Teasdale-Corti Global Health Research Partnership (TC) / partenariat Teasdale-Corti de recherche en santé mondiale
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Item Strengthening health care systems for HIV and AIDS in sub-Saharan Africa and the Caribbean: a program of research(2007) Edwards, N; Kahwa, E; Kaseje, D; Mill, J; Webber, JItem Création d'une nouvelle génération d'études épidemiologiques en santé mentale(2007) Caron, J; Tousignant, M; Pedersen, D; Fleury, M J; Cargo, MGrâce à une subvention des Instituts de recherche en santé du Canada (IRSC), il se développe actuellement une nouvelle génération d’études en épidémiologie sociale et psychiatrique dans une zone circonscrite se situant dans le sud-ouest de Montréal où vivent 258 000 personnes. Ce programme de recherche repose sur une étude prospective longitudinale visant à identifier les déterminants de la santé mentale de la population, et sur quatre études spécifiques qui abordent des paramètres importants pour la santé mentale : l’écologie sociale et physique des quartiers, le soutien social, le stigma social et les services en santé mentale. Ce programme est complété par l’utilisation de la dernière génération des outils technologiques et informatiques soit un système d’information géographique (SIG) qui permet d’apprécier les effets du contexte sur la santé mentale. Les bases théoriques sur lesquels repose ce modèle sont présentées de même qu’une description sommaire des méthodes utilisées.Item Psychosocial Counselling in Nepal: Perspectives of Counsellors and Beneficiaries(2007-02) Jordans, Mark J; Keen, Annalise S; Pradhan, Hima; Tol, Wietse AThe aims of this qualitative study were (1) to add to the understanding of the growing field of psychosocial counselling in Nepal, and (2) gather concrete points for improvement of services. Semi-structured interviews were conducted with clients (n=34), para-professional counsellors (n=26) and managers (n=23) of organizations in which psychosocial counselling was taking place. The main findings were that stakeholders generally presented a positive view of the significance and supportive function of psychosocial counselling, while providing useful suggestions for improvement. Matters of ongoing training and supervision, confidentiality and integration of counselling within mainstream care provision need to be addressed and potentially adapted. Implications for other non-Western countries with little mental health resources are discussed.Item Debating war-trauma and post-traumatic stress disorder (PTSD) in an interdisciplinary arena(2008) Kienzler, HResearchers have tried to determine and verify the effects of violent conflicts on the mental health of those affected by focusing on war trauma, posttraumatic stress disorder (PTSD), and other trauma-related disorders. This, in turn, led to the development of different kinds of theories and aid programs that aim at preventing and treating the consequences of violence and mental health. Until now, there is no agreement on the public health value of the concept of PTSD and no agreement on the appropriate type of mental-health care. Instead, psychiatrists have engaged in sometimes fierce discussions over the universality of war trauma, PTSD, and other trauma-related disorders. The two most polar positions are those who try to validate PTSD as a universal and cross-culturally valid psychopathological response to traumatic distress which may be cured or ameliorated with (Western) clinical and psychosocial therapeutic measures, and those who argue that the Western discourse on trauma only makes sense in the context of a particular cultural and moral framework and, therefore, becomes problematic in the context of other cultural and social settings. Although these positions seem mutually exclusive, their debates have led to the development of less radical approaches toward war-trauma and PTSD. The purpose of this literature review is to analyse the discourses on and debates over war-trauma and PTSD in the psychiatric literature in order to establish a better understanding for the diverse conceptualizations, interpretations and proposed healing strategies. Moreover, I discuss the cultural construction and conceptualization of war-trauma and PTSD from an anthropological perspective and show how anthropologists contribute to psychiatric debates so as to ensure more sophisticated diagnoses and healing strategies in culturally diverse contexts.Item Women in Guatemala’s Metropolitan Area: Violence, Law, and Social Justice(2008) Godoy-Paiz, PaulaThe article examines the legal framework for addressing violence against women in post war Guatemala. New laws constitute a response to, and have occurred concurrent to, an increase in violent crime against women, particularly in the form of mass rapes and murders. The paper juxtaposes the laws for addressing violence against women with Guatemalan women's complex, multilayered and multi-dimensional life experiences. The latter expose the limitations of strictly legal understandings of the phenomenon of gender-based violence and highlight the need for broad social justice approaches that take into account the different structures of violence, inequality, and injustice present in women’s lives.Item Leveraging nursing research to transform healthcare systems(2008) Edwards, N CItem Training Clinicians in Cultural Psychiatry: