Journeys to tuberculosis treatment: a qualitative study of patients, families and communities in Jogjakarta, Indonesia

<p>Abstract</p> <p>Background</p> <p>Many tuberculosis (TB) patients in Indonesia are diagnosed late. We seek to document patient journeys toward TB diagnosis and treatment and factors that influence health care seeking behavior.</p> <p>Methods</p> <p>TB patients in Jogjakarta municipality (urban) and Kulon Progo district (rural) were recruited from health care facilities participating in the DOTS strategy and health care facilities not participating in the DOTS strategy, using purposive sampling methods. Data were collected through in-depth interviews with TB patients and members of their family and through Focus Group Discussions (FGD) with community members.</p> <p>Results</p> <p>In total, 67 TB patients and 22 family members were interviewed and 6 FGDs were performed. According to their care seeking behavior patients were categorized into National TB program's (NTP) dream cases (18%), 'slow-but-sure patients' (34%), 'shopaholics' (45%), and the NTP's nightmare case (3%). Care seeking behavior patterns did not seem to be influenced by gender, place of residence and educational level. Factors that influenced care seeking behavior include income and advice from household members or friends. Family members based their recommendation on previous experience and affordability. FGD results suggest that the majority of people in the urban area preferred the hospital or chest clinic for diagnosis and treatment of TB whereas in the rural area private practitioners were preferred. Knowledge about TB treatment being free of charge was better in the urban area. Many community members from the rural area doubted whether TB treatment would be available free of charge.</p> <p>Conclusion</p> <p>Most TB patients took over a month to reach a DOTS facility after symptoms appeared and had consulted a number of providers. Their income and advice from household members and friends were factors that influenced their care seeking behavior most.</p

An internal health systems research portfolio assessment of a low-income country research institution

<p>Abstract</p> <p>Background</p> <p>In order to determine the type and amount of health systems research being conducted within ICDDR,B (also known as the Centre), a leading research institution in Bangladesh, an internal review of all on-going research protocols was conducted in September 2007.</p> <p>Methods</p> <p>A review of all ongoing research protocols within the Centre was conducted. The names of the investigators and the institutional divisions of the protocols were removed in order to decrease the amount of reviewer bias. The building blocks of the World Health Organization's "Framework for Action" on health systems was used to categorize the protocols considered to be health systems research projects. Several additional items were collected, e.g. the highest level of education completed by the Principal Investigator. A total dollar value was placed on the health systems research portfolio of the institution based on the budgets of the selected protocols.</p> <p>Results</p> <p>As of September 2007 16 out of 118 (13.5%) reviewed protocols were considered to be health systems research projects. Results of the six building blocks of the health system categorization demonstrated that a majority of these protocols involved elements of health services delivery. There was very little engagement in more downstream systems and policy research that involved leadership and governance of the health system. Eleven of the HSR studies were local in scope, while there was only one study that has a multinational focus. The Centre's total dollar value for the health systems research project portfolio added up to US$ 3,723,331.</p> <p>Conclusions</p> <p>This internal review can serve as a snap shot of on-going activities, and as a baseline for future assessments against which to monitor progress in the area of health systems research. Further, it can serve as a model for other institutions striving to assess and develop health systems research programmes and capacity.</p

Farmer perceptions and responses to soil degradation in Swaziland

Soil degradation is globally concerning due to its adverse effects on the environment and agricultural production. Much of Swaziland is at risk from degradation. This paper assesses farmer perceptions and responses to soil degradation in 2002 and 2014, focusing on two land uses that underpin rural livelihoods: arable land and rangeland areas. It uses repeat household surveys and semi-structured interviews, in two case study chiefdoms in the country’s middleveld (KaBhudla and Engcayini) in the first longitudinal study of its kind. We find that observations of land degradation are perceived mainly through changes in land productivity, with chemical degradation occurring predominantly on arable land and physical degradation and erosion mainly in rangeland areas. Changes in rainfall are particularly important in determining responses. While perceptions of the causes and impacts of degradation largely concur with the scientific literature, responses were constrained by poor land availability, shorter and more unpredictable cropping seasons because of changing rains and low awareness, access to or knowledge of agricultural inputs. We suggest that sustainable arable land management can be enhanced through improved access to alternative sources of water, use of management practices that retain soil and moisture and greater access to agricultural inputs and capacity building to ensure their appropriate use. We suggest collaborative management for settlement planning that integrates soil conservation and livestock management strategies such as controlled stocking levels and rotational grazing could improve land quality in rangeland areas. Together, these approaches can help land users to better manage change

Diclofenac Prolongs Repolarization in Ventricular Muscle with Impaired Repolarization Reserve

