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The Cochrane Database of Systematic... Jul 2023Primary healthcare (PHC) integration has been promoted globally as a tool for health sector reform and universal health coverage (UHC), especially in low-resource... (Review)
Review
BACKGROUND
Primary healthcare (PHC) integration has been promoted globally as a tool for health sector reform and universal health coverage (UHC), especially in low-resource settings. However, for a range of reasons, implementation and impact remain variable. PHC integration, at its simplest, can be considered a way of delivering PHC services together that sometimes have been delivered as a series of separate or 'vertical' health programmes. Healthcare workers are known to shape the success of implementing reform interventions. Understanding healthcare worker perceptions and experiences of PHC integration can therefore provide insights into the role healthcare workers play in shaping implementation efforts and the impact of PHC integration. However, the heterogeneity of the evidence base complicates our understanding of their role in shaping the implementation, delivery, and impact of PHC integration, and the role of contextual factors influencing their responses.
OBJECTIVES
To map the qualitative literature on healthcare workers' perceptions and experiences of PHC integration to characterise the evidence base, with a view to better inform future syntheses on the topic.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search date was 28 July 2020. We did not search for grey literature due to the many published records identified.
SELECTION CRITERIA
We included studies with qualitative and mixed methods designs that reported on healthcare worker perceptions and experiences of PHC integration from any country. We excluded settings other than PHC and community-based health care, participants other than healthcare workers, and interventions broader than healthcare services. We used translation support from colleagues and Google Translate software to screen non-English records. Where translation was not feasible we categorised these records as studies awaiting classification.
DATA COLLECTION AND ANALYSIS
For data extraction, we used a customised data extraction form containing items developed using inductive and deductive approaches. We performed independent extraction in duplicate for a sample on 10% of studies allowed for sufficient agreement to be reached between review authors. We analysed extracted data quantitatively by counting the number of studies per indicator and converting these into proportions with additional qualitative descriptive information. Indicators included descriptions of study methods, country setting, intervention type, scope and strategies, implementing healthcare workers, and client target population.
MAIN RESULTS
The review included 184 studies for analysis based on 191 included papers. Most studies were published in the last 12 years, with a sharp increase in the last five years. Studies mostly employed methods with cross-sectional qualitative design (mainly interviews and focus group discussions), and few used longitudinal or ethnographic (or both) designs. Studies covered 37 countries, with close to an even split in the proportions of high-income countries (HICs) and low- and middle-income countries (LMICs). There were gaps in the geographical spread for both HICs and LMICs and some countries were more dominant, such as the USA for HICs, South Africa for middle-income countries, and Uganda for low-income countries. Methods were mainly cross-sectional observational studies with few longitudinal studies. A minority of studies used an analytical conceptual model to guide the design, implementation, and evaluation of the integration study. The main finding was the various levels of diversity found in the evidence base on PHC integration studies that examined healthcare workers' perceptions and experiences. The review identified six different configurations of health service streams that were being integrated and these were categorised as: mental and behavioural health; HIV, tuberculosis (TB) and sexual reproductive health; maternal, women, and child health; non-communicable diseases; and two broader categories, namely general PHC services, and allied and specialised services. Within the health streams, the review mapped the scope of the interventions as full or partial integration. The review mapped the use of three different integration strategies and categorised these as horizontal integration, service expansion, and service linkage strategies. The wide range of healthcare workers who participated in the implementation of integration interventions was mapped and these included policymakers, senior managers, middle and frontline managers, clinicians, allied healthcare professionals, lay healthcare workers, and health system support staff. We mapped the range of client target populations.
AUTHORS' CONCLUSIONS
This scoping review provides a systematic, descriptive overview of the heterogeneity in qualitative literature on healthcare workers' perceptions and experience of PHC integration, pointing to diversity with regard to country settings; study types; client populations; healthcare worker populations; and intervention focus, scope, and strategies. It would be important for researchers and decision-makers to understand how the diversity in PHC integration intervention design, implementation, and context may influence how healthcare workers shape PHC integration impact. The classification of studies on the various dimensions (e.g. integration focus, scope, strategy, and type of healthcare workers and client populations) can help researchers to navigate the way the literature varies and for specifying potential questions for future qualitative evidence syntheses.
