Medical Care In Rural Areas Research Articles

Bridging gaps: improving the access of primary health care in rural Ukraine through mobile health units

Rural healthcare is an integral part of the Ukrainian healthcare system. However, access to healthcare for the rural population is uneven due to poor development of medical infrastructure and staffing. The problem of access to medical care in rural areas has been exacerbated by the full-scale war.The objective: to study and analyze the current state of accessibility of primary health care in rural areas in Ukraine, followed by a discussion of promising areas for the introduction of mobile health units as a tool for implementing the “Medical Guarantees” program in hard-to-reach regions of Ukraine.Materials and methods. The study included data from official statistical reports, regulatory documents and scientific sources. The methodology includes bibliosemantic, medical and statistical methods and the method of structural logical analysis.Results. It has been established that the low level of access to primary health care for the rural population of Ukraine has been significantly exacerbated by the devastating impact of the war on medical and transport infrastructure, especially in the frontline and recently de-occupied rural areas, and by migration processes. The situation is complicated by the fact that most patients in rural areas are elderly people who are physically unable to use public transportation, even if it is available. The analysis of international practice has shown that mobile health units can be introduced into the public healthcare system as a temporary measure to meet the urgent needs of the Ukrainian population, especially in rural areas. Integration of mobile health units into the state program “Medical Guarantees” can effectively address the urgent health care needs to increase access to health care for the rural population of Ukraine. State regulation of the division of these units will eliminate problems such as duplication and uneven service delivery and will create a transparent system of remuneration for the staff included in these units.Conclusions. The results of the study suggest that the practice of mobile medical units should be introduced as a tool for implementing the “Medical Guarantees” program for regions/locations of Ukraine with low access to medical infrastructure, namely remote rural areas and areas that have been devastated by the war. Mobile medical units will ensure the stability of access to primary health care services and contribute to improving the health of the population.

DYNAMIC CHANGES IN HEALTH INDICATORS OF THE POPULATION OF THE SIBERIAN FEDERAL DISTRICT

HighlightsThe results of the study revealed a recent increase in the mortality of the rural population in the Siberian Federal District, and in Russia in general, which required a separate study to identify its causes. Thus, new management solutions should be developed to improve the resource capacity of the healthcare system in the context of the COVID-19 pandemic. AbstractBackground. Currently, the main strategic goals include increasing life expectancy, reducing mortality rates of the country`s population and improving medical and demographic indicators. This task is becoming especially relevant in rural areas.Aim. To analyze changes in public health indicators of the rural population in the context of the COVID-19 pandemic using the Siberian Federal District data.Methods. The research methods that were used in this study are as follows: statistical and comparative analysis, and generalization on the basis of prior experience. For the analysis the statistical data and reports from the Ministry of Health of Russia, Federal State Statistics Service, and the Siberian Federal District were selected.Results. The analysis of demographic indicators in the Siberian Federal District for the period from 2018 to 2021 showed higher mortality rates compared to the national average, especially in the Altai Territory (1.2 times higher). In 2020 the overall incidence in rural areas both in the Russian Federation as a whole and in the Siberian Federal District decreased for almost all types of diseases (respiratory diseases -2.4%, digestive diseases -13.4%, diseases of the circulatory system -5.3%, infectious and parasitic diseases -11.8%, malignancies -5.3%, injuries and poisoning -5.2%) compared to 2019, whereas there was a growth of the indicator in 2021 in the district being 14% higher than in the Russian Federation. The incidence rate of new coronavirus infection (COVID-19) and life expectancy at birth in the rural population are given, but it should be noted that although the incidence rate of COVID-19 in 2021 in the Omsk region was lower than the national average, mortality from this disease remains the highest in the Siberian Federal District and it exceeded the national average by 1.4 times. To assess the availability of medical care in rural areas, the indicators of the availability of medical personnel and hospital beds were analyzed, showing a steady downward trend.Conclusion. The results of this study make it possible to identify new directions and initiatives for the development of management strategies to improve the resource capacity of the healthcare system at the federal and regional levels.