Background: The aim of the present work was to characterize the electrophysiological effects of the non-steroidal anti- inflammatory drug diclofenac and to study the possible proarrhythmic potency of the drug in ventricular muscle. Methods: Ion currents were recorded using voltage clamp technique in canine single ventricular cells and action potentials were obtained from canine ventricular preparations using microelectrodes. The proarrhythmic potency of the drug was investigated in an anaesthetized rabbit proarrhythmia model. Results: Action potentials were slightly lengthened in ventricular muscle but were shortened in Purkinje fibers by diclofenac (20 mM). The maximum upstroke velocity was decreased in both preparations. Larger repolarization prolongation was observed when repolarization reserve was impaired by previous BaCl 2 application. Diclofenac (3 mg/kg) did not prolong while dofetilide (25 mg/kg) significantly lengthened the QT c interval in anaesthetized rabbits. The addition of diclofenac following reduction of repolarization reserve by dofetilide further prolonged QT c . Diclofenac alone did not induce Torsades de Pointes ventricular tachycardia (TdP) while TdP incidence following dofetilide was 20%. However, the combination of diclofenac and dofetilide significantly increased TdP incidence (62%). In single ventricular cells diclofenac (30 mM) decreased the amplitude of rapid (I Kr ) and slow (I Ks ) delayed rectifier currents thereby attenuating repolarization reserve. L-type calcium current (I Ca ) was slightly diminished, but the transient outward (I to ) and inward rectifier (I K1 ) potassium currents were not influenced. Conclusions: Diclofenac at therapeutic concentrations and even at high dose does not prolong repolarization markedly and does not increase the risk of arrhythmia in normal heart. However, high dose diclofenac treatment may lengthen repolarization and enhance proarrhythmic risk in hearts with reduced repolarization reserve

Maternal underestimation of child’s weight at pre-school age and weight development between age 5 and 12 years: The abcd-study

Background: Healthcare monitoring of child growth reduces with age, which may increase parental influences on children’s weight development. This study aimed to examine the association between maternal underestimation of child’s weight at age 5/6 and weight development between 5 and 12 years. Methods: We pe

Adding colour-realistic video images to audio playbacks increases stimulus engagement but does not enhance vocal learning in zebra finches

Bird song and human speech are learned early in life and for both cases engagement with live social tutors generally leads to better learning outcomes than passive audio-only exposure. Real-world tutor-tutee relations are normally not uni- but multimodal and observations suggest that visual cues related to sound production might enhance vocal learning. We tested this hypothesis by pairing appropriate, colour-realistic, high frame-rate videos of a singing adult male zebra finch tutor with song playbacks and presenting these stimuli to juvenile zebra finches (Taeniopygia guttata). Juveniles exposed to song playbacks combined with video presentation of a singing bird approached the stimulus more often and spent more time close to it than juveniles exposed to audio playback only or audio playback combined with pixelated and time-reversed videos. However, higher engagement with the realistic audio-visual stimuli was not predictive of better song learning. Thus, although multimodality increased stimulus engagement and biologically relevant video content was more salient than colour and movement equivalent videos, the higher engagement with the realistic audio-visual stimuli did not lead to enhanced vocal learning. Whether the lack of three-dimensionality of a video tutor and/or the lack of meaningful social interaction make them less suitable for facilitating song learning than audio-visual exposure to a live tutor remains to be tested.Animal science

Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector

textabstractThere is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be characterized as a system involving managed competition and mandatory healthcare insurance. Information about the quality of care provided by hospitals has been publicly available since 2008. In this paper, we evaluate the relationship between quality scores for three diagnosis groups and the market power indicators of hospitals. We estimate the impact of competition on quality in an environment of liberalized pricing. For this research, we used unique price and production data relating to three diagnosis groups (cataract, adenoid and tonsils, bladder tumor) produced by Dutch hospitals in the period 2008–2011. We also used the quality indicators relating to these diagnosis groups. We reveal a negative relationship between market share and quality score for two of the three diagnosis groups studied, meaning that hospitals in competitive markets have better quality scores than those in concentrated markets. We therefore conclude that more competition is associated with higher quality scores

The Incremental Cooperative Design of Preventive Healthcare Networks

This document is the Accepted Manuscript version of the following article: Soheil Davari, 'The incremental cooperative design of preventive healthcare networks', Annals of Operations Research, first published online 27 June 2017. Under embargo. Embargo end date: 27 June 2018. The final publication is available at Springer via http://dx.doi.org/10.1007/s10479-017-2569-1.In the Preventive Healthcare Network Design Problem (PHNDP), one seeks to locate facilities in a way that the uptake of services is maximised given certain constraints such as congestion considerations. We introduce the incremental and cooperative version of the problem, IC-PHNDP for short, in which facilities are added incrementally to the network (one at a time), contributing to the service levels. We first develop a general non-linear model of this problem and then present a method to make it linear. As the problem is of a combinatorial nature, an efficient Variable Neighbourhood Search (VNS) algorithm is proposed to solve it. In order to gain insight into the problem, the computational studies were performed with randomly generated instances of different settings. Results clearly show that VNS performs well in solving IC-PHNDP with errors not more than 1.54%.Peer reviewe