Need For Advocacy Research Articles

The Allure of Abdominal Scarification (`UDE`) among the Esan Tribe in South-South Nigeria – A Prospective Analysis

Background: The practice of inflicting cuts (incisions) on the anterior abdominal wall to treat splenomegaly of various causes is a very common one in some parts of Edo State, Nigeria. Such incisions may result in several complications including sepsis (especially in children who are the major targets); massive blood loss leading to symptomatic anemia that may require blood transfusions or lead to death and massive keloidal growth as sequelae in some of the patients. This practice is a long-term practice of the Esan people of the central part of Edo State Nigeria. This study aims to identify the factors that continue to make this practice attractive to members of the community, the common complications encountered, and how to develop an advocacy tool for health education and promote the health-seeking behavior of the populace.
 Methods: This was a prospective community based cross-sectional descriptive study that was conducted in all the 5 Esan speaking local government areas of Edo State where this practice is very common. The study was done between January 2017 and June 2018. Participants were interviewed using a structured questionnaire by previously trained researchers, after pretesting and validation. The questionnaire was administered on 700 adults, however, 500 were returned. The data obtained were summarized as frequencies and percentages.
 Results: The majority of the participants were middle-aged. Ninty-five percent (95%) of respondents were aware of the practice of abdominal scarification and 80% of them think it is effective. It was mainly carried out by herbalists in 95% of the respondents. Half of the respondents were unaware of any complications associated with the procedure.
 Conclusion: Abdominal scarification is a common practice among the Esan people of south-south Nigeria. They believe it's effective, affordable, and risk-free. This is despite the availability of effective alternatives in orthodox medicine. There is, therefore, a need for advocacy and health education considering the dangers and complications associated with the practice.

Advocacy in Headache Medicine: Tips at the Bedside, the Institutional Level, and Beyond.

We describe the pervasiveness of headache diseases across the globe and the need for healthcare advocacy, define healthcare advocacy, and identify how providers can incorporate healthcare advocacy into clinical practice and beyond. Nearly 3 billion people across the globe experience migraine or tension-type headache, yet headache diseases receive a fraction of the funding that is allocated to other diseases. Despite its prevalence, those with headache diseases, especially migraine, experience external and internal stigma. As physicians, our job extends past the direct needs of the patient and must also focus on the systemic problems affecting our patients such as accessibility to healthcare providers and treatment options, as well as addressing stigma. We can empower our patients with education, community, and supportive, non-stigmatizing language used to describe headache diseases. Headache diseases are prevalent throughout the world and contribute to a substantial amount of disability. Disability is further compounded by stigma. Advocacy starts with empowering patients and peers with knowledge. It extends into the workplace to create accommodations and in the community to raise awareness and lobby for access to specialists, treatment options, and research funding.

COVID-19: Pandemic burden in Sub-Saharan Africa and the right to health - The need for advocacy in the face of growing privatisation.

For Africa, the backdrop1 against which COVID-19 emerged is a stark one. Although sub-Saharan Africa accounts for 11% of the world’s population, it bears 24% of the global disease burden. The continent is home to 60% of the people with human immunodeficiency virus (HIV), and over 90% of malarial patients. In this region, infectious diseases such as malaria and HIV cause 69% of deaths. As states respond to COVID-19, we need to keep our eyes open to what effective responses are notifying us about our healthcare systems, so that we can craft sustainable interventions as a result and uphold the right to health. This is especially true in the light of the ongoing nature of pandemics on the continent, making urgent the need to maximise the value of our health system and its resources, as we seek lasting transformation.

