17 research outputs found
Breaking Borders: How Barriers to Global Mobility Hinder International Partnerships in Academic Medicine
No full textThis article describes the authors' personal experiences of collaborating across international borders in academic research. International collaboration in academic medicine is one of the most important ways by which research and innovation develop globally. However, the intersections among colonialism, academic medicine, and global health research have created a neocolonial narrative that perpetuates inequalities in global health partnerships. The authors critically examine the visa process as an example of a racist practice to show how the challenges of blocked mobility increase inequality and thwart research endeavors. Visas are used to limit mobility across certain borders, and this limitation hinders international collaborations in academic medicine. The authors discuss the concept of social closure and how limits to global mobility for scholars from low- and middle-income countries perpetuate a cycle of dependence on scholars who have virtually barrier-free global mobility-these scholars being mainly from high-income countries. Given the current sociopolitical milieu of increasing border controls and fears of illegal immigration, the authors' experiences expose what is at stake for academic medicine when the political sphere, focused on tightening border security, and the medical realm, striving to build international research collaborations, intersect. Creating more equitable global partnerships in research requires a shift from the current paradigm that dominates most international partnerships and causes injury to African scholars.</p
Risk Factors and Triggers That May Result in Patient-Initiated Violence on Inpatient Psychiatric Units : An Integrative Review
No full textThe aim of the present integrative review is to identify and describe risk factors and triggers that may result in patient-initiated violence on inpatient psychiatric units. Original studies were searched for in PubMed, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature. From the 826 identified publications, 18 were included for a synthesis. The results are presented in three themes, which demonstrate that patient characteristics, staff approach, and the ward environment are influencers that may trigger the emergence of violent incidents. Incidents are discussed from the theoretical framework of complexity science as dynamic, highly variable in manifestation, and adaptive, in that the forthcoming process and outcomes are highly dependent on how the surrounding environment responds. Our recommendation is that staff on inpatient wards recognize the myriad influencers that may trigger inpatient violence in a context of highly complex interactions. © The Author(s) 2019.</p
Development of a Complex Intervention for Effective Management of Type 2 Diabetes in a Developing Country
No full textThere has been little focus on designing tailored diabetes management strategies in developing countries. The aim of this study is to develop a theory-driven, tailored and context-specific complex intervention for the effective management of type 2 diabetes at a tertiary care setting of a developing country. We conducted interviews and focus groups with patients, health professionals, and policymakers and undertook thematic analysis to identify gaps in diabetes management. The results of our previously completed systematic review informed data collection. We used the United Kingdom Medical Research Council framework to guide the development of the intervention. Results comprised 48 interviews, two focus groups with 11 participants and three co-design panels with 24 participants. We identified a lack of structured type 2 diabetes education, counselling, and collaborative care of type 2 diabetes. Through triangulation of the evidence obtained from data collection, we developed an intervention called VICKY (patient-centred collaborative care and structured diabetes education and counselling) for effective management of type 2 diabetes. VICKY comprised five components: (1) patient-centred collaborative care; (2) referral system for patients across transitions of care between different health professionals of the diabetes care team; (3) tools for the provision of collaborative care and documentation of care; (4) diabetes education and counselling by trained diabetes educators; and (5) contextualised diabetes education curriculum, educational materials, and documentation tools for diabetes education and counselling. Implementation of the intervention may help to promote evidence-based, patient-centred, and contextualised diabetes care for improved patient outcomes in a developing country
Prevalence and risk factors of metabolic syndrome in Ethiopia: describing an emerging outbreak in HIV clinics of the sub-Saharan Africa – a cross-sectional study
No full textObjectives HIV-induced chronic inflammation, immune activation and combination antiretroviral therapy (cART) are linked with adverse metabolic changes known to cause cardiovascular adversities. This study evaluates the prevalence of lipodystrophy, and metabolic syndrome (MetS), and analyses risk factors in HIV-infected Ethiopians taking cART.Methods A multicentre cross-sectional study was conducted at tertiary-level hospitals. Eligible participants attending the HIV clinics were enrolled. Sociodemographic, anthropometric, clinical, HIV treatment variables, lipid profile, fasting blood glucose level, risk factors and components of MetS, also lipodystrophy, were studied. Data were analysed by SPSS statistical package V.25 with descriptive and analytical statistics. For multivariable analysis of risk factors, a logistic regression model was used. Results were presented in frequency and percentages, mean±SD, or median+IQR. Statistical significance was