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Cultural adaptations to augment health and mental health services: a systematic review
No full textAbstract
Background
Membership in diverse racial, ethnic, and cultural groups is often associated with inequitable health and mental health outcomes for diverse populations. Yet, little is known about how cultural adaptations of standard services affect health and mental health outcomes for service recipients. This systematic review identified extant themes in the research regarding cultural adaptations across a broad range of health and mental health services and synthesized the most rigorous experimental research available to isolate and evaluate potential efficacy gains of cultural adaptations to service delivery.
Methods
MEDLINE, PsycINFO, CINAHL, EMBASE, and grey literature sources were searched for English-language studies published between January 1955 and January 2015. Cultural adaptations to any aspect of a service delivery were considered. Outcomes of interest included changes in service provider behavior or changes in the behavioral, medical, or self-reported experience of recipients.
Results
Thirty-one studies met the inclusion criteria. The most frequently tested adaptation occurred in preventive services and consisted of modifying the content of materials or services delivered. None of the included studies focused on making changes in the provider\u2019s behavior. Many different populations were studied but most research was concerned with the experiences and outcomes of African Americans. Seventeen of the 31 retained studies observed at least one significant effect in favor of a culturally adapted service. However there were also findings that favored the control group or showed no difference. Researchers did not find consistent evidence supporting implementation of any specific type of adaptation nor increased efficacy with any particular cultural group.
Conclusions
Conceptual frameworks to classify cultural adaptations and their resultant health/mental health outcomes were developed and applied in a variety of ways. This review synthesizes the most rigorous research in the field and identifies implications for policy, practice, and research, including individualization, cost considerations, and patient or client satisfaction, among others
Improved trends in cardiovascular complications among subjects with type 2 diabetes in Korea: a nationwide study (2006\u20132013)
No full textAbstract
Background
Representative data on the secular trends in cardiovascular disease (CVD) are limited in Asian populations with diabetes. We aimed to estimate the temporal trends in cardiovascular complications using Korean nationwide whole population-based claims data in subjects with and without diabetes.
Methods
Type 2 diabetes was defined as a current medication history of anti-diabetic drugs and the presence of International Classification of Diseases (ICD)-10 codes (E11\u2013E14) as diagnosis. We compared the 8-year rates of six cardiovascular complications [i.e., ischemic heart disease, acute myocardial infarction (AMI), ischemic stroke, hemorrhagic stroke, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG)] in Korean adults aged 30\ua0years and older using data from four consecutive nationwide databases (2006\u20132007, 2008\u20132009, 2010\u20132011, and 2012\u20132013) of Korean national health insurance service.
Results
A total of 1,645,348, 1,971,559, 2,291,247, and 2,562,612 subjects with type 2 diabetes were found in the year of 2006\u20132007, 2008\u20132009, 2010\u20132011, and 2012\u20132013, respectively. Age and gender standardized rates of the six predefined cardiovascular complications decreased in Korean adults with type 2 diabetes during the study period. The greatest relative reductions were observed for hospitalization due to AMI (\u221237.28%), followed by hospitalizations due to ischemic stroke (\u221236.98%). In the overall population without type 2 diabetes, the greatest relative reductions were observed for hospitalization for hemorrhagic stroke (\u221229.47%), followed by hospitalization due to ischemic stroke (\u221228.92%). Relative decreases in all six predefined cardiovascular complications were generally more profound in adults with diabetes than in those without diabetes, which led to significant decrease in the relative risks of all six cardiovascular complications in subjects with diabetes over the past 8\ua0years. However, people with diabetes still had a two- to sixfold higher risk of hospitalization for major CVD events and interventions than people without diabetes.
Conclusions
Our findings suggest a significant reduction in the rate of people affected by CVD within the diabetic population. However, as the number of people with diabetes rises, the absolute burden of CVD will still be high in Korea
The prognostic role of the cancer stem cell marker CD44 in ovarian cancer: a meta-analysis
No full textAbstract
Background
CD44 has recently been reported as a cancer stem cell marker in ovarian cancer. However, the clinicopathological and prognostic value of this marker in ovarian cancer remains controversial; Here, we aimed to investigate the correlation between CD44 expression and the clinicopathological features or survival of ovarian cancer patients.