The Future is Female: Urology Workforce Projection From 2020 to 2060

To project the size and demographics of the female urology workforce into 2060. We assessed current urology workforce estimates using 2019 American Urological Association Annual Census data. We used the Accreditation Council for Graduate Medical Education's Data Resource Book from 2007 to 2018 to determine the incoming urology workforce. With these inputs, we calculated urologic workforce projections using two stock and flow models. In our continued growth model, the total number of urologists will be lowest in 2025 with 11,600 urologists and recover to baseline by 2040 with 13,377 urologists. The total number of female urologists will grow 3.77-fold from 2020 to 2060 with an absolute increase of 3,792 urologists. Comparatively, the total number of male urologists will grow 1.33-fold with an absolute increase of 3,996 urologists. In our stagnant growth model, the total number of urologists will be lowest in 2030 with 11,354 urologists and will not recover to baseline by the end of our projection. The total number of female urologists will grow 2.18-fold from 2020 to 2060 with an absolute increase of 1,615 urologists. Comparatively, the total number of male urologists will decrease by 21.5% with an absolute decrease of 2,579 urologists. In the context of the impending urologic workforce shortage, female urologists make up a significant proportion of the workforce growth over the next four decades in both the continued growth and growth stagnant models. This projection highlights the need for purposeful recruitment, structural changes, and advocacy among urology leadership to support female urologists.

"No one could calm him down": Mothers' experience of autism diagnosis and obtainment of resources in an urban public school district.

Introduction: The purpose of this study was to explore the experience of accessing autism diagnosis and resources in a Midwest urban public school district for diverse mothers of children with autism spectrum disorder. Method: We employed thematic analysis using narrative inquiry methodology to analyze the data from 9 mothers (n = 5 African American, n = 2 Hispanic, and n = 2 White) who participated in a focus group. Results: Three themes were identified by the researchers: (a) late medical diagnosis (subthemes: problems that parents didn't perceive as signs of autism spectrum disorder, making comparisons to other siblings or children), (b) negative communication experiences (subthemes: husband and wife, parent and educational professionals), and (c) coping strategies (subthemes: resources, prayer). Discussion: The mothers' narratives indicated a strong need for advocacy and parent-school partnership. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Green Deal as a Climate Changes Dam on the Road to Health

Abstract Public health professionals (PHP) have a dual task in climate change. They should persuade their colleagues in clinical medicine of the importance of all the issues covered by the GD. The fact that the health sector contributes to the overall emissions of 4.4% speaks to the lack of awareness within the health sector itself. The issue of providing adequate infrastructure for the health sector is essential. Strengthening the opportunities and development of the circular economy within healthcare is more than just a current issue. The second task of PHP is targeting the broader population. The public health mission is being implemented, inter alia, through numerous activities related to environmental monitoring and assessment of the impact on health. GD should be a roadmap for priorities and actions in public health, bearing in mind: an ambitious goal of climate neutrality, an insistence on clean, affordable and safe energy, a strategy for a clean and circular economy. GD provides a framework for the development of sustainable and smart transport, the development of green agriculture and policies from field to table. It also insists on biodiversity conservation and protection actions. The pursuit of zero pollution and an environment free of toxic chemicals, as well as incorporating sustainability into all policies, is also an indispensable part of GD. GD represents a leadership step in the global framework towards a healthier future and comprises all the non-EU members as well. The public health sector should consider the GD as an argument for achieving goals at national levels, and align national public health policies with the goals of this document. There is a need for stronger advocacy of health and public-health interests along with incorporating sustainability into all policies. Achieving goals requires the education process for healthcare professionals covering all of topics of climate change, energy and air pollution to a much greater extent than before.

“Being Born like This, I Have No Right to Make Anybody Listen to Me”: Understanding Different Forms of Stigma among Thai Transgender Women Living with HIV in Thailand

ABSTRACT This study explores the ways Thai transgender women are affected by internalized, perceived, vicarious and enacted stigma. Participants were eleven Thai transgender women living with HIV, who were asked about experiences of stigma in their daily lives. Various forms of verbal, psychological and physical harassment were reported. Internalized stigma and stigma within the transgender community itself were significant. Participants tended not to blame their family members or others in their social structure for their experiences of stigma. They tended to see the solution to tackle the problem of stigma mainly in changes in the behavior of transgender women themselves. This paper suggests that transgender people themselves should better understand how the structure, culture and institutions of mainstream society instill, reinforce and perpetuate stigma against, within and among them. There is a need for advocacy directed toward manifesting societal emancipation of Thai transgender people—starting with legal reform.

