450 results match your criteria higher-level facility

Why do strategies to strengthen primary health care succeed in some places and fail in others? Exploring local variation in the effectiveness of a community health worker managed digital health intervention in rural India.

BMJ Glob Health 2021 Jul;6(Suppl 5)

The George Institute for Global Health, Newtown, New South Wales, Australia.

Introduction: Digital health interventions (DHIs) have huge potential as support modalities to identify and manage cardiovascular disease (CVD) risk in resource-constrained settings, but studies assessing them show modest effects. This study aims to identify variation in outcomes and implementation of SMARTHealth India, a cluster randomised trial of an ASHA-managed digitally enabled primary healthcare (PHC) service strengthening strategy for CVD risk management, and to explain how and in what contexts the intervention was effective.

Methods: We analysed trial outcome and implementation data for 18 PHC centres and collected qualitative data via focus groups with ASHAs (n=14) and interviews with ASHAs, PHC facility doctors and fieldteam mangers (n=12) Drawing on principles of realist evaluation and an explanatory mixed-methods design we developed mechanism-based explanations for observed outcomes. Read More

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Proportion, Characteristics and Maternal Outcome of women referred for childbirth to a tertiary hospital in northern Tanzania - A descriptive retrospective study based on a hospital birth registry.

Sex Reprod Healthc 2021 Jul 10;29:100646. Epub 2021 Jul 10.

Kilimanjaro Christian Medical University College, Moshi, Tanzania; Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre, Moshi Tanzania.

Objective: Timely identification of danger signs and prompt referral to higher level may prevent complication associated with childbirth. With a high MMR in Tanzania, there is need to highlight the information on the proportion of women referred to tertiary healthcare, their basic characteristics and outcomes. This study aimed to determine the proportion, basic characteristics and outcomes among women referred while in labour, from lower health facilities to a tertiary hospital in northern Tanzania. Read More

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Symbiotic nitrogen fixation in the reproductive structures of a basidiomycete fungus.

Curr Biol 2021 Jul 2. Epub 2021 Jul 2.

Department of Botany and Plant Pathology, Purdue University, West Lafayette, IN 47907, USA. Electronic address:

Nitrogen (N) fixation is a driving force for the formation of symbiotic associations between N-fixing bacteria and eukaryotes. Limited examples of these associations are known in fungi, and none with sexual structures of non-lichenized species. The basidiomycete Guyanagaster necrorhizus is a sequestrate fungus endemic to the Guiana Shield. Read More

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The Functional Consequences of the Novel Ribosomal Pausing Site in SARS-CoV-2 Spike Glycoprotein RNA.

Int J Mol Sci 2021 Jun 17;22(12). Epub 2021 Jun 17.

Laboratory of Retinal Cell & Molecular Biology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA.

The SARS-CoV-2 Spike glycoprotein (S protein) acquired a unique new 4 amino acid -PRRA- insertion sequence at amino acid residues (aa) 681-684 that forms a new furin cleavage site in S protein as well as several new glycosylation sites. We studied various statistical properties of the -PRRA- insertion at the RNA level (CCUCGGCGGGCA). The nucleotide composition and codon usage of this sequence are different from the rest of the SARS-CoV-2 genome. Read More

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Automatic Actionable Information Processing and Trust Management towards Safer Internet of Things.

Sensors (Basel) 2021 Jun 25;21(13). Epub 2021 Jun 25.

Research and Academic Computer Network (NASK), Kolska 12, 01-045 Warsaw, Poland.

The security of the Internet of Things (IoT) is a very important aspect of everyday life for people and industries, as well as hospitals, military, households and cities. Unfortunately, this topic is still too little researched and developed, which results in exposing users of Internet of Things to possible threats. One of the areas which should be addressed is the creation of a database of information about vulnerabilities and exploits in the Internet of Things; therefore, the goal of our activities under the VARIoT (Vulnerability and Attack Repository for IoT) project is to develop such a database and make it publicly available. Read More

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Helping Older Residents Remain in Subsidized Housing: Predictive Validity of the Live Well at Home-Rapid Screen (LWAH-RS) in a Real-World Application.

