Assessing the relationship between coverage of essential health services and poverty levels in low- and middle-income countries

Universal health coverage (UHC) aims to provide essential health services and financial protection to all. This study aimed to assess the relationship between the service coverage aspect of universal health coverage and poverty in low- and middle-income countries (LMICs). Using country-level data from 96 LMICs from 1990 to 2017, we employed fixed-effects and random-effects regressions to investigate the association of eight service coverage indicators (inpatient admissions; antenatal care; skilled birth attendance; full immunization; cervical and breast cancer screening rates; diarrhoea and acute respiratory infection treatment rates) with poverty headcount ratios and gaps at the $1.90,$3.20 and $5.50 poverty lines. Missing data were imputed using within-country linear interpolation or extrapolation. One-unit increases in seven service indicators (breast cancer screening being the only one with no significant associations) were associated with reduced poverty headcounts by 2.54, 2.46 and 1.81 percentage points at the$1.90, $3.20 and$5.50 lines, respectively. The corresponding reductions in poverty gaps were 0.99 ($1.90), 1.83 ($3.20) and 1.89 ($5.50) percentage points. Apart from cervical cancer screening, which was only significant in one poverty headcount model ($5.50 line), all other service indicators were significant in either the poverty headcount or gap models at both $1.90 and$3.20 poverty lines. In LMICs, higher service coverage rates are associated with lower incidence and intensity of poverty. Further research is warranted to identify the causal pathways and specific circumstances in which improved health services in LMICs might help to reduce poverty

Experience of UK Latin Americans caring for a relative living with dementia: A qualitative study of family carers

INTRODUCTION: Most studies of the Latin American immigrant experience and care for relatives living with dementia have been in the United States (US). In the United Kingdom (UK), unlike the US, most Latin Americans are first generation immigrants and are a rapidly increasing population. Therefore, we aimed to explore the UK experiences of Latin Americans caring for a relative with dementia. METHODS: We purposively recruited UK-based Latin American family carers of people with dementia ensuring maximum diversity. We conducted semi-structured qualitative interviews (in English or Spanish) with 11 family carers, stopping recruiting when we reached thematic saturation. We took an inductive thematic analytic approach. FINDINGS: Four main themes were identified: (1) Family comes first, particularly older people, leading to an obligation to care; (2) dementia as an illness that is accepted and talked about, which is regarded as positive with close networks but not wider society; (3) difficult behaviours are not the responsibility of the person with dementia, who is often conceptualised as a child; and (4) caring expectations lead to incompatibility with formal services, and a reluctance to leave people with dementia alone. CONCLUSIONS: Familial obligation is the driver for family carers and acceptance of the illness helped despite adversities. Openness to talk about dementia with close networks was distinctive and helpful, contrasting with wider society, where greater awareness of dementia is needed. Considering the person with dementia as a child did not seem to undermine personhood and enabled maintenance of compassion. The relative with dementia was a priority. There was a lack of culturally and linguistically appropriate services, thus restricting family carers' ability to fulfil other roles, such as parental

Relación de los factores de riesgo con la aparición de flebitis en pacientes hospitalizados del servicio de medicina del hospital María Auxiliadora, junio-agosto 2017

El presente estudio lleva por título “Relación de los factores de riesgo con la aparición de flebitis en pacientes hospitalizados del servicio de medicina del Hospital María Auxiliadora, Junio – Agosto 2017” que tuvo como objetivo determinar la relación que existe entre los factores de riesgo con la aparición de flebitis en los pacientes hospitalizados del servicio de Medicina del Hospital María Auxiliadora, Junio-Agosto 2017. El presente trabajo se realizó en los meses de Junio a Agosto el cual se enfocó desde un plano cuantitativo, como método se utilizó el nivel descriptivo de corte transversal. Con un diseño correlacional, la población estuvo conformada por 44 pacientes, de lo cual se tomó en su totalidad a la población del área de Medicina del Hospital María Auxiliadora, Junio-Agosto 2017The present study entitled “Relationship of risk factors and the appearance of phlebitis in hospitalized patients of the medical service of the Maria Auxiliadora Hospital, in June - August 2017”, seeks to determine the relationship between risk factors and the appearance of phlebitis. It was focused from a quantitative level, as a method was used descriptive cross-sectional level. With a correlational design, the population consisted of 44 patients from the Medicin

