887 research outputs found
Patient experiences and health system responsiveness in South Africa
<p>Abstract</p> <p>Background</p> <p>Patients' views are being given more and more importance in policy-making. Understanding populations' perceptions of quality of care is critical to developing measures to increase the utilization of primary health care services. Using the data from the South African <it>World Health Survey </it>(WHS), the current study aims to evaluate the degree of health care service responsiveness (both out-patient and in-patient) and comparing experiences of individuals who used public and private services in South Africa.</p> <p>Methods</p> <p>A population-based survey of 2352 participants (1116 men and 1236 women) was conducted in South Africa in 2003, the WHS – as part of a World Health Organization (WHO) project focused on health system performance assessment in member countries.</p> <p>Results</p> <p>Health care utilization was among those who attended in-patient care 72.2% attended a public and 24.3% a private facility, and of those who attended out-patient care 58.7% attended a public and 35.7% a private facility. Major components identified for out-patient care responsiveness in this survey were highly correlated with health care access, communication and autonomy, secondarily to dignity, confidentiality and quality of basic amenities, and thirdly to health problem solution. The degree of responsiveness with publicly provided care was in this study significantly lower than in private health care. Overall patient non-responsiveness for the public out-patient service was 16.8% and 3.2% for private care. Discrimination was also one of the principal reasons for non-responsiveness in all aspects of provided health care.</p> <p>Conclusion</p> <p>Health care access, communication, autonomy, and discriminatory experiences were identified as priority areas for actions to improve responsiveness of health care services in South Africa.</p
Mortalidade infantil evitavel e barreiras de acesso a atencao basica no Recife, Brasil
Estudo experimental da ação da metilprednisolona utilizada antes do traumatismo raquimedular em ratos Wistar
Fear expression is suppressed by tyrosine administration
Animal studies have demonstrated that catecholamines regulate several aspects of fear conditioning. In humans, however, pharmacological manipulations of the catecholaminergic system have been scarce, and their primary focus has been to interfering with catecholaminergic activity after fear acquisition or expression had taken place, using L-Dopa, primarily, as catecholaminergic precursor. Here, we sought to determine if putative increases in presynaptic dopamine and norepinephrine by tyrosine administered before conditioning could affect fear expression. Electrodermal activity (EDA) of 46 healthy participants (24 placebo, 22 tyrosine) was measured in a fear instructed task. Results showed that tyrosine abolished fear expression compared to placebo. Importantly, tyrosine did not affect EDA responses to the aversive stimulus (UCS) or alter participants' mood. Therefore, the effect of tyrosine on fear expression cannot be attributed to these factors. Taken together, these findings provide evidence that the catecholaminergic system influences fear expression in humans
Comparing the short-term memory binding test and RAVLT as predictors of hippocampal atrophy
BACKGROUND: The Rey Auditory Verbal Learning Test (RAVLT) assesses the long-term verbal episodic memory, while the short-term memory binding (STMB) tests assess conjunctive memory binding. In the STMB, participants should remember the integration of shapes (or objects) and colors, forming a unique representation in memory. OBJECTIVE: The objective of this study was to compare the STMB and the RAVLT as predictors of hippocampal atrophy. METHODS: All participants underwent neuropsychological assessment and MRI data were collected. Participants were 17 patients with mild cognitive impairment (MCI) and 12 patients with Alzheimer’s disease (AD). All participants performed the RAVLT test and two different paradigms of the STMB test: change detection and free recall. In the change detection task, patients need to recognize if there was a difference in shapes and colors (unbound) or shape-color integrations (bound) between two consecutive screens. In the free recall task, patients were asked to recall aloud objects and colors individually (unbound condition) or object-color integrations (bound condition) that they had just seen in a screen. The groups were compared using ANCOVA analyses, and regression analyses were used to evaluate which cognitive paradigm better predicted the hippocampal atrophy. RESULTS: 10 patients showed no hippocampal atrophy (all were MCI patients) and 19 had atrophy (7 MCI and 12 AD). The group with atrophy was older and showed worse performance in the cognitive tasks. The regression model using the atrophy (positive or negative) as the dependent variable, and the STMB tasks, RAVLT delayed score, age and education as the predictors, indicated that only the STMB change detection bound task was retained in the model (R = 0.517, R2 = 0.268, p = 0.004), explaining 26,8% of the variance. Present findings suggest that the change detection STMB task may be a better marker of neurodegeneration than the other tests
In vitro susceptibility characteristics of Cryptococcus neoformans varieties from AIDS patients in Goiânia, Brazil
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A needs assessment study for optimising prescribing practice in secondary care junior doctors: the Antibiotic Prescribing Education among Doctors (APED).
