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The facilitating factors and barriers encountered in the adoption of a humanized birth care approach in a highly specialized university affiliated hospital
Roxana Behruzi, Marie Hatem, Lise Goulet, William Fraser
BMC Women's Health , 2011, DOI: 10.1186/1472-6874-11-53
Abstract: The aim of this study was to explore the organizational and cultural factors, which act as barriers or facilitators in the provision of humanized obstetrical care in a highly specialized, university-affiliated hospital in Quebec province, in Canada.A single case study design was chosen. The study sample included 17 professionals and administrators from different disciplines, and 157 women who gave birth in the hospital during the study. The data was collected through semi-structured interviews, field notes, participant observations, a self-administered questionnaire, documents, and archives. Both descriptive and qualitative deductive content analyses were performed and ethical considerations were respected.Both external and internal dimensions of a highly specialized hospital can facilitate or be a barrier to the humanization of birth care practices in such institutions, whether independently, or altogether. The greatest facilitating factors found were: caring and family- centered model of care, professionals' and administrators' ambient for the provision of humanized birth care besides the medical interventional care which is tailored to improve safety, assurance, and comfort for women and their children, facilities to provide a pain-free birth, companionship and visiting rules, dealing with the patients' spiritual and religious beliefs. The most cited barriers were: the shortage of health care professionals, the lack of sufficient communication among the professionals, the stakeholders' desire for specialization rather than humanization, over estimation of medical performance, finally the training environment of the hospital leading to the presence of too many health care professionals, and consequently, a lack of privacy and continuity of care.The argument of medical intervention and technology at birth being an opposing factor to the humanization of birth was not seen to be an issue in the studied highly specialized university affiliated hospital.Childbirth is b
Barriers to the adoption of the ART approach as perceived by dental practitioners in governmental dental clinics, in Tanzania
Kikwilu, Emil N.;Frencken, Jo E.;Mulder, Jan;
Journal of Applied Oral Science , 2009, DOI: 10.1590/S1678-77572009000500011
Abstract: objectives: this study aimed to determine the magnitude of the barriers to the practice of atraumatic restorative treatment (art) as perceived by dental practitioners working in pilot dental clinics, and determine the influence of these barriers on the practice of art. material and methods: a validated and tested questionnaire on barriers that may hinder the practice of art was administered to 20 practitioners working in 13 pilot clinics. factor analysis was performed to generate barrier factors. these were patient load, management support, cost sharing, art skills and operator opinion. the pilot clinics kept records of teeth extracted; teeth restored by conventional approach and teeth restored by art approach. these treatment records were used to compute the percentage of art restorations to total teeth treated, percentage of art restorations to total teeth restored and percentage of total restorations to total teeth treated. the mean barrier scores were generated and compared to independent variables, using the t-test. the influence of barriers to art-related dependent variables was determined using pearson correlation coefficients. results: mean barrier values were low, indicating low influence on art practice. female practitioners had higher scores on patient load than male practitioners (p = 0.003). assistant dental officers had higher scores on cost sharing than dental therapists (p = 0.024). practitioners working in urban clinics had higher mean scores on patient load than those who worked in rural clinics (p = 0.0008). all barrier factors were negatively correlated with art practice indices but all had insignificant association with art practice indices. conclusion: the barriers studied were of low magnitude, with no significant impact on practice of art in dental clinics in the pilot area.
Barriers to a healthy lifestyle among patients attending primary care clinics at a university hospital in Riyadh.  [cached]
AlQuaiz Aljoharah,Tayel Salwa
Annals of Saudi Medicine , 2009,
Abstract: Background And Objectives: The occurrence and progress of chronic non-communicable diseases (NCDs) is associated with unhealthy lifestyles and behaviors. Modification of barriers to healthy lifestyle can produce great benefits. The objective of this study was to identify barriers to physical activity and healthy eating among patients attending primary health care clinics in Riyadh city. Patients and Methods: A cross-sectional study was conducted at King Khalid University Hospital (KKUH) in Riyadh city. Four hundred and fifty participants attending primary health care clinics (PHCC) from 1 March to 30 April 2007 were randomly selected. A questionnaire about barriers to physical activity and healthy eating was adapted from the CDC web site. Results: The prevalence of physical inactivity among the Saudi population in the study was 82.4% (371/450). Females were more physically inactive (87.6%, 268/306) compared to males (71.5%, 103/144) (P< .001). The most common barrier to physical activity was lack of resources (80.5%, 326/405), which was significantly higher among females than males and among the lower income versus the higher income group. The most common barrier to healthy diet was lack of willpower. More than four-fifths (80.3%, 354/441) of the study group stated that they did not have enough will to stick to a diet. Conclusion: Lack of resources was the most important barrier for physical activity, while lack of willpower and social support were both barriers for adherence to physical activity and a healthy diet.
