Teasdale-Corti Global Health Research Partnership (TC) / partenariat Teasdale-Corti de recherche en santé mondiale
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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 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 Achieving Universal Health Coverage: State of Community Empowerment in Bangladesh(2012) Joarder, T; Uddin, A; Islam, AItem Action Research for the Health and Safety of Domestic Workers in Montreal: Using Numbers to Tell Stories and Effect Change(2010) Hanley, J; Premji, S; Messing, K; Lippel, KIn 2007, a Filipina organization in Quebec (PINAY) sought the help of university researchers to document the workplace health and safety experiences of domestic workers. Together, they surveyed 150 domestic workers and produced a report that generated interest from community groups, policy-makers, and the media. In this article, we—the university researchers—offer a case study of community-university action research. We share the story of how one project contributed to academic knowledge of domestic workers' health and safety experiences and also to a related policy campaign. We describe how Quebec workers' compensation legislation excludes domestic workers, and we analyze the occupational health literature related to domestic work. Striking data related to workplace accidents and illnesses emerged from the survey, and interesting lessons were learned about how occupational health questions should be posed. We conclude with a description of the successful policy advocacy that was possible as an outcome of this project.Item Agriculture and health inter-sectorial research process to reduce hazardous pesticide health impacts among smallholder farmers in the Andes(BioMed Central, London, GB, 2011) Cole, Donald C.; Orozco, Fadya; Pradel, Willy; Suquillo, Jovanny; Mera, XavierWork with multiple actors is needed to shift agriculture away from pesticide use, and towards greater sustainability and human health, particularly for vulnerable smallholder farmers. This research in potato and vegetable farming communities in the Andean highlands worked with partners from various sectors over several projects. Increased involvement in organic agriculture was associated with greater household food security and food sovereignty. More diversified, moderately developed agricultural systems had lower pesticide use and better child nutrition. The Ecuadorian Ministry of Health has rolled out pesticide poisoning surveillance modeled on this research.Item AIDS-Related Discrimination and its Effects on Prevention Service Adherence among Female Entertainment Workers(2011) Shi, G; Yin, F; Wu, J; Guo, L; Remis, R S[Objective] To investigate AIDS-related discrimination among female entertainment workers (FEWs) and its effect on prevention service adherence. [Methods] A total of 126 FEWs were randomly selected from Juyuan New Area as the study subjects, interviewed with an unified questionnaire for socio-demographic, behavioral, cognition and AIDS-related discrimination status, and tested for HIV, HSV-2, syphilis, gonorrhea and Chlamydia trachomatis with blood and urine samples. [Results] Among the 126 FEWs investigated, 31.75% came from large KTVs, 62.70% from small hair salons, 2.38% from small foot care stores, and 3.17% from small bathrooms. None was HIV-positive and 22.22% was infected with sexually transmitted diseases (STD). The mean score of AIDS-related discrimination was 4.19 plus or minus 1.61. AIDS-related discrimination had a statistical relationship with the level of AIDS knowledge ( chi super(2)=5.184, P=0.023). Only 23.81% had HIV tests ever, and "don't know where to go to get a test" and "chance of having AIDS is low" were the main reasons for not to get a test. Those having STD-related symptoms in the past one month accounted for 61.90%, and 70.51% saw a doctor. Those who went for routine STD check-ups in the past one year taken 50.00%, and the mean of STD checkups were 1.79 plus or minus 0.99. In their last sexual encounter, 96.83% used condoms when having sex with clients, but 45.74% did so when with regular sexual partners. The proportion of having a miscarriage ever was 11.11%, and 65.87% for an abortion ever. The times of miscarriage and abortion varied from 1 to 7, with the median of 1. Those using contraceptives accounted for 97.62%, among which 66.67% chose condoms. chi super(2) test showed AIDS-related discrimination had a statistical relationship with HIV test ( chi super(2)=5.936, P=0.015) and sexually transmitted infection rate ( chi super(2)=4.829, P=0.028). [Conclusion] AIDS-related discrimination is common among FEWs. HIV prevention service adherence is far from being satisfactory, and AIDS-related discrimination has an effect on some HIV prevention service adherence.Item Alimentación no saludable, inactividad física y obesidad en la población infantil colombiana: un llamado urgente al estado y la sociedad civil para emprender acciones efectivas(2012) Gómez, Luis Fernando; Ibarra, Marian Lorena; Lucumí, Diego Iván; Arango, Carlos Mario; Parra, AngelaColombia, al igual que la mayoría de los países de América Latina, ha experimentado una rápida transición nutricional, la cual se ha dado en un contexto caracterizado por altos niveles de pobreza, inequidad y exclusión social; sumado a acelerados procesos de globalización y una creciente influencia