Topics: Child; Female; Humans; Cross-Sectional Studies; Family; Health Personnel; Health Services; Primary Health Care
PubMed: 37466272
DOI: 10.1002/14651858.CD013603.pub3 -
Frontiers in Neuroscience 2024Transcutaneous spinal cord stimulation (TSCS), a non-invasive form of spinal cord stimulation, has been shown to improve motor function in individuals living with spinal...
INTRODUCTION
Transcutaneous spinal cord stimulation (TSCS), a non-invasive form of spinal cord stimulation, has been shown to improve motor function in individuals living with spinal cord injury (SCI). However, the effects of different types of TSCS currents including direct current (DC-TSCS), alternating current (AC-TSCS), and spinal paired stimulation on the excitability of neural pathways have not been systematically investigated. The objective of this systematic review was to determine the effects of TSCS on the excitability of neural pathways in adults with non-progressive SCI at any level.
METHODS
The following databases were searched from their inception until June 2022: MEDLINE ALL, Embase, Web of Science, Cochrane Library, and clinical trials. A total of 4,431 abstracts were screened, and 23 articles were included.
RESULTS
Nineteen studies used TSCS at the thoracolumbar enlargement for lower limb rehabilitation (gait & balance) and four studies used cervical TSCS for upper limb rehabilitation. Sixteen studies measured spinal excitability by reporting different outcomes including Hoffmann reflex (H-reflex), flexion reflex excitability, spinal motor evoked potentials (SMEPs), cervicomedullay evoked potentials (CMEPs), and cutaneous-input-evoked muscle response. Seven studies measured corticospinal excitability using motor evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS), and one study measured somatosensory evoked potentials (SSEPs) following TSCS. Our findings indicated a decrease in the amplitude of H-reflex and long latency flexion reflex following AC-TSCS, alongside an increase in the amplitudes of SMEPs and CMEPs. Moreover, the application of the TSCS-TMS paired associative technique resulted in spinal reflex inhibition, manifested by reduced amplitudes in both the H-reflex and flexion reflex arc. In terms of corticospinal excitability, findings from 5 studies demonstrated an increase in the amplitude of MEPs linked to lower limb muscles following DC-TSCS, in addition to paired associative stimulation involving repetitive TMS on the brain and DC-TSCS on the spine. There was an observed improvement in the latency of SSEPs in a single study. Notably, the overall quality of evidence, assessed by the modified Downs and Black Quality assessment, was deemed poor.
DISCUSSION
This review unveils the systematic evidence supporting the potential of TSCS in reshaping both spinal and supraspinal neuronal circuitries post-SCI. Yet, it underscores the critical necessity for more rigorous, high-quality investigations.
PubMed: 38591069
DOI: 10.3389/fnins.2024.1372222 -
Frontiers in Public Health 2024Ghana established Community-based Health Planning and Services (CHPS) as the primary point of contact for primary healthcare in 1999. CHPS has since emerged as the...
INTRODUCTION
Ghana established Community-based Health Planning and Services (CHPS) as the primary point of contact for primary healthcare in 1999. CHPS has since emerged as the country's primary strategy for providing close-to-client healthcare delivery, with numerous positive health outcomes recorded as a result of its implementation. There is, however currently a paucity of systematic reviews of the literature on CHPS. The purpose of this study was not only to investigate dominant trends and research themes in Community-based Health Planning and Services, but also to track the evolution of the CHPS intervention from its inception to the present.
METHOD
We adopted a systematic review approach for selected articles that were searched on Google Scholar, PubMed, and Scopus databases. The study was conducted and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We then applied a reflexive thematic analysis approach in synthesizing the results.
RESULTS
The search resulted in 127 articles of which 59 were included in the final review. Twenty (20) papers targeted the national level, eighteen (18) for the regional level, sixteen (16) for the district level, two (2) for the sub-district level, and three (3) papers targeted the community. The years 2017 and 2019 were recorded to be the years with the highest number of publications on CHPS in Ghana.
CONCLUSION
Community-based Health Planning and Services (CHPS) is an effective tool in addressing barriers and challenges to accessing quality and affordable health care causing significant effects on health. It provides close-to-client healthcare delivery in the community.