Structural Barriers to Timely Initiation of Antiretroviral Treatment in Vietnam: Findings from Six Outpatient Clinics  [PDF]
Dam Anh Tran, Anthony Shakeshaft, Anh Duc Ngo, John Rule, David P. Wilson, Lei Zhang, Christopher Doran
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0051289
Abstract: In Vietnam, premature mortality due to AIDS-related conditions is commonly associated with late initiation to antiretroviral therapy (ART). This study explores reasons for late ART initiation among people living with HIV (PLHIV) from the perspectives of health care providers and PLHIV. The study was undertaken in six clinics from five provinces in Vietnam. Baseline CD4 counts were collected from patient records and grouped into three categories: very late initiators (≤100 cells/mm3 CD4), late initiators (100–200 cells/mm3) and timely initiators (200–350 cells/mm3). Thirty in-depth interviews with patients who started ART and 15 focus group discussions with HIV service providers were conducted and thematic analysis of the content performed. Of 934 patients, 62% started ART very late and 11% initiated timely treatment. The proportion of patients for whom a CD4 count was obtained within six months of their HIV diagnosis ranged from 22% to 72%. The proportion of patients referred to ART clinics by voluntary testing and counselling centres ranged from 1% to 35%. Structural barriers to timely ART initiation were poor linkage between HIV testing and HIV care and treatment services, lack of patient confidentiality and a shortage of HIV/AIDS specialists. If Vietnam’s treatment practice is to align with WHO recommendations then the connection between voluntary counselling and testing service and ART clinics must be improved. Expansion and decentralization of HIV/AIDS services to allow implementation at the community level increased task sharing between doctors and nurses to overcome limited human resources, and improved patient confidentiality are likely to increase timely access to HIV treatment services for more patients.
Barriers and Knowledge of Benefits Regarding Family Planning Methods Among Women Attending Antenatal Clinics in a Southern Nigerian Community  [cached]
Omokhoa Adeleye,O.A. Akoria; Z.O. Shuaib and O.D. Ogholoh
Asian Journal of Medical Sciences , 2010,
Abstract: This study was undertaken to elicit barriers and knowledge gaps regarding the benefits of family planning among women in Irrua, Edo State, Nigeria. Using a cross-sectional design, a structured questionnaire was administered to 180 consenting women attending antenatal clinic sessions in a large hospital. The control of family size, 72/180 (40.0%) and child spacing, 64/180 (35.6%) were the major benefits of family planning stated. The most direct benefit to maternal health - absence of pregnancy complications - was the least mentioned (5%). A total of 18/180 (10.0%) stated that family planning w as of no benefit. No statistically significant association was demonstrated between educational levels and the knowledge of family planning benefits. Respondents aged 30 - 49 years were more likely than the younger ones to state child spacing as a benefit of family planning methods [logistic regression: p = 0.004; OR = 2.61 (95% CI = 1.37 - 4.98)]. The commonest reasons for objecting to family planning were the fear of infertility, 28/114 (24.6%), incom plete family size, 24/114 (21.1%), side effects of contraceptives, 19/114 (16.7%) and partners’ objection, 17/114 (14.9%). This study demonstrates important knowledge gaps with respect to family planning benefits. T his could reflect poor knowledge delivery or uptake on family planning. The findings suggest that women’s knowledge and experiences regarding family planning are crucial to interventions on fertility control. Overall, the study shows that the identified knowledge gaps and barriers reflect opportunities for holistic interventions including needs-sensitive health education for males and females on family planning.
