Human resources: the Cinderella of health sector reform in Latin America

Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies – decentralization and privatization – have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform. This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region. The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Synthesis and characterization of hydroxyapatite nanoparticles and their application in protein adsorption

Hydroxyapatite (HAp) is a bioceramic material used to decrease the operatory time for bone trauma fixing, protein purification, prosthetic covering, and complementing the consolidation and substitution in bone solutions since this material works in favor of the bone neoformation when it is in touch with the physiological tissue. In this work the hydrothermal method, by using a starting solution containing hydrate dipotassium hydrogen phosphate, K 2HPO4�3H2O, and cetyltrimethylammonium bromide, CTAB, dissolved in deionized water was employed to synthesize HAp nanoparticles with sizes between 15 and 60 nm, high policrystallinity and Ca/P and Ca/O ratios close to the theoretical. The synthesized HAp particles were characterized by X-ray diffraction (XRD), transmission electron microscopy (TEM), and energy dispersive spectroscopy (EDS). Pellets with a diameter of 5 mm and weight of 150 mg were used to support the fibrinogen (FGN) and bovine serum albumin (BSA) adsorption (0.15, 0.7, and 1.5 mg/ml) studies. The protein adsorption studies were carried out via atomic force microscopy (AFM). � 2010 Elsevier B.V. All rights reserved

Physical properties of CdTe:Cu films grown at low temperature by pulsed laser deposition

CdTe:Cu films were grown by pulsed laser deposition on Corning glass slides at a substrate temperature of 300�C. The thin films were grown using CdTe and Cu2Te powders, varying the Cu2Te concentration from 3 to 10wt. %. The structural, compositional, optical, and electrical properties were analyzed as a function of the nominal copper concentration. X-ray diffraction shows that films have CdTe cubic phase. The compositional analysis indicates that CdTe:Cu films grown with lower Cu content have Te excess, on the other hand, films with higher Cu content have Te deficiencies. The electrical measurements showed that CdTe:Cu films grown with low Cu content present lowest resistivity. � 2012 American Institute of Physics