28 research outputs found
The effects of an HIV project on HIV and non-HIV services at local government clinics in urban Kampala.
No full textBACKGROUND: HIV/AIDS is a major public health concern in Uganda. There is widespread consensus that weak health systems hamper the effective provision of HIV/AIDS services. In recent years, the ways in which HIV/AIDS-focused programs interact with the delivery of other health services is often discussed, but the evidence as to whether HIV/AIDS programs strengthen or distort overall health services is limited. The aim of this study was to examine the effect of a PEPFAR-funded HIV/AIDS program on six government-run general clinics in Kampala. METHODS: Longitudinal information on the delivery of health services was collected at each clinic. Monthly changes in the volume of HIV and non-HIV services were analyzed by using multilevel models to examine the effect of an HIV/AIDS program on health service delivery. We also conducted a cross-sectional survey utilizing patient exit interviews to compare perceptions of the experiences of patients receiving HIV care and those receiving non-HIV care. RESULTS: All HIV service indicators showed a positive change after the HIV program began. In particular, the number of HIV lab tests (10.58, 95% Confidence Interval (C.I.): 5.92, 15.23) and the number of pregnant women diagnosed with HIV tests (0.52, 95%C.I.: 0.15, 0.90) increased significantly after the introduction of the project. For non-HIV/AIDS health services, TB lab tests (1.19, 95%C.I.: 0.25, 2.14) and diagnoses (0.34, 95%C.I.: 0.05, 0.64) increased significantly. Noticeable increases in trends were identified in pediatric care, including immunization (52.43, 95%C.I.: 32.42, 74.43), malaria lab tests (1.21, 95%C.I.: 0.67, 1.75), malaria diagnoses (7.10, 95%C.I.: 0.73, 13.46), and skin disease diagnoses (4.92, 95%C.I.: 2.19, 7.65). Patients' overall impressions were positive in both the HIV and non-HIV groups, with more than 90% responding favorably about their experiences. CONCLUSIONS: This study shows that when a collaboration is established to strengthen existing health systems, in addition to providing HIV/AIDS services in a setting in which other primary health care is being delivered, there are positive effects not only on HIV/AIDS services, but also on many other essential services. There was no evidence that the HIV program had any deleterious effects on health services offered at the clinics studied
Clinical severity of haemophilia A: does the classification of the 1950s still stand?
No full textThe classification of haemophilia originates from 1950s and has been adopted unchallengedly by the ISTH in 2001. The aim of this study was: does the current classification compare onset of bleeding and age at first treatment, as well as annual joint bleeding frequency according to baseline FVIII activity? Data on age and reason of diagnosis, onset of treatment, onset of bleeding and bleeding frequency from 411 patients with haemophilia A born after 1970 were collected. Data were analysed according to base-line FVIII activity levels. Age at diagnosis, onset of bleeding and start of treatment according to FVIII activity were compared with the current classification. Overall, the distinction between severe and non-severe haemophilia was clear. The distinction between mild and moderate haemophilia was more difficult, mostly due to the wide variability in the group of patients with moderate haemophilia. Patients with severe haemophilia experienced their milestones like diagnosis, first treatment and joint bleed earliest, mostly as infants aged 0-3 years, whereas patients with moderate haemophilia reached these milestones around toddler age, 2-7 years, and patients with mild haemophilia reached them when they were in elementary school, around the ages of 5-14 years. This study confirms the clinical distinction between severe and non-severe haemophilia A. However, the group of moderate haemophilia patients showed a wide variability, warranting close follow-up and individualized treatment
‘SASA! is the medicine that treats violence’. Qualitative findings on how a community mobilisation intervention to prevent violence against women created change in Kampala, Uganda
No full textBackground: Intimate partner violence (IPV) violates women's human rights and is a serious public health concern. Historically strategies to prevent IPV have focussed on individuals and their relationships without addressing the context under which IPV occurs. Primary prevention of IPV is a relatively new focus of international efforts and what SASA!, a phased community mobilisation intervention, seeks to achieve. Methods: Conducted in Kampala, Uganda, between 2007 and 2012, the SASA! Study is a cluster randomised controlled trial to assess the community-level impact of SASA! This nested qualitative study explores pathways of individual- and community-level change as a result of SASA! Forty in-depth interviews with community members (20 women, 20 men) were conducted at follow-up, audio recorded, transcribed verbatim and analysed using thematic analysis complemented by constant comparative methods. Results: SASA! influenced the dynamics of relationships and broader community norms. At the relationship level, SASA! is helping partners to explore the benefits of mutually supportive gender roles; improve communication on a variety of issues; increase levels of joint decision-making and highlight non-violent ways to deal with anger or disagreement. Not all relationships experienced the same breadth and depth of change. At the community level, SASA! has helped foster a climate of non-tolerance of violence by reducing the acceptability of violence against women and increasing individuals’ skills, willingness, and sense of responsibility to act to prevent it. It has also developed and strengthened community-based structures to catalyse and support on-going activism to prevent IPV. Discussion: This paper provides evidence of the ways in which community-based violence prevention interventions may reduce IPV in low-income settings. It offers important implications for community mobilisation approaches and for prevention of IPV against women. This research has demonstrated the potential of social norm change interventions at the community level to achieve meaningful impact within project timeframes
Microarray profile of the humoral immune response to influenza vaccination in breast cancer patients treated with chemotherapy
No full textDetection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines.