The right to breathe: a sociological commentary on racialized injustice, borders and violence

PurposeThis article is a commentary on the structure, context and unsettling circumstances of prejudice, discrimination, racial violence and injustice in the contemporary US.Design/methodology/approachUsing the narrating voices of victims of authority violence in part, the author presents a sociological analysis of the patterns of racial injustice, borders and racialized police violence. The author uses tenets of C.W. Mill's Sociological Imagination to dissect these patterns historically and social structurally.Social implicationsUsing contemplative narrative, the author stimulates reflection on the social structural forces that perpetuate racial injustice. The author deliberates on the role and responsibilities of universities and the broader community in the struggle for a just society. Echoing societal calls to tackle and eliminate systemic subjugation, the author reiterates the need for reformist advocacy, for civility and the preservation of the human rights of all citizens.Originality/valueThe author offers principles of reflective action to chart a pathway for a just and equitable society; ultimately shaping a mature system of democracy and collective liberation.

Communication experiences of family caregivers of hospitalized adults with intellectual and developmental disabilities-A qualitative study.

AimTo explore communication experiences between family caregivers of adults with intellectual and developmental disabilities (I/DD) and healthcare personnel during hospitalization.DesignA qualitative descriptive study approach with interviews of family caregivers was used.MethodFace‐to‐face, semi‐structured interviews were conducted from June–September 2015 with ten family caregivers of adults with I/DD. Participants were recruited through an advocacy organization in the north‐eastern United States. Data were analysed by content analysis. The Standards for Reporting Qualitative Research was the chosen checklist.ResultsThe four overarching themes: “Need for Advocacy”; “Need for Better Communication”; “Sense of Abandonment”; and “Lack of Confidence” along with 12 subthemes were identified. Overall, participants reported miscommunications leading to instances of mistrust in hospital staff's competence to deliver quality patient care.

Inclusion of Dancer Wellness Education Programs in U.S. Colleges and Universities: A 20-Year Update

During the 1990s dancer wellness education began to be codified and understood empirically in U.S. colleges and universities. Those efforts stemmed from a burgeoning knowledge base in dance medicine and science that continues to evolve. However, the current status of dancer wellness education remains largely undocumented. The purpose of this study was to explore the inclusion of dancer wellness education in U.S. colleges and universities. The results were derived from a cross-sectional study of 199 higher education dance administrators at 4-year institutions that were selected using stratified random sampling procedures with data collected through an online survey. Seventy-two participants (36.18%) completed at least part of the survey, and of those 62 (86.11%) completed the entire survey. The majority of dance programs were undergraduate-only (71%), not accredited by the National Association of Schools of Dance (67%), and emphasized dance performance and choreography (89%). Sixty percent offered a formal dancer wellness program, 70% had at least one dancer wellness specialist on faculty, and 20% offered training programs to become dancer wellness specialists. Fewer than half (42.19%) preferred their faculty to have college or university level study in dancer wellness, and only 17.19% required it. Of 11 possible curricular topics, the typical undergraduate program included 64.52% and the typical graduate program 51.87%. Regardless of program level, the top five topics were anatomy, kinesiology, somatics, dance conditioning, and dance injuries. The average school offered 58% of identified supplementary programs at "high levels." Only modest differences were found between programs based on degree level, accreditation status, or program affiliation. Although some positive trends in the evolution of dancer wellness education have occurred over the last two decades, there remains a need for ongoing advocacy and widespread implementation in U.S. colleges and universities.

“Nothing suitable for us”: experiences of women with physical disabilities in accessing maternal healthcare services in Northern Vietnam