Attitude towards research and research skills in undergraduate students of a private university of Lima, 2023

Esta investigación consideró como objetivo determinar la relación entre la actitud hacia la investigación y las competencias investigativas en estudiantes de pregrado de una universidad privada de Lima, 2023. La investigación se enmarcó en el enfoque cuantitativo, método hipotético – deductivo, tipo aplicada, diseño no experimental y nivel descriptivo correlacional. La muestra estuvo conformada por 85 estudiantes de pregrado de VIII, IX y X ciclos de una universidad privada de Lima. Para la recolección de los datos se dispuso de dos instrumentos; Cuestionario de actitud hacia la investigación, de Barrios y Ulises (2020) el cual constó de 28 ítems y el Cuestionario de competencias investigativas, de Ruiz et al. (2020) el cual constó de 40 ítems. Los resultados de la prueba de hipótesis general reportaron que el nivel de significancia fue de 0,000 < 0,05, lo cual indica que existe relación significativa entre la actitud hacia la investigación y las competencias investigativas; del mismo modo se observa que el índice Rho de Spearman = 0,418 indicando que la relación entre las variables del estudio es positiva y de intensidad moderada, es decir, que una actitud positiva hacia la investigación favorece el desarrollo de las competencias investigativas

Diabetes mellitus tipo II y niveles de depresión en el Hospital Regional Docente de Trujillo, 2017

El objetivo fue determinar la relación entre la Diabetes Mellitus tipo II y los Niveles de Depresión en el Hospital Regional Docente de Trujillo, 2017. Material y métodos. Fue una investigación descriptiva, de correlación, aplicado a 160 pacientes diagnosticados de diabetes mellitus tipo 2 en el Hospital Regional Docente de Trujillo, 2017 y 160 pacientes sin diagnóstico de diabetes mellitus tipo 2. Resultados. Se determinó que la depresión se relacionó significativamente en magnitud moderado con la depresión (x2 = 45.249, p<0.01). De los 160 pacientes sin diabetes Mellitus tipo II, 63.1% no reportan depresión, en tanto de los 160 que tienen diagnóstico de diabetes Mellitus tipo II, 40.6%, reporta depresión leve, 19.4% moderada, 8.8% severa y 5% extrema. Se determinó que en el grupo de mujeres (n=110) existe mayor prevalencia del diagnóstico depresión leve (42.7%); en contraste con el grupo de varones (n=50) de los cuales 36% reportan depresión en magnitud leve. De los 160 pacientes con diabetes mellitus tipo 2 existe una mayor prevalencia en pacientes con edades entre los 51 y 60 años depresión leve (53.1%) seguido de pacientes con edades entre 41 y 50 años (35.9%). En tanto, el diagnóstico de diabetes mellitus tipo 2 y depresión moderada es más prevalente en edades de 61 a 70 años. Conclusiones. Si existe relación entre la diabetes mellitus tipo 2 y los niveles de depresión, hallándose en mayor frecuencia la depresión leve y en menor frecuencia la depresión extrema. Por otro lado la mayor frecuencia de depresión se evidenció en el sexo femenino predominando la depresión leve, de igual forma que en el sexo masculino predomino la depresión leve. El rango de edad de 51 a 60 años fue el que presento la mayor frecuencia de depresión

Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review

PURPOSE: This scoping review aimed to synthesise the available evidence on barriers and facilitators of weight bearing after hip fracture surgery in older adults. METHODS: Published (Cochrane Central, MEDLINE, EMBASE, CINAHL, and PEDro) and unpublished (Global Health, EThOS, WorldCat dissertation and thesis, ClinicalTrials.gov , OpenAIRE, DART-Europe) evidence was electronically searched from database inception to 29 March 2022. Barriers and facilitators of weight bearing were extracted and synthesised into patient, process (non-surgical), process (surgical), and structure-related barriers/facilitators using a narrative review approach. RESULTS: In total, 5594 were identified from the primary search strategy, 1314 duplicates were removed, 3769 were excluded on title and abstract screening, and 442 were excluded on full-text screening. In total, 69 studies (all from published literature sources) detailing 47 barriers and/or facilitators of weight bearing were included. Of barriers/facilitators identified, 27 were patient-, 8 non-surgical process-, 8 surgical process-, and 4 structure-related. Patient facilitators included anticoagulant, home discharge, and aid at discharge. Barriers included preoperative dementia and delirium, postoperative delirium, pressure sores, indoor falls, ventilator dependence, haematocrit < 36%, systemic sepsis, and acute renal failure. Non-surgical process facilitators included early surgery, early mobilisation, complete medical co-management, in-hospital rehabilitation, and patient-recorded nurses' notes. Barriers included increased operative time and standardised hip fracture care. Surgical process facilitators favoured intramedullary fixations and arthroplasty over extramedullary fixation. Structure facilitators favoured more recent years and different healthcare systems. Barriers included pre-holiday surgery and admissions in the first quarter of the year. CONCLUSION: Most patient/surgery-related barriers/facilitators may inform future risk stratification. Future research should examine additional process/structure barriers and facilitators amenable to intervention. Furthermore, patient barriers/facilitators need to be investigated by replicating the studies identified and augmenting them with more specific details on weight bearing outcomes