Topics: United States; Humans; Community Health Services; Primary Health Care; Health Planning; Ghana; Delivery of Health Care
PubMed: 38504682
DOI: 10.3389/fpubh.2024.1337803 -
Frontiers in Bioengineering and... 2023To systematically evaluate the efficacy of moxibustion in diarrhea-predominant irritable bowel syndrome (IBS-D) model rats. A comprehensive search was conducted in the...
To systematically evaluate the efficacy of moxibustion in diarrhea-predominant irritable bowel syndrome (IBS-D) model rats. A comprehensive search was conducted in the China National Knowledge Infrastructure, WanFang Data, VIP, PubMed, Embase, and Web of Science databases from their inception to June 30, 2023. Relevant animal experiments investigating moxibustion for treating IBS-D in model rats were included. Two independent researchers screened the literature, extracted data, and evaluated the risk of bias in the selected studies. The meta-analysis was performed using RevMan 5.3 software. In total, 21 animal studies comprising 680 model rats were included. The meta-analysis results demonstrated that moxibustion enhanced the threshold capacity of the abdominal withdrawal reflex (AWR) [standardized mean difference (SMD) = 1.84; 95% confidence interval (CI): 1.09, 2.60; < 0.00001], ameliorated the rate of loose stool (SMD = -4.03; 95% CI: -5.76, -2.30; < 0.00001), and decreased the colon 5-hydroxytryptamine (SMD = -3.67; 95% CI: -5.33, -2.01; < 0.00001), serum interleukin-1β (SMD = -3.24, 95% CI: -4.06, -2.41; < 0.00001), serum tumor necrosis factor-α (SMD = -2.35, 95% CI: -4.12, -0.58; < 0.00001), and serum substance P (SMD = -5.14, 95% CI: -8.45, -1.83; = 0.002) concentrations. Moxibustion did not affect the blood calcitonin gene-related peptide level compared to the blank model group ( = 0.15). Moxibustion modulated the brain-gut interaction, reduced visceral hypersensitivity, inhibited intestinal inflammation, and regulated the immune balance, improving the rate of loose stool and increasing the AWR threshold capacity in IBS-D model rats, achieving good analgesic and antidiarrheal effects. However, these conclusions require further validation due to limitations in the quantity and quality of the included studies.
PubMed: 38162185
DOI: 10.3389/fbioe.2023.1309661 -
PloS One 2023Post-mortem brain donation affords the opportunity to characterise disease by exploring global neuropathological changes. Such opportunities are essential to progress...
PURPOSE
Post-mortem brain donation affords the opportunity to characterise disease by exploring global neuropathological changes. Such opportunities are essential to progress knowledge of CNS tumours such as Glioblastoma. A comprehensive understanding of the experience of consenting to brain donation is crucial to maximising consent rates while providing patient-centred care. This review aimed to synthesise the reported facilitators and barriers according to potential donors, next-of-kin (NOK) and clinician respondents.
DESIGN
Database searches included Embase, Medline, PsycINFO, Psychology and Behavioural Science and Scopus. Search terms focused on motivations, attitudes and psychosocial experiences of brain donation. Exclusions included organ transplantation and brain death. All studies were assessed for quality and validity using tools from the Joanna Briggs Institute. To determine perceptions of benefit and harm, a method guided by the thematic analysis of Braun and Clarke was employed to reflexively assess and identify common themes and experiences.
RESULTS
40 studies (15 qualitative, 25 quantitative) were included involving participants with paediatric cancer, neurodegenerative and psychological diseases. Perceptions of benefit included benefit to future generations, aiding scientific research, avoidance of waste, improved treatments and the belief that donation will bring consolation or aid in the grieving process. Perceptions of harm included a perceived conflict with religious beliefs, disfigurement to the donor, emotional distress at the time of autopsy and discord or objections within the family.
CONCLUSION
Brain donation can afford a sense of purpose, meaning and empowerment for donors and their loved ones. Careful strategies are required to mitigate or reduce potential harms during the consent process.
