Availability Of Treatment Resources Research Articles

Inter-Ethnic Variations in the Clinical, Pathological, and Molecular Characteristics of Wilms Tumor.

Wilms tumor is the commonest primary renal malignancy in children and demonstrates substantial inter-ethnic variation in clinical, pathological, and molecular characteristics. Wilms tumor occurs at a lower incidence and at a younger age in Asians compared to Caucasians and Africans. Asians also present at an earlier stage of disease, with a higher incidence of favorable histology tumors and a lower incidence of perilobar nephrogenic rests compared to Caucasians, while African children present with more advanced disease. Studies have implicated population differences in the incidence of WT1 mutations, loss of imprinting of the IGF2 locus, and loss of heterozygosity of 1p/16q, or 1q gain as possible bases for epidemiological differences in the disease profile of Wilms tumors in various ethnic groups. Yet, evidence to support these associations is confounded by differences in treatment protocols and inequalities in the availability of treatment resources and remains limited by the quality of population-based data, especially in resource-limited settings.

Availability of Treatment Resources in Emergency Department for the Management of Acute Toxic Exposure and Poisionings in Governmental Hospitals in Dessie Town

Introduction: Accessibility of drugs and over the counter drugs in hospitals are not enough andsuch accessibility of drugs act as preparedness of a hospital emergency departments in health facilities in controlling of emergency poisoning. Methods: Institution wide retrospective cross-sectional study design was conducted. Data was collected using semi-structured questionnaire. Three nurses were trained about the data collection of this study and data entry was done by using SPSS version 20.0. Results- There were a sum of 520 toxic cases were get service (169 from Boru Meda Hospital and 351 from Dessie Referral Hospital). The first cause of poisoning was Organophosphate poison with the case of 140 (26.9%). From decontamination resources sodium sulphate, sorbitol, ipecac syrup, polyethylene glycol and colloids not present from both hospitals. From stabilization resources there were no colloids in both hospitals. From antidots only atropine sulphate, calcium gluconate, polyvalent antivenom and sodium bicarbonate were accessible through all time of the study period in both hospitals. Conclusion and Recommendation: - The supply of drugs and over the counter drugs in those hospitals were partially present, apart from stabilization resources. It is recommended if selected antidotes, stabilization, decontamination and elimination treatments are accessible.

Understanding Users' Experiences of a Novel Web-Based Cognitive Behavioral Therapy Platform for Depression and Anxiety: Qualitative Interviews From Pilot Trial Participants.

Digital mental health interventions (DMHIs) can help bridge the gap between the demand for mental health care and availability of treatment resources. The affordances of DMHIs have been proposed to overcome barriers to care such as accessibility, cost, and stigma. Despite these proposals, most evaluations of the DMHI focus on clinical effectiveness, with less consideration of users' perspectives and experiences. We conducted a pilot randomized controlled trial of "Overcoming Thoughts," a web-based platform that uses cognitive and behavioral principles to address depression and anxiety. The "Overcoming Thoughts" platform included 2 brief interventions-cognitive restructuring and behavioral experimentation. Users accessed either a version that included asynchronous interactions with other users ("crowdsourced" platform) or a completely self-guided version (control condition). We aimed to understand the users' perspectives and experiences by conducting a subset of interviews during the follow-up period of the trial. We used purposive sampling to select a subset of trial participants based on group assignment (treatment and control) and symptom improvement (those who improved and those who did not on primary outcomes). We conducted semistructured interviews with 23 participants during the follow-up period that addressed acceptability, usability, and impact. We conducted a thematic analysis of the interviews until saturation was reached. A total of 8 major themes were identified: possible opportunities to expand the platform; improvements in mental health because of using the platform; increased self-reflection skills; platform being more helpful for certain situations or domains; implementation of skills into users' lives, even without direct platform use; increased coping skills because of using the platform; repetitiveness of platform exercises; and use pattern. Although no differences in themes were found among groups based on improvement status (all P values >.05, ranging from .12 to .86), there were 4 themes that differed based on conditions (P values from .01 to .046): helpfulness of self-reflection supported by an exercise summary (greater in control); aiding in slowing thoughts and feeling calmer (greater in control); overcoming patterns of avoidance (greater in control); and repetitiveness of content (greater in the intervention). We identified the different benefits that users perceived from a novel DMHI and opportunities to improve the platform. Interestingly, we did not note any differences in themes between those who improved and those who did not, but we did find some differences between those who received the control and intervention versions of the platform. Future research should continue to investigate users' experiences with DMHIs to better understand the complex dynamics of their use and outcomes.

Systems-level barriers to treatment in a cervical cancer prevention program in Kenya: Several observational studies.

