De Landelijke Bestuurskunde Dag

Donderdag 19 maart werd in Nijmegen de zesde Landelijke Bestuurskunde Dag georganiseerd. Het thema van deze dag was: "De overheid: Vernieuwer of Vernieler?" Met een redelijk grote groep enthousiastelingen vertrokken we om half acht naar het Oosten. Dit in tegenstelling tot de Leidse docenten. Er waren er slechts nul aanwezig

Treatment of Infections in Young Infants in Low- and Middle-Income Countries:A Systematic Review and Meta-analysis of Frontline Health Worker Diagnosis and Antibiotic Access

BACKGROUND: Inadequate illness recognition and access to antibiotics contribute to high case fatality from infections in young infants (<2 months) in low- and middle-income countries (LMICs). We aimed to address three questions regarding access to treatment for young infant infections in LMICs: (1) Can frontline health workers accurately diagnose possible bacterial infection (pBI)?; (2) How available and affordable are antibiotics?; (3) How often are antibiotics procured without a prescription? METHODS AND FINDINGS: We searched PubMed, Embase, WHO/Health Action International (HAI), databases, service provision assessments (SPAs), Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and grey literature with no date restriction until May 2014. Data were identified from 37 published studies, 46 HAI national surveys, and eight SPAs. For study question 1, meta-analysis showed that clinical sign-based algorithms predicted bacterial infection in young infants with high sensitivity (87%, 95% CI 82%-91%) and lower specificity (62%, 95% CI 48%-75%) (six studies, n = 14,254). Frontline health workers diagnosed pBI in young infants with an average sensitivity of 82% (95% CI 76%-88%) and specificity of 69% (95% CI 54%-83%) (eight studies, n = 11,857) compared to physicians. For question 2, first-line injectable agents (ampicillin, gentamicin, and penicillin) had low variable availability in first-level health facilities in Africa and South Asia. Oral amoxicillin and cotrimoxazole were widely available at low cost in most regions. For question 3, no studies on young infants were identified, however 25% of pediatric antibiotic purchases in LMICs were obtained without a prescription (11 studies, 95% CI 18%-34%), with lower rates among infants <1 year. Study limitations included potential selection bias and lack of neonatal-specific data. CONCLUSIONS: Trained frontline health workers may screen for pBI in young infants with relatively high sensitivity and lower specificity. Availability of first-line injectable antibiotics appears low in many health facilities in Africa and Asia. Improved data and advocacy are needed to increase the availability and appropriate utilization of antibiotics for young infant infections in LMICs. REVIEW REGISTRATION: PROSPERO International prospective register of systematic reviews (CRD42013004586). Please see later in the article for the Editors' Summary

Family care: An exploratory study of experience and expectations among older Chinese immigrants in Australia

Objectives: Family caregiving in East Asian cultures is traditionally based on the Confucian ethic of filial piety that mandates total, holistic care for elders. While research suggests changes in 'family care' are occurring in Asian countries themselves, remarkably little is known about immigrant Asian families in Australia. The study aimed to explore the experience of 'family care' among Chinese-speaking older people who have migrated to Australia in later life. Method: In-depth interviews were conducted in Cantonese with a convenience sample of five cases, including six older Chinese and analysed inductively for dominant themes. Findings: Although no single model of 'family care' emerged, findings reveal significant departures from the norms of filial piety and an overall 'westernisation' of care practices, both in relation to what families actually do for their parents and what the older people themselves expect. Conclusions: Transformation of filial culture has implications for policy, service planning and professional practice. It cannot be assumed that elderly Chinese immigrants' needs are being met through traditional family structures. Copyright © eContent Management Pty Ltd.link_to_subscribed_fulltex

Deconvolution by Design — an Approach to the Inverse Problem of Ultrasonic Testing

In this paper we present some preliminary results on a new approach to the problem of characterizing flaws using ultrasonics. The approach takes advantage of the fact that we have control over the time waveform of the probing pulse in an ultrasonic test. It also takes advantage of some special properties of the inverse Gaussian function and an effective, stable, continuous deconvolution procedure which is based on this special function. The procedure also has the special feature that the error in the resultant of the deconvolution, which contains all available information about the flaw-scatterer, can be estimated in a powerful way.</p

Cross-sectional study on the availability of essential medicines at public health facilities in Jur River County, South Sudan

Introduction: The availability of essential medicines in health facilities in Jur River County (JRC), South Sudan, is below expectations. This is despite the requirement that all citizens should be provided with adequate quality health care services. The objective of the study was to assess the availability of essential medicines and inventory management practices in JRC. Method: This was a cross sectional study conducted in 31 of the 51 health facilities in JRC. These were 23 primary health care units (PHCUs) and eight primary health care centres (PHCCs). Data were collected using a structured questionnaire, logistics management information system (LMIS) data reports and checklist forms. All the completed checklists and questionnaires were analysed using IBM SPSS statistics version 20.0 and LMIS data was analysed using excel spreadsheet. Results: The main findings were stockouts and overstocking of essential medicines, low skilled health workers (HWs) and ineffective rotation of medicines in the health facilities. From January – August 2021, the stockouts of essential medicines in PHCUs and PHCCs were 44% and 34% respectively, whereas the incidences of over stockings were 22% and 31% respectively. Almost all (97%) of the health facilities kept records of essential medicines, revealing stockouts of 90.3% on the day of the visit. Of the 31 HWs interviewed 23 (74.9%) were community health workers (CHWs), four (12.9%) nurses and four (12.9%) pharmacy technicians; most (87.1%) had attained secondary education. Conclusion: The quantities of essential medicines were inadequate and able to cover only two months. The major reasons were inadequate supply of essential medicines; recruitment of CHWs and nurses, instead of pharmacy technicians in the management of supplies; ineffective rotation of medicines within and other health facilities. More research is needed on the factors affecting the availability of medicines at the health facilities in JRC