BACKGROUND: Appropriate antimicrobial prescribing is essential for patient care, yet up to half of antimicrobial prescriptions written in the UK are sub-optimal. Improving prescriber education has recently been promoted as a mechanism to optimise antimicrobial use, but identification of key learning objectives to facilitate this is so far lacking. Using qualitative methods we investigated junior doctor knowledge, attitudes, and behaviours around antimicrobial prescribing to identify key areas to address in future educational programmes.
METHODS: A cross-sectional survey of qualified doctors in training in West London was undertaken exploring antimicrobial prescribing practices and educational needs.
RESULTS: Among 140 junior doctors from 5 London hospitals, a third (34 %) reported prescribing primarily unsupervised, and two thirds (67 %) reported difficulties obtaining prescribing support outside of hours. 20 % stated not feeling confident in writing an antimicrobial prescription, but confidence was increased through having confirmatory diagnostic results (24) and obtaining advice from a senior doctor (26 %); whether this senior was from their own specialty, or an infection-specialist, varied significantly (p < 0.01) by experience. Only a small percentage (5-13 %; depending on number of years post-qualification) of participants stated their previous antimicrobial education was effective. 60 % of those in their first year post qualification reported wanting further education in antimicrobial prescribing, rising to 74 % among more experienced junior doctors. Specific areas of educational need identified were (i) principles of antimicrobial prescribing, (ii) diagnosis of infections, (iii) clinical review of patients with infections, (iv) prescribing in the context of antimicrobial resistance, and (v) laboratory testing and test results.
CONCLUSIONS: A significant proportion of junior doctors report lone prescribing of antimicrobials in the context of low self-perceived confidence and knowledge in this field, and frequent difficulty in accessing help when necessary. Innovative training, targeting five specific areas identified through this needs assessment, is urgently needed by junior doctors practising in secondary care
Reference Ranges for the Clinical Laboratory Derived from a Rural Population in Kericho, Kenya
The conduct of Phase I/II HIV vaccine trials internationally necessitates the development of region-specific clinical reference ranges for trial enrolment and participant monitoring. A population based cohort of adults in Kericho, Kenya, a potential vaccine trial site, allowed development of clinical laboratory reference ranges. Lymphocyte immunophenotyping was performed on 1293 HIV seronegative study participants. Hematology and clinical chemistry were performed on up to 1541 cohort enrollees. The ratio of males to females was 1.9∶1. Means, medians and 95% reference ranges were calculated and compared with those from other nations. The median CD4+ T cell count for the group was 810 cells/µl. There were significant gender differences for both red and white blood cell parameters. Kenyan subjects had lower median hemoglobin concentrations (9.5 g/dL; range 6.7–11.1) and neutrophil counts (1850 cells/µl; range 914–4715) compared to North Americans. Kenyan clinical chemistry reference ranges were comparable to those from the USA, with the exception of the upper limits for bilirubin and blood urea nitrogen, which were 2.3-fold higher and 1.5-fold lower, respectively. This study is the first to assess clinical reference ranges for a highland community in Kenya and highlights the need to define clinical laboratory ranges from the national community not only for clinical research but also care and treatment
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