No full textPreviously undiagnosed anaemia is common in elective orthopaedic surgical patients and is associated with increased likelihood of blood transfusion and increased perioperative morbidity and mortality. A standardized approach for the detection, evaluation, and management of anaemia in this setting has been identified as an unmet medical need. A multidisciplinary panel of physicians was convened by the Network for Advancement of Transfusion Alternatives (NATA) with the aim of developing practice guidelines for the detection, evaluation, and management of preoperative anaemia in elective orthopaedic surgery. A systematic literature review and critical evaluation of the evidence was performed, and recommendations were formulated according to the method proposed by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. We recommend that elective orthopaedic surgical patients have a haemoglobin (Hb) level determination 28 days before the scheduled surgical procedure if possible (Grade 1C). We suggest that the patient's target Hb before elective surgery be within the normal range, according to the World Health Organization criteria (Grade 2C). We recommend further laboratory testing to evaluate anaemia for nutritional deficiencies, chronic renal insufficiency, and/or chronic inflammatory disease (Grade 1C). We recommend that nutritional deficiencies be treated (Grade 1C). We suggest that erythropoiesis-stimulating agents be used for anaemic patients in whom nutritional deficiencies have been ruled out, corrected, or both (Grade 2A). Anaemia should be viewed as a serious and treatable medical condition, rather than simply an abnormal laboratory value. Implementation of anaemia management in the elective orthopaedic surgery setting will improve patient outcomes.Journal ArticlePractice GuidelineResearch Support, Non-U.S. Gov'tReviewSCOPUS: re.jinfo:eu-repo/semantics/publishe
MYELOMATÖZ MENENJİT OLGU SUNUMU
No full textMYELOMATÖZ MENENJİT OLGU SUNUMUMultipl myelom(MM) monoklonal immunglobulin artışı ile karakterizemalign hematolojik bir hastalıktır. MM’de santral sinir sistemi tutulumu(%1) nadir görülmekle birlikte, görüntülemelerinde soliter lezyon olmaksızın myelomatöz menenjit saptanması daha da nadirdir. Son yıllarda yenitedavi protokolleri ile MM prognozunda iyileşme sağlanmasına rağmenSSS tutulumlu MM’nin prognozu hala oldukça kötüdür. Myelomatözmenenjit için hala yaygın kabul gören net bir tedavi protokolü yoktur.Burada izleminde myelomatöz menenjit gelişen bir vakayı sunmaktayız.POSTER BİLDİRİLERKonuşma Metinlerive Bildiri Özetleri 2182016 yılında bel ağrısı şikayeti ile başvurduğu polikliniğimizde multiplemyelom tanısı alan 45 yaşında, komorbidi olmayan kadın hastaya tedaviolarak 2 kür VAD, 3 kür VCD ve ardından Ocak 2017 tarihinde OKİT yapıldı. İdame tedavisi almayan hasta Nisan 2020’de yaygın vücut ağrıları iletarafımıza başvurdu ve çekilen MRG’de lumbal bölgede görülen lezyonnüks olarak değerlendirilerek lumbal bölgeye 10 seans radyoterapi uygulandı. Haziran 2020’de lenalidomid tedavisi başlanan hastada tedavinin 3.gününde konuşmada zorluk, şiddetli baş ağrısı, baş dönmesi ve presenkop ataklarının olması nedeniyle çekilen MRG’de dural sinüs trombozuolarak değerlendirildi ve ilaç kesildi. Hastanın tarafımızca tekrarlanan kranial MRG’de karsinomatöz menenjit lehine bulgular saptanması üzerinemyelom tutulumu ile ikincil malignitelerin ayrımı açısından endoskopi,kolonoskopi, mamografi, toraks, abdomen ve boyun BT tetkikleri yapıldı.Tomografide tiroid bezi sol lobda ve sağ akciğer üst lob posteriorundanodül gözlendi. Göğüs hastalıklarının önerisiyle PET-BT ve bronkoskopiplanlandı. PET-BT görüntüsünde akciğerde tutulum izlenmedi. Ancaktiroid bezinde tutulum izlenmesi üzerine USG ile değerlendirilip biyopsialındı. Önemi belirsiz atipi olarak sonuçlandı. Bronkoskopide maligniteyönünden bir bulguya rastlanmadı. Karaciğer segment 7 ve 4b’de izlenenmilimetrik lezyonlar nedeniyle MRG ve USG ile değerlendirildi ve patolojisaptanmadı. Yapılan tetkiklerde ikinci bir malignite saptanmaması veBOS örneklemesinde plazma hücreleri görülmesi nedeniyle myelomatözmenenjit olarak kabul edildi. 