ObjectiveTo identify health systems-level barriers to treatment for women who screened positive for high-risk human papillomavirus (hrHPV) in a cervical cancer prevention program in Kenya.MethodsIn a trial of implementation strategies for hrHPV-based cervical cancer screening in western Kenya in 2018–2019, women underwent hrHPV testing offered through community health campaigns, and women who tested positive were referred to government health facilities for cryotherapy. The current analysis draws on treatment data from this trial, as well as two observational studies that were conducted: 1) periodic assessments of the treatment sites to ascertain availability of resources for treatment and 2) surveys with treatment providers to elicit their views on barriers to care. Bivariate analyses were performed for the site assessment data, and the provider survey data were analyzed descriptively.ResultsSeventeen site assessments were performed across three treatment sites. All three sites reported instances of supply stockouts, two sites reported treatment delays due to lack of supplies, and two sites reported treatment delays due to provider factors. Of the 16 providers surveyed, ten (67%) perceived lack of knowledge of HPV and cervical cancer as the main barrier in women’s decision to get treated, and seven (47%) perceived financial barriers for transportation and childcare as the main barrier to accessing treatment. Eight (50%) endorsed that providing treatment free of cost was the greatest facilitator of treatment.ConclusionPatient education and financial support to reach treatment are potential areas for intervention to increase rates of hrHPV+ women presenting for treatment. It is also essential to eliminate barriers that prevent treatment of women who present, including ensuring adequate supplies and staff for treatment.

Preamble of the Clinical Practice Guidelines.

From 2005 onwards, the Indian Psychiatric Society came up with treatment guidelines for various psychiatric disorders to meet the requirements of our patients in the context of prevailing existing resources. There have been several developments in the management of these disorders since then. In view of the same, it was decided to update the existing treatment guidelines for various psychiatric disorders. These new set of guidelines attempt to update the previous guidelines by emphasizing what is new in the field. These guidelines should be read in conjunction with the earlier version of the clinical practice guidelines as developed and published by the Indian Psychiatric Society in the year 2005 & 2006. These guidelines are not particularly applicable to any specific treatment setting and may need minor modifications to suit the needs of patients in a specific setting. The recommendations are primarily meant for adult patients. The needs of children or the elderly may be different. Finally, it is expected that recommendations made will have to be tailored to suit the needs of individual patients. Although these guidelines focus on management of various disorders, yet the clinicians need to remember that management must focus on the whole patient and not just the disorder. The recommendations given as part of the revised guidelines are based on the available evidence base, expert consensus and the feedback obtained from the membership. Several factors influence the treatment of various psychiatric disorders. Common ingredients of management plan are shown in Table-1. Particular consideration needs to be given to clinical parameters like cross-sectional and longitudinal course of symptoms, type of predominant symptoms, presence or absence of medical comorbidity, comorbid substance abuse/dependence, life stage of patients and their special needs. Socio-cultural factors e.g. beliefs about the illness and their treatments are particularly important, as are the availability of treatment-resources. The general goals of treatment should be to decrease the frequency, severity and impact of episodes (exacerbations) and maximize functioning between the episodes. Specific goals will depend on the specific phases of illness.Table 1: Common ingredients of a management plan

“I Do My Best To Listen to Patients”: Qualitative Insights Into DAWN2 (Diabetes Psychosocial Care From the Perspective of Health Care Professionals in the Second Diabetes Attitudes, Wishes and Needs Study)

PurposeThe aim of this study was to describe the perspectives of diabetes care professionals regarding the roles and responsibilities of people with diabetes (PWD), health care professionals (HCPs), and the larger society to improve the provision of person-centered diabetes care. MethodsThe survey contained open-ended items about challenges of, successes of, and wishes for improvements in treating adults with diabetes. All responses were systematically coded using a schema developed and validated through multinational collaboration. FindingsParticipants were 4785 diabetes care professionals (physicians, nurses, and dietitians) from 17 countries. The data contained 2 distinct themes. One theme reflected the fact that the roles and responsibilities of HCPs are transitioning from those of one who “tells” to one who “listens” to PWD. Some ways that HCPs can “listen” to PWD and family members is to involve them in goals and to encourage self-management for the improvement of treatment. The second theme identified barriers to successful diabetes care, which include a lack of time and collaboration from HCPs, a lack of availability of resources for treatment, and a lack of psychosocial support. ImplicationsThe views of diabetes care professionals are in transition from a conventional hierarchic approach to a PCC approach. Further adoption of this approach would be facilitated by additional psychosocial training and educational/psychological resources, increased teamwork, and societal changes that would make it easier for people to live successfully with diabetes.

Implementation of evidence-based healthcare in Papua New Guinea

The aim of this research was to understand how health workers in developing countries reach diagnostic and treatment decisions. In developing countries, health workers are often forced to make diagnostic and treatment decisions based on limited knowledge, unhelpful information, infrequent and low technology back-up services and without the support of more senior staff. Yet patients continue to be treated. This paper investigates how primary healthcare workers in such contexts reach these diagnostic and treatment decisions. Using a qualitative methodology, 58 primary healthcare workers from the three primary healthcare facilities in Papua New Guinea--aid posts, sub-health centres and health centres--participated in an in-depth interview, in order to investigate how diagnostic and treatment decisions were made. Although participants were originally trained in the biomedical model, they lived and worked in a context where other belief systems operated to diagnose and treat illness. This led to the coexistence of at least three models of treatment: the biomedical model, traditional indigenous health practices and Christian beliefs. Thus, a homogenous biomedical understanding of health and well-being was not possible in this setting, and treatment options did not always follow the biomedical recommendations. In developing countries where competing medical frame works exist, evidence-based practices may be more difficult to implement. Although the skill and knowledge of the provider and availability of treatment resources are still important, belief in the accuracy of the diagnosis and the potency of the treatment by the patient and the patient's community as well as the health provider may be just as significant.