Topics: Child; Humans; Tissue and Organ Procurement; Tissue Donors; Brain; Attitude; Autopsy
PubMed: 38117774
DOI: 10.1371/journal.pone.0295438 -
Psicologia, Reflexao E Critica :... Apr 2024Research has consistently shown that some children are more vulnerable at the time of school readiness. Better understanding the characteristics of these children is... (Review)
Review
BACKGROUND
Research has consistently shown that some children are more vulnerable at the time of school readiness. Better understanding the characteristics of these children is therefore important. Most studies have used a variable-based approach, which may mask the presence of small but important subgroups of children with mixed patterns of readiness strengths and weaknesses. Identifying subgroups with mixed readiness patterns using a person-centered approach matters because their developmental trajectories might differ in important ways from children with broader difficulties across all readiness domains.
OBJECTIVE
This systematic review attempts to synthesize existing profiles of school readiness conducted on preschool-aged children and to describe how these various profiles are associated with children's academic achievement and social adjustment during their school years. Specifically, we described how the school readiness profiles vary in number of profiles identified and differences in the specific domains of school readiness. We further describe the school readiness profiles and how they predict later academic and social outcomes. Furthermore, we focus on profile differences between at-risk and non-at-risk preschoolers.
METHODS
Longitudinal studies published between 2005 and 2022 on profiles of school readiness before school entry and at least one subsequent academic and/or social outcomes were extracted from five databases. Eight articles were included in this systematic review out of the 117 screened peer-reviewed articles.
RESULTS
All the studies incorporated both the cognitive and socioemotional domains of school readiness in their profiles. Fifteen profiles of school readiness at preschool age were identified based on the child level of cognitive and socioemotional skills, with 7 profiles at risk of later academic and social difficulties. Despite variation, children in these at-risk profiles of school readiness shared similar features.
CONCLUSION
This literature review provides an exhaustive summary on the number of profiles and domains of school readiness most frequently reported in studies using a person-centered approach. Yielding an in-depth description of at-risk profiles of school readiness can help designing early preventive intervention for these children.
PubMed: 38630214
DOI: 10.1186/s41155-024-00298-y -
Psicologia, Reflexao E Critica :... May 2024Prospective memory is the ability to engage in an intention to be performed in the future. The main objective of this study was to identify instruments that assess both... (Review)
Review
BACKGROUND
Prospective memory is the ability to engage in an intention to be performed in the future. The main objective of this study was to identify instruments that assess both time-based and event-based prospective memory in children and adolescents and that have the potential to be clinically applicable.
METHOD
Three databases (PubMed, Scopus, and PsycINFO) were searched to identify existing PM measures in original articles published until 2022. Literature searches were conducted using the following terms: (prospective memor* OR memor* for intentions) AND (neuropsychological assessment) AND (test* OR instrument* OR questionnaire* OR task*) AND (psychometric properties) AND (child* OR adolescen*). Relevant studies identified in the reference lists were also included in the review.
RESULTS
Ten instruments were identified and classified into three categories: (a) test batteries, (b) experimental procedures, and (c) questionnaires. All the instruments identified were described concerning their content and the psychometric properties available. Some of the instruments presented empirical evidence regarding validity and reliability, but no one provided normative data.
CONCLUSION
Besides the recent progress regarding studies publishing the development of a variety of novel measures, there are still many limitations surrounding the assessment of PM in the youth population because of the yet incipient psychometric properties presented by the majority of the PM instruments. Recommendations for a gold-standard PM instrument for assessing children and adolescents are provided.
PubMed: 38709384
DOI: 10.1186/s41155-024-00300-7 -
BMC Complementary Medicine and Therapies Jan 2024As cancer and its therapy comes with a wide range of negative effects, people look for options to mitigate these effects. Reflexology is among the options of...
BACKGROUND
As cancer and its therapy comes with a wide range of negative effects, people look for options to mitigate these effects. Reflexology is among the options of complementary medicine.
METHOD
In March 2022 a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychInfo, CINAHL and Medline) to find studies concerning the use, effectiveness and potential harm of reflexology on cancer patients.
RESULTS
From all 821 search results, 29 publications concerning 26 studies with 2465 patients were included in this systematic review. The patients treated with reflexology were mainly diagnosed with breast, lung, gastrointestinal and hematological cancer. Outcomes were mainly pain, quality of life, anxiety, depression, fatigue. The studies had moderate to low quality and reported heterogeneous results: Some studies reported significant improvements in above mentioned outcomes while other studies did not find any changes concerning these endpoints.