Accessibility of medical care in the public and private sectors of healthcare (based on the results of a sociological survey of the population of the Vologda region)

Introduction. In the Vologda region healthcare there are complex management and economic (acute shortage of doctors) and spatial (large territory, complex settlement system) restrictions on the availability of medical care. The private health sector is an alternative to the public sector, but it expands the burden of public spending. This actualizes research aimed at assessing the availability of medical care in both sectors of the industry.
 Purpose of the study. Assessment of the availability of medical care for the population of the Vologda region in the public and private sectors.
 Materials and methods. The toolkit is a questionnaire survey of the population (sample consisted of 1,500 people) conducted in the region in 2018 and 2020. The analysis is carried out by means of the distribution of respondents’ estimates, expressed in specific weights of the total amount of responses, in the comparative context of demographic and territorial groups, the public and commercial sectors of the industry. The integral index of accessibility of medical care is proposed and tested.
 Results. Respondents estimate the availability of medical care/services in private medical institutions higher than in public ones (the accessibility index (AI), in 2020 was 179.6 and 163.4, respectively). During the study period, the index increased, but the gap between sectors remained. The lowest subjective estimates of accessibility were received by medical care in rural areas (AI for the public sector — 167.8, private — 179.5) and in Cherepovets (AI accounted of, respectively, 148.1 and 151.4). The highest level of accessibility was found in small towns (AI was 177.6 and 194.8).
 Limitations. When studying the availability of medical care in the region, 1,500 questionnaires were evaluated, which represents a sufficient reference sample to solve the tasks set.
 Conclusion. The study allowed obtaining valuable results, which, along with the developed tools (in particular, the index of accessibility of medical care), are recommended to the authorities for monitoring the situation in the healthcare of the region.

СОВРЕМЕННЫЕ ТЕНДЕНЦИИ РАЗВИТИЯ ЗДРАВООХРАНЕНИЯ В СЕЛЬСКОЙ МЕСТНОСТИ

We consider current trends in the development of healthcare in rural areas and features of the organization of municipal health care. We describe issues of medicine and health care in rural areas both in Russia and abroad. The considered factors influence the increase in the availability and quality of qualified medical care in rural areas. An integrated approach is important in healthcare in rural areas. The specific features of the organization of medical care in rural areas are directly related to environmental factors. Rural medicine is a specific area of domestic healthcare, since two parallel processes are combined in Russia: the reform of the agricultural sector as a whole and the reform of rural health care. The inconsistency of these processes makes it difficult to provide quality medical care in rural areas. The formation and implementation of joint federal and regional programs require adherence to unity in solving problems. At the same time, the planning of the bed capacity of medical organizations outside large cities does not take into account the peculiarities of settlement in a certain territory, the age and sex composition of the population, the peculiarities in the structure of morbidity, the stages in the organization of medical care, which gives rise to structural disproportions that affect its accessibility to the population and quality.

Sustainable Development in the Context of the Architecture of Environmental Friendly Medical Centers in Rural Areas (Case for Ukraine)

The study of ways to improve medical care in rural areas is relevant for many countries, including Ukraine, whose territory continues to be destroyed for five months (at the time of writing) due to Russian military aggression. The article is based on the results of research by various scientists, primarily related to the sustainable development of architecture and urban planning, as well as the author’s research in recent years. The article’s purpose is to search for new architectural forms of organizing medical care in rural settlements that would contribute to the influx of young people and the development of medicine. An analytical method, a review of information sources, a full-scale survey with photo fixation, a survey of rural residents, and conceptual and exploratory design as part of the educational process at the university were used. The result of the study is a proposal for the design of new types of buildings with two main functions (“work” + “housing”).

Coin retained in the upper esophagus for more than 4 years: A case report and literature review.

Coins are among the most common foreign bodies ingested by children, especially those below 5years of age. Early endoscopic retrieval of esophageal coins minimizes the risk of serious complications. However, significant morbidity and mortality are reported when coins are retained in the gastrointestinal tract for prolonged periods of time. We report a case in which a coin was retained in the upper esophagus for 4years and presented a distinctive clinical course. An esophageal coin retained for a prolonged period may place the patient at a risk of complications such as tracheoesophageal fistulas. The management of patients with complicated aerodigestive tract foreign bodies is challenging. To avoid a delayed diagnosis and to improve the patients' safety, the quality of medical care in rural areas should be monitored by implementing continuous educational programs for primary physicians.