Purpose This article explores how maternal healthcare access was experienced by women with physical disabilities in Northern Vietnam. Methods A qualitative methodology with an interpretive phenomenological design was used. In-depth interviews were conducted with women with physical disabilities who had given birth in the previous three years. Twenty-nine women participated in a first in-depth interview, and 27 women completed follow-up interviews. Physical access audits were also conducted at 14 facilities providing maternal healthcare services. Data were thematically analyzed. Results The women said they highly valued antenatal care but rarely attended postnatal check-ups. Their decisions around service uptake were influenced by attitudinal barriers from staff, particularly failure to recognize that women with physical disabilities had a right to motherhood and quality maternal healthcare. Specialized information on pregnancy and childbirth for women with physical disabilities was limited. Long waiting times, confusing referral systems, and financial hardship were also significant problems in accessing maternal healthcare. Many healthcare facilities were not disability friendly. Conclusions Women with physical disabilities in Northern Vietnam encountered multiple challenges when accessing maternal healthcare services. Many Vietnamese healthcare services are ill-equipped to provide disability-inclusive and responsive maternal healthcare because of inadequate structural design, attitudinal barriers, limited appropriate information, and financial burden. There should be increased attention paid to mainstreaming the needs of women with physical disabilities into maternal healthcare services in Vietnam. Implications for rehabilitation There is a need for strong and sustained advocacy from all related staff, including rehabilitation workers, to improve the quality of healthcare for pregnant women with physical disabilities in Vietnam. Disability training should be integrated into mainstream in-service courses for maternal healthcare providers and curricula for medical, midwifery and nursing students. A resource package that provides women with physical disabilities with reliable and comprehensive information on disability and pregnancy, childbirth and maternal healthcare should be developed and disseminated. Professional protocols and infrastructure for maternal healthcare for women with physical disabilities should be more sensitive and responsive to their needs and rights.

Information, communication, advocacy, and complaint: how the spouse of a man with aphasia managed his discharge from hospital

ABSTRACT Background: The impact of stroke and aphasia has been recognised as a family problem for many years with studies highlighting spouses’ need for information at different times along the recovery journey, for practical and emotional support, recognition, and respite. In particular, the decision-making around discharge from hospital, or planning for rehabilitation, is not always collaborative even though family involvement assists family members to plan and adjust to their new caring role. Aims: This study aims to explore how the wife of a man with aphasia managed his discharge from hospital in the acute phase post-stroke. It provides an opportunity for health professional learning and sensitisation through the detailed analysis of a de-identified but a real case that happened to reflect key issues reported by families in previous research: lack of information, poor communication with healthcare professionals, and the need for advocacy. Methods and procedures: The data for this paper are drawn from two sources: a single in-depth interview with the wife collected as part of an earlier large multi-site study that included interviews with 48 family members of people with aphasia after stroke; and two complaint letters she wrote to the hospital and two letters received back. This study uses a narrative analysis of the interview, and a systemic functional linguistics (SFL) analysis of the letters in order to shed light on the key issues of information, communication, and advocacy. Outcomes and results: The narrative analysis of the interview and the SFL analysis of the letters together help to unpack the reasons why the wife felt motivated to write a complaint letter to the hospital where her husband had been admitted post-stroke. The letters themselves demonstrate careful choices of language for both parties, with the hospital discounting the wife’s concerns and closing down the exchange. They also reflect a profound misunderstanding by the hospital about the functional consequences of aphasia and its impact on the family. Conclusions: It is important that family members, taking on a caring role for people with aphasia after stroke, are supported with clear information and good communication in acute settings. This may enable them to be engaged in the recovery process as partners with healthcare teams and more effectively support adjustments to post-stroke life in the longer term.

Is this a men’s world? On the need to study descriptive representation of women in lobbying and policy advocacy

ABSTRACT How well are women represented in the world of political advocacy? Despite the important role of interest groups in modern democracies, the demographic composition of the interest group community remains a blind spot in public policy research. Based on data on over 1000 lobbyists in five European countries, we suggest that the share of women in the world of advocacy is significantly lower than in parliaments. We therefore argue that gender biases in political advocacy need to move high up on the research agenda. As key avenues for future studies, we raise the effects these imbalances have on agenda setting and political decision-making, as well as their symbolic effects on female participation and perceived legitimacy. Moreover, we call for research addressing the complex supply and demand-side factors that cause gender inequalities in lobbying to address this problem in practice.

Global Health and Surgical Infection: From Neglect to Emerging Frontier.

