150 research outputs found
(P1-28) Primary Health Care (PHC) Approach in Emergencies and Disasters
This presentation will focus on outlining the issues and challenges to developing a framework for a PHC approach for emergencies and disasters. The emphasis will be how the use of the PHC principles to achieve equity and social justice can improve disaster response. These approaches include; universal coverage/equity, community participation, intersectoral collaboration and the use of appropriate technology. Discussion will include; the revitalization of PHC and the role of PHC in emergencies and the challenges of the PHC approach in emergencies. Responding to emergencies from the perspective of disaster risk management, community based health work force and self care will be reviewed. Finally, pre-emergency preparedness focusing on community based benchmarks, community based disaster management planning and strengthening health systems based on PHC will be discusse
Primary Health care and DisastersâThe Current State of the Literature: What We Know, Gaps and Next Steps
Introduction: The 2009 Global Platform for Disaster Risk Reduction/Emergency Preparedness (DRR/EP) and the Hyogo Framework for Action 2005-2015 demonstrate increased international commitment to DRR/EP in addition to response and recovery. In addition, the World Health Report 2008 has re-focused the world's attention on the renewal of Primary Health Care (PHC) as a set of values/principles for all sectors. Evidence suggests that access to comprehensive PHC improves health outcomes and an integrated PHC approach may improve health in low income countries (LICs). Strong PHC health systems can provide stronger health emergency management, which reinforce each other for healthier communities. Problem: The global re-emphasis of PHC recently necessitates the health sector and the broader disaster community to consider health emergency management from the perspective of PHC. How PHC is being described in the literature related to disasters and the quality of this literature is reviewed. Identifying which topics/lessons learned are being published helps to identify key lessons learned, gaps and future directions. Methods: Fourteen major scientific and grey literature databases searched. Primary Health Care or Primary Care coupled with the term disaster was searched (title or abstract). The 2009 ISDR definition of disaster and the 1978 World Health Organization definition of Primary Health Care were used. 119 articles resulted. Results: Literature characteristics; 16% research papers, only 29% target LICs, 8% of authors were from LICs, 7% clearly defined PHC, 50% used PHC to denote care provided by clinicians and 4% cited PHC values and principles. Most topics related to disaster response. Key topics; true need for PHC, mental health, chronic disease, models of PHC, importance of PHC soon after a natural disaster relative to acute care, methods of surge capacity, utilization patterns in recovery, access to vulnerable populations, rebuilding with the PHC approach and using current PHC infrastructure to build capacity for disasters. Conclusions: Primary Health Care is very important for effective health emergency management during response and recovery, but also for risk reduction, including preparedness. There is need to; increase the quality of this research, clarify terminology, encourage paper authorship from LICs, develop and validate PHC- specific disaster indicators and to encourage organizations involved in PHC disaster activities to publish data. Lessons learned from high-income countries need contextual analysis about applicability in low-income countrie
Automated quantification of mitral valve geometry on multi-slice computed tomography in patients with dilated cardiomyopathy: Implications for transcatheter mitral valve replacement
Objectives The primary aim of this study was to quantify the dimensions and geometry of the mitral valve complex in patients with dilated cardiomyopathy and significant mitral regurgitation. The secondary aim was to evaluate the validity of an automated segmentation algorithm for assessment of the mitral valve compared to manual assessment on computed tomography. Background Transcatheter mitral valve replacement (TMVR) is an evolving technique which relies heavily on the lengthy evaluation of cardiac computed tomography (CT) datasets. Limited data is available on the dimensions and geometry of the mitral valve in pathological states throughout the cardiac cycle, which may have implications for TMVR device design, screening of suitable candidates and annular sizing prior to TMVR. Methods A retrospective study of 15 of patients with dilated cardiomyopathy who had undergone full multiphase ECG gated cardiac CT. A comprehensive evaluation of mitral valve geometry was performed at 10 phases of the cardiac cycle using the recommended D-shaped mitral valve annulus (MA) segmentation model using manual and automated CT interpretation platforms. Mitral annular dimensions and geometries were compared between manual and automated methods. Results Mitral valve dimensions in patients with dilated cardiomyopathy were similar to previously reported values (MAarea Diastole: 12.22âŻÂ±âŻ1.90âŻcm2), with dynamic changes in size and geometry between systole and diastole of up to 5%. The distance from the centre of the MA to the left ventricular apex demonstrated moderate agreement between automated and manual methods (Ïc = 0.90) with other measurements demonstrating poor agreement between the two methods (ÏcâŻ=âŻ0.75â0.86). Conclusions Variability of mitral valve annulus measurements are small during the cardiac cycle. Novel automated algorithms to determine cardiac cycle variations in mitral valve geometry may offer improved segmentation accuracy as well as improved CT interpretation times
