| Records |
| Author |
Sousa, K. de M.; Oliveira, W.I.F. de; Melo, L.O.M. de; Alves, E.A.; Piuvezam, G.; Gama, Z.A. da S. |
| Title |
A qualitative study analyzing access to physical rehabilitation for traffic accident victims with severe disability in Brazil |
Type |
Journal Article |
| Year |
2017 |
Publication |
Disability and Rehabilitation |
Abbreviated Journal |
Disabil Rehabil |
| Volume |
39 |
Issue |
6 |
Pages |
568-577 |
| Keywords |
Brazil; health services accessibility; quality of health care; rehabilitation; traffic accidents |
| Abstract |
Purpose To identify access barriers to physical rehabilitation for traffic accident (TA) victims with severe disability and build a theoretical model to provide guidance towards the improvement of these services. Methods Qualitative research carried out in the city of Natal (Northeast Brazil), with semi-structured interviews with 120 subjects (19 key informer health professionals and 101 TA victims) identified in a database made available by the emergency hospital. The interviews were analyzed using Alceste software, version 4.9. Results The main barriers present in the interviews were: (1) related to services: bureaucratic administrative practises, low offer of rehabilitation services, insufficient information on rehabilitation, lack of guidelines that integrate hospital and ambulatory care and (2) related to patients: financial difficulties, functional limitations, geographic distance, little information on health, association with low education levels and disbelief in the system and in rehabilitation. Conclusion The numerous access barriers were presented in a theoretical model with causes related to organizational structure, processes of care, professionals and patients. This model must be tested by health policy-makers and managers to improve the quality of physical rehabilitation and avoid unnecessary prolongation of the suffering and disability experienced by TA survivors. Implications for rehabilitation Traffic accidents (TAs) are a global health dilemma that demands integrality of preventive actions, pre-hospital and hospital care and physical rehabilitation (PR). This study lays the foundation for improving access to PR for TA survivors, an issue of quality of care that results in preventable disabilities. The words of the patients interviewed reveal the suffering of victims, which is often invisible to society and given low priority by health policies that relegate PR to a second plan ahead of prevention and urgent care. A theoretical model of the causes of the problem of access to PR was built. The identified barriers are potentially preventable through the intervention of health policy-makers, managers, regulators and rehabilitation professionals, and by encouraging the participation of patients. Addressing timely access barriers involves the expansion of the supply of services and rehabilitation professionals, regulation and standardization of referencing practises and encouraging the provision of information to patients about continuity of care and their health needs. |
| Address |
d Department of Collective Health, Federal University of Rio Grande Do Norte , Natal , Brazil |
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0963-8288 |
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PMID:26987029 |
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no |
| Call Number |
ref @ user @ |
Serial |
97458 |
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Ramke, J.; Petkovic, J.; Welch, V.; Blignault, I.; Gilbert, C.; Blanchet, K.; Christensen, R.; Zwi, A.B.; Tugwell, P. |
| Title |
Interventions to improve access to cataract surgical services and their impact on equity in low- and middle-income countries |
Type |
Journal Article |
| Year |
2017 |
Publication |
The Cochrane Database of Systematic Reviews |
Abbreviated Journal |
Cochrane Database Syst Rev |
| Volume |
11 |
Issue |
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Pages |
Cd011307 |
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BACKGROUND: Cataract is the leading cause of blindness in low- and middle-income countries (LMICs), and the prevalence is inequitably distributed between and within countries. Interventions have been undertaken to improve cataract surgical services, however, the effectiveness of these interventions on promoting equity is not known. OBJECTIVES: To assess the effects on equity of interventions to improve access to cataract services for populations with cataract blindness (and visual impairment) in LMICs. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2017, Issue 3), MEDLINE Ovid (1946 to 12 April 2017), Embase Ovid (1980 to 12 April 2017), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 12 April 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 12 April 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 12 April 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 12 April 2017. We did not use any date or language restrictions in the electronic searches for trials. SELECTION CRITERIA: We included studies that reported on strategies to improve access to cataract services in LMICs using the following study designs: randomised and quasi-randomised controlled trials (RCTs), controlled before-and-after studies, and interrupted time series studies. Included studies were conducted in LMICs, and were targeted at disadvantaged populations, or disaggregated outcome data by 'PROGRESS-Plus' factors (Place of residence; Race/ethnicity/ culture/ language; Occupation; Gender/sex; Religion; Education; Socio-economic status; Social capital/networks. The 'Plus' component includes disability, sexual orientation and age). DATA COLLECTION AND ANALYSIS: Two authors (JR and JP) independently selected studies, extracted data and assessed them for risk of bias. Meta-analysis was not possible, so included studies were synthesised in table and text. MAIN RESULTS: From a total of 2865 studies identified in the search, two met our eligibility criteria, both of which were cluster-RCTs conducted in rural China. The way in which the trials were conducted means that the risk of bias is unclear. In both studies, villages were randomised to be either an intervention or