Web-based survey of resources for treatment and long-term follow-up for children with brain tumors in developing countries

Information about pediatric survivors of brain tumors in developing countries is scant. In this study, we aimed to investigate the availability of resources for treatment and long-term follow-up of children with central nervous system tumors in developing countries. A web-based questionnaire on available services and follow-up of brain tumor survivors was posted at www.cure4kids.org , and registered users were invited to participate. A total of 140 evaluable responses from developing countries (n = 103) and high-income countries (n = 37) were obtained. There was a significant correlation between gross national income and the availability of services for treatment and follow-up and between patient load and the availability of some services. The resources for treatment and long-term follow-up of children with brain tumors need to be improved in developing countries.

Depression Screening of Perinatal Women: An Evaluation of the Healthy Start Depression Initiative

Depression Screening of Perinatal Women: An Evaluation of the Healthy Start Depression Initiative

Can the Health-Care System Meet the Challenge of Pandemic Flu? Planning, Ethical, and Workforce Considerations

The federal pandemic influenza plan predicts that 30% of the population could be infected. The impact of this pandemic would quickly overwhelm the public health and health-care delivery systems in the U.S. and throughout the world. Surge capacity for staffing, availability of drugs and supplies, and alternate means to provide care must be included in detailed plans that are tested and drilled ahead of time. Accurate information on the disease must be made available to health-care staff and the public to reduce fear. Spokespersons must provide clear, consistent messages about the disease, including actions to be taken to contain its spread and treat the afflicted. Home care will be especially important, as hospitals will be quickly overwhelmed. Staff must be prepared ahead of time to assure their ability and willingness to report to work, and public health must plan ahead to adequately confront ethical issues that will arise concerning the availability of treatment resources. The entire community must work together to meet the challenges posed by an epidemic. Identification and resolution of these challenges and issues are essential to achieve adequate public health preparedness.

A SURVEY OF ATTITUDES AMONG DRUG USER TREATMENT PROVIDERS TOWARD THE TREATMENT OF INHALANT USERS

This study assessed the attitudes of drug user treatment program directors towards the problem of inhalant “abuse.” In 2000, surveys were mailed to directors asking about treatment success and prognosis for inhalant users, level of neurological damage incurred by users, availability of treatment resources, their program's policies toward admission of users, and staff training needs for inhalant use. Two open-ended questions queried their assessment of barriers to treatment and subjective feelings about the topic of inhalant use. Five hundred and fifty responses were received. Findings show that program directors perceive a great deal of neurological damage incurred through inhalant use and have a general pessimism about treatment effectiveness and recovery. The respondents also felt that there were insufficient resources for inhalant user treatment and that special staff training in the area was needed. The majority of the directors indicated that they have or would treat inhalant users. Implications for future research and policy change are discussed.

An overview of primary prevention

The historical antecedents of primary prevention are to be found in the methods of public health but also in insights from counseling and psychotherapy. Primary prevention is defined as being proactive and is aimed predominately at high-risk groups not yet affected by the condition to be prevented. Its success is measured in a decline in the incidence (new cases) of a condition compared with controls. Only through prevention can we reduce incidence. between the enormous number of individuals at risk for emotional disturbance and the limited availability of treatment resources. This paper prevention programs and examines the arguments espoused by those who are opposed to prevention theory and its implementation. Opposition is strongest from those who accept an organic disease model of mental disorders and from conservative groups that oppose social change aimed at the empowerment of exploited groups. It is the only feasible way to deal with the gap presents strategies for implementing effective

Treatment of waste water from marine products processing plants

Different types of pollutants produced as by‐products in various marine product processing plants are described. A detailed discussion on the effects of these polluting materials on the environment follows. Various technologies available for treating waste water contaminated with the above are introduced. Methods are described for evaluating various processing methods and choosing a method that meets individual processing requirements based on factors such as the degree to which waste water is to be treated, availability of resources for treatment, economics and other factors. Waste water treatment is an integral part of the production process and must be seen in this light.

Treatment recommendations for mentally disordered offenders: More than roulette?

AbstractClinical judgments on the treatability and prognosis of mentally disordered offeenders (MDO) may strongly influence legal dispositions and the availability of treatment resources. This study examined 1,238 discharge summaries for MDOs referred for court assessments. Psychiatrists evidenced marked variability in how often they recommended treatment and how frequently they judged patients to have a poor prognosis. Two logit analyses suggested that diagnosis and consultation by other clinicians were associated with (a) treatment recommendations (i.e., Axis I diagnosis and social work consultations) and (b) prognosis (i.e., Axis II diagnosis and psychology consultations).