Acceptability of a primary care-based opioid and pain review service:a mixed-methods evaluation in England
Evaluation of a primary care-based opioid and pain review service:a mixed-methods evaluation in two GP practices in England
The 1999 international emergency humanitarian evacuation of the Kosovars to Canada: A qualitative study of service providers' perspectives at the international, national and local levels
BACKGROUND: In response to the Kosovo crisis, Canada received 5,500 Albanian Kosovar refugees in 1999 as part of the emergency humanitarian evacuation and settlement effort. This study attempts to describe the experiences of service providers at the international, national, and local levels, involved in the organization and delivery of health and settlement services in Canada for the Kosovar refugees. METHODS: A qualitative case study design using key informant interviews was used. Nominated sampling was used to identify 17 individuals involved in the organization and delivery of health and settlement. Key themes were identified and recommendations made to provide a framework for the development of policy to guide response to future humanitarian emergencies. RESULTS: Six themes emerged: (1) A sense of being overwhelmed, (2) A multitude of health issues, (3) critical challenges in providing health care, (4) access to health and settlement services, (5) overall successes and (6) need for a coordinated approach to migration health. CONCLUSIONS: For those involved, the experience was overwhelming but rewarding. Interviewees' major concerns were the need for a more comprehensive and coordinated approach to the flow of medical information and handling of specific health problems
A case analysis of partnered research on palliative care for refugees in Jordan and Rwanda
© 2021, The Author(s). Background: This case analysis describes dilemmas and challenges of ethical partnering encountered in the process of conducting a research study that explored moral and practical dimensions of palliative care in humanitarian crisis settings. Two contexts are the focus of this case analysis: Jordan, an acute conflict-induced refugee situation, and Rwanda, a protracted conflict-induced refugee setting. The studyâs main goal was to better understand ways humanitarian organizations and health care providers might best support ethically and contextually appropriate palliative care in humanitarian contexts. An unintended outcome of the research was learning lessons about ethical dimensions of transnational research partnerships, which is the focus of this case analysis. Discussion: There exist ongoing challenges for international collaborative research in humanitarian conflict-induced settings. Research partnerships were crucial for connecting with key stakeholders associated with the full study (e.g., refugees with life limiting illness, local healthcare providers, aid organization representatives). While important relationships were established, obstacles limited our abilities to fully attain the type of mutual partnership we aimed for. Unique challenges faced during the research included: (a) building, nurturing and sustaining respectful and equitable research partnerships between collaborators in contexts of cultural difference and global inequality; (b) appropriate ethics review and challenges of responding to local decision-makerâs research needs; and (c) equity and fairness towards vulnerable populations. Research strategies were adapted and applied to respond to these challenges with a specific focus on (d) research rewards and restitution. Conclusions: This case analysis sheds light on the importance of understanding cultural norms in all research roles, building relationships with decision makers, and developing teams that include researchers from within humanitarian crisis settings to ensure that mutually beneficial research outcomes are ethical as well as culturally and contextually relevant
Introduction: Interpreting British European Policy
Britain has had particular problems reconciling itself to the idea of being a âEuropeanâ actor and a wholehearted member of the EEC/EU since 1973. Now, potentially, the âawkward partnerâ, is edging towards the exit door of the EU because a membership referendum is an increasingly likely prospect in the coming years. The aim of this special issue is to consider how we can account for the present state of affairs by adopting an interpretivist perspective on British European policy over the past four decades. The article begins with a comprehensive review of the extant literature on Britain and Europe, and an elaboration of the âtraditions and dilemmasâ framework within which the contributors have studied the empirical material in their articles. It then explains the major themes that connect the articles and suggests how future research might build on the agenda proposed in this special issue
Immigrant womenâs experiences of maternity services in Canada: a meta-ethnography
Objective: to synthesise data on immigrant women's experiences of maternity services in Canada.