control group. Adults identified with vision-impairing cataract, following village-based vision and eye health assessment, either received an intervention to increase uptake of cataract surgery (if their village was an intervention group), or to receive 'standard care' (if their village was a control group).One study (n = 434), randomly allocated 26 villages or townships to the intervention, which involved watching an informational video and receiving counselling about cataract and cataract surgery, while the control group were advised that they had decreased vision due to cataract and it could be treated, without being shown the video or receiving counselling. There was low-certainty evidence that providing information and counselling had no effect on uptake of referral to the hospital (OR 1.03, 95% CI 0.63 to 1.67, 1 RCT, 434 participants) and little or no effect on the uptake of surgery (OR 1.11, 95% CI 0.67 to 1.84, 1 RCT, 434 participants). We assessed the level of evidence to be of low-certainty for both outcomes, due to indirectness of evidence and imprecision of results.The other study (n = 355, 24 towns randomised) included three intervention arms: free surgery; free surgery plus reimbursement of transport costs; and free surgery plus free transport to and from the hospital. These were compared to the control group, which was reminded to use the “low-cost” ( USD 38) surgical service. There was low-certainty evidence that surgical fee waiver with/without transport provision or reimbursement increased uptake of surgery (RR 1.94, 95% CI 1.14 to 3.31, 1 RCT, 355 participants). We assessed the level of evidence to be of low-certainty due to indirectness of evidence and imprecision of results.Neither of the studies reported our primary outcome of change in prevalence of cataract blindness, or other outcomes such as cataract surgical coverage, surgical outcome, or adverse effects. Neither study disaggregated outcomes by social subgroups to enable further assessment of equity effects. We sought data from both studies and obtained data from one; the information video and counselling intervention did not have a differential effect across the PROGRESS-Plus categories with available data (place of residence, gender, education level, socioeconomic status and social capital). AUTHORS' CONCLUSIONS: Current evidence on the effect on equity of interventions to improve access to cataract services in LMICs is limited. We identified only two studies, both conducted in rural China. Assessment of equity effects will be improved if future studies disaggregate outcomes by relevant social subgroups. To assist with assessing generalisability of findings to other settings, robust data on contextual factors are also needed. |
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School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand |
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English |
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1361-6137 |
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PMID:29119547 |
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no |
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ref @ user @ |
Serial |
97501 |
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Ribeiro, A.P.; Souza, E.R. de; Sousa, C.A.M. de |
| Title |
Injuries caused by firearms treated at Brazilian urgent and emergency healthcare services |
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Journal Article |
| Year |
2017 |
Publication |
Ciencia & Saude Coletiva |
Abbreviated Journal |
Cien Saude Colet |
| Volume |
22 |
Issue |
9 |
Pages |
2851-2860 |
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This paper analyzes the medical care given at Brazilian urgent and emergency healthcare services to people injured by firearms in 2014. A cross-sectional study was carried out on care given to patients with firearms injuries in 24 capital cities of Brazilian states and in the Brazilian Federal District, included in the VIVA Survey. Simple and relative frequencies of the variables related to the patients and to the event were calculated, and a logistic model for complex samples was applied adopting care for firearms injuries patients as outcome. The results show the following percentages of care events as caused by firearms: 0.7% for the category 'other accidents (other than transport-related accidents)', 1.5% for self-inflicted injuries, 15.9% for injuries due to assault, and 65.1% of cases arising from legal intervention. The care given was predominantly to young male adults (age 20-39), of mixed race and with a low level of schooling. The most common injuries were: to arms and legs; and to multiple organs. The paper concludes by discussing the efforts to control firearms held by the public in Brazil, and how they can lead to severe and lethal outcomes in quarrels and interpersonal disputes. |
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Departamento de Estudos sobre Violencia e Saude Jorge Careli/Claves, Escola Nacional de Saude Publica, Fiocruz. Av. Brasil 4036/7 masculine, Manguinhos. 21040-210 Rio de Janeiro RJ Brasil. adalpeixoto@yahoo.com.br |
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Lesoes provocadas por armas de fogo atendidas em servicos de urgencia e emergencia brasileiros |
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1413-8123 |
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PMID:28954136 |
Approved |
no |
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ref @ user @ |
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97503 |
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Miguel, M.G.; Barreto, R.P.; Pereira, S.Y. |
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Study of a tropical soil in order to use it to retain aluminum, iron, manganese and fluoride from acid mine drainage |
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Journal Article |
| Year |
2017 |
Publication |
Journal of Environmental Management |
Abbreviated Journal |
J Environ Manage |
| Volume |
204 |
Issue |
Pt 1 |
Pages |
563-570 |
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Acid mine drainage; Column test; Contaminant transport; Liner; Tropical soils; Waste rock pile |