A Canadian Perspective(2008) Kirmayer, L J; Rousseau, C; Guzder, J; Jarvis, G EThe authors summarize the pedagogical approaches and curriculum used in the training of clinicians in cultural psychiatry at the Division of Social and Transcultural Psychiatry, McGill University. We reviewed available published and unpublished reports on the history and development of training in cultural psychiatry at McGill to identify the main orientations, teaching methods, curriculum, and course content. Student evaluations of teaching were reviewed. The training strategies and curriculum are related to the larger social context of Canadian society including the history of migration, current demography, and policies of multiculturalism. The McGill program includes core teaching, clinical rotations, an intensive summer program, and annual Advanced Study Institutes. The interdisciplinary training setting emphasizes general knowledge rather than specific ethnocultural groups, including: understanding the cultural assumptions implicit in psychiatric theory and practice; exploring the clinician’s personal and professional identity and social position; evidence-based conceptual frameworks for understanding the interaction of culture and psychopathology; learning to use an expanded version of the cultural formulation in DSM-IV for diagnostic assessment and treatment planning; and developing skills for working with interpreters and culture-brokers, who mediate and interpret the cultural meaning and assumptions of patient and clinician. An approach to cultural psychiatry grounded in basic social science perspectives and in trainees’ appreciation of their own background can prepare clinicians to respond effectively to the changing configurations of culture, ethnicity, and identity in contemporary health care settings.Abstract TeaserItem Cultural influences on the assessment of children’s pain(2009) Finley, G A; Kristjánsdóttir, Ó; Forgeron, P ACulture is commonly regarded as a factor in pain behaviour and experience, but the meaning of the term is often unclear. There is little evidence that pain perception is modified by cultural or ethnic factors, but pain expression by children and interpretation by caregivers may be affected by the culture of the patient or the caregiver. The present paper examines some of the research regarding cultural influences on children’s pain assessment, and addresses directions for future research. A focus on cultural influences should not distract clinicians from the need to be sensitive to individual beliefs and attitudes.Item Modernizing concepts of access and equity(2009) Gulliford, MFormer UK Prime Minister Tony Blair once observed that ‘the purpose of the twentieth century welfare state was to treat citizens as equals; the purpose of the twenty-first century reforms must be to treat them as individuals as well’ (Blair, 2002). Emphasis on the individual is evident in recent UK health service policy, which identifies the aims of ‘personalizing services [by] making [them] fit for everyone’s needs. That includes those people traditionally less likely to seek help or who find themselves discriminated against in some way’ (p. 9). ‘The National Health Service needs to give patients more rights and control over their own health care’ (Department of Health, 2008: 33)...Item Building Nurses’ Capacity in Community Health Services(2009) MacDonald, Jo-AnneThis paper describes core processes, components, and insights gained from a research internship offered through the University of Ottawa, Canada. The growing demand for high quality nursing research requires the development and implementation of strategies for enhanced research capacity. A three-month intensive internship was developed as a main feature of a nursing chair held by the first author. The internship was deliberately structured around core processes of providing individual and group mentoring, creating opportunities for experiential education, and strengthening networks with researchers and decision-makers in health services and policy research. Building and sustaining individual research capacity was supported with strategies to address system challenges. If nurses are going to make their voices heard and increase their contributions to novel health service delivery approaches, building research capacity will be a core element. The internship may be a useful prototype for the development of initiatives to build research capacity in other settings.Item Gathering speed and taking flight : multi-country qualitative data analysis(2009) Atkinson, U; Grundy, Q; Harrowing, J N; Hepburn-Brown, C; Mill, J EOBJECTIVE: Preparation for the conduct of multi-country research is analogous to securing the aircraft and taxiing down the runway in anticipation of flight. The process of designing and implementing data analysis strategies for a research project entitled “Nursing practice in HIV prevention and care in Sub-Saharan Africa and the Caribbean” is described. Management of qualitative data from two of the project tools will be used to highlight the ethical considerations, electronic and telecommunications challenges, wide range of expertise, and other practical and logistical issues that were encountered. METHODS: Investigators, collaborators, research assistants, and students representing five countries worked together to develop protocols and frameworks