taken as p<0.05.Results Among 518 studied participants, two-thirds were females, and the mean age of the study population was 45 years (SD=11). The mean duration of cART was 10 years (SD=4). Median CD4 count was 460 cells/mm3. The prevalence of MetS according to the Adult Treatment Panel III (2005) criteria was 37.6%. In multivariable analysis, independent risk factors for MetS were age >45 years (aHR 1.8, 95% CI 1.2 to 2.4), female sex (aHR 1.8, 95% CI 1.1 to 2.8), body mass index (BMI)>25 kg/m2 (aHR 2.7, 95% CI 1.8 to 4.1), efavirenz-based cART (aHR 2.8, 95% CI 1.6 to 4.8) and lopinavir/ritonavir-based cART (aHR 3.7, 95% CI 1.0 to 13.3). The prevalence of lipodystrophy was 23.6%. Prior exposure to a stavudine-containing regimen was independently associated with lipodystrophy (aHR 3.1, 95% CI 1.6 to 6.1).Conclusion Our study revealed 38% of the participants had MetS indicating considerable cardiovascular disease (CVD) risks. Independent risk factors for MetS were BMI≥25 kg/m2, efavirenz and lopinavir/ritonavir-based cART, female sex and age ≥45 years. In addition to prevention, CVD risk stratification and management will reduce morbidity and mortality in people with HIV infection
Early detection and management of major non-communicable diseases in urban primary healthcare facilities in Ethiopia:a study protocol for a type-3 hybrid implementation-effectiveness design
No full textIntroduction Integrating early detection and management of non-communicable diseases in primary healthcare has an unprecedented role in making healthcare more accessible particularly in low- and middle-income countries such as Ethiopia. This study aims to design, implement and evaluate an evidence-based intervention guided by the HEARTS technical package and implementation guide to address barriers and facilitators of integrating early detection and management of hypertension, diabetes mellitus and cardiovascular diseases in primary healthcare settings of Addis Ababa.Methodology We will employ a type-3 hybrid implementation-effectiveness study from November 2020 to May 2022. This study will target patients ≥40 years of age. Ten health centres will be randomly selected from each subcity of Addis Ababa. The study will have four phases: (1) Baseline situational analysis (PEN facility-capacity assessment, 150 observations of patient healthcare provider interactions and 697 patient medical record reviews), (2) Consolidated Framework for Implementation Research (CFIR) inspired qualitative assessment of barriers and facilitators (20 in-depth interviews of key stakeholders), (3) Design of intervention protocol. The intervention will have capacity enhancement components including training of non-communicabledisease (NCDservice providers, provision of essential equipment/supporting materials and monthly monitoring and feedback and (4) Implementation monitoring and evaluation phase using the RE-AIM (reach, efficacy, adoption, implementation and maintenance) framework. Outcomes on early detection and management of NCDs will be assessed to examine the effectiveness of the study.Ethics and dissemination plan Ethical clearance was obtained from the Addis Ababa University, College of Health Sciences Institutional Review Board and Addis Ababa Health Bureau. We plan to present the findings from this research in conferences and publish them in peer-reviewed journals
Additional file 1 of Prevalence of Gestational Diabetes Mellitus among pregnant women attending antenatal care clinic of St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
No full textAdditional file 1: Table S1. GDMManuscript
Predictors of poor glycemic control among patients with type 2 diabetes on follow-up care at a tertiary healthcare setting in Ethiopia
No full textAbstract Objective Contemporary clinical guidelines endorsed that glycemic control is the ultimate goal in the management patients with diabetes. The aim of this study was to assess the prevalence of glycemic control and to identify predictors of poor glycemic control in patients with type 2 diabetes (T2D). A cross-sectional study was conducted among systematically selected 357 diabetic patients. Data were collected through direct patients’ interviews and medical chart review. Binary logistic regression analyses were performed and analyzed using SPSS version 22.0. Results Participants’ mean age was (± SD) 56.1 ± 11.6 years. Nearly four in five (77.9%) of the participants had comorbidities, mainly of hypertension, and 60.2% had diabetic complications, mainly diabetes neuropathy. Poor glycemic control was found in 68.3% of the participants with a mean (± SD) FBG of 174.1 ± 48.9 mg/dL. Being female gender, having greater body mass index and low medication adherence was significantly associated with poor glycemic control. In conclusion, the overall aspects of glycemic control level of patients were far from the standards. Being female, greater body mass index and poor medication adherence were predictors of poor glycemic control. In response to this finding, an aggressive intervention that targets in improving the glycemic control is required
Bivariate and multivariate analysis of factors associated with drug therapy problems among patients with diabetes on follow up at TASH, Addis Ababa, Ethiopia, 2017.
No full textBivariate and multivariate analysis of factors associated with drug therapy problems among patients with diabetes on follow up at TASH, Addis Ababa, Ethiopia, 2017.</p
MOESM1 of Predictors of poor glycemic control among patients with type 2 diabetes on follow-up care at a tertiary healthcare setting in Ethiopia
No full textAdditional file 1. Medication profiles among patients with T2D on follow up at diabetes center, Ethiopia, 2018
Treatment satisfaction in diabetes patients at diabetes clinic of TASH, 2017.
No full textTreatment satisfaction in diabetes patients at diabetes clinic of TASH, 2017.</p