Barriers to successful care for chronic kidney disease
Oliver Lenz, Durga P Mekala, Daniel V Patel, Alessia Fornoni, David Metz, David Roth
BMC Nephrology , 2005, DOI: 10.1186/1471-2369-6-11
Abstract: We performed a cross-sectional analysis of 198 patients with an estimated glomerular filtration rate of less than 30 ml/min/1.73 m2 and determined whether K/DOQI goals were met for calcium, phosphate, calcium-phosphate product, parathyroid hormone, albumin, bicarbonate, hemoglobin, lipids, and blood pressure.We found that only a small number of patients achieved K/DOQI targets. Recent referral to the nephrologist, failure to attend scheduled clinic appointments, African American ethnicity, diabetes, and advanced renal failure were significant predictors of low achievement of K/DOQI goals.We conclude that raising awareness of chronic kidney disease and K/DOQI goals among primary care providers, early referral to a nephrologist, the exploration of socioeconomic barriers and cultural differences, and both patient and physician education are critical to improve CKD care in patients with Stage 4 and 5 CKD.The National Kidney Foundation has recently launched a major effort to define Chronic Kidney Disease (CKD) and formulate clinical practice guidelines [1,2]. It has been clearly shown that complications of CKD, such as anemia, metabolic acidosis, nutritional deficits, secondary hyperparathyroidism, and hypertension, significantly contribute to morbidity and mortality [3-10]. It has been proposed that care for patients with CKD be best delivered in dedicated CKD clinics that provide a multidisciplinary approach to patients with CKD [11,12]. Typically, these clinics are staffed with nephrologists, dieticians, social workers, and educators, and the team works closely with vascular surgeons for access placement. However, little is known about the effectiveness of these clinics at academic centers. The purpose of this cross-sectional analysis is determine to what extent K/DOQI goals are achieved in a dedicated CKD clinic serving a urban, socio-economically disadvantaged minority population.IRB approval for this study was obtained from the Human Subjects Research Office of the
Knowledge, Attitudes and Barriers towards Prevention of Mother-To-Child Transmission of HIV among Women Attending Antenatal clinics in Uyam District of Zaki-Biam in Benue State, Nigeria
Samuel K Hembah-Hilekaan, Terlumun Z Swende, Terkaa T Bito
African Journal of Reproductive Health , 2012,
Abstract: Benue State in North Central Nigeria has one of the highest HIV/AIDS prevalence rates of 9.3%, among children and adults aged 13-45years. To improve the survival of mothers and children and to identify the major challenges in scaling-up PMTCT services, a descriptive, study was conducted to assess knowledge, attitudes and barriers to the uptake of PMTCT by 384 women attending antenatal clinics (ANC) in Uyam, Zaki-Biam, a semi-urban area of Benue State. A standard questionnaire was used for data collection. A high number of subjects knew that unprotected sexual intercourse is a risk factor for transmission, with most 281 (73.2%) of them aware that an HIV infected woman could get pregnant; while 275 (71.6%) knew that infection can be transmitted from the mother to her unborn child. Only 214 (55.7%) of the study participants had done the HIV test in pregnancy because of, inadequate VCT centers, issues of stigma and absence of family support including attitudes of staff. Age, parity and socio- economic status, as well as location influenced the responses of respondents. In spite of the increasing public awareness in Nigeria about HIV/AIDS, there still exist gaps as a result of different levels of education and access to information, coupled with lack of trained personnel and adequately equipped health care facilities. To improve survival and probably eliminate HIV/AIDS, the integration of PMTCT into primary health care services in Nigerian communities should be considered. (Afr J Reprod Health 2012; 16[3]: 27-34).
Domino tilings with barriers  [PDF]
James Propp,Richard Stanley
Mathematics , 1998,
Abstract: In this paper, we continue the study of domino-tilings of Aztec diamonds. In particular, we look at certain ways of placing ``barriers'' in the Aztec diamond, with the constraint that no domino may cross a barrier. Remarkably, the number of constrained tilings is independent of the placement of the barriers. We do not know of a combinatorial explanation of this fact; our proof uses the Jacobi-Trudi identity.
Academic Freedom and Religiously Affiliated Universities
Liviu Andreescu
Journal for the Study of Religions and Ideologies , 2008,
Abstract: This paper explores the relationship between the principle of academic freedom and religiously-affiliated higher education. The arguments advanced are based on a general theory concerning the role of universities in a democratic society, and as such they are intended to apply to any such society, irrespective of the particulars of religious higher education in a specific national context. The article looks at three classes of arguments advanced against a “secular” standard of academic freedom: arguments on the nature of academic disciplines in religious colleges; arguments concerning the relationship between the institutional mission of religious universities and academic freedom; and arguments from democracy and religious freedom. The paper concludes that none of these arguments are successful in claiming a different standard of academic freedom for religiously-affiliated universities; and that, further, a “secular” standard leaves such institutions adequate room to express their religious dimension.
Group cocycles and the ring of affiliated operators  [PDF]
Jesse Peterson,Andreas Thom
Mathematics , 2007,
Abstract: In this article we study cocycles of discrete countable groups with values in l^2(G) and the ring of affiliated operators UG. We clarify properties of the first cohomology of a group G with coefficients in l^2(G) and answer several questions from [CTV]. Moreover, we obtain strong results about the existence of free subgroups and the subgroup structure, provided the group has a positive first l^2-Betti number. We give numerous applications and examples of groups which satisfy our assumptions.
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