Consumer responsibility in the context of transition to green economy in Romania

This paper presents a quantitative research with two main directions: (1) to determine the strength of a possible association between the consumers’ expectations from the companies and their willingness to be actively involved in the transition to green economy and (2) to establish the degree to which the level of education influences the expectations of the consumer regarding green technologies when deciding to buy from a company. It was confirmed that although there is a significant level of awareness regarding the impact of companies on the environment, it is not transposed proportionally in the awareness of the consumers of their own responsibility in the transition process towards a green economy. Given the obtained results, the Romanian consumer, although aware of the importance of protecting the environment, is not convinced of his own responsibility in this process, being rather inclined to believe that it is rather an obligation of companies to ensure a transition towards a green economy than their own

Birth companionship in a government health system: a pilot study in Kigoma, Tanzania

Background Having a companion of choice throughout childbirth is an important component of good quality and respectful maternity care for women and has become standard in many countries. However, there are only a few examples of birth companionship being implemented in government health systems in low-income countries. To learn if birth companionship was feasible, acceptable and led to improved quality of care in these settings, we implemented a pilot project using 9 intervention and 6 comparison sites (all government health facilities) in a rural region of Tanzania. Methods The pilot was developed and implemented in Kigoma, Tanzania between July 2016 and December 2018. Women delivering at intervention sites were given the choice of having a birth companion with them during childbirth. We evaluated the pilot with: (a) project data; (b) focus group discussions; (c) structured and semi-structured interviews; and (d) service statistics. Results More than 80% of women delivering at intervention sites had a birth companion who provided support during childbirth, including comforting women and staying by their side. Most women interviewed at intervention sites were very satisfied with having a companion during childbirth (96–99%). Most women at the intervention sites also reported that the presence of a companion improved their labor, delivery and postpartum experience (82–97%). Health providers also found companions very helpful because they assisted with their workload, alerted the provider about changes in the woman’s status, and provided emotional support to the woman. When comparing intervention and comparison sites, providers at intervention sites were significantly more likely to: respond to women who called for help (p = 0.003), interact in a friendly way (p < 0.001), greet women respectfully (p < 0.001), and try to make them more comfortable (p = 0.003). Higher proportions of women who gave birth at intervention sites reported being “very satisfied” with the care they received (p < 0.001), and that the staff were “very kind” (p < 0.001) and “very encouraging” (p < 0.001). Conclusion Birth companionship was feasible and well accepted by health providers, government officials and most importantly, women who delivered at intervention facilities. The introduction of birth companionship improved women’s experience of birth and the maternity ward environment overall

Exploring the associations between intimate partner violence and women's mental health: Evidence from a population-based study in Paraguay

Using a nationally representative sample from the 2008 Paraguayan National Survey of Demography and Sexual and Reproductive Health, we examine the association between emotional, physical, and sexual intimate partner violence (IPV) and mental health among women aged 15-44 years who have ever been married or in a consensual union. The results from multivariate logistic regression models demonstrate that controlling for women's socioeconomic and marital status and history of childhood abuse and their male partners' unemployment and alcohol consumption, IPV is independently associated with an increased risk for common mental disorders (CMD) and suicidal ideation measured by the Self Reporting Questionnaire (SRQ-20). IPV variables substantially improve the explanatory power of the models, particularly for suicidal ideation. Emotional abuse, regardless of when it occurred, is associated with the greatest increased risk for CMD whereas recent physical abuse is associated with the greatest increased risk for suicidal ideation. These findings suggest that efforts to identify women with mental health problems, particularly suicidal ideation, should include screening for the types and history of IPV victimization.Paraguay Intimate partner violence Child abuse Sexual abuse Mental health Common mental disorders Suicidal ideation Latin America Women

Implementation of a Customized Safety Checklist in Gastrointestinal Endoscopy and the Importance of Team Time Out—A Dual-Center Pilot Study

Background and Objectives: Checking and correctly preparing the patient for endoscopic procedures is a mandatory step for the safety and quality of the interventions. The aim of this paper is to emphasize the importance and necessity of a “team time out” as well as the implementation of a customized “checklist” before the actual procedure. Material and Methods: We developed and implemented a checklist for the safe conduct of endoscopies and for the entire team to thoroughly know about the patient’s medical history. The subjects of this study were 15 physicians and 8 endoscopy nurses who performed overall 572 consecutive GI endoscopic procedures during the study period. Results: This is a prospective pilot study performed in the endoscopy unit of two tertiary referral medical centers. We customized a safety checklist that includes the steps to be followed before, during and after the examination. It brings together the whole team participating in the procedure in order to check the key points during the following three vital phases: before the patient falls asleep, before the endoscope is inserted and before the team leaves the examination room. The perception of team communication and teamwork was improved after the introduction of the checklist. The checklist completion rates, identity verification rates of patients by the endoscopist, adequate histological labeling management and explicit recording of follow-up recommendations are some of the parameters that improved post-intervention. Conclusions: Using a checklist and adapting it to local conditions is a high-level recommendation of the Romanian Ministry of Health. In a medical world where safety and quality are essential, a checklist could prevent medical errors, and team time out can ensure high-quality endoscopy, enhance teamwork and offer patients confidence in the medical team