PROBLEMS OF ENSURING HUMAN RIGHTS TO PUBLIC SERVICES FOR THE RESIDENTS OF THE UNITED TERRITORIAL COMMUNITIES OF UKRAINE

Modern Ukraine is characterized by a period of fundamental changes in state-building and law-making. Since 2014 the ongoing constitutional reform is aimed at optimal organization of local self-government. By searching the ways to decentralize, Ukraine aims to ensure the proper functioning of basic municipal institutions. The united territorial community (UTC) is the primary element of local democracy and therefore plays an important role in addressing issues related to the daily needs of community members. The local level authorities provide ineffective governance and they do not provide the scope of public services that residents need, especially in rural areas. The existence of an underdeveloped health care system in Ukraine has led to low quality and inaccessibility of medical care to the population, especially in rural areas. The beginning of the rural healthcare reform was laid by the adoption of the Law of Ukraine, “On increasing the availability and quality of medical care in rural areas.” The system for high-quality and affordable healthcare to rural residents can be created by: 1) optimizing delivery; 2) training; 3) access to specialized facilities; 4) telehealth; 5) creating appropriate infrastructure; 6) working conditions and living standards for healthcare professionals; 7) preventive measures for public health; 8) ensuring interaction between central and local executive authorities. UTCs must utilize the powers granted to them by law to create a client-oriented system of public administration while protecting citizens’ constitutional rights – particularly their rights to health protection and healthcare.

Adverse drug reactions reporting practice and associated factors among community health extension workers in public health facilities, Southwest, Nigeria.

Introductiontimely adverse drug reactions (ADRs) reporting has contributed immensely towards public health safety. Community health extension workers (CHEWs) provides basic medical care in rural areas. This study assessed the knowledge, attitude, practice, and determinants of ADRs reporting among CHEWs in public health institutions, Southwest, Nigeria.Methodsa cross-sectional survey of 333 CHEWs randomly selected from public health facilities using self-administered questionnaires. The questionnaire sought information on the knowledge, attitude and practice of CHEWs towards ADRs reporting. The knowledge and attitude questions were scored and categorized. The association between dependent and independent variables assessed with bivariate and multivariate logistic regressions, and p < 0.05 considered statistically significant.Resultsamong 333 respondents, 205 (61.6%) had encountered patients with ADRs but only 26 (12.6%) had reported it with yellow forms. About half, 169 (50.8%), and 191 (57.4%) respondents had a positive attitude and inadequate knowledge of ADRs reporting respectively. Sex (aOR: 2.84, 95% CI: 2.10-7.10; p < 0.0001), working in Ogbomoso area (aOR: 3.3, 95% CI: 1.34-8.21; p=0.01), and training (aOR: 2.01, 95% CI: 1.20-3.42; p = 0.01) were factors associated with adequate knowledge. The determinant of ADRs reporting was training (aOR: 3.63, 95% CI: 1.13-11.63; p = 0.03).Conclusionthough CHEWs had a slightly positive attitude, they had inadequate knowledge and poor ADRs reporting. The determinant of inadequate ADRs reporting knowledge and under reporting was lack of training. There is an urgent need for educational intervention programmes towards improving knowledge and practices of ADRs reporting among CHEWs.

Understanding needs and expectations of heart failure patients and their caregivers regarding digital health - the PASSION-HF project

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): INTERREG-NWE Background/Introduction Current heart failure (HF) healthcare provision is not sufficient. Due to demographic changes and subsequent increases in comorbidities, along with unequal distribution of medical care in rural areas, alternative approaches need be sought. The use of eHealth applications has potential to enable patients to become more self-sufficient. The "PASSION-HF" project aims to develop an interactive decision-making system – a virtual doctor – that provides solutions based on current guidelines and artificial intelligence. Patient independence is maximized through 24/7 access to personalized HF-management. Furthermore, the application defines decision points, where medical professionals need to be included. Purpose To understand needs and expectations of HF patients and their informal caregivers in regard to a virtual doctor. Methods We conducted an exploratory mixed-methods study within the Netherlands, UK, Ireland and Germany. Semi-structured qualitative interviews were supplemented by a standardized questionnaire. The interviews focused on i) acceptance and motivation to use a virtual doctor and ii) experience and perception of current health care provision. The interviews were analysed using the content analysis according to Mayring (2010) with the help of "ATLAS.TI" software. Additional information about the role of informal caregivers, technology acceptance and decision-making processes was collected via questionnaires. Results A total of 49 patients and 33 informal caregivers were interviewed. Most patients were male (76%), aged between 60 and 69 years (43%). Three key themes were identified in regard to an interactive decision-making system: 1) Reassurance, because patients felt uncertain about their condition and their symptoms, they had a strong desire for an application that could monitor their health 24/7, was able to spot deteriorations, before they occured and gave them instant feedback about their current health status; 2) Personalized advice, e.g. patients wanted the virtual doctor to adapt medication, sport activities and food recommendations to their current health status; and 3) Transparency, e.g. patients wanted to know, where the recommendations are coming from and justifications for management modifications. Interview findings also identified that the HF-nurses play a significant role in the care and management of the condition. Across all countries with HF-nurses, they were the primary point of contact, when patients had any HF related concerns. Conclusion The findings provide valuable information for the development and implementation of eHealth solutions. Patients want reassurance, independently of the availability of healthcare services, combined with personalized advice regarding day-to-day management of their HF. For the next step, we are planning a multicentre clinical trial to test the prototype of the application. Here all decisions are examined by a clinical committee and benefits are evaluated.

