information generated by demographic surveillance can inform the decentralization efforts of national and provincial health authorities. Among the areas of particular importance are the following: making population-based information available and providing an information resource; evaluating programmes and interventions; and developing applications to policy and practice. The question is posed as to whether their potential contribution to health system reform justifies arguing for adaptations to these field sites and expanded investment in them.

‣ Poverty and health sector inequalities

Wagstaff,Adam
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2002 Português
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Poverty and ill-health are intertwined. Poor countries tend to have worse health outcomes than better-off countries. Within countries, poor people have worse health outcomes than better-off people. This association reflects causality running in both directions: poverty breeds ill-health, and ill-health keeps poor people poor. The evidence on inequalities in health between the poor and non-poor and on the consequences for impoverishment and income inequality associated with health care expenses is discussed in this article. An outline is given of what is known about the causes of inequalities and about the effectiveness of policies intended to combat them. It is argued that too little is known about the impacts of such policies, notwithstanding a wealth of measurement techniques and considerable evidence on the extent and causes of inequalities.

‣ Ethics in international health research: a perspective from the developing world

Bhutta,Zulfiqar Ahmed
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2002 Português
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Health research plays a pivotal role in addressing inequities in health and human development, but to achieve these objectives the research must be based on sound scientific and ethical principles. Although it is accepted that ethics play a central role in health research in developing countries, much of the recent debate has focused on controversies surrounding internationally sponsored research and has taken place largely without adequate participation of the developing countries. The relationship between ethical guidelines and regulations, and indigenously sponsored and public health research has not been adequately explored. For example, while the fundamental principles of ethical health research, such as community participation, informed consent, and shared benefits and burdens, remain sacrosanct other issues, such as standards of care and prior agreements, merit greater public debate within developing countries. In particular, the relationship of existing ethical guidelines to epidemiological and public health research merits further exploration. In order to support health research in developing countries that is both relevant and meaningful, the focus must be on developing health research that promotes equity and on developing local capacity in bioethics. Only through such proactive measures can we address the emerging ethical dilemmas and challenges that globalization and the genomics revolution will bring in their wake.

‣ Management of severely ill children at first-level health facilities in sub-Saharan Africa when referral is difficult

Simoes,Eric A.F.; Peterson,Stefan; Gamatie,Youssouf; Kisanga,Felix S.; Mukasa,Gelasius; Nsungwa-Sabiiti,Jesca; Were,M. Wilson; Weber,Martin W.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2003 Português
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OBJECTIVES: To quantify the main reasons for referral of infants and children from first-level health facilities to referral hospitals in sub-Saharan Africa and to determine what further supplies, equipment, and legal empowerment might be needed to manage such children when referral is difficult. METHODS: In an observational study at first-level health facilities in Uganda, the United Republic of Tanzania, and Niger, over 3-5 months, we prospectively documented the diagnoses and severity of diseases in children using the standardized Integrated Management of Childhood Illness (IMCI) guidelines. We reviewed the facilities for supplies and equipment and examined the legal constraints of health personnel working at these facilities. FINDINGS: We studied 7195 children aged 2-59 months, of whom 691 (9.6%) were classified under a severe IMCI classification that required urgent referral to a hospital. Overall, 226 children had general danger signs, 292 had severe pneumonia or very severe disease, 104 were severely dehydrated, 31 had severe persistent diarrhoea, 207 were severely malnourished, and 98 had severe anaemia. Considerably more ill were 415 young infants aged one week to two months: nearly three-quarters of these required referral. Legal constraints and a lack of simple equipment (suction pumps...

‣ A critical examination of summary measures of population health

Murray,Christopher J.L.; Salomon,Joshua A.; Mathers,Colin
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2000 Português
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In the past decade, interest has been rising in the development, calculation and use of summary measures of population health, which combine information on mortality and non-fatal health outcomes. This paper reviews the issues and challenges in the design and application of summary measures and presents a framework for evaluating different alternatives. Summary measures have a variety of uses, including comparisons of health in different populations and assessments of the relative contributions of different diseases, injuries and risk factors to the total disease burden in a population. Summary measures may be divided into two broad families: health expectancies and health gaps. Within each family, there are many different possible measures, but they share a number of inputs, including information on mortality, non-fatal health outcomes, and health state valuations. Other critical points include calculation methods and a range of conceptual and methodological issues regarding the definition, measurement and valuation of health states. This paper considers a set of basic criteria and desirable properties that may lead to rejection of certain summary measures and the development of new ones. Despite the extensive developmental agenda that remains...

‣ Analysis of how the health systems context shapes responses to the control of human immunodeficiency virus: case-studies from the Russian Federation

Atun,Rifat A.; McKee,Martin; Drobniewski,Francis; Coker,Richard
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2005 Português
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OBJECTIVE: To develop a methodology and an instrument that allow the simultaneous rapid and systematic examination of the broad public health context, the health care systems, and the features of disease-specific programmes. METHODS: Drawing on methodologies used for rapid situational assessments of vertical programmes for tackling communicable disease, we analysed programmes for the control human of immunodeficiency virus (HIV) and their health systems context in three regions in the Russian Federation. The analysis was conducted in three phases: first, analysis of published literature, documents and routine data from the regions; second, interviews with key informants, and third, further data collection and analysis. Synthesis of findings through exploration of emergent themes, with iteration, resulted in the identification of the key systems issues that influenced programme delivery. FINDINGS: We observed a complex political economy within which efforts to control HIV sit, an intricate legal environment, and a high degree of decentralization of financing and operational responsibility. Although each region displays some commonalities arising from the Soviet traditions of public health control, there are considerable variations in the epidemiological trajectories...

‣ Bridging the implementation gap between knowledge and action for health

Haines,Andy; Kuruvilla,Shyama; Borchert,Matthias
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2004 Português
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There is widespread evidence of failure to implement health interventions that have been demonstrated to be cost-effective by high-quality research; this failure affects both high-income and low-income countries. Low-income countries face additional challenges to using research evidence including: the weakness of their health systems, the lack of professional regulation and a lack of access to evidence. There is a need to strengthen institutions and mechanisms that can more systematically promote interactions between researchers, policy-makers and other stakeholders who can influence the uptake of research findings. The concept of public engagement with health research requires a public that is both informed and active. Even when systematic reviews are available further work is needed to translate their findings into guidelines or messages that are understandable to patients and health professionals. Many of the commonly used approaches for keeping health professionals' knowledge up-to-date appear to have small or inconsistent effects. The evidence-base is more extensive for interventions directed towards professionals, such as education, reminders or feedback, than for those directed at organizations or patients. The effect of interventions varies according to the setting and the behaviour that is targeted. Case studies in low-income settings suggest that some strategies can result in increased coverage of evidence-based interventions...