Assuntos
Conjuntivite/etiologia , Síndrome de Stevens-Johnson/complicações , Adolescente , Antibacterianos/administração & dosagem , Curativos Biológicos , Conjuntivite/diagnóstico , Conjuntivite/terapia , Ciclosporina/administração & dosagem , Eritromicina/administração & dosagem , Glucocorticoides/administração & dosagem , Humanos , Imunossupressores/administração & dosagem , Masculino , Prednisolona/administração & dosagemRESUMO
BACKGROUND: The threat of a global influenza pandemic and the adoption of the World Health Organization (WHO) International Health Regulations (2005) highlight the value of well-coordinated, functional disease surveillance systems. The resulting demand for timely information challenges public health leaders to design, develop and implement efficient, flexible and comprehensive systems that integrate staff, resources, and information systems to conduct infectious disease surveillance and response. To understand what resources an integrated disease surveillance and response system would require, we analyzed surveillance requirements for 19 priority infectious diseases targeted for an integrated disease surveillance and response strategy in the WHO African region. METHODS: We conducted a systematic task analysis to identify and standardize surveillance objectives, surveillance case definitions, action thresholds, and recommendations for 19 priority infectious diseases. We grouped the findings according to surveillance and response functions and related them to community, health facility, district, national and international levels. RESULTS: The outcome of our analysis is a matrix of generic skills and activities essential for an integrated system. We documented how planners used the matrix to assist in finding gaps in current systems, prioritizing plans of action, clarifying indicators for monitoring progress, and developing instructional goals for applied epidemiology and in-service training programs. CONCLUSION: The matrix for Integrated Disease Surveillance and Response (IDSR) in the African region made clear the linkage between public health surveillance functions and participation across all levels of national health systems. The matrix framework is adaptable to requirements for new programs and strategies. This framework makes explicit the essential tasks and activities that are required for strengthening or expanding existing surveillance systems that will be able to adapt to current and emerging public health threats.
Assuntos
Controle de Doenças Transmissíveis/organização & administração , Surtos de Doenças/prevenção & controle , Planejamento em Saúde/métodos , Vigilância da População/métodos , Administração em Saúde Pública/métodos , África , América Central , Humanos , Filipinas , Análise e Desempenho de TarefasRESUMO
Public health officials and the communities they serve need to: identify priority health problems; formulate effective health policies; respond to public health emergencies; select, implement, and evaluate cost-effective interventions to prevent and control disease and injury; and allocate human and financial resources. Despite agreement that rational, data-based decisions will lead to improved health outcomes, many public health decisions appear to be made intuitively or politically. During 1991-1996, the US Centers for Disease Control and Prevention implemented the US Agency for International Development funded Data for Decision-Making (DDM) Project. DDM goals were to: (a) strengthen the capacity of decision makers to identify data needs for solving problems and to interpret and use data appropriately for public health decisions; (b) enhance the capacity of technical advisors to provide valid, essential, and timely data to decision makers clearly and effectively; and (c) strengthen health information systems (HISs) to facilitate the collection, analysis, reporting, presentation, and use of data at local, district, regional, and national levels. Assessments were conducted to identify important health problems, problem-driven implementation plans with data-based solutions as objectives were developed, interdisciplinary, in-service training programs for mid-level policy makers, program managers, and technical advisors in applied epidemiology, management and leadership, communications, economic evaluation, and HISs were designed and implemented, national staff were trained in the refinement of HISs to improve access to essential data from multiple sources, and the effectiveness of the strategy was evaluated. This strategy was tested in Bolivia, Cameroon, Mexico, and the Philippines, where decentralization of health services led to a need to strengthen the capacity of policy makers and health officers at sub-national levels to use information more effectively. Results showed that the DDM strategy improved evidence-based public health. Subsequently, DDM concepts and practices have been institutionalized in participating countries and at CDC.
Assuntos
Tomada de Decisões Gerenciais , Países em Desenvolvimento , Medicina Baseada em Evidências/educação , Planejamento em Saúde/organização & administração , Administração em Saúde Pública/educação , Informática em Saúde Pública , Bolívia , Camarões , Prioridades em Saúde , Humanos , Relações Interinstitucionais , México , Filipinas , Política , Resolução de ProblemasRESUMO
El metanálisis es un procedimiento cada vez más usado en medicina clínica para mejorar los métodos tradicionales de revisión narrativa mediante acumulación sistemática de información y cuantificación del efecto. La combinación de datos de varios estudios mediante metanálisis puede incrementar la potencia estadística, apuntar alguna relación entre variables y hacer generalizables los resultados con mayor rigor que los métodos de revisión no cuantitativa. Como todos los métodos de revisión, el metanálisis puede resultar limitado por sesgos de selección, datos inadecuados o sesgos de interpretación de los datos. De todas formas, las ventajas mencionadas convierten al metanálisis en un método que vale la pena someter a prueba y evaluación empírica
Esta traducción del artículo Meta-analysis: A quantitative approach to research integration se publica con autorización de la revista y del autor
Assuntos
Pesquisa , Metanálise , Métodos Epidemiológicos , Literatura de Revisão como AssuntoRESUMO
Sending new medical school graduates into rural areas does give underserved populations access to modern medical care, perhaps for the first time. However, these young physicians usually spend most of their time providing strictly clinical services and are generally eager to leave at the end of their assignment. Some have referred to this practice as «parachuting» a doctor into an underserved area. An alternative is to focus first on building up permanent health service facilities in rural areas that are staffed by appropriate paraprofessionals. The young physician can then play a much more important role, serving as an administrator, researcher, evaluator, and teacher of the local staff; his clinical activities would generally be confined to the more complicated medical problems that arise. Such a model has been implemented in Kenya and Tanzania. An informal field assessment in Colombia has indicated that this model could be effectively applied there as well; indeed, it has been the hope of Colombian policymakers that the rural intern would function in such a way. However, this would require developing the nation's system of health services, as well as providing specific training aimed at preparing the medical student to perform his assigned role (Au)
Assuntos
Internato e Residência , Saúde da População Rural , Colômbia , QuêniaRESUMO
En muchos países de este Hemisferio y otros lugares del mundo se exige a los recién graduados de las escuelas de medicina un período de servicio rural. Este artículo examina el caso de Colombia, a la par que presenta un modelo preparado conforme a la experiencia obtenida en dicho país y en Kenia, y sugiere las maneras en que se podría mejorar la contribución de los internos rurales en Colombia (AU)