Sustainability and Success of Cleft Surgery in Developing Countries: Satisfaction Outcome of 125 Patients Operated in Myanmar

Non-syndromic orofacial clefts are significantly linked to socioeconomic status. Because of limited access to proper medical care in rural areas of developing countries charity missions are highly required to mitigate negative outcome, but there is still a lack of data on humanitarian missions’ sustainability and success. A retrospective analysis of 125 patients who underwent cleft surgery during humanitarian missions in Myanmar was performed. Patients’ satisfaction with facial features and function was evaluated pre- and post-surgery. Furthermore, postoperative complications and satisfaction with follow-up care have been analyzed. Between 2008 and 2020 125 patients underwent cleft surgery by the Interplast team. The median patient’s age was 2,58 years (mean=7 years) with a range of 3 months to 54 years. Group 1 (patients with cleft lip only, n=58) was analyzed on satisfaction with facial aspects and significant improvement was found. All 125 patients were evaluated regarding function features like eating or drinking and their post-surgical satisfaction was significantly higher than before surgery. To analyze if hearing and nasal breathing difficulties in patients with cleft palate can be decreased by primary cleft surgery these parameters were analyzed in group 2 (n=67). Group 2 as well reported significant improvement. Even with limited medical infrastructure and later primary surgery than in developed countries, cleft surgeries can be performed successfully and sustainable by integrating local surgeons in charity missions. Patients benefit greatly by these missions and further investigation on humanitarian cleft missions should be conducted.

Analysis of Trends in the Development of Availability of Medical Services for Rural Population

The article summarizes the arguments and counter-arguments within the scientific discussion on the availability of medical services for the rural population. The main purpose of the study is to analyze the current principles of state policy of Ukraine in the field of health and accessibility and quality of health care in rural areas. Systematization of literature sources and approaches to solving the problem of access to health services has shown that many problematic issues in the field of access to health services in rural areas in Ukraine and around the world, related to investment, personnel management and effective government regulation. The urgency of solving this scientific problem is that medical care should be provided in all regions and agglomerations of the country equally effectively and focus on patient requests. The study of the availability of medical care in rural areas in the article is carried out in the following logical sequence: bibliometric analysis of research, the next step is a survey of consumers of medical services on the basis of the district hospital; analysis of the results of the survey of respondents; providing guidance on key health issues and areas. The methodological tools of the study were survey methods and expert assessments, comparative and bibliometric analysis, the study period was chosen 2011-2021. The object of the study was the Sumy Central District Clinical Hospital, as it provides services to patients living in rural areas. The study empirically confirms and theoretically proves that there are problems with having a family doctor in families, as 1% of respondents indicated that they do not have a family doctor and have not consulted him, while more than half of respondents are satisfied with the result of a doctor’s visit, however, a significant share did not indicate the exact answer, which gives reason to think about the existing problems that led to such results. The results of the study can be useful for further research and recommendations for future opportunities to effectively influence the development of access to health services in rural areas and at the same time improve and enhance the quality of services provided in cities.

