Improving the use of medicines in community health centres, Timor-Leste

While access to essential medicines has become recognised as a human right, problems concerning the inappropriate use of medicines have emerged. Medicines lose their therapeutic value and can impair both individual health and public health if inappropriately used. Inappropriate use of medicines diminishes the quality of healthcare and causes resources to be wasted, which is especially serious in under-resourced countries. To improve the use of medicines, the introduction of standard treatment guidelines (STGs) is suggested as a potential strategy. The aim of this DrPH thesis is to study the use of medicines, focusing on adherence to new STGs in Community Health Centers (CHCs) in Timor-Leste. The country is now trying to establish an equitable and sustainable healthcare system under extremely resource-limited conditions. The study used mixed research methods, collecting data from randomly selected 20 rural CHCs, 1,799 retrospective samples from patient registration books, 583 prospective observations, and 55 semi-structured interviews of health personnel were collected. Timor-Leste's medicine use was found, in general, to be acceptable. For example, use of injections was extremely low. Training, especially clinical nurse training, influenced knowledge of, attitudes to, and practical use of medicines and also prescribing adherence to STGs. Other factors that influenced the use of STGs were: health personnel's agreement with the policy concept and contents of STGs; health personnel's positive perception of the changes brought about by the introduction of STGs; development of STGs in a health policy framework: the fact that their STGs were easy to use repeatedly; and a supportive environment and systems to use STGs. Constant socialisation and timely updates of STGs are necessary. Interrelation and consistency across policies and programs should be maintained. The position of training within the health policy framework should be clearly understood by the all people concerned. Follow-up supervision is needed both for individuals and the CHC. Anticipated support should be well functioning

Effect of different types of carbohydrate supplementation on glycogen supercompensation in rat skeletal muscle

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Fragile States, Infectious Disease and Health Security: The Case for Timor-Leste

Timor-Leste is a very young and developing nation state. Endemic infectious disease and weakened health security coupled with its growing and inclusive public institutions keep Timor-Leste fragile and in transition on the spectrum of state stability. The objective here is to systematically review Timor-Leste's state and public health successes, showing how a fragile state can consistently improve its status on the continuum of stability and improve health security for the population. The case study follows a state case study approach, together with a disease burden review and a basic description of the health portrait in relation to Timor-Leste's fragile state status. Disease burden and health security are directly proportional to state stability and indirectly proportional to state failure. Timor-Leste is a clear example of how public health can feed into increased state stability. Our discussion attempts to describe how the weak and fragile island nation of Timor-Leste can continue on its current path of transition to state stability by increasing health security for its citizens. We surmise that this can be realized when public policy focuses on primary healthcare access, inclusive state institutions, basic hygiene and preventative vaccination programs. Based on our review, the core findings indicate that by increasing health security, a positive feedback loop of state stability follows. The use of Timor-Leste as a case study better describes the connection between public health and health security; and state stability, development and inclusive state institutions that promote health security

Fragile States, Infectious Disease and Health Security: The Case for Timor-Leste

Timor-Leste is a very young and developing nation state. Endemic infectious disease and weakened health security coupled with its growing and inclusive public institutions keep Timor-Leste fragile and in transition on the spectrum of state stability. The objective here is to systematically review Timor-Leste's state and public health successes, showing how a fragile state can consistently improve its status on the continuum of stability and improve health security for the population. The case study follows a state case study approach, together with a disease burden review and a basic description of the health portrait in relation to Timor-Leste's fragile state status. Disease burden and health security are directly proportional to state stability and indirectly proportional to state failure. Timor-Leste is a clear example of how public health can feed into increased state stability. Our discussion attempts to describe how the weak and fragile island nation of Timor-Leste can continue on its current path of transition to state stability by increasing health security for its citizens. We surmise that this can be realized when public policy focuses on primary healthcare access, inclusive state institutions, basic hygiene and preventative vaccination programs. Based on our review, the core findings indicate that by increasing health security, a positive feedback loop of state stability follows. The use of Timor-Leste as a case study better describes the connection between public health and health security; and state stability, development and inclusive state institutions that promote health security

Allergic Reactions to Local Anesthetics in Dental Patients: Analysis of Intracutaneous and Challenge Tests