Methods
An extensive literature search in the PubMed, EMBASE, and Wanfang databases (up to June 1, 2016) was conducted to identify studies that assessed the clinical or prognostic significance of CD44 expression in ovarian cancer. A meta-analysis was then performed to clarify the association between CD44 expression and clinical outcomes of ovarian cancer patients.
Results
A total of 18 publications consisting of 2161 patients were included for this meta-analysis. Our data reveal that CD44-positive expression in ovarian cancers were significantly associated with a high TMN stage (pooled OR\ua0=\ua02.11, 95% CI 1.26\u20133.53, P\ua0=\ua00.004) and poor 5-year overall survival (RR\ua0=\ua01.42, 95% CI 1.01\u20132.00, P\ua0=\ua00.05). However, CD44 expression was not associated with tumor grade, lymphatic metastasis, age of the patients, residual tumor size, response to chemotherapy, or ascites volume (P\ua0>\ua00.05).
Conclusion
Detection of CD44 may be an effective tool for pathological diagnosis and prognostic prediction of ovarian cancer patients in clinical applications
Malaria epidemiology in central Myanmar: identification of a multi-species asymptomatic reservoir of infection
No full textAbstract
Background
The spread of artemisinin-resistant Plasmodium falciparum is a global health concern. Myanmar stands at the frontier of artemisinin-resistant P. falciparum. Myanmar also has the highest reported malaria burden in Southeast Asia; it is integral in the World Health Organization\u2019s plan to eliminate malaria in Southeast Asia, yet few epidemiological data exist for the general population in Myanmar.
Methods
This cross-sectional, probability household survey was conducted in Phyu township, Bago Region (central Myanmar), during the wet season of 2013. Interviewers collected clinical and behavioural data, recorded tympanic temperature and obtained dried blood spots for malaria PCR and serology. Plasmodium falciparum positive samples were tested for genetic mutations in the K13 region that may confer artemisinin resistance. Estimated type-specific malaria PCR prevalence and seroprevalence were calculated, with regression analysis to identify risk factors for seropositivity to P. falciparum . Data were weighted to account for unequal selection probabilities.
Results
1638 participants were sampled (500 households). Weighted PCR prevalence was low (n\ua0=\ua041, 2.5%) and most cases were afebrile (93%). Plasmodium falciparum was the most common species (n\ua0=\ua019. 1.1%) and five (26%) P. falciparum samples harboured K13 mutations. Plasmodium knowlesi was detected in 1.0% (n\ua0=\ua016) and Plasmodium vivax was detected in 0.4% (n\ua0=\ua07). Seroprevalence was 9.4% for P. falciparum and 3.1% for P. vivax . Seroconversion to P. falciparum was 0.003/year in the whole population, but 16-fold higher in men over 23\ua0years old (LR test p\ua0=\ua00.016).
Discussion
This is the first population-based seroprevalence study from central Myanmar. Low overall prevalence was discovered. However, these data suggest endemic transmission continues, probably associated with behavioural risk factors amongst working-age men. Genetic mutations associated with P. falciparum artemisinin resistance, the presence of P. knowlesi and discrete demographic risk groups present opportunities and challenges for malaria control. Responses targeted to working-age men, capable of detecting ..
Stigmatization among methadone maintenance treatment patients in mountainous areas in northern Vietnam
No full textAbstract
Background
Stigma and discrimination may adversely affect the benefits of methadone maintenance treatment (MMT) for drug users, especially in disadvantaged settings. This study assessed stigma and discrimination against MMT patients in the mountainous and rural areas in Vietnam and explored their associated factors to inform implementation strategies.
Methods
We interviewed 241 MMT patients in two clinics: one in Tuyen Quang Province\u2019s inner city and the other in Son Duong District, to assess stigma and discrimination that patients perceived and experienced. Socioeconomic status, health behaviors, health status, and history of drug abuse were examined. Multivariate linear and logistic regression models were used to explore factors associated with stigma and discrimination.