CONCLUSION
Due to the very heterogeneous results and methodical limitations of the included studies, a clear statement regarding the effectiveness of reflexology on cancer patients is not possible. The current evidence indicates that reflexology is superior to passive control groups for pain, quality of life and fatigue, however, more studies with comparable active control groups are needed.
Topics: Humans; Quality of Life; Musculoskeletal Manipulations; Pain; Neoplasms; Fatigue
PubMed: 38212747
DOI: 10.1186/s12906-023-04220-4 -
Clinical Case Reports Jun 2024The co-occurrence of myasthenia gravis (MG) and lichen planus (LP) is a rare phenomenon, with only 13 cases reported in the English literature between 1971 and 2024....
KEY CLINICAL MESSAGE
The co-occurrence of myasthenia gravis (MG) and lichen planus (LP) is a rare phenomenon, with only 13 cases reported in the English literature between 1971 and 2024. Patients with MG or LP, regardless of the thymoma status, require close monitoring for other autoimmune diseases.
ABSTRACT
Myasthenia gravis (MG) is an uncommon autoimmune disease, resulting in fatigable muscle weakness in the ocular, bulbar, and respiratory muscles, as well as muscles of the extremities. Lichen planus (LP) is an autoimmune mucocutaneous disease, presenting with pruritic and violaceous plaques on the skin and mucosal surfaces. So far, MG and LP co-occurrence is only reported in anecdotal individuals. This study reports a patient with MG and LP and systematically reviews the English literature on this rare co-occurrence from 1971 to 2024, indicating only 13 cases with similar conditions. A 67-year-old man presented with ocular and progressive bulbar symptoms, a year after being diagnosed with generalized LP. Laboratory evaluations were normal except for the high anti-AchR-Ab titer and a positive ANA titer. Neurologic examinations revealed asymmetric bilateral ptosis, weakness and fatigability in proximal muscles, and a severe reduction in the gag reflex. He was diagnosed with late-onset, seropositive MG. The treatment included pyridostigmine (60 mg, three times daily), intravenous immunoglobulin (25 g daily for 5 days), and oral prednisolone. There was no evidence of thymoma in the chest x-ray and CT scan without contrast. However, a CT scan with contrast was not performed due to the patient's unstable condition. A common autoimmune mechanism may underlie the unclear pathophysiology of MG and LP co-occurrence, with or without thymoma. Patients with MG, LP, or thymoma require close monitoring and assessment for other possible autoimmune diseases.
PubMed: 38883218
DOI: 10.1002/ccr3.9065 -
Inflammatory Bowel Diseases Nov 2023Total proctocolectomy with ileal pouch anal anastomosis (IPAA) for medically refractory ulcerative colitis or dysplasia may be associated with structural and...
BACKGROUND
Total proctocolectomy with ileal pouch anal anastomosis (IPAA) for medically refractory ulcerative colitis or dysplasia may be associated with structural and inflammatory complications. However, even in their absence, defecatory symptoms secondary to dyssynergic defecation or fecal incontinence may occur. Although anorectal manometry is well established as the diagnostic test of choice for defecatory symptoms, its utility in the assessment of patients with IPAA is less established. In this systematic review, we critically evaluate the existing evidence for anopouch manometry (APM).
METHODS
A total of 393 studies were identified, of which 6 studies met all inclusion criteria. Studies were not pooled given different modalities of testing with varying outcome measures.
RESULTS
Overall, less than 10% of symptomatic patients post-IPAA were referred to APM. The prevalence of dyssynergic defecation as defined by the Rome IV criteria in symptomatic patients with IPAA ranged from 47.0% to 100%. Fecal incontinence in patients with IPAA was characterized by decreased mean and maximal resting anal pressure on APM, as well as pouch hyposensitivity. The recto-anal inhibitory reflex was absent in most patients with and without incontinence.
CONCLUSION
Manometry alone is an imperfect assessment of pouch function in patients with defecatory symptoms, and confirmatory testing may need to be performed with dynamic imaging.
Topics: Humans; Fecal Incontinence; Proctocolectomy, Restorative; Anastomosis, Surgical; Rectum; Colitis, Ulcerative; Anal Canal; Colonic Pouches
PubMed: 36351035
DOI: 10.1093/ibd/izac234