Assessing health system responsiveness in primary health care facilities in Tanzania.

BACKGROUND: Health system performance is one of the important components of the health care delivery; its achievement depends on the quality of services rendered and the health system responsiveness of its beneficiaries. Health system responsiveness is a multi-dimensional concept and is usually measured through several domains. Health system responsiveness (HSR) remains to be a key indicator for evaluation of health system performance in any settings. This study aimed at assessing the situation of health system responsiveness in primary health facilities in Tanzania prior to introduction of the Direct Health Facility Financing (DHFF) program. METHODS: This was a cross sectional study conducted between January and February in 2018. We collected data from 42 primary health facilities (14 health centers and 28 dispensaries) where a questionnaire was administered to a total of 422 participants. The questionnaire collected information on attention, respect to dignity, clear communication, autonomy, access to care, respect to confidentiality and basic amenities. Descriptive analysis was done to determine the distribution of the variables whereas ANOVA and linear regression analysis was employed to discern the association between variables. RESULTS: More than 67% of participants had visited the same health facility more than 5 times. Sixty seven percent of the patients were residing within 5kms from the public primary health care facilities. The geographical access to health care scored the lowest (43.5% for Dispensaries and 36% for Health center) mean as compared to other domains of health system responsiveness. The highest score was in respect to confidentiality (86.7%) followed by respect to dignity (81.4%). Linear regression analysis revealed no statistical association between any of the social demographic features with the overall HSR performances. However, in post hoc analysis, Pwani and Shinyanga regions didn't differ significantly in terms of their performances whereas those two regions differ from all other regions. CONCLUSION: Based on the study findings health system responsiveness domains has performed relatively poor in many regions except for respect of dignity and confidentiality scored high of all the domains. Shinyanga and Pwani regions scored relatively well in all domains this could have been due to the effect of Results Based financing (RBF) in the respective regions. All in all the Government and other stakeholders in the health sector they should deliberately invest on the access to care domain as seem to be a challenge as compared to others

Desafios das novas fronteiras agrícolas de produção de milho e sorgo no Brasil: desafios da região do MATOPIBA.

Compreendendo a região do Bioma Cerrado dos Estados do Maranhão, Piauí, Tocantins e Bahia, tornou-se nos últimos anos a denominada grande fronteira agrícola do Brasil. A topografia plana, os solos profundos e o clima favorável ao cultivo das principais culturas de grãos e fibras possibilitaram o crescimento vertiginoso da região, que até o final da década de 1980 se baseava fortemente na pecuária extensiva

Produção de soja no Estado do Tocantins: percepções inicias sobre o sistema produtivo.

O trabalho foi desenvolvido nos anos de 2011 e 2012, através da sistematização de informações dos principais municípios produtores de soja, segundo dados da CONAB e da Secretaria da Agricultura do Estado do Tocantins (SEAGRO).Editado por Adilson de Oliveira Junior, Regina Maria Villas Bôas de Campos Leite, Cesar de Castro

Simbol-X Hard X-ray Focusing Mirrors: Results Obtained During the Phase A Study

Simbol-X will push grazing incidence imaging up to 80 keV, providing a strong improvement both in sensitivity and angular resolution compared to all instruments that have operated so far above 10 keV. The superb hard X-ray imaging capability will be guaranteed by a mirror module of 100 electroformed Nickel shells with a multilayer reflecting coating. Here we will describe the technogical development and solutions adopted for the fabrication of the mirror module, that must guarantee an Half Energy Width (HEW) better than 20 arcsec from 0.5 up to 30 keV and a goal of 40 arcsec at 60 keV. During the phase A, terminated at the end of 2008, we have developed three engineering models with two, two and three shells, respectively. The most critical aspects in the development of the Simbol-X mirrors are i) the production of the 100 mandrels with very good surface quality within the timeline of the mission; ii) the replication of shells that must be very thin (a factor of 2 thinner than those of XMM-Newton) and still have very good image quality up to 80 keV; iii) the development of an integration process that allows us to integrate these very thin mirrors maintaining their intrinsic good image quality. The Phase A study has shown that we can fabricate the mandrels with the needed quality and that we have developed a valid integration process. The shells that we have produced so far have a quite good image quality, e.g. HEW <~30 arcsec at 30 keV, and effective area. However, we still need to make some improvements to reach the requirements. We will briefly present these results and discuss the possible improvements that we will investigate during phase B.Comment: 6 pages, 3 figures, invited talk at the conference "2nd International Simbol-X Symposium", Paris, 2-5 december, 200