10 seans kranial radyoterapi alan hastayaardından VD-PACE tedavi protokolünün birinci kürü tarafımızca verildi.Hastanın şikayetleri geriledi. Hasta tedavi devamını almak üzere tarafımızca izlenmeye devam ediyor.Sonuç olarak, miyelomlu bir hastada nörolojik semptomların ortaya çıkması durumunda, daha sık görülen olası nedenlerin yanında myelomatözmenenjit de göz önünde bulundurulmalı, hasta MRG ve lomber ponksiyon ile değerlendirilmelidir.Anahtar kelimeler: Multipl myelom, Myelomatöz menenjitKaynaklar1 Nieuwenhuizen L, Biesma DH. Central nervous system myelomatosis: review ofliterature. Eur J Hematol. 2002;117:103–8.2 Gozzeti A, Cerase A, Lotti F, Rossi D, Palumbo A. Extramedullary intracranial localization of multiple myeloma and treatment with novel agents: a retrospective surveyof 50 patients. Cancer. 2012;118:1574–84.</p
Clinical severity of haemophilia A: does the classification of the 1950s still stand?
No full textThe classification of haemophilia originates from 1950s and has been adopted unchallengedly by the ISTH in 2001. The aim of this study was: does the current classification compare onset of bleeding and age at first treatment, as well as annual joint bleeding frequency according to baseline FVIII activity? Data on age and reason of diagnosis, onset of treatment, onset of bleeding and bleeding frequency from 411 patients with haemophilia A born after 1970 were collected. Data were analysed according to base-line FVIII activity levels. Age at diagnosis, onset of bleeding and start of treatment according to FVIII activity were compared with the current classification. Overall, the distinction between severe and non-severe haemophilia was clear. The distinction between mild and moderate haemophilia was more difficult, mostly due to the wide variability in the group of patients with moderate haemophilia. Patients with severe haemophilia experienced their milestones like diagnosis, first treatment and joint bleed earliest, mostly as infants aged 0-3 years, whereas patients with moderate haemophilia reached these milestones around toddler age, 2-7 years, and patients with mild haemophilia reached them when they were in elementary school, around the ages of 5-14 years. This study confirms the clinical distinction between severe and non-severe haemophilia A. However, the group of moderate haemophilia patients showed a wide variability, warranting close follow-up and individualized treatment
The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries: A Systematic Review
No full textThis paper summarizes the literature on the impact of state subsidized or social health insurance schemes that have been offered, mostly on a voluntary basis, to the informal sector in low-and middle-income countries. A substantial number of papers provide estimations of average treatment on the treated effect for insured persons. We summarize papers that correct for the problem of self-selection into insurance and papers that estimate the average intention to treat effect. Summarizing the literature was difficult because of the lack of (1) uniformity in the use of meaningful definitions of outcomes that indicate welfare improvements and (2) clarity in the consideration of selection issues. We find the uptake of insurance schemes, in many cases, to be less than expected. In general, we find no strong evidence of an impact on utilization, protection from financial risk, and health status. However, a few insurance schemes afford significant protection from high levels of out-of-pocket expenditures. In these cases, however, the impact on the poor is weaker. More information is needed to understand the reasons for low enrollment and to explain the limited impact of health insurance among the insured. JEL codes: I10, I15. © The Author 2012. Published by Oxford University Press on behalf of the International Bank for Reconstruction and Development/ THE WORLD BANK. All rights reserved
