All content matching "health"

Ambulatory and hospitalized patients with suspected and confirmed mpox: an observational cohort study from Brazil

Summary Background By October 30, 2022, 76,871 cases of mpox were reported worldwide, with 20,614 cases in Latin America. This study reports characteristics of a case series of suspected and confirmed mpox cases at a referral infectious diseases center in Rio de Janeiro, Brazil. Methods This was a single-center, prospective, observational cohort study that enrolled all patients with suspected mpox between June 12 and August 19, 2022. Mpox was confirmed by a PCR test. We compared characteristics of confirmed and non-confirmed cases, and among confirmed cases according to HIV status using distribution tests. Kernel estimation was used for exploratory spatial analysis. Findings Of 342 individuals with suspected mpox, 208 (60.8%) were confirmed cases. Compared to non-confirmed cases, confirmed cases were more frequent among individuals aged 30–39 years, cisgender men (96.2% vs. 66.4%; p < 0.0001), reporting recent sexual intercourse (95.0% vs. 69.4%; p < 0.0001) and using PrEP (31.6% vs. 10.1%; p < 0.0001). HIV (53.2% vs. 20.2%; p < 0.0001), HCV (9.8% vs. 1.1%; p = 0.0046), syphilis (21.2% vs. 16.3%; p = 0.43) and other STIs (33.0% vs. 21.6%; p = 0.042) were more frequent among confirmed mpox cases. Confirmed cases presented more genital (77.3% vs. 39.8%; p < 0.0001) and anal lesions (33.1% vs. 11.5%; p < 0.0001), proctitis (37.1% vs. 13.3%; p < 0.0001) and systemic signs and symptoms (83.2% vs. 64.5%; p = 0.0003) than non-confirmed cases. Compared to confirmed mpox HIV-negative, HIV-positive individuals were older, had more HCV coinfection (15.2% vs. 3.7%; p = 0.011), anal lesions (45.7% vs. 20.5%; p < 0.001) and clinical features of proctitis (45.2% vs. 29.3%; p = 0.058). Interpretation Mpox transmission in Rio de Janeiro, Brazil, rapidly evolved into a local epidemic, with sexual contact playing a crucial role in its dynamics and high rates of coinfections with other STI. Preventive measures must address stigma and social vulnerabilities. Funding Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz).

An innovative leadership development initiative to support building everyday resilience in health systems

Effective management and leadership are essential for everyday health system resilience, but actors charged with these roles are often underprepared and undersupported to perform them. Particular challenges have been observed in interpersonal and relational aspects of health managers’ work, including communication skills, emotional competence and supportive oversight. Within the Resilient and Responsive Health Systems (RESYST) consortium in Kenya, the authors worked with two county health and hospital management teams to adapt a package of leadership development interventions aimed at building these skills. This article provides insights into: (1) the content and co-development of a participatory intervention combining two core elements: a complex health system taught course, and an adapted communications and emotional competence process training; and (2) the findings from a formative evaluation of this intervention which included observations of the training, individual interviews with participating managers and discussions in regular meetings with managers.

Collective strategies to cope with work related stress among nurses in resource constrained settings: An ethnography of neonatal nursing in Kenya

Nursing is central to the provision of hospital-based care and is particularly so in the treatment of newborns. Continuous, effective provision of a basic set of interventions can have a highly positive impact on neonatal mortality, and most of these key interventions are delivered by nurses.  Unfortunately, neonatal wards in low income settings are typified by a high ratio of sick infants to nurses, which makes it difficult to deliver even basic care and limits the level of quality that is achievable. In the context of neonatal nursing in low-income countries, nursing stress is of particular concern because workloads are higher and the demands on individuals are greater. While a great deal of research has been directed towards nursing stress, the study of how stress affects nursing practice at the ward level has not been a priority, particularly in LMIC settings. Instead, the study of nursing over-work, burnout and resilience has largely been focused on individuals and their personal, psychological characteristics. In the course of this study, the authors found that theories of individualised burnout and resilience did not help to explain the practices that seemed most important in reducing nurses' exposure to stress. Their research question asks instead how nurses collectively cope with workload and stress and how this affects nursing practice. 

How mental health care should change as a consequence of the COVID-19 pandemic

Where, when, and how the diagnosis of human leishmaniasis is defined: answers from the Brazilian Control Program

Technology for effective partnership collaboration

This guide, from the Tropical Health and Education Trust (THET), identifies online and electronic tools that can help partnerships collaborate more effectively.