Attitude towards research and research skills in undergraduate students of a private university of Lima, 2023

Esta investigación consideró como objetivo determinar la relación entre la actitud hacia la investigación y las competencias investigativas en estudiantes de pregrado de una universidad privada de Lima, 2023. La investigación se enmarcó en el enfoque cuantitativo, método hipotético – deductivo, tipo aplicada, diseño no experimental y nivel descriptivo correlacional. La muestra estuvo conformada por 85 estudiantes de pregrado de VIII, IX y X ciclos de una universidad privada de Lima. Para la recolección de los datos se dispuso de dos instrumentos; Cuestionario de actitud hacia la investigación, de Barrios y Ulises (2020) el cual constó de 28 ítems y el Cuestionario de competencias investigativas, de Ruiz et al. (2020) el cual constó de 40 ítems. Los resultados de la prueba de hipótesis general reportaron que el nivel de significancia fue de 0,000 < 0,05, lo cual indica que existe relación significativa entre la actitud hacia la investigación y las competencias investigativas; del mismo modo se observa que el índice Rho de Spearman = 0,418 indicando que la relación entre las variables del estudio es positiva y de intensidad moderada, es decir, que una actitud positiva hacia la investigación favorece el desarrollo de las competencias investigativas

Protocol for a feasibility randomised controlled trial of the ‘Outdoor’ mobility intervention for older adults after hip fracture

Background A high proportion of patients do not regain outdoor mobility after hip fracture. Rehabilitation explicitly targeting outdoor mobility is needed to enable these older adults to recover activities which they value most. The overarching aim of this study is to determine the feasibility of a randomised controlled trial which aims to assess the clinical- and cost-effectiveness of an intervention designed to enable recovery of outdoor mobility among older adults after hip fracture (the OUTDOOR intervention). Methods This is a protocol for a multi-centre pragmatic parallel group (allocation ratio 1:1) randomised controlled assessor-blinded feasibility trial. Adults aged 60 years or more, admitted to hospital from- and planned discharge to- home, with self-reported outdoor mobility in the threemonths pre-fracture, surgically treated for hip fracture, and who are able to consent and participate, are eligible. Individuals who require two or more people to support mobility on discharge will be excluded. Screening and consent (or consent to contact) will take place in hospital. Baseline assessment and randomisation will follow discharge from hospital. Participants will then receive usual care (delivered by physiotherapy, occupational therapy, or therapy assistants), or usual care plus the OUTDOOR intervention. The OUTDOOR intervention includes a goal-orientated outdoor mobility programme (supported by up to six inperson visits), therapist-led motivational dialogue (supported by up to four telephone calls), supported by a past-patient led video where recovery experiences are shared, and support to transition to independent ongoing recovery. Therapists delivering the OUTDOOR intervention (distinct from those supporting usual care) will receive training in motivational interviewing and behaviour change techniques. Baseline demographics will be collected. Patient reported outcome measures including health related quality of life, activities of daily living, pain, community mobility, falls related self-efficacy, resource use, readmissions, and mortality will be collected at baseline, 6-weeks, 12-weeks, and 6-months (for those enrolled early in the trial) post-randomisation. Exercise adherence (6- and 12- weeks) and intervention acceptability (12-weeks) will be collected. A subset of 20 participants will also support accelerometery data collection for 10 days at each time point. Dissemination The trial findings will be disseminated to patients and the public, health professionals and researchers through publications, presentations and social media channels.</p