J Gerontol Soc Work 2021 Jul 1:1-13. Epub 2021 Jul 1.

School of Social Work, University of Minnesota, Saint Paul, Minnesota, USA.

Common Bond Communities (CBC) is a nonprofit organization that provides housing for low-income individuals and families. CBC utilized the Live Well at Home-Rapid Screen (LWAH-RS) to identify the risks for nursing home admission or assisted living entry among housing residents aged 60 or above. Drawing data from 842 assessments, we studied how well the LWAH-RS predicted moves to nursing homes or assisted living settings. Read More

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Futile trauma transfers: An infrequent but costly component of regionalized trauma care.

J Trauma Acute Care Surg 2021 Jul;91(1):72-76

From the Department of Surgery at the University of Kansas Medical Center, Kansas City, Kansas.

Background: Appropriate interfacility transfers are a key component of highly functioning trauma systems but transfer of unsalvageable patients can overburden the resources of higher-level centers. We sought to identify the occurrence and associated reasons for futile transfers within our trauma system.

Methods: Using prospectively collected data from our system database, a retrospective cohort study was conducted to identify patients who underwent interfacility transfer to our American College of Surgeons level I center. Read More

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Impact of the COVID-19 Pandemic on Emergency Department Transfers to a Higher Level of Care.

West J Emerg Med 2021 May 17;22(3):561-564. Epub 2021 May 17.

Kingman Regional Medical Center Emergency Medicine, Kingman, Arizona.

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, a reduction in emergency department (ED) visits was seen nationally according to the US Centers for Disease Control and Prevention. However, no data currently exists for the impact of ED transfers to a higher level of care during this same time period. The primary objective of the study was to determine whether the COVID-19 pandemic affected the rate of non-COVID-19 transfers from a rural community ED. Read More

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The Effect of Transfer on Outcomes in Burns.

J Burn Care Res 2021 Jun 4. Epub 2021 Jun 4.

Department of Surgery, University of Louisville, Louisville, KY.

Patients with burn injuries are often initially transported to centers without burn capabilities, requiring subsequent transfer to a higher level of care. This study aimed to evaluate the effect of this treatment delay on outcomes. Adult burn patients meeting American Burn Association (ABA) criteria for transfer at a single burn center were retrospectively identified. Read More

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Predicting Metastasis from Cues of Metastatic Cancer Stem-like Cells-3D-Ultrasensitive Metasensor at a Single-Cell Level.

ACS Nano 2021 06 3;15(6):9967-9986. Epub 2021 Jun 3.

Nano Characterization Laboratory, Department of Aerospace Engineering, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada.

Metastasis is the primary reason for treatment failure and cancer-related deaths. Hence forecasting the disease in its primary state can advance the prognosis. However, existing techniques fail to reveal the tumor heterogeneity or its evolutionary cascades; hence they are not feasible to predict the onset of metastatic cancer. Read More

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Correlates of birth registrations in East and Southern Africa and implications for civil registration and vital statistics systems.

A Onagoruwa Q Wodon

Public Health 2021 Jun 29;195:70-75. Epub 2021 May 29.

The World Bank, Washington, DC, USA. Electronic address:

Objectives: To analyze the role of both demand- and supply-side factors affecting birth registrations in East and Southern Africa by combining information on children, mothers, and their household on the one hand and information on the areas where they live on the other hand.

Study Design: The study used deidentified data from recent Demographic and Health Surveys implemented in five East and Southern African countries: Malawi (2015), Mozambique (2011), Uganda (2016), Tanzania (2015), and Zambia (2013-2014). The analysis was based on children under the age of five whose mothers provided information on whether the child's birth was registered administratively and whether they have a birth certificate. Read More

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Plasma D-dimer and FDP are promising biomarkers to predict perioperative fibrinolysis and bleeding following primary total joint arthroplasty: A STROBE compliant article.