for the management and analysis of data. RESULTS: Analysis teams identified barriers and created innovative strategies for learning the necessary skills to manage data efficiently and rigorously. Because the intent of the study is to build leadership capacity for research and policy development among nurses in low and middle income countries, identifying and addressing best practices collaboratively was an important initial part of the process. CONCLUSIONS: A successful journey begins by ensuring all team members are on board. The authors will discuss the communication strategies and resources that were established in order to maximize capacity building and consistent analysis in this multi-country program of research.Item Access to health care services - an English policy perspective(2009) Goddard, MInternational trends highlight the confluence of economics, politics and legal considerations in the health policy process. Health Economics, Policy and Law serves as a forum for scholarship on health policy issues from these perspectives, and is of use to academics, policy makers and health care managers and professionals. HEPL is international in scope, publishes both theoretical and applied work, and contains articles on all aspects of health policy. Considerable emphasis is placed on rigorous conceptual development and analysis, and on the presentation of empirical evidence that is relevant to the policy process.Item Aplicación, efectividad y contexto político de la atención primaria integral de salud: resultados preliminares de una revisión de la literatura mundial(2009) Labonté, Ronald; Sanders, David; Baum, Fran; Schaay, Nikki; Packer, CorinneItem Challenges in developing community mental health services in Sri Lanka(2009) Fernando, S; Weerackody, CThere are several issues to be faced in developing mental health services in South Asia if they are to be culturally and socially appropriate to the needs of the communities in the region. The meanings of mental health relevant to culturally appropriate service development can be obtained by exploring local notions of well-being, systems of care available to people and current practices among those seeking help for mental health problems. Participatory research carried out in communities in Sri Lanka affected by prolonged armed conflict and by the 2004 tsunami clarified the nature of well-being as perceived by communities themselves. Subsequent development of mental health services for Sri Lanka can be based on community consultation, using methodologies and interventions that involve the participation of the communities and their local institutions, and adapting relevant western approaches to the Sri Lankan context.Item Access as a policy-relevant concept in low- and middle-income countries(2009) McIntyre, D; Thiede, M; Birch, SAlthough access to health care is frequently identified as a goal for health care policy, the precise meaning of access to health care often remains unclear. We present a conceptual framework that defines access to health care as the empowerment of an individual to use health care and as a multidimensional concept based on the interaction (or degree of fit) between health care systems and individuals, households, and communities. Three dimensions of access are identified: availability, affordability, and acceptability, through which access can be evaluated directly instead of focusing on utilisation of care as a proxy for access. We present the case for the comprehensive evaluation of health care systems as well as the dimensions of access, and the factors underlying each dimension. Such systemic analyses can inform policy-makers about the ‘fit’ between needs for health care and receipt of care, and provide the basis for developing policies that promote improvements in the empowerment to use care.Item Human resources and the quality of emergency obstetric care in developing countries: a systematic review of the literature(2009-02) Dogba, Maman; Fournier, PierreBackground: This paper reports on a systematic literature review exploring the importance of human resources in the quality of emergency obstetric care and thus in the reduction of maternal deaths. Methods: A systematic search of two electronic databases (ISI Web of Science and MEDLINE) was conducted, based on the following key words "quality obstetric* care" OR "pregnancy complications OR emergency obstetric* care OR maternal mortality" AND "quality health care OR quality care" AND "developing countries. Relevant papers were analysed according to three customary components of emergency obstetric care: structure, process and results. Results: This review leads to three main conclusions: (1) staff shortages are a major obstacle to providing good quality EmOC; (2) women are often dissatisfied with the care they receive during childbirth; and (3) the technical quality of EmOC has not been adequately studied. The first two conclusions provide lessons to consider when formulating EmOC policies, while the third point is an area where more knowledge is needed.Item Building capacity for nurse-led research(2009-02) Edwards, N; Webber, J; Mill, J; Kahwa, E; Roelofs, SAim: To discuss factors that have influenced the development of research capacity among nurses in lower and middle-income countries (LMICs). Background: Concerned health scientists have addressed the importance of building