The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study

Background In post-stroke patients, impairment of quality of life (QOL) has been associated with functional impairment, age, anxiety, depression, and fatigue. Good social support, higher education, and better socioeconomic status are associated with better QOL among stroke survivors. In Africa, studies from Nigeria and Tanzania have reported on post-stroke QOL. Background Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization’s recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake. Methods A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites. Results Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve. Conclusions The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.

Performance analysis of brazilian public and philanthropic hospitals

This paper presents the results of a research that aimed at identifying optimal performance standards of Brazilian public and philanthropic hospitals. In order to carry out the analysis, a model based on Data Envelopment Analysis (DEA) was developed. We collected financial data from hospitals’ financial statements available on the internet, as well as operational data from the Information Technology Department of the Brazilian Public Health Care System – SUS (DATASUS). Data from 18 hospitals from 2007 to 2011 were analyzed. Our DEA model used both operational and financial indicators (variables). In order to develop this model, two indicators were considered inputs: Values (in Brazilian Reais) of Fixed Assets and Planned Capacity. On the other hand, the following indicators were considered outputs: Net Margin, Return on Assets and Institutional Mortality Rate. As regards the proposed model, there were five hospitals with optimal performance and four hospitals were considered inefficient, upon the analysis of the variables, considering the analyzed period. Analysis of the weights indicated the most relevant variables for determining efficiency and scale variable values, which is an important tool to aid the decision-making by hospital managers. Finally, the scale variables determined the returns on production, indicating that 14 hospitals work with scale diseconomies. This may indicate inefficiency in the resource management of the Brazilian public health-care system, by analyzing this set of proposed variables.

Hospital Staff Perceptions of Health Promotion Activities in Public Hospitals

The aim of this study was to determine the level of staff support for health promotion activities in Queensland public hospitals.

Barriers to health promotion activities in public hospitals

Despite the central role hospitals have in the health care system, relatively few health promotion activities are conducted in Australian public hospitals. This study investigated the types of obstacles that were perceived to inhibit health promotion activities in hospitals. A questionnaire for self-completion was sent to medical superintendents in all public hospitals in Queensland and 112 questionnaires were returned (92.6 per cent response rate). The results indicated that lack of finance, lack of interest by relevant others, and needs (for appropriate programs, training and patient receptivity) were the barriers reported by superintendents. The barriers of 'interest' and 'needs' were related to a lack of written policies in some areas, but not directly to levels of other health promotion activities being conducted in the hospitals. Success in facilitating health promotion programs in hospitals will need to include a change in the environment, in particular the views of medical superintendents. The combination of attitude change and the availability of a motivated person (such as a health promotion officer) to lead the activities may be needed in order to produce an increase in the level of health promotion in public hospitals. Article in Australian and New Zealand Journal of Public Health 20(5):500-4 · November 1996

Cancer Control Activities in Australian Public Hospitals

Cancer is a major cause of death in Australia and there is considerable interest in the role health education in hospital settings has in reducing this burden. Based on a survey of medical superintendents and other hospital staff, this article describes the cancer control activities routinely conducted in Australian public hospitals. The survey considered cigarette smoking, alcohol, diet and nutrition, exercise, and the early detection of skin cancer, cervical cancer, and breast cancer. Overall 112 medical superintendents (93%) participated and a further 163 hospital staff members provided additional details. Not unexpectedly, the survey confirmed the very low level of activity and identified a number of specific issues that need to be addressed in order to enhance cancer control activities in public hospitals. Given the relatively higher level of activity, and the prominence of cigarette smoking and alcohol consumption as health issues, one approach might be to initially concentrate on these areas when they are related to the patient's condition. Article in International Quarterly of Community Health Education 15(3):229-40 · January 1994