Background: In past decades, surgical site infections (SSIs) were neglected and not given much global attention in low- and middle-income countries (LMICs). The risk and incidence of SSIs in LMICs continue to increase. Methods: We reviewed the limited quality data on SSIs and complicated intra-abdominal infections in these settings that have hampered advocacy and infection prevention and control efforts. Results: This review identifies the rising profile of global surgery that has resulted in efforts to scale up access to surgical care as well as increase surgical volumes to address unmet needs. The fallout of these efforts would be increasing SSI rates and a rising volume of laparotomies for intra-abdominal infections. Conclusion: Surgical infections are an emerging frontier in global health and surgery. There is an urgent need for global advocacy and investments in their prevention and control.

Beyond Employment: A Broader Vision Linking Activity and Participation to Health, Well-Being, and Recovery.

Employment is a well-recognized and important indicator of recovery from mental illness. However, a broad range of personally and socially meaningful activity and participation opportunities, beyond paid employment, can be valuable for those in recovery. Facilitating access to these opportunities necessitates pivoting practice toward a broader understanding of activity and participation experiences associated with recovery, health, and well-being and further developing evidence-informed practices. Moreover, there is a need for advocacy to advance engagement in a broad range of activity and participation opportunities that is grounded in the principles of social justice.

Outpatient and Inpatient Service Use by Chinese Adults Living in Rural Low-Income Households

ABSTRACT This study applied the Andersen Model of Health Care Utilization to explore the variables associated with health service use among Chinese adults living in rural low-income households. A survey of 2,429 adults living in 787 low-income households in Jiangsu, China was conducted in 2017. Respondents were asked the presence of outpatient service in the past one month and the amount of hospitalization in the past one year. Mixed effect logistic and negative binomial models were used to examine the relationship of individual-level and household-level characteristics with health service use. Health condition was the predominant determinant of both outpatient and inpatient service use (Odds Ratio [OR] >1, p < .001). Individuals living in a poor household were less likely to use outpatient service (OR = 0.05, 95% confidence interval CI: 0.00, 0.71), and the longer in poverty status the less likely to use outpatient service (OR = 0.92, CI: 0.86, 0.99). Age was associated with a lower likelihood to use outpatient service (OR = 0.93, CI: 0.93, 1.00), and this relationship was stronger for larger households (OR = 1.01, CI: 1.00, 1.01). For inpatient service use, most household-level measures were insignificant. Rural Chinese health service use was influenced primarily by needs variables. Outpatient service use was constrained by household enabling variables. Older adults were at a disadvantage of using outpatient service when the family prioritized younger members in allocating resources. These results suggest the need for policy advocacy to expand insurance reimbursement and improve benefits for poor older adults.

Abusive Head Trauma in Infants and Children.

Abusive head trauma (AHT) remains a significant cause of morbidity and mortality in the pediatric population, especially in young infants. In the past decade, advancements in research have refined medical understanding of the epidemiological, clinical, biomechanical, and pathologic factors comprising the diagnosis, thereby enhancing clinical detection of a challenging diagnostic entity. Failure to recognize AHT and respond appropriately at any step in the process, from medical diagnosis to child protection and legal decision-making, can place children at risk. The American Academy of Pediatrics revises the 2009 policy statement on AHT to incorporate the growing body of knowledge on the topic. Although this statement incorporates some of that growing body of knowledge, it is not a comprehensive exposition of the science. This statement aims to provide pediatric practitioners with general guidance on a complex subject. The Academy recommends that pediatric practitioners remain vigilant for the signs and symptoms of AHT, conduct thorough medical evaluations, consult with pediatric medical subspecialists when necessary, and embrace the challenges and need for strong advocacy on the subject.