Medicine (Baltimore) 2021 May;100(20):e26058

Department of Orthopaedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.

Abstract: Perioperative bleeding is associated with postoperative hyperfibrinolysis caused by surgical trauma in the setting of total hip and knee arthroplasty (THA/ TKA). The study aimed to clarify the dynamics of postoperative fibrinolytic activity and the values of fibrin degeneration products and thromboelastography (TEG) to guide precisive antifibrinolytic therapy.Forty three patients undergoing primary unilateral THAs and 40 TKAs were included to the prospective observational cohort study. Read More

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Increasing facility delivery through maternity waiting homes for women living far from a health facility in rural Zambia: a quasi-experimental study.

BJOG 2021 May 16. Epub 2021 May 16.

Boston University School of Public Health, Boston, MA, USA.

Objective: To report on the effectiveness of a standardised core Maternity Waiting Home (MWH) model to increase facility deliveries among women living >10 km from a health facility.

Design: Quasi-experimental design with partial randomisation at the cluster level.

Setting: Seven rural districts in Zambia. Read More

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Men's knowledge, attitude, and barriers towards emergency contraception: A facility based cross-sectional study at King Saud University Medical City.

PLoS One 2021 26;16(4):e0249292. Epub 2021 Apr 26.

Department of Family and Community Medicine, King Saud University Chair for Medical Education Research and Development, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Background: Male partners have a considerable role in influencing women's contraceptive decision making to reduce the chance of unintended pregnancy. Most studies are focused on women's knowledge and barriers for emergency contraception (EC) use. There is limited research on this topic from the male perspective. Read More

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Linkage to intensive adherence counselling among HIV-positive persons on ART with detectable viral load in Gomba district, rural Uganda.

AIDS Res Ther 2021 04 20;18(1):15. Epub 2021 Apr 20.

School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

Background: Antiretroviral therapy (ART) adherence is a primary determinant of sustained viral suppression, HIV transmission risk, disease progression and death. The World Health Organization recommends that adherence support interventions be provided to people on ART, but implementation is suboptimal. We evaluated linkage to intensive adherence counselling (IAC) for persons on ART with detectable viral load (VL). Read More

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Affordability of Essential Medicines and Associated Factors in Public Health Facilities of Jimma Zone, Southwest Ethiopia.

Adv Pharmacol Pharm Sci 2021 16;2021:6640133. Epub 2021 Mar 16.

Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia.

Background: Affordability is one of the key dimensions for access to essential medicines, and poor affordability impedes access to treatment in health facilities. The concept of affordability is associated with the issue of impoverishment and catastrophic expenditure. The provision of affordable and appropriate essential medicines is a vital component of a well-functioning health system. Read More

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A nonthrombotic pulmonary embolus caused by polyalkylimide dermal filler: A case report and literature review of medication management.

J Am Pharm Assoc (2003) 2021 Jul-Aug;61(4):e324-e331. Epub 2021 Mar 11.

Background: This report presents the case of a patient who developed a nonthrombotic embolus attributed to a polyalkylimide dermal filler, and it also charts pharmacotherapeutic strategies for polyalkylimide complications reported in the literature.

Case Summary: A 31-year-old female presented to a community teaching hospital with dyspnea, hemoptysis, and fever. A thorough history revealed that the patient received intragluteal injections of a polyalkylimide dermal filler (Bio-Alcamid) 4 days before hospitalization, although it was initially and incorrectly diagnosed as silicone embolism syndrome. Read More

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Evaluating disparities in access to obstetric services for American Indian women across Montana.

J Rural Health 2021 Mar 23. Epub 2021 Mar 23.

Jake Jabs College of Business and Entrepreneurship, Montana State University, Bozeman, Montana, USA.

Purpose: Pregnant women across the rural United States have increasingly limited access to obstetric care, especially specialty care for high-risk women and infants. Limited research focuses on access for rural American Indian/Alaskan Native (AIAN) women, a population warranting attention given persistent inequalities in birth outcomes.