Constructing Threat: How Americans Identify Economic Competitors

China’s emergence as an economic powerhouse has often been portrayed as threatening to America’s economic strength and to its very identity as “the global hegemon.” The media’s alarmist response to an economic competitor is familiar to those who remember US-Japanese relations in the 1980s. In order to better understand the basis of American threat perception, this study explores the independent and interactive impact of three variables (perceptions of the Other’s capabilities, perceptions of the Other as a threat versus as an opportunity, and perceptions of the Other’s political culture) on attitudes toward two different economic competitors (Japan 1977-1995 and China 1985-2011). Utilizing four methods (historical process tracing, public polling data analysis, social scientific experimentation, and content analysis), this study demonstrates that increases in the Other’s economic capabilities have a much smaller impact on attitudes than is commonly believed. It further shows that while perceptions of threat/opportunity played a significant role in shaping attitudinal response toward Japan, perceptions of political culture are the most important factor driving attitudes toward China today. This study contributes to a better understanding of how states react to threats and construct negative images of their economic rivals. It also helps to explain the current Sino-American relationship and enables better predictions as to its potential future course. Finally, these findings contribute to cultural explanations of the democratic peace phenomenon and provide a boundary condition (political culture) for the liberal proposition that opportunity ameliorates conflict in the economic realm.

Assimilation or Transnationalism? Evidence from the Latino National Survey for Mexicans, Puerto Ricans, Cubans, and South Americans who Immigrated to the USA from 1958 to 2005

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Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems

BACKGROUND: Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study. METHODS: This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics). RESULTS: The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided. CONCLUSION: The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.

African-Americans in Iowa, February 2016

To recall and celebrate the positive contributions to our nation made by people of African descent, American historian Carter G. Woodson established Black History Week beginning on Feb. 12, 1926. In 1976, as part of the nation’s bicentennial, the week was expanded into Black History Month.

Native Americans in Iowa 2016

Demographic profile of the Native American population in Iowa compiled from Census statistics.

Asian/Pacific Americans Strategic Plan 2013-2014, September 2013

Strategic Plan for Asian and Pacific Islanders.

Análisis de las barreras para la unificación de una Historia Clínica Electrónica -HCE- en Colombia

Objetivo: Identificar las barreras para la unificación de una Historia Clínica Electrónica –HCE- en Colombia. Materiales y Métodos: Se realizó un estudio cualitativo. Se realizaron entrevistas semiestructuradas a profesionales y expertos de 22 instituciones del sector salud, de Bogotá y de los departamentos de Cundinamarca, Santander, Antioquia, Caldas, Huila, Valle del Cauca. Resultados: Colombia se encuentra en una estructuración para la implementación de la Historia Clínica Electrónica Unificada -HCEU-. Actualmente, se encuentra en unificación en 42 IPSs públicas en el departamento de Cundinamarca, el desarrollo de la HCEU en el país es privado y de desarrollo propio debido a las necesidades particulares de cada IPS. Conclusiones: Se identificaron barreras humanas, financieras, legales, organizacionales, técnicas y profesionales en los departamentos entrevistados. Se identificó que la unificación de la HCE depende del acuerdo de voluntades entre las IPSs del sector público, privado, EPSs, y el Gobierno Nacional.

Perspective of Healthcare Workers about Digitization in the Healthcare Sector in Armed Forces Hospitals in Taif Region, Saudi Arabia

Aim: The purpose of the present study was to determine the impact of digitization in healthcare on health workers' perceptions in Armed Forces Hospital, Taif. Methodology: A quantitative descriptive design based on deductive approach was used in the study. 370 participants employed in Armed Force hospitals in Taif were recruited based on convenience sampling. A survey was distributed among participants to collect demographic data and data on digitization benefits, challenges, and status and perceptions of health workers. The collected responses were then entered into SPSS software for performing descriptive stats, ANOVA test and regression analysis to determine the relationship between research variables. Results: The demographic results showed more male participants (64.9%) than females (35%), with more participants having a Master's education. Results from the ANOVA test and regression analysis revealed a positive and significant correlation between digitization benefits (0.842), digitization challenges (0.838), and digitization status (0.898) with health workers' perceptions. Also, a 1% change in digitization benefits, challenges, and status can result in an 18% change in perceptions. Conclusion: Overall, the study found a significant and positive relationship impact of digitization of health on perceptions of health workers. Recommendation: It is suggested that future studies investigate the factors and strategies influencing the change of perceptions associated with the digitization of health.

Applying The Maternal Near Miss Approach For The Evaluation Of Quality Of Obstetric Care: A Worked Example From A Multicenter Surveillance Study.

To assess quality of care of women with severe maternal morbidity and to identify associated factors. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 0.039). This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.