FORMATION OF MEDICAL STAFF OF THE PODILLIA REGION DURING THE SECOND HALF OF THE 1940’s – EARLY 1950’s OF THE TWENTIETH CENTURY

Summary. The purpose of the article is to investigate the process of formation of medical personnel of the Podillia region in the postwar period. The research methodology is based on the principles of historicism, systematization, scientificity, verification, authorial objectivity, moderate narrative constructivism, as well as on the use of general scientific (analysis, synthesis, generalization) and special-historical (historical-genetic, historical-typological, historical-systemic) methods. The scientific novelty is that for the first time the peculiarities of the formation of medical staff of the Podillia region in the postwar period are studied, as well as the role of local medical schools in the training of highly qualified medical workers. Also, the author of the article for the first time introduces into scientific circulation a number of archival materials. Conclusions. Thus, the Podillia region is one of the regions of Ukraine that suffered the most from the Nazi occupation. All this had a negative impact on its industrial potential and demographic situation. The medical sphere of Podillya was especially affected. In the post-war period, the health care sector of the region was rapidly restored. An extremely positive result of changes in the post-war medical sphere of the Podillya regions was the spread of specialized medical care in rural areas, the association of hospitals and outpatient clinics in rural district centers made it possible to introduce specialization of medical staff in certain specialties substituting general practitioners. However, it was not enough to restore the full functioning of the medical sector in the region. At that time, the Podillia region faced an acute shortage of medical workers: doctors, paramedics, nurses, etc. During the second half of the 1940s and the beginning of the 1950s, the problem of forming qualified medical staff for medical educational institutions in the region was generally solved. We should note here the huge post-war labor enthusiasm of the inhabitants of the Podillia region, thanks to which it was possible to solve the shortage of medical personnel in the region within the shortest possible time. Among medical institutions, a special place is occupied by the Vinnytsia Medical Institute, which, thanks to the efforts of both faculty and students, has become not only a powerful educational alley of the research institution of Podillia. All this in general contributed to the training of highly qualified medical personnel. As for the policy of the Soviet government in this area, to encourage the success of students in education and work, it used the so-called extra-economic factors, the most common of which was the organization of socialist competitions both between medical schools and within them between student groups, faculties, etc.

Analysis of afirst responder system for emergency medical care in rural areas: first results and experiences

In emergency situations it is essential to get access to medical treatment as early as possible. In Germany, the time interval from alarm to arrival should be less than 10-15 min. The emergency medical service (EMS) cannot comply with this recommendation in approximately 10% of the emergencies in Baden-Württemberg. In addition to the traditional EMS system, avoluntary system of first responders has been developed over the last years to reduce this interval. They are incorporated into the alarm system of the traditional EMS and are alarmed as soon as an emergency call arrives. Data on process times (from alarm to begin of treatment or duration of treatment until arrival of EMS) and quality are rare. In Baden-Württemberg, the emergency aid "Deutsche Lebens-Rettungs-Gesellschaft e.V. (DLRG)" Nordhardt can only estimate times and quality of primary care. The objective of this analysis was to describe and evaluate such afirst responder system. The presented study investigated the emergency responses of afirst responder system in Nordhardt, close to Karlsruhe, Germany. A total of 367 emergency data sets from 2017 containing information on operating time, medical history, suspected diagnosis and medical treatment, were evaluated. Of these, 363 anonymized emergency records including the complete information (concerning process time and medical treatment) were analyzed. The focus was on different time intervals from alarm to treatment and until arrival of the EMS. Additionally, the quality of medical treatment and the measured vital data were examined. The median response time and time to access to the patient was 2 min in both. The patient was reached within approximately 4 min and treated for another 5 min until the EMS arrived. In two thirds of the patients, the vital parameters were measured, 5patients were resuscitated, 23received supplementary oxygen, 4patients were ventilated and 11patients suffering from hypoglycemia showed aclinical benefit from the early treatment. A total of 50trauma patients were treated, 5with cervical spine stabilization and 38received abody check. The first responders from Nordhardt received an emergency call nearly every day. In two thirds of the calls they were faster than the EMS as they usually have local sites with ashorter distance to the emergency scene where they are able to deal with critical medical cases until the EMS arrives. Despite the small case numbers, it could be concluded that the early medical treatment with respect to resuscitation based on earlier arrival on site may help to increase the survival rate of patients. The first responders were also able to manage airway problems with additional oxygen or other airway devices. Other medical treatment performed by the first responders, such as administration of glucose in hypoglycemic patients positively affected the patient's condition. There is atactical advantage to include first responders in traditional EMS services. Further studies are needed to examine these questions in larger samples also over alonger time period. Standardization and digitalization of the records could help to gain more data in this field.

Medical service unity: an effective approach for medical care in rural areas in China.