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The Ore Treatment Unit (UTM-Caldas), in the city of Caldas, Minas Gerais, Brazil, nowadays in decommissioning stage, was the first uranium extraction mine in Brazil. Several negative environmental impacts in the area have occurred, because of mining, treatment and beneficiation processes. Waste rock pile 4 (WRP-4) generates acid mine drainage (AMD), which is discharged in the Nestor Figueiredo retention pond (NFP). However, leakage of acid water by the NFP dam foundation has been constantly observed. Therefore, this research aimed to investigate a typical tropical soil, in order to use it as mineral liner for the NFP to minimize the leakage of acid water through the dam foundation and to retain predominant chemical species. Geotechnical, chemical and mineralogical tests were performed to characterize the soil and a column test was carried out using the acid mine drainage as contaminant, which contained aluminum (Al), manganese (Mn), iron (Fe) and fluoride (F-). The soil presented micro aggregation, acid pH, and low values of organic matter content and cation exchange capacity, which are characteristics of highly weathered soils. Diffusion was the predominant transport mechanism in the column test. Effluent solutions with pH less than 6.0 indicated the formation of insoluble Al-F complexes in the soil and desorption of iron and manganese at concentrations above those allowed by the Brazilian legislation. At pH greater than 6.0, the desorption of iron and manganese and release of aluminum and fluoride in the free form occurred, with concentrations also higher than the allowed by the Brazilian legislation. |
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Institute of Geoscience, University of Campinas (Unicamp), Brazil |
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0301-4797 |
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PMID:28942188 |
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ref @ user @ |
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97504 |
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Saunders, M.J.; Wingfield, T.; Tovar, M.A.; Baldwin, M.R.; Datta, S.; Zevallos, K.; Montoya, R.; Valencia, T.R.; Friedland, J.S.; Moulton, L.H.; Gilman, R.H.; Evans, C.A. |
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A score to predict and stratify risk of tuberculosis in adult contacts of tuberculosis index cases: a prospective derivation and external validation cohort study |
Type |
Journal Article |
| Year |
2017 |
Publication |
The Lancet. Infectious Diseases |
Abbreviated Journal |
Lancet Infect Dis |
| Volume |
17 |
Issue |
11 |
Pages |
1190-1199 |
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BACKGROUND: Contacts of tuberculosis index cases are at increased risk of developing tuberculosis. Screening, preventive therapy, and surveillance for tuberculosis are underused interventions in contacts, particularly adults. We developed a score to predict risk of tuberculosis in adult contacts of tuberculosis index cases. METHODS: In 2002-06, we recruited contacts aged 15 years or older of index cases with pulmonary tuberculosis who lived in desert shanty towns in Ventanilla, Peru. We followed up contacts for tuberculosis until February, 2016. We used a Cox proportional hazards model to identify index case, contact, and household risk factors for tuberculosis from which to derive a score and classify contacts as low, medium, or high risk. We validated the score in an urban community recruited in Callao, Peru, in 2014-15. FINDINGS: In the derivation cohort, we identified 2017 contacts of 715 index cases, and median follow-up was 10.7 years (IQR 9.5-11.8). 178 (9%) of 2017 contacts developed tuberculosis during 19 147 person-years of follow-up (incidence 0.93 per 100 person-years, 95% CI 0.80-1.08). Risk factors for tuberculosis were body-mass index, previous tuberculosis, age, sustained exposure to the index case, the index case being in a male patient, lower community household socioeconomic position, indoor air pollution, previous tuberculosis among household members, and living in a household with a low number of windows per room. The 10-year risks of tuberculosis in the low-risk, medium-risk, and high-risk groups were, respectively, 2.8% (95% CI 1.7-4.4), 6.2% (4.8-8.1), and 20.6% (17.3-24.4). The 535 (27%) contacts classified as high risk accounted for 60% of the tuberculosis identified during follow-up. The score predicted tuberculosis independently of tuberculin skin test and index-case drug sensitivity results. In the external validation cohort, 65 (3%) of 1910 contacts developed tuberculosis during 3771 person-years of follow-up (incidence 1.7 per 100 person-years, 95% CI 1.4-2.2). The 2.5-year risks of tuberculosis in the low-risk, medium-risk, and high-risk groups were, respectively, 1.4% (95% CI 0.7-2.8), 3.9% (2.5-5.9), and 8.6%. (5.9-12.6). INTERPRETATION: Our externally validated risk score could predict and stratify 10-year risk of developing tuberculosis in adult contacts, and could be used to prioritise tuberculosis control interventions for people most likely to benefit. FUNDING: Wellcome Trust, Department for International Development Civil Society Challenge Fund, Joint Global Health Trials consortium, Bill & Melinda Gates Foundation, Imperial College National Institutes of Health Research Biomedical Research Centre, Foundation for Innovative New Diagnostics, Sir Halley Stewart Trust, WHO, TB REACH, and Innovation for Health and Development. |
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Section of Infectious Diseases and Immunity, Imperial College London, London, UK; Wellcome Trust Imperial College Centre for Global Health Research, London, UK; Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Innovacion Por la Salud Y Desarrollo (IPSYD), Asociacion Benefica PRISMA, Lima, Peru |
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1473-3099 |
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PMID:28827142 |
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ref @ user @ |
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97505 |
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