research capacity among health professionals. Strengthening capacity specifically among LMIC nurses has been infrequently discussed. Without the requisite educational preparation or an enabling environment for research, nurses are unlikely to either demand research capacity-building opportunities or initiate research examining nursing practice and health system challenges. Methods: A scan was conducted of nine internationally funded research capacity-building initiatives to identify programme targeting and the proportion of nurse trainees. A literature review examined graduate and post-graduate training opportunities for LMIC nurses, and barriers and enablers to nurses' involvement in research. Informal consultations were held with nurse leaders in 15 LMICs and leaders of eight LMIC nursing organizations. Findings: The scan found a generic targeting of health professionals with a very low percentage of nurse trainees. Programmes specifically targeting nurses did attract and prepare a significant number of nurses. Factors limiting nurses' involvement in research include hierarchies of power among disciplines, scarce resources, a lack of graduate and post-graduate education opportunities, few senior mentors, and prolonged underfunding of nursing research. Conclusions: Fully engaging LMIC nurses in health services research may yield pragmatic and evidence-informed service delivery and policy recommendations. Investments in supports for nursing research capacity may enrich global health policy effectiveness and improve quality of care.Item Comprehensive Primary Health Care in Australia: findings from a narrative review of the literature(2010) Hurley, Catherine; Baum, Fran; Johns, Julie; Labonte, RonObjectives: To identify the extent to which the Alma Ata defined Comprehensive Primary Health Care (CPHC) approach is practised and evaluated in Australia and to describe the role that GPs and other medical practitioners play in it along with implications of this for future policy in light of the Health and Hospital Reform Commission (HHRC) and Primary Health Care taskforce reports, 2009 recommendations. Methods: We conducted a narrative review of the literature (published and grey) from 1987 to mid 2007 as part of a global review carried out by teams of researchers in six regions in 2007. Results: In Australia, the CPHC approach occurs chiefly in Aboriginal Controlled Community Health Services, state funded community health and in rural/remote and inner city areas. Participation by GPs in CPHC is limited by funding structures, workforce shortages and heavy workloads. Factors that facilitated the CPHC approach include flexibility in funding and service provision, cultural appropriateness of services, participation and ownership by local consumers and communities and willingness to address the social determinants of health. Conclusions: The recent HHRC and Primary Health Care Taskforce reports recommend an expansion of CPHC services as a means of tackling health inequities. The findings of this review suggest that resources will need to be directed beyond individual treatment to population health issues, cross-sector collaboration and consumer participation in order to realise the CPHC model. Without attention to these areas PHC will not be comprehensive and its ability to contribute to reducing inequities will be severely hampered. The absence of an evaluation culture supported with resources for CPHC programs and services also hinders the ability of practitioners and policy makers to assess the benefits of these programs and how their implementation can be improved. Funding structures, workforce issues and evaluation of programs will all need to be addressed if the health sector is to contribute to the goal of reducing health inequities.Item Survey on KAP and impact factors of condom use among construction workers in Shanghai,China(2010) Ren, J; Calzavara, L; Kang, L; Fang, H; Zhuang, MObjective To understand the level of knowledge,attitude and practice (KAP) related to condom use and relevant impact factors among construction workers in Shanghai so as to provide evidence base for further promotion of condom use.Methods A face-to-face questionnaire survey was conducted among 1871 construction workers who were randomly selected from 18 sites in three districts of Shanghai.The collected information included demography,working experience,living conditions,KAP related condom use,etc.Results Most of the surveyed construction workers were married and male.Average age was 39±10.4 years;80.8% of them only had primary or junior middle schooling or even below.The scores of knowledge and attitude related to condom use were very low.The proportion of consistent condom use with casual sex partners was significantly higher than that with regular sex partners (53.3% vs 10.6%;P0.001).The factors related with lower frequency of condom use included older age,cohabitation,married/remarried status and long daily working time,their OR values being 0.57,0.22,0.46 and 0.71,respectively.Conclusion Construction workers play a bridge role of transmitting HIV/STI from the high risk population to the general population because they are highly floating and sexually active,with insufficient condom use knowledge and less frequency of condom use,etc.Therefore,strong promotion of condom use should be conducted among this special population group.