562,101 research outputs found

    Health system barriers influencing timely breast cancer diagnosis and treatment among women in low and middle-income Asian countries: evidence from a mixed-methods systematic review.

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    Globally, breast cancer is the most common cancer type and the leading cause of cancer mortality among women in developing countries. A high prevalence of late breast cancer diagnosis and treatment has been reported predominantly in Low- and Middle-Income Countries (LMICs), including those in Asia. Thus, this study utilized a mixed-methods systematic review to synthesize the health system barriers influencing timely breast cancer diagnosis and treatment among women in Asian countries. We systematically searched five electronic databases for studies published in English from 2012 to 2022 on health system barriers that influence timely breast cancer diagnosis and treatment among women in Asian countries. The review was conducted per the methodology for systematic reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while health system barriers were extracted and classified based on the World Health Organization (WHO)'s Health Systems Framework. The mixed-methods appraisal tool was used to assess the methodological quality of the included studies. Twenty-six studies were included in this review. Fifteen studies were quantitative, nine studies were qualitative, and two studies used a mixed-methods approach. These studies were conducted across ten countries in Asia. This review identified health systems barriers that influence timely breast cancer diagnosis and treatment. The factors were categorized under the following: (1) delivery of health services (2) health workforce (3) financing for health (4) health information system and (5) essential medicines and technology. Delivery of health care (low quality of health care) was the most occurring barrier followed by the health workforce (unavailability of physicians), whilst health information systems were identified as the least barrier. This study concluded that health system factors such as geographical accessibility to treatment, misdiagnosis, and long waiting times at health facilities were major barriers to early breast cancer diagnosis and treatment among Asian women in LMICs. Eliminating these barriers will require deliberate health system strengthening, such as improving training for the health workforce and establishing more healthcare facilities. [Abstract copyright: © 2022. The Author(s).

    Elements of integrated care approaches for older people: a review of reviews

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    Objective: The World Health Organization (WHO) recently proposed an Integrated Care for Older People approach to guide health systems and services in better supporting functional ability of older people. A knowledge gap remains in the key elements of integrated care approaches used in health and social care delivery systems for older populations. The objective of this review was to identify and describe the key elements of integrated care models for elderly people reported in the literature. Design: Review of reviews using a systematic search method. Methods: A systematic search was performed in MEDLINE and the Cochrane database in June 2017. Reviews of interventions aimed at care integration at the clinical (micro), organisational/service (meso) or health system (macro) levels for people aged =60 years were included. Non-Cochrane reviews published before 2015 were excluded. Reviews were assessed for quality using the Assessment of Multiple Systematic Reviews (AMSTAR) 1 tool. Results: Fifteen reviews (11 systematic reviews, of which six were Cochrane reviews) were included, representing 219 primary studies. Three reviews (20%) included only randomised controlled trials (RCT), while 10 reviews (65%) included both RCTs and non-RCTs. The region where the largest number of primary studies originated was North America (n=89, 47.6%), followed by Europe (n=60, 32.1%) and Oceania (n=31, 16.6%). Eleven (73%) reviews focused on clinical 'micro' and organisational 'meso' care integration strategies. The most commonly reported elements of integrated care models were multidisciplinary teams, comprehensive assessment and case management. Nurses, physiotherapists, general practitioners and social workers were the most commonly reported service providers. Methodological quality was variable (AMSTAR scores: 1-11). Seven (47%) reviews were scored as high quality (AMSTAR score =8). Conclusion: Evidence of elements of integrated care for older people focuses particularly on micro clinical care integration processes, while there is a relative lack of information regarding the meso organisational and macro system-level care integration strategies

    The governance of basic health coverage: A systematic review

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    Background: Governance is a concept with multiple meanings. In health coverage systems around the world, there is always an interest in studying governance and measuring its impact on the performance of existing systems and proposing evaluation tools. Objectives: This study aimed to assess the application of governance in health medical coverage systems across the globe by conducting a systematic literature review. Specifically, it looked at whether we can define a standard model of health coverage governance and assess the governance of a country’s medical coverage. Methods: A systematic review of the literature was conducted using Google Scholar in July 2019. We searched studies, published from 2002 to July 2019, on the governance of basic health coverage that were published in English and French. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was followed to conduct systematic reviews. Results: We identified 27 studies that met our inclusion criteria. The governance of basic health coverage is analyzed in all publications that focused on health systems in a particular country or more that one country or looked at the phenomenon globally. A few of the included studies carried out specifications of governance in a health medical coverage context. The World Bank proposes an evaluation framework of the governance of health medical coverage using five main dimensions: coherent decision-making structures, stakeholder participation, transparency and information, supervision and regulation, and consistency and stability. Conclusions: Our systematic review of the governance of basic health coverage showed that few studies have focused on this topic. The difficulty lies in the interaction that exists between basic health coverage and other systems: health and social protection systems. Our study also concluded that one study, that of the World Bank, evaluated the governance of basic health coverage. This reflection will be useful for all decision-makers who want to assess the governance of their health care system, provided that it is adapted to the country context. [Ethiop. J. Health Dev. 2020; 34(3): 217-225] Key words: Governance, social security, health insurance, basic health coverag