Medical care in rural China has long suffered because of a concentration of medical resources in major hospitals in cities. The patients in rural areas thus do not have affordable access to quality medical services. To tackle such issues, a tiered medical scheme (TMS) was promoted by the Chinese State Council in 2015. It divides hospitals into three tiers and encourages collaborations among different tiers within a region in order to provide better accessibility to medical care for patients in rural areas. The implementation of the TMS policy has not been successful, because the previous funding model, which allocated funding to each hospital according to the number of patients treated, did not facilitate close collaborations between different hospitals. In this report, the medical service unity (MSU) approach, which has been piloted in Funan county, is reported. The MSU organises the tiered hospitals as a unity in terms of medical capabilities and financial abilities. With the radical reform of financial decentralisation, three flows are thereby enabled: the funding flow binds together the hospitals into a unity, the patient flow shares the load across the providers and eases barriers to access, and the resource flow ensures accessibility and affordability for patients. The MSU approach has been shown by the pilot project in Funan to be effective for the realisation of the TMS policy, benefiting hospitals, doctors and patients. The successful experience of the Funan MSU could be introduced to other regions across China and other countries. In particular, future finance reform policies for the health system would largely benefit the health reforms and especially the decentralisation of medical resources to rural areas.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ ЗАБОЛЕВАЕМОСТИ ЖЕНЩИН ГОРОДА И СЕЛА

It is revealed that socio-economic factors have different impacts on women's health, namely on the pelvic organs in women of the towns and villages. Ultrasound examination and biochemical parameters of the liver show a greater number of diseases in rural women compared to urban. Strategic priorities in addressing identified challenges are improving medical care in rural areas, prevention and consultation of the rural population on the issues of gynecological diseases.

Snakebite incidence in two townships in Mandalay Division, Myanmar.

IntroductionThe global incidence of snakebite is estimated at more than 2.5 million cases annually, with greater than 100,000 deaths. Historically, Myanmar has one of the highest incidences of venomous snakebites. In order to improve the health outcomes of snakebite patients in Myanmar, access to accurate snakebite incidence data is crucial. The last population-based study in Myanmar was conducted more than a decade ago. In 2014, the Ministry of Health and Sports data from health facilities indicated an incidence of about 29.5 bites/ 100,000 population/year (a total of 15,079 bites). Since data from health facilities lack information about those who do not seek health care from government health services, a new population-based survey was conducted in 2 rural areas of Mandalay region. The survey data were compared to those obtained from healthcare services.Method4,276 rural respondents in Kyaukse and Madaya townships in Mandalay Division were recruited using cluster sampling that involved random selection of 150 villages and random sampling of 30 households from each village. One adult member of each household was interviewed using a structured questionnaire.ResultsOne respondent from each of 4,276 households represented 19,877 residents from 144 villages. 24 people in these households had suffered snakebite during the last one year giving an annual incidence of 116/100,000. During the last ten years, 252 people suffered snakebites. 44.1% of the victims were women. 14% of the villages reported 4 or more bites during the last ten years, whereas 27% villages reported no snakebites. 92.4% of the victims recovered fully, 5.4% died, and 2% suffered long term health issues. One victim was reported to have died from causes unrelated to the snakebite. While there was no statistically significant difference between outcomes for children and adults, 4 of 38 of those under 18 years of age died compared to 7 of 133 adults between 19 to 40 years of age.ConclusionThis incidence reported by the community members points to substantially more snakebites than the number of snakebite patients attending health facilities. This higher incidence points to the need for a nation-wide population-based survey, community education about gaining access to care where antivenom is available, and to the potential need for a larger supply of antivenom and expansion of medical care in rural areas.

ДОСВІД ЗАСТОСУВАННЯ ТЕЛЕМЕДИЧНИХ ТЕХНОЛОГІЙ НА ПЕРВИННОМУ РІВНІ МЕДИЧНОЇ ДОПОМОГИ

Мета роботи – висвітлити досвід використання телемедичних технологій у навчально-практичних центрах первинної медико-­санітарної допомоги Тернопільського державного медичного університету імені І. Я. Горбачевського.Основна частина. У статті висвітлено приклади застосування телемедичних технологій у навчально-практичних центрах первинної медико-санітарної допомоги Тернопільського державного медичного університету імені І. Я. Горбачевського. Подано перелік телемедичних послуг, які доцільно впровадити на первинному рівні медичної допомоги.Висновок. Створені Тернопільським державним медичним університетом імені І. Я. Горбачевського навчально-практичні центри засвідчують реальні можливості виконання Закону України “Про підвищення доступності та якості медичного обслуговування у сільській місцевості” шляхом запровадження на рівні закладів первинної медичної допомоги технологій телемедицини.