Results
The majority of respondents reported experiencing stigma and discrimination including blame/judgment (95.1%), shame (95.1%), disclosure (71.4%), and the fear of human immunodeficiency virus (HIV) transmission by others (74.1%). Unemployed patients were more likely to experience discrimination (Coef\u2009=\u2009\u22121.18, 95% CI\u2009=\u2009\u22121.87; \u22120.89). Those who were taking an antiretroviral were more likely to disclose their health status (Coef\u2009=\u20092.27, 95% CI\u2009=\u20090.6; 3.94). In addition, a higher likelihood of being blamed/judged and shamed was associated with those who suffered from anxiety/depression (Coef\u2009=\u20091.59, 95% CI\u2009=\u20090.24; 2.93 and Coef\u2009=\u20091.07, 95% CI\u2009=\u20090.36; 1.79, respectively).
Conclusions
MMT patients in these mountainous areas perceived high levels of stigma and discrimination which were associated with mental health disorders, unemployment, and HIV infection. These findings highlighted the importance of reducing drug use and HIV-related stigma against high-risk populations. Besides, psychosocial and familial supports, as well as job referrals, also play crucial roles in terms of promoting quality of life among MMT patients
Factors associated with occupancy of pharmacist positions in public sector hospitals in Uganda: a cross-sectional study
No full textAbstract
Background
Pharmacists are invaluable resources in health care. Their expertise in pharmacotherapy and medicine management both ensures that medicines of appropriate quality are available in health facilities at the right cost and are used appropriately. Unfortunately, some countries like Uganda have shortage of pharmacists in public health facilities, the dominant providers of care. This study investigated the factors that affect the occupancy of pharmacist positions in Uganda\u2019s public hospitals, including hiring patterns and job attraction and retention.
Methods
A cross-sectional survey of 91 registered pharmacists practicing in Uganda and desk review of records from the country\u2019s health care worker (HCW) recruiting agency was done in the months of May, June, and July, 2016. Pharmacist interviews were done using self-administered structured questionnaire and analyzed by descriptive statistics and chi-square test.
Results
Slight majority (53%) of the interviewed pharmacists work in two sectors. About 60% of the pharmacists had ever applied for public hospital jobs. Of those who received offers ( N \u2009=\u200946), 30% had declined them. Among those who accepted the offers ( N \u2009=\u200941), 41% had already quit. Meanwhile, the pace of hiring pharmacists into Uganda\u2019s public sector is too slow. Low socio-economic status of family in childhood ( \u3c7
2
\u2009=\u20092.77, p \u2009=\u20090.10), admission through matriculation and diploma scheme ( \u3c7
2
\u2009=\u20092.37, p \u2009=\u20090.12), internship in countryside hospitals ( \u3c7
2
\u2009=\u20092.24, p \u2009=\u20090.13), working experience before pharmacy school ( \u3c7
2
\u2009=\u20092.21, p \u2009=\u20090.14), salary expectation ( \u3c7
2
\u2009=\u20091.76, p \u2009=\u20090.18), and rural secondary education ( \u3c7
2
\u2009=\u20091.75, p \u2009=\u20090.19) favored attraction but in a statistically insignificant manner. Retention was most favored by zero postgraduate qualification ( \u3c7
2
..
Early initiation of breastfeeding among mothers of children under the age of 24\ua0months in Southern Ethiopia
No full textAbstract
Background
The early initiation of breastfeeding (EIBF), or timely initiation of breastfeeding, is the proportion of children put to the breast within one hour of birth. It is an important strategy for reducing perinatal and infant morbidity and mortality, but it remains under practiced in Ethiopia. The aim of the study was to assess the prevalence and the predicting factors associated with EIBF.
Methods
A community based cross-sectional study was conducted in 634 mothers in Dale Woreda, South Ethiopia. Multistage cluster sampling was used to select participating mothers. EIBF was outcome variable whereas sociodemographic characteristics and knowledge and practice of maternal health service were explanatory variables. A face-to-face interview using a pretested semi-structured questionnaire was done from September 2012 to March 2013. To investigate predicting factors, bivariate and multivariate logistic regression analysis was done.
Results
A total of 634 mothers of children under 24\ua0months were interviewed. During the time of data collection, 94.3% of the mothers had breastfed. The prevalence of EIBF was 83.7%. Ownership of the house was a significant predicting factor for EIBF. Mothers who lived in rented houses were significantly less likely (60%) to initiate breastfeeding within one hour of birth compared to mothers who owned their own house: Adjusted odds ratio 0.40 (95% Confidence Interval 0.16, 0.97).