Knowledge and Compliance with Standard Precautions amongst Healthcare Workers in Selected Hospitals in Rivers State, Nigeria

Background: Standard precautions (SPs) in the hospital are very important in the reduction of health care workers’ exposure to occupational health hazards but most hospitals are used to reactive rather than proactive safety practices. The effect of reactive safety practices is overwhelming to health care workers, hospitals and the society. Thus, this study assessed health care workers’ knowledge and compliance with standard precautions.&#x0D; Materials and Methods: Descriptive cross-sectional design and proportionate stratified random sampling method was adopted and a sample size of 391was selected using Taro-Yamane formula. The study relied on a structured questionnaire to elicit information from respondents and a reliability of 0.87 was obtained. Descriptive and inferential statistics were used with the aid of statistical package for social science (SPSS) software version 21.&#x0D; Results: Healthcare workers’ (HCWs) have fair knowledge of SPs and poor compliance with SPs. Also, there is significant association between HCWs’ knowledge of SPs and gender, marital status, years of experience and job category in the hospitals (p &lt; 0.05). Consequently, there is significant association between compliance with SPs and gender, years of experience and job categories in the hospitals (p &lt; 0.05).&#x0D; Conclusion: There is great need for strong advocacy on knowledge of SPs and compliance with SPs in the hospitals to curb increasing occupational health hazards. The Nigeria government and hospital managements should develop an all-encompassing integrated SPs policies, strategies and procedures consistent with global best practices.

Real-world use of chemotherapy for Kaposi\u2019s sarcoma in a large community-based HIV primary care system in Kenya

BackgroundKaposi’s sarcoma (KS) is one of the most common HIV-associated malignancies in sub-Saharan Africa. Worldwide, the availability of antiretroviral therapy (ART) has improved KS survival. In resource-rich settings, survival has also benefited from chemotherapy, which is widely available. Little is known, however, about the epidemiology of chemotherapy use for HIV-associated KS in resource-limited regions such as sub-Saharan Africa.MethodsWe identified all patients newly diagnosed with HIV-related KS from 2009 to 2012 in the 26-clinic AMPATH network, a large community-based care network in Kenya. We ascertained disease severity at diagnosis, frequency of initiation of chemotherapy, and distribution of chemotherapeutic regimens used. Indications for chemotherapy included AIDS Clinical Trial Group T1 stage and/or “severe” disease defined by WHO KS treatment guidelines.ResultsOf 674 patients diagnosed with KS, charts were available for 588; 61% were men, median age was 35 years, and median CD4 at KS diagnosis was 185 cells/μl. At time of diagnosis, 58% had at least one chemotherapy indication, and 22% had more than one indication. For patients with a chemotherapy indication, cumulative incidence of chemotherapy initiation (with death as a competing event) was 37% by 1 month and 56% by 1 year. Median time from diagnosis to chemotherapy initiation was 25 days (IQR 1–50 days). In multivariable regression, patients with > 3 chemotherapy indications at time of diagnosis had a 2.30 (95% CI 1.46–3.60) increased risk of rapid chemotherapy initiation (within 30 days of diagnosis) compared to those with only one chemotherapy indication (p < 0.001). Initial regimens were bleomycin-vincristine (78%), adriamycin-bleomycin-vincristine (11%), etoposide (7%), and gemcitabine (4%).ConclusionsA substantial fraction of patients with KS in East Africa are diagnosed at advanced disease stage. For patients with chemotherapy indications, nearly half did not receive chemotherapy by one year. Liposomal anthracyclines, often used in resource-rich settings, were not first line. These findings emphasize challenges in East Africa cancer care, and highlight the need for further advocacy for improved access to higher quality chemotherapy in this setting.

Strengthening risk communication systems for public health emergencies in the WHO South-East Asia Region.

Risk communication and community engagement are critical aspects of public health emergency preparedness and response and therefore one of the eight original core capacities of the International Health Regulations (2005). Joint external evaluations in eight out of eleven countries of the World Health Organization South-East Asia Region reveal that there is considerable variation in risk communication capacities among countries. Of the five areas evaluated - risk communication systems, internal and partner coordination, public communication, community engagement and listening, and risky behaviour and misinformation - the strongest areas, across the region, are partner coordination and community engagement, while risk communication systems is the weakest area and needs further strengthening. For strong and sustainable risk communication for public health emergencies in the WHO South East Asia Region, institutionalized capacity-building supported by increased budgetary allocations to this area is needed. There is a strong need for advocacy to and sensitization of key policy-makers and decision-makers at country level regarding the importance and advantages of being prepared on risk communication plans and systems.