Design: a qualitative systematic literature review using a meta-ethnographic approach.
Methods: a comprehensive search strategy of multiple databases was employed in consultation with an information librarian, to identify qualitative research studies published in English or French between 1990 and December 2011 on maternity care experiences of immigrant women in Canada. A modified version of Noblit and Hare's meta-ethnographic theoretical approach was undertaken to develop an inductive and interpretive form of knowledge synthesis. The seven-phase process involved comparative textual analysis of published qualitative studies, including the translation of key concepts and meanings from one study to another to derive second and third-order concepts encompassing more than that offered by any individual study. ATLAS.ti qualitative data analysis software was used to store and manage the studies and synthesise their findings.
Findings: the literature search identified 393 papers, of which 22 met the inclusion criteria and were synthesised. The literature contained seven key concepts related to maternity service experiences including social (professional and informal) support, communication, socio-economic barriers, organisational environment, knowledge about maternity services and health care, cultural beliefs and practices, and different expectations between health care staff and immigrant women. Three second-order interpretations served as the foundation for two third-order interpretations. Societal positioning of immigrant women resulted in difficulties receiving high quality maternity health care. Maternity services were an experience in which cultural knowledge and beliefs, and religious and traditional preferences were highly relevant as well but often overlooked in Canadian maternity settings.
Key conclusions and implications for practice: in order to implement woman-centred care, to enhance access to maternity services, and to promote immigrant women's health, it is important to consider these women's social position, cultural knowledge and beliefs, and traditional customs in the health care
Protein kinase Aâinduced myofilament desensitization to Ca2+ as a result of phosphorylation of cardiac myosinâbinding protein C
In skinned myocardium, cyclic AMPâdependent protein kinase A (PKA)-catalyzed phosphorylation of cardiac myosinâbinding protein C (cMyBP-C) and cardiac troponin I (cTnI) is associated with a reduction in the Ca2+ responsiveness of myofilaments and an acceleration in the kinetics of cross-bridge cycling, although the respective contribution of these two proteins remains controversial. To further examine the relative roles that cTnI and cMyBP-C phosphorylation play in altering myocardial function, we determined the Ca2+ sensitivity of force (pCa50) and the activation dependence of the rate of force redevelopment (ktr) in control and PKA-treated mouse myocardium (isolated in the presence of 2,3-butanedione monoxime) expressing: (a) phosphorylatable cTnI and cMyBP-C (wild type [WT]), (b) phosphorylatable cTnI on a cMyBP-Cânull background (cMyBP-Câ/â), (c) nonphosphorylatable cTnI with serines23/24/43/45 and threonine144 mutated to alanines (cTnIAla5), and (d) nonphosphorylatable cTnI on a cMyBP-Cânull background (cTnIAla5/cMyBP-Câ/â). Here, PKA treatment decreased pCa50 in WT, cTnIAla5, and cMyBP-Câ/â myocardium by 0.13, 0.08, and 0.09 pCa units, respectively, but had no effect in cTnIAla5/cMyBP-Câ/â myocardium. In WT and cTnIAla5 myocardium, PKA treatment also increased ktr at submaximal levels of activation; however, PKA treatment did not have an effect on ktr in cMyBP-Câ/â or cTnIAla5/cMyBP-Câ/â myocardium. In addition, reconstitution of cTnIAla5/cMyBP-Câ/â myocardium with recombinant cMyBP-C restored the effects of PKA treatment on pCa50 and ktr reported in cTnIAla5 myocardium. Collectively, these results indicate that the attenuation in myofilament force response to PKA occurs as a result of both cTnI and cMyBP-C phosphorylation, and that the reduction in pCa50 mediated by cMyBP-C phosphorylation most likely arises from an accelerated cross-bridge cycling kinetics partly as a result of an increased rate constant of cross-bridge detachment
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