Some dental patients have histories of adverse reactions to local anesthesia. The aim of the present study was to investigate the frequency of allergy to local anesthetics of dental patients who had histories of adverse reactions to local anesthesia based on the results of allergy tests in our institute over a period of 5 years. We investigated the past medical records of dental patients retrospectively, and twenty patients were studied. Three of the 20 showed a positive or false-positive reaction in the intracutaneous test, and one patient showed a false-positive reaction in the challenge test. Our results suggest that the frequency of allergy to local anesthetics is low even if patients have histories of adverse reactions to local anesthesia. However, allergy tests of local anesthetics should be performed in patients in whom it is uncertain whether they are allergic

P301S Mutant Human Tau Transgenic Mice Manifest Early Symptoms of Human Tauopathies with Dementia and Altered Sensorimotor Gating

Tauopathies are neurodegenerative disorders characterized by the accumulation of abnormal tau protein leading to cognitive and/or motor dysfunction. To understand the relationship between tau pathology and behavioral impairments, we comprehensively assessed behavioral abnormalities in a mouse tauopathy model expressing the human P301S mutant tau protein in the early stage of disease to detect its initial neurological manifestations. Behavioral abnormalities, shown by open field test, elevated plus-maze test, hot plate test, Y-maze test, Barnes maze test, Morris water maze test, and/or contextual fear conditioning test, recapitulated the neurological deficits of human tauopathies with dementia. Furthermore, we discovered that prepulse inhibition (PPI), a marker of sensorimotor gating, was enhanced in these animals concomitantly with initial neuropathological changes in associated brain regions. This finding provides evidence that our tauopathy mouse model displays neurofunctional abnormalities in prodromal stages of disease, since enhancement of PPI is characteristic of amnestic mild cognitive impairment, a transitional stage between normal aging and dementia such as Alzheimer's disease (AD), in contrast with attenuated PPI in AD patients. Therefore, assessment of sensorimotor gating could be used to detect the earliest manifestations of tauopathies exemplified by prodromal AD, in which abnormal tau protein may play critical roles in the onset of neuronal dysfunctions

Factors associated with access to health care among foreign residents living in Aichi Prefecture, Japan: secondary data analysis

他言語要約 (日本語) 背景 日本において、外国人住民は日本人に比べて保健医療へのアクセスバリアがあり、健康のアウトカムもよくないことが知られている。しかし、外国人住民の保健医療に関する状況は大きく変化し続けており、「取り残された」人を特定することは困難である。そこで本研究では、NGOの無料健康相談を受けた外国人住民を対象に、「医療機関を受診するように勧められた」「医療機関を紹介された」ことを保健医療へのアクセスバリアを示唆する代理指標として、これらに関連する要因を明らかにすることを目的とした。. 方法 愛知県内の複数の会場で外国人住民を対象とした無料健康相談会を行っているNGOの活動記録を用いて二次データ分析を行った。保険加入を含む参加者特性を明らかにした上で、二変量分析(χ2検定) および多変量分析 (log-binomial回帰分析)を行い保健医療へのアクセスバリアと関連する要因を明らかにした。. 結果 抽出された608例のうち、相談時に医療機関への受診を勧められたのは164例(27.5%)、医療機関への紹介は72例(11.8%)であった。公的保険に加入していない人は、公的保険に加入している人に比べて、医療機関への受診を勧められる割合 (prevalence)が1.56倍(95%信頼区間 [CI]:1.19–2.05)高かった。仕事をしていない人および学生は、専門職者に比べて医療施設への紹介を有意に多く受けており、prevalence ratioはそれぞれ3.28(95%信頼区間 [CI]:1.64–6.57) および2.77(95%CI,1.18–6.46) であった。. 結論 大多数は保険に加入していたが、無料健康相談を利用する前に正式な医療制度へのアクセスが制限されていたことを示唆する、医療機関を受診するよう勧められた参加者が30%近くいた。本研究結果は、保険に加入していない人、仕事をしていない人、学生など、保健医療へのアクセスが脆弱だと考えられる人たちを示した。誰もが「取り残されない」ようにするために、エビデンスを更新しながら、脆弱な人々へ必要な支援を提供することが肝要である。

Physical assessment ability of nurses and midwives on maternal care in Mongolia

This study examined the physical assessment ability of Mongolian nurses and midwives en-gaged in maternal care and the factors that could influence this ability. We found that nurses and midwives from prefectural hospitals had higher scores than those from national and district (soum) hospitals. The latter group could not perform more than half of the 28 tested proce-dures on their own, even though most had over 10 years ’ experience. Therefore, to decrease the Mongolian maternal mortality ratio, we argue that in-service training for nurses and midwives in both the capital city and peripheral areas is needed