Methods: Using Montana birth certificate data (2014-2018), we examined variation in travel time to give birth and access to different levels of obstetric care (i. Read More

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Rare case of pancrelipase therapy-induced neutropaenia.

BMJ Case Rep 2021 Mar 22;14(3). Epub 2021 Mar 22.

Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.

A 61-year-old man was transferred to our facility from an outside hospital due to refractory neutropaenia of unknown aetiology. The patient presented to the referring hospital with a 5-day history of worsening diarrhoea and abdominal pain. Initial lab results at presentation showed severe neutropaenia with an absolute neutrophil count of 0. Read More

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Practical Considerations for and Outcomes of Interfacility ECMO Transfer of Patients With COVID-19 During a Pandemic: Mayo Clinic Experience.

Mayo Clin Proc Innov Qual Outcomes 2021 Apr 3;5(2):525-531. Epub 2021 Mar 3.

Department of Critical Care Medicine, Mayo Clinic Arizona, Phoenix.

Interfacility transport of a critically ill patient with acute respiratory distress syndrome (ARDS) may be necessary for a higher level of care or initiation of extracorporeal membrane oxygenation (ECMO). During the COVID-19 pandemic, ECMO has been used for patients with severe ARDS with successful results. Transporting a patient after ECMO cannulation by the receiving facility brings forth logistic challenges, including availability of adequate personal protective equipment for the transport team and hospital capacity management issues. Read More

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The COVID-19 Army Rapid Assessment Tool (CARAT) for Management of COVID-19 in the Deployed Setting.

Med J (Ft Sam Houst Tex) 2021 Jan-Mar(PB 8-21-01/02/03):150-155


The COVID-19 pandemic poses unique challenges within the austere clinical setting, and the time between patient presentation and deterioration is a critical opportunity for intervention. In some cases, this may be a life-saving transfer to a higher level of care. US Central Command (CENTCOM) has provided valuable guidance for COVID-19 management in the operational environment,1 and has proposed the National Early Warning System 2 (NEWS2) scoring tool as a useful adjunct to gauging illness severity. Read More

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Associations of subclinical autistic-like traits with brain structural variation using diffusion tensor imaging and voxel-based morphometry.

Eur Psychiatry 2021 Mar 3;64(1):e27. Epub 2021 Mar 3.

Cognitive Neuropsychiatry Lab, Department of Psychiatry and Psychotherapy, Philipps-University Marburg/Marburg University Hospital-UKGM, Marburg, Germany.

Background: Previous case-control studies of autistic spectrum disorder (ASD) have identified altered brain structure such as altered frontal and temporal cortex volumes, or decreased fractional anisotropy (FA) within the inferior fronto-occipital fasciculus in patients. It remains unclear whether subclinical autistic-like traits might also be related to variation in these brain structures.

Methods: In this study, we analyzed magnetic resonance imaging (MRI) data of 250 psychiatrically healthy subjects phenotyped for subclinical autistic-like traits using the Autism Spectrum Quotient (AQ). Read More

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The impact of social health insurance on rural populations.

Eur J Health Econ 2021 Apr 27;22(3):473-483. Epub 2021 Feb 27.

Department of Economics, Lancaster University Management School, Lancaster University, Lancaster, LA2 0PF, UK.

Improving health outcomes of rural populations in low- and middle-income countries represents a significant challenge. A key part of this is ensuring access to health services and protecting households from financial risk caused by unaffordable medical care. In 2003, China introduced a heavily subsidised voluntary social health insurance programme that aimed to provide 800 million rural residents with access to health services and curb medical impoverishment. Read More

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Understanding the roles of community health workers in improving perinatal health equity in rural Uttar Pradesh, India: a qualitative study.

Int J Equity Health 2021 Feb 23;20(1):63. Epub 2021 Feb 23.

Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.

Background: Despite substantial reductions in perinatal deaths (stillbirths and early neonatal deaths), India's perinatal mortality rates remain high, both nationally and in individual states. Rates are highest among disadvantaged socio-economic groups. To address this, India's National Health Mission has trained community health workers called Accredited Social Health Activists (ASHAs) to counsel and support women by visiting them at home before and after childbirth. Read More

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February 2021

Evaluation of health surveillance system attributes: the case of neglected tropical diseases in Kenya.