Three-Dimensional Handheld Scanning to Quantify Head-Shape Changes in Spring-Assisted Surgery for Sagittal Craniosynostosis

Three-dimensional (3D) imaging is an important tool for diagnostics, surgical planning, and evaluation of surgical outcomes in craniofacial procedures. Gold standard for acquiring 3D imaging is computed tomography that entails ionizing radiations and, in young children, a general anaesthesia. Three-dimensional photographic imaging is an alternative method to assess patients who have undergone calvarial reconstructive surgery. The aim of this study was to assess the utility of 3D handheld scanning photography in a cohort of patients who underwent spring-assisted correction surgery for scaphocephaly. Pre- and postoperative 3D scans acquired in theater and at the 3-week follow-up in clinic were postprocessed for 9 patients. Cephalic index (CI), head circumference, volume, sagittal length, and coronal width over the head at pre-op, post-op, and follow-up were measured from the 3D scans. Cephalic index from 3D scans was compared with measurements from planar x-rays. Statistical shape modeling (SSM) was used to calculate the 3D mean anatomical head shape of the 9 patients at the pre-op, post-op, and follow-up. No significant differences were observed in the CI between 3D and x-ray. Cephalic index, volume, and coronal width increased significantly over time. Mean shapes from SSM visualized the overall and regional 3D changes due to the expansion of the springs in situ. Three-dimensional handheld scanning followed by SSM proved to be an efficacious and practical method to evaluate 3D shape outcomes after spring-assisted cranioplasty in individual patients and the population

Spirometry reference equations for central European populations from school age to old age.

Spirometry reference values are important for the interpretation of spirometry results. Reference values should be updated regularly, derived from a population as similar to the population for which they are to be used and span across all ages. Such spirometry reference equations are currently lacking for central European populations. To develop spirometry reference equations for central European populations between 8 and 90 years of age. We used data collected between January 1993 and December 2010 from a central European population. The data was modelled using "Generalized Additive Models for Location, Scale and Shape" (GAMLSS). The spirometry reference equations were derived from 118'891 individuals consisting of 60'624 (51%) females and 58'267 (49%) males. Altogether, there were 18'211 (15.3%) children under the age of 18 years. We developed spirometry reference equations for a central European population between 8 and 90 years of age that can be implemented in a wide range of clinical settings

Cultivo do milho segunda safra e sorgo no Estado do Tocantins: situação atual e demandas de pesquisa.

O cultivo de milho no Estado do Tocantins vem crescendo significativamente. Somente na última safra, o aumento da área cultivada foi superior a 100% quando comparado ao ano anterior. Já o cultivo do sorgo é pouco significativo. Grande parte deste impulso foi decorrente da utilização pelos produtores de cultivares de soja de ciclo precoce, diminuindo os riscos para o milho cultivado na sequência. Mesmo com o aumento da área cultivada, a produtividade de milho ainda é relativamente baixa quando comparada a outras regiões já tradicionais no cultivo do milho segunda safra. Para entender o sistema de cultivo de milho e sorgo adotado e levantar as demandas de pesquisas e transferência de tecnologia no Tocantins, uma equipe de pesquisadores da Embrapa percorreu propriedades em diferentes localidades do Estado, a fim de levantar informações e conhecer as técnicas adotadas pelos produtores. Por meio de questionários foram levantadas informações quanto ao histórico de cultivo de milho e sorgo, os tratos culturais adotados e as demandas a serem atendidas pela Embrapa para impulsionar o cultivo destas culturas. Embora estejam muito bem consolidadas no Bioma Cerrado, quando implementadas no Tocantins, as altas temperaturas, baixa altitude e chuvas irregulares no verão são fatores preponderantes para que os produtores ainda tenham incertezas quanto ao cultivo, pois a janela entre a colheita da soja e a semeadura do milho ou sorgo é menor quando comparada às outras regiões. Além disso, pesquisas básicas envolvendo o cultivo do milho em rotação ainda são escassas e precisam ser intensificadas nesta região