地域を守る医療ガバナンスの課題

In recent years, public hospitals in Japan's rural areas, which are the main providers of medical care in rural areas, have been experiencing worsening financial conditions. In response, in 2007, the Ministry of Internal Affairs and Communications issued public hospital reform guidelines to local municipalities, requesting that they improve public hospital management as quickly as possible. Because the worsening fi nancial position of public hospitals is linked to their special organizational structure of strong ties with local governments, the guidelines urged making hospitals managerially independent from municipalities. However, in rural areas that would be especially strongly affected by the guidelines, the issue of medical care is an administrative issue of high public interest, and public hospitals and municipalities are linked inseparably. Consequently, whether the independence of public hospitals from municipalities as proposed by the guidelines is suitable for rural areas persists as an important research subject. This study, which was conducted to clarify management improvement measures for public hospitals in rural areas and benefi cial governance structures necessary to enable such measures, examined Oguni-Town in Yamagata Prefecture, which improved management of public hospitals without making them independent from municipalities. Measures adopted and implemented by the Oguni public hospital during 2008.2011, including the implementation of a change in the classification of hospital beds, promotion of medical examinations, and introduction of generic drugs, raised medical practice income and contributed to the improvement of management. These measures were developed through cooperation and the exchange of ideas among medical personnel of various specialties and local government officials. Such collaboration is a method that has been emphasized by Oguni-Town throughout its town planning activities. Through the use of common methods, administrative support for public hospital reform was obtained readily. Because the protection of medical care in rural areas is an important part of community building, it can be argued that maintaining a close relation between medical care providers and the community is important.

Le diabète sucré en Afrique : un enjeu de santé publique

W.H.O. predicts that there will be some 438 million diabetic patients in 2030, most of them living in developing countries. The IFD estimates that the prevalence of diabetes will rise by 98% in Africa during the next 20 years, with dramatic implications for public health and national budgets of the poorest countries. Type 2 diabetes is the most common form in Africa; type 1 is rarer than in western countries and tends to occur later. Two other forms seem specific to black Africans: ketosis-prone atypical diabetes, and tropical malnutrition-related diabetes. An increasing prevalence of obesity, diabetes and impaired glucose tolerance is observed in all parts of Africa. Several factors contribute to this situation, including aging, dietary transitions and lack of physical activity, all of which are related to rapid urbanization. In Africa, diabetes is associated with a high mortality rate, especially among insulin-dependent patients. Poor metabolic control can lead to severe ketosis and hypoglycemic accidents that carry a poor prognosis. Microvascular complications include retinopathy and nephropathy, and most patients cannot afford hemodialysis. Foot ulcers are frequent, due to trauma and neuropathies. Macrovascular complications are also increasing, with a high prevalence of hypertension. The poor prognosis of diabetes in Africa is related to late diagnosis, poor education, inadequate access to insulin, antidiabetic drugs and glycemia self-monitoring devices, absence of controlled diets, and difficult access to medical care in rural areas. Patient empowerment, knowledge and self-care must be improved. African governments must develop national prevention programs. Special attention must be paid to the prevention of obesity and diabetes. The urban environment, infrastructure, education, exercise and safe nutrition must be part of an overall policy designed to reduce the burden of chronic non transmissible diseases.

The Relationship Between Incident Reporting by Nurses and Safety Management in Hospitals

This study examines the relationship between nurses' perceptions of incident reporting, the frequency of incident reporting on wards, and safety management in hospitals. A self-administered survey was conducted on 528 nurses in 8 hospitals that provide core medical care in rural areas of Japan. Each of these hospitals is equipped with more than 90 beds. The relationship among perceptions of incident reporting, the frequency of incident reporting on wards, and safety management was examined using Pearson correlation coefficients calculated using ward scores. Safety managers' attitudes and safety management at the ward level were found to have significant correlation with fear of reprisal caused by incident reporting, willingness to carry out incident reporting, and recognition of the importance of incident reporting. On wards where staff and safety managers discuss incidents and their root causes, staff are less fearful of incident reporting, understand the significance of incident reporting, and report incidents more willingly. There is a need for ward managers not only to demonstrate leadership in terms of safety management but also to discuss incidents with staff.