BMC Public Health 2021 02 23;21(1):396. Epub 2021 Feb 23.

School of Health Systems and Public Health (SHSPH), University of Pretoria, Pretoria, South Africa.

Background: Control of preventive chemotherapy-targeted neglected tropical diseases (PC-NTDs) relies on strengthened health systems. Efficient health information systems provide an impetus to achieving the sustainable development goal aimed at ending PC-NTD epidemics. However, there is limited assessment of surveillance system functions linked to PC-NTDs and hinged on optimum performance of surveillance system attributes. Read More

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February 2021

Prevalence of musculoskeletal low back pain among registered nurses: Results of an online survey.

J Clin Nurs 2021 Jun 8;30(11-12):1675-1683. Epub 2021 Mar 8.

Department of Nursing and Midwifery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.

Aims And Objectives: The aim of this study was to describe the prevalence of low back pain (LBP) and the use of lifting aids and ergonomics among Czech registered nurses.

Background: Low back pain is the most common occupational health problem affecting nurses. Frequent manual lifting of heavy loads, including patients, is one of the main duties of nursing staff, which causes compressive and shear forces on the vertebrae of the lower spine. Read More

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SafeNET: Initial development and validation of a real-time tool for predicting mortality risk at the time of hospital transfer to a higher level of care.

PLoS One 2021 8;16(2):e0246669. Epub 2021 Feb 8.

The Wolff Center at UPMC, Pittsburgh, Pennsylvania, United States of America.

Background: Processes for transferring patients to higher acuity facilities lack a standardized approach to prognostication, increasing the risk for low value care that imposes significant burdens on patients and their families with unclear benefits. We sought to develop a rapid and feasible tool for predicting mortality using variables readily available at the time of hospital transfer.

Methods And Findings: All work was carried out at a single, large, multi-hospital integrated healthcare system. Read More

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February 2021

Uganda's "EID Systems Strengthening" model produces significant gains in testing, linkage, and retention of HIV-exposed and infected infants: An impact evaluation.

PLoS One 2021 4;16(2):e0246546. Epub 2021 Feb 4.

Clinton Health Access Initiative, Kampala, Uganda.

Introduction: A review of Uganda's HIV Early Infant Diagnosis (EID) program in 2010 revealed poor retention outcomes for HIV-exposed infants (HEI) after testing. The review informed development of the 'EID Systems Strengthening' model: a set of integrated initiatives at health facilities to improve testing, retention, and clinical care of HIV-exposed and infected infants. The program model was piloted at several facilities and later scaled countrywide. Read More

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February 2021

Availability and factors influencing community level handwashing facility in Ethiopia: Implication for prevention of infectious diseases.

PLoS One 2021 19;16(1):e0243228. Epub 2021 Jan 19.

Department of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, Amhara Regional State, Ethiopia.

Background: Handwashing is one of the most effective ways to prevent transmission of infectious diseases. A substantial body of research has examined the status and determinants of handwashing facilities in healthcare settings and schools. However, its status at home in the community, especially in developing countries, remains unclear. Read More

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Different activation signatures in the primary sensorimotor and higher-level regions for haptic three-dimensional curved surface exploration.

Neuroimage 2021 05 14;231:117754. Epub 2021 Jan 14.

Section on Functional Imaging Methods, National Institute of Mental Health, Bethesda, MD, USA; Functional MRI Core Facility, National Institute of Mental Health, Bethesda, MD, USA.

Haptic object perception begins with continuous exploratory contact, and the human brain needs to accumulate sensory information continuously over time. However, it is still unclear how the primary sensorimotor cortex (PSC) interacts with these higher-level regions during haptic exploration over time. This functional magnetic resonance imaging (fMRI) study investigates time-dependent haptic object processing by examining brain activity during haptic 3D curve and roughness estimations. Read More

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