Conclusion
More than three-fourths of mothers initiated breastfeeding within an hour. Findings from our study suggest that improving the mother's socioeconomic status as reflected by house ownership, being a significant predictor of EIBF, would have a central role in improving EIBF
Clinical practice guidelines for the management of chronic musculoskeletal pain in primary healthcare: a systematic review
No full textAbstract
Background
Up-to-date, high quality, evidence-based clinical practice guidelines (CPGs) that are applicable for primary healthcare are vital to optimize services for the population with chronic musculoskeletal pain (CMSP). The study aimed to systematically identify and appraise the available evidence-based CPGs for the management of CMSP in adults presenting in primary healthcare settings.
Methods
A systematic review was conducted. Twelve guideline clearinghouses and six electronic databases were searched for eligible CPGs published between the years 2000 and May 2015. CPGs meeting the inclusion criteria were appraised by three reviewers using the Appraisal of Guidelines Research and Evaluation (AGREE) II.
Results
Of the 1082 records identified, 34 were eligible, and 12 CPGs were included based on the inclusion and exclusion criteria. The methodological rigor of CPG development was highly variable, and the median domain score was 66%. The median score for stakeholder involvement was 64%. The lowest median score was obtained for the domain applicability (48%). There was inconsistent use of frameworks to aggregate the level of evidence and the strength of the recommendation in the included CPGs. The scope and content of the included CPGs focussed on opioid prescription.
Conclusion
Numerous CPGs that are applicable for the primary healthcare of CMSP exists, varying in their scope and methodological quality. This study highlights specific elements to enhance the development and reporting of CPGs, which may play a role in the uptake of guidelines into clinical practice. These elements include enhanced reporting of methodological aspects, the use of frameworks to enhance decision making processes, the inclusion of patient preferences and values, and the consideration of factors influencing applicability of recommendations.
Trial registration
PROSPERO CRD42015022098
Lower gastrointestinal bleeding\u2014Computed Tomographic Angiography, Colonoscopy or both?
No full textAbstract
Background
Lower endoscopy (LE) is the standard diagnostic modality for lower gastrointestinal bleeding (LGIB). Conversely, computed tomographic angiography (CTA) offers an immediate non-invasive diagnosis visualizing the entire gastrointestinal tract. The aim of this study was to compare these 2 modalities with regards to diagnostic value and bleeding control.
Methods
Tertiary center retrospective analysis of consecutive patients admitted for LGIB between 2006 and 2012. Comparison of patients with LE vs. CTA as first exam, respectively, with emphasis on diagnostic accuracy and bleeding control.
Results
Final analysis included 183 patients; 122 (66.7%) had LE first, while 32 (17.5%) had CTA; 29 (15.8%) had neither of both exams. Median time to CTA was shorter compared to LE (3 (IQR\u2009=\u20098.2) vs. 22 (IQR\u2009=\u200936.9) hours, P \u2009<\u20090.001). Active bleeding was identified in 31% with CTA vs. 15% with LE ( P \u2009=\u20090.031); a non-actively bleeding source was found by CTA and LE in 22 vs. 31%, respectively ( P \u2009=\u20090.305). Bleeding control required endoscopy in 19%, surgery in 14% and embolization in 1.6%, while 66% were treated conservatively. Post-interventional bleeding was mostly controlled by endoscopic therapy (57%). 80% of patients with active bleeding on CTA required surgery.
Conclusions
Post-interventional LGIB was effectively addressed by LE. For other causes of LGIB, CTA was efficient, and more available than colonoscopy. Treatment was conservative for most patients. In case of active bleeding, CTA could localize the bleeding source and predict the need for surgery
Campylobacter coli infection in pet birds in southern Italy
No full textAbstract
Avian species are considered as the main reservoir of Campylobacter spp. However, few data are available on the presence of this microorganism in pet birds. This study was therefore performed to determine the prevalence of Campylobacter spp. in pet birds bred in southern Italy. Faecal samples were collected from 88 cages housing different species of pet birds and examined by bacteriological culture and polymerase chain reaction. A total of 13.6% of the cage samples were positive for Campylobacter coli . Other Campylobacter spp. were not found. The study shows that C. coli can be isolated from the cages of apparently healthy pet birds, which should therefore be considered as potential carriers of C. coli and a possible source of infection for humans and companion animals