política y mediática de las grandes corporaciones de bebidas y alimentos ultra-procesados. Esta situación tiene un impacto potencialmente negativo en la salud infantil, al afectar sus patrones de actividad física y alimentación. Existen acciones poblacionales efectivas para la promoción de la actividad física y la alimentación saludable en niños, niñas y adolescentes, que podrían implementarse en Colombia si se contara con la voluntad política del gobierno y la participación activa de la sociedad civil. (Global Health Promotion, 2012; 19(3): 87–92)Item Almost universal coverage: HIV testing among TB patients in a rural public programme(2012) Chimbindi, N; Bärnighausen, T; Newell, M LItem Analysis on knowledge and practice of AIDS/STDs among female sex workers in Minhang district of Shanghai(2012) Yu, F; Zhang, J; Feng, Y; Huang, A; Fan, YTo investigate the living features and the knowledge and practice of AIDS/STDs among female entertainment workers(FEWs),so as to provide evidence to design,implement and assess AIDS/STDs prevention and invention.[Methods] A total of 125 FEWs,who were selected from 28 commercial entertainment locales(7 large and 21 small locales) in 2 communities by multistage cluster sampling method,were recruited for a questionnaire survey.[Results] There were significant differences in age,education,marital status and monthly income between FEWs working in large locales and those in small locales(P 0.01).Logistic regression analysis indicated that less condom use in married groups than in single groups(P 0.01).People who had higher scores in condom use knowledge and self-efficiency test revealed a higher rate of condom use in each sexual behavior.[Conclusion] FEWs,who are at the risk of infection at all times,are still the key population for AIDS/STDs prevention and control.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 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 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 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 Challenges of scaling up and of knowledge transfer in an action research project in Burkina Faso to exempt the worst-off from health care user fees(2011-11) Ridde, Valéry; Yaogo, Maurice; Kafando, Yamba; Kadio, Kadidiatou; Ouedraogo, MoctarThis article analyzes an action research project aimed at finding an appropriate solution to make health care accessible to the most impoverished in a rural district of Burkina Faso. A mixed methods interdisciplinary research approach was critical to grasping the complexity of this community-based process. Combined with partnerships with local decision-makers the approach was very effective. At the instigation of an NGO, four other districts in Burkina Faso and Niger reproduced this experiment. However, national decision-makers showed no interest in this action and remain unconcerned about finding solutions. Recommendations are made for strategies to disseminate results.Item Community Health Workers’ Perspectives on Their Contribution to Rural Health and Well-Being in Iran(2011) Javanparast, S; Baum, F; Labonte, R; Sanders, DObjectives. The activities of community health workers (CHWs) have been identified as key to improvements in the health of Iran's rural population. We explored the perceptions of CHWs regarding their contribution to rural health in Iran. Methods. Three research assistants familiar with the Iranian primary health care network conducted face-to-face interviews with CHWs in 18 provinces in Iran. Results. Findings showed that Iranian CHWs have an in-depth understanding of health, including its social determinants, and are responsible for a wide range of activities. Respondents reported that trust-based relationships with rural communities, an altruistic motivation to serve rural people, and sound health knowledge and skills are the most important factors facilitating successful implementation of the CHW program in Iran. By contrast, high workload and the lack of a support system were mentioned as barriers to effective performance. Conclusions. The CHW program in Iran is a compelling example of comprehensive primary health care, in that CHWs provide basic health care but also work with community members and other sectors to address the social determinants of health.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 Comprehensive Primary Health Care in South America: contexts, achievements and policy implications(2011) Ramírez, Naydú Acosta; Pollard Ruiz, Jennifer; Vega Romero, Román; Labonté, RonaldThis article summarizes an extensive review of South American experiences with primary health care. The studies fall along an effectiveness spectrum, from complete and ideal implementation of comprehensive primary health care to varying degrees of partial implementation. Rights-based health policies have been developed within the legal and constitutional frameworks of many countries in the region. Conditions that were found to promote successful implementation of primary health care are outlined, together with features that help create more equitable health services and health outcomes. In cases with a weak rights-based approach, it was more difficult to implement and coordinate primary health care.Item 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 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 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.