Maternal death surveillance efforts: notification and review coverage rates in 30 low-income and middle-income countries, 2015–2019

Objective Performance of maternal death surveillance and response (MDSR) relies on the system’s ability to identify and notify all maternal deaths and its ability to review all maternal deaths by a committee. Unified definitions for indicators to assess these functions are lacking. We aim to estimate notification and review coverage rates in 30 countries between 2015 and 2019 using standardised definitions.Design Repeat cross-sectional surveys provided the numerators for the coverage indicators; United Nations (UN)-modelled expected country maternal deaths provided the denominators.Setting 30 low-income and middle-income countries responding to the Maternal Health Thematic Fund annual surveys conducted by the UN Population Fund between 2015 and 2019.Outcome measures Notification coverage rate (CRn) was calculated as the proportion of expected maternal deaths that were notified at the national level annually; review coverage rate (CRr) was calculated as the proportion of expected maternal deaths that were reviewed annually.Results The average annual CRn for all countries increased from 17% in 2015 to 28% in 2019; the average annual CRr increased from 8% to 13%. Between 2015 and 2019, 22 countries (73%) reported increases in the CRn—with an average increase of 20 (SD 18) percentage points—and 24 countries (80%) reported increases in CRr by 7 (SD 11) percentage points. Low values of CRr contrasts with country-published review rates, ranging from 46% to 51%.Conclusion MDSR systems that count and review all maternal deaths can deliver real-time information that could prompt immediate actions and may improve maternal health. Consistent and systematic documentation of MDSR efforts may improve national and global monitoring. Assessing the notification and review functions using coverage indicators is feasible, not affected by fluctuations in data completeness and reporting, and can objectively capture progress

Geospatial analysis for reproductive, maternal, newborn, child and adolescent health: gaps and opportunities

Reproductive, maternal, newborn, child and adolescent health (RMNCAH) indicators, such as the maternal mortality ratio, often serve as a litmus test for health system performance, because women’s and children’s health lies at the core of any health system.1 The health and survival of women and children does not depend on a single intervention, but on packages of interventions delivered at all levels of the health system. Mapping and tracking RMNCAH therefore captures changes in wider health system performance. But mapping has traditionally been the domain of disease-specific tracking, providing useful, but limited snapshots of progress embedded in vertical intervention mechanisms. Although disease-specific spatial mapping and research are effective ways to identify geographic inequities and to inform service provision, geographic and spatial analyses of RMNCAH have the potential to provide a broader perspective. But such analyses, especially for routine RMNCAH care provision, have been underused despite their potential to inform programmes and policies in low/middle-income countries. This commentary also argues that visualisation of RMNCAH data provides a potent social accountability and decision-making tool. Given the topic’s importance, a supplement on the use of geographic information systems (GIS) in RMNCAH is long overdue.Most geospatial studies in RMNCAH start with the geographical placement of facilities and facility staff—the fundamental infrastructure of all health systems—and the location of communities. Clearly, tackling frequently occurring birth and childhood health emergencies requires accessible, person-centred systems located near the client.2 Previous geospatial studies that have focused on determining access or distance to facilities have benefited from analytical techniques developed in the environmental science and physical geography fields. Few previous studies consider realistic travel over terrain or health facility ‘bypassing,’ where healthcare-seeking clients choose not to use their closest facility. This supplement thus breaks new ground by demonstrating that geospatial analysis has

Best practices in availability, management and use of geospatial data to guide reproductive, maternal, child and adolescent health programmes

The commentary provides a set of considerations and some examples for reproductive, maternal, newborn, child and adolescent health (RMNCAH) programmes that wish to use geospatial data.Monitoring RMNCAH data trends or change over time and estimating disease burden remain major challenges due to limited reliable geolocated data sources, inconsistent spatial denominators and technical capacity needs.Increased availability of spatial data, such as satellite imagery and geolocated survey and facility data, coupled with recent methodological refinements, has created new opportunities for use of geographic information systems to achieve spatial disaggregation of RMNCAH data and highlights subnational monitoring among vulnerable populations.More refined geospatial analyses can help to close the gap for countries with high maternity-related deaths and suffering