    Developing and refining the methods for a ‘one-stop shop’ for research evidence about health systems

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    Background: Policymakers, stakeholders and researchers have not been able to find research evidence about health systems using an easily understood taxonomy of topics, know when they have conducted a comprehensive search of the many types of research evidence relevant to them, or rapidly identify decision-relevant information in their search results. Methods: To address these gaps, we developed an approach to building a ‘one-stop shop’ for research evidence about health systems. We developed a taxonomy of health system topics and iteratively refined it by drawing on existing categorization schemes and by using it to categorize progressively larger bundles of research evidence. We identified systematic reviews, systematic review protocols, and review-derived products through searches of Medline, hand searches of several databases indexing systematic reviews, hand searches of journals, and continuous scanning of listservs and websites. We developed an approach to providing ‘added value’ to existing content (e.g., coding systematic reviews according to the countries in which included studies were conducted) and to expanding the types of evidence eligible for inclusion (e.g., economic evaluations and health system descriptions). Lastly, we developed an approach to continuously updating the online one-stop shop in seven supported languages. Results: The taxonomy is organized by governance, financial, and delivery arrangements and by implementation strategies. The ‘one-stop shop’, called Health Systems Evidence, contains a comprehensive inventory of evidence briefs, overviews of systematic reviews, systematic reviews, systematic review protocols, registered systematic review titles, economic evaluations and costing studies, health reform descriptions and health system descriptions, and many types of added-value coding. It is continuously updated and new content is regularly translated into Arabic, Chinese, English, French, Portuguese, Russian, and Spanish. Conclusions: Policymakers and stakeholders can now easily access and use a wide variety of types of research evidence about health systems to inform decision-making and advocacy. Researchers and research funding agencies can use Health Systems Evidence to identify gaps in the current stock of research evidence and domains that could benefit from primary research, systematic reviews, and review overviews. Electronic supplementary material The online version of this article (doi:10.1186/1478-4505-13-10) contains supplementary material, which is available to authorized users

    Health system barriers influencing timely breast cancer diagnosis and treatment among women in low and middle-income Asian countries: evidence from a mixed-methods systematic review

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    Background Globally, breast cancer is the most common cancer type and the leading cause of cancer mortality among women in developing countries. A high prevalence of late breast cancer diagnosis and treatment has been reported predominantly in Low- and Middle-Income Countries (LMICs), including those in Asia. Thus, this study utilized a mixed-methods systematic review to synthesize the health system barriers influencing timely breast cancer diagnosis and treatment among women in Asian countries. Methods We systematically searched five electronic databases for studies published in English from 2012 to 2022 on health system barriers that influence timely breast cancer diagnosis and treatment among women in Asian countries. The review was conducted per the methodology for systematic reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while health system barriers were extracted and classified based on the World Health Organization (WHO)‘s Health Systems Framework. The mixed-methods appraisal tool was used to assess the methodological quality of the included studies. Results Twenty-six studies were included in this review. Fifteen studies were quantitative, nine studies were qualitative, and two studies used a mixed-methods approach. These studies were conducted across ten countries in Asia. This review identified health systems barriers that influence timely breast cancer diagnosis and treatment. The factors were categorized under the following: (1) delivery of health services (2) health workforce (3) financing for health (4) health information system and (5) essential medicines and technology. Delivery of health care (low quality of health care) was the most occurring barrier followed by the health workforce (unavailability of physicians), whilst health information systems were identified as the least barrier. Conclusion This study concluded that health system factors such as geographical accessibility to treatment, misdiagnosis, and long waiting times at health facilities were major barriers to early breast cancer diagnosis and treatment among Asian women in LMICs. Eliminating these barriers will require deliberate health system strengthening, such as improving training for the health workforce and establishing more healthcare facilities

    Maternal mortality in the covid-19 pandemic: findings from a rapid systematic review

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    BACKGROUND: The COVID-19 pandemic is having significant direct and associated effects on many health outcomes, including maternal mortality. As a useful marker of healthcare system functionality, trends in maternal mortality provide a lens to gauge impact and inform mitigation strategies. OBJECTIVE: To report the findings of a rapid systematic review of studies on levels of maternal mortality before and during the COVID-19 pandemic. METHODS: We systematically searched for studies on the 1st March 2021 in MEDLINE and Embase, with additional studies identified through MedRxiv and searches of key websites. We included studies that reported levels of mortality in pregnant and postpartum women in time-periods pre- and during the COVID-19 pandemic. The maternal mortality ratio was calculated for each study as well as the excess mortality. RESULTS: The search yielded 3411 references, of which five studies were included in the review alongside two studies identified from grey literature searches. Five studies used data from national health information systems or death registries (Mexico, Peru, Uganda, South Africa, and Kenya), and two studies from India were record reviews from health facilities. There were increased levels of maternal mortality documented in all studies; however, there was only statistical evidence for a difference in maternal mortality in the COVID-19 era for four of these. Excess maternal mortality ranged from 8.5% in Kenya to 61.5% in Uganda. CONCLUSIONS: Measuring maternal mortality in pandemics presents many challenges, but also essential opportunities to understand and ameliorate adverse impact both for women and their newborns. Our systematic review shows a dearth of studies giving reliable information on levels of maternal mortality, and we call for increased and more systematic reporting of this largely preventable outcome. The findings help to highlight four measurement-related issues which are priorities for continuing research and development

    Maternal mortality in the covid-19 pandemic: findings from a rapid systematic review

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    BACKGROUND: The COVID-19 pandemic is having significant direct and associated effects on many health outcomes, including maternal mortality. As a useful marker of healthcare system functionality, trends in maternal mortality provide a lens to gauge impact and inform mitigation strategies. OBJECTIVE: To report the findings of a rapid systematic review of studies on levels of maternal mortality before and during the COVID-19 pandemic. METHODS: We systematically searched for studies on the 1st March 2021 in MEDLINE and Embase, with additional studies identified through MedRxiv and searches of key websites. We included studies that reported levels of mortality in pregnant and postpartum women in time-periods pre- and during the COVID-19 pandemic. The maternal mortality ratio was calculated for each study as well as the excess mortality. RESULTS: The search yielded 3411 references, of which five studies were included in the review alongside two studies identified from grey literature searches. Five studies used data from national health information systems or death registries (Mexico, Peru, Uganda, South Africa, and Kenya), and two studies from India were record reviews from health facilities. There were increased levels of maternal mortality documented in all studies; however, there was only statistical evidence for a difference in maternal mortality in the COVID-19 era for four of these. Excess maternal mortality ranged from 8.5% in Kenya to 61.5% in Uganda. CONCLUSIONS: Measuring maternal mortality in pandemics presents many challenges, but also essential opportunities to understand and ameliorate adverse impact both for women and their newborns. Our systematic review shows a dearth of studies giving reliable information on levels of maternal mortality, and we call for increased and more systematic reporting of this largely preventable outcome. The findings help to highlight four measurement-related issues which are priorities for continuing research and development

    The COVID-19 pandemic and healthcare systems in Africa:A scoping review of preparedness, impact and response

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    BACKGROUND: The COVID-19 pandemic has overwhelmed health systems in both developed and developing nations alike. Africa has one of the weakest health systems globally, but there is limited evidence on how the region is prepared for, impacted by and responded to the pandemic. METHODS: We conducted a scoping review of PubMed, Scopus, CINAHL to search peer-reviewed articles and Google, Google Scholar and preprint sites for grey literature. The scoping review captured studies on either preparedness or impacts or responses associated with COVID-19 or covering one or more of the three topics and guided by Arksey and O’Malley’s methodological framework. The extracted information was documented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension checklist for scoping reviews. Finally, the resulting data were thematically analysed. RESULTS: Twenty-two eligible studies, of which 6 reported on health system preparedness, 19 described the impacts of COVID-19 on access to general and essential health services and 7 focused on responses taken by the healthcare systems were included. The main setbacks in health system preparation included lack of available health services needed for the pandemic, inadequate resources and equipment, and limited testing ability and surge capacity for COVID-19. Reduced flow of patients and missing scheduled appointments were among the most common impacts of the COVID-19 pandemic. Health system responses identified in this review included the availability of telephone consultations, re-purposing of available services and establishment of isolation centres, and provisions of COVID-19 guidelines in some settings. CONCLUSIONS: The health systems in Africa were inadequately prepared for the pandemic, and its impact was substantial. Responses were slow and did not match the magnitude of the problem. Interventions that will improve and strengthen health system resilience and financing through local, national and global engagement should be prioritised

    The COVID-19 pandemic and healthcare systems in Africa: a scoping review of preparedness, impact and response.

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    BACKGROUND: The COVID-19 pandemic has overwhelmed health systems in both developed and developing nations alike. Africa has one of the weakest health systems globally, but there is limited evidence on how the region is prepared for, impacted by and responded to the pandemic. METHODS: We conducted a scoping review of PubMed, Scopus, CINAHL to search peer-reviewed articles and Google, Google Scholar and preprint sites for grey literature. The scoping review captured studies on either preparedness or impacts or responses associated with COVID-19 or covering one or more of the three topics and guided by Arksey and O'Malley's methodological framework. The extracted information was documented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension checklist for scoping reviews. Finally, the resulting data were thematically analysed. RESULTS: Twenty-two eligible studies, of which 6 reported on health system preparedness, 19 described the impacts of COVID-19 on access to general and essential health services and 7 focused on responses taken by the healthcare systems were included. The main setbacks in health system preparation included lack of available health services needed for the pandemic, inadequate resources and equipment, and limited testing ability and surge capacity for COVID-19. Reduced flow of patients and missing scheduled appointments were among the most common impacts of the COVID-19 pandemic. Health system responses identified in this review included the availability of telephone consultations, re-purposing of available services and establishment of isolation centres, and provisions of COVID-19 guidelines in some settings. CONCLUSIONS: The health systems in Africa were inadequately prepared for the pandemic, and its impact was substantial. Responses were slow and did not match the magnitude of the problem. Interventions that will improve and strengthen health system resilience and financing through local, national and global engagement should be prioritised

    Experiences of stigma amongst HIV-positive people encountering the healthcare system in Scandinavia: a systematic review.

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    Abstract Objective: This systematic review aims to investigate the experiences of HIV-related stigma among people living with HIV in Scandinavia Introduction: Stigma has existed for centuries, with some groups of people being more prone to stigma than others, one example being people living with HIV. HIV-related stigma has existed from the beginning of the epidemic, 1980's, and may still be experienced after almost 40 years. HIV-related stigma may cause both physical and psychological illnesses and is seen as a barrier to treatment and medication adherence, as well as being an obstacle in the fight against HIV. The treatment and attitudes have changed since the 1980s, thus it is expected that people living with HIV should be treated as any other patients. This review attempts to explore the experiences of people living with HIV in relation to stigma and the health care system in modern times. Inclusion criteria: This systematic review included studies dated between 2011 and 2021 that are conducted in the Scandinavian countries. Participants were living with HIV, and with focus on their experiences of stigma in relation to their diagnosis. If not solely focusing on the healthcare system, the included studies had to include experiences from the healthcare system. The studies had to be written in English or any of the Scandinavian languages (Swedish, Danish, and Norwegian. Methods: The databases used to obtain relevant studies were Cinahl, Medline, PsychInfo, and Norart. Pubmed, google scholar and grey literature were used for supporting and background information. Articles included is written in English or any of the Scandinavian languages (Swedish, Danish, and Norwegian). Four studies were included in the review, three from Sweden, and one from Norway – all written in English. Last search was conducted in 10th of January 2022. When writing this review and conducting the search and critical appraisal JBI approach for systematic review were used, as well as the CASP-checklist and Finding What Works in Health Care: Standards for Systematic Reviews description on synthesizing body of evidence. This review explored only qualitative studies with in-depth interviews. One study was excluded due to methodological approach being quantitative, the other studies excluded were due to lack of information concerning stigma in the healthcare system. Results: The studies reviewed did not primarily focus on experiences of stigma within the health care system/setting, however, they all reported to some extent situations and experiences of HIV-related stigma in their study. All the participants were living with HIV in Sweden or in Norway and were both male and female. The review extracted 21 findings regarding experiences of HIV-related stigma in healthcare system. These was subcategorized into two sub-categories: Experiences with health care providers and treatment. Conclusions: Across the reviewed studies, participants reported being fairly satisfied to satisfied with their experience in the healthcare system, however HIV-related stigma in the healthcare system in Scandinavia is still experienced. Experiences of HIV-related stigma has become evident in this review, and current literature support the evidence found. Further research on HIV-related stigma in the health care in Norway, as well as further research on healthcare providers knowledge